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Hearing Disorders: HELP
Articles by Matthew L. Carlson
Based on 62 articles published since 2010
(Why 62 articles?)
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Between 2010 and 2020, M. L. Carlson wrote the following 62 articles about Hearing Disorders.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Guideline Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Otologic and Audiologic Screening for Patients With Vestibular Schwannomas. 2018

Sweeney, Alex D / Carlson, Matthew L / Shepard, Neil T / McCracken, D Jay / Vivas, Esther X / Neff, Brian A / Olson, Jeffrey J. ·Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas. · Department of Neurosurgery, Baylor College of Medicine, Houston, Texas. · Department of Otorhinolaryngology, Mayo Clinic School of Medicine, Rochester, Minnesota. · Department of Neurosurgery, Mayo Clinic School of Medicine, Rochester, Minnesota. · Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia. · Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia. ·Neurosurgery · Pubmed #29309699.

ABSTRACT: QUESTION 1: What is the expected diagnostic yield for vestibular schwannomas when using a magnetic resonance imaging (MRI) to evaluate patients with previously published definitions of asymmetric sensorineural hearing loss? TARGET POPULATION: These recommendations apply to adults with an asymmetric sensorineural hearing loss on audiometric testing. RECOMMENDATION: Level 3: On the basis of an audiogram, it is recommended that MRI screening on patients with ≥10 decibels (dB) of interaural difference at 2 or more contiguous frequencies or ≥15 dB at 1 frequency be pursued to minimize the incidence of undiagnosed vestibular schwannomas. However, selectively screening patients with ≥15 dB of interaural difference at 3000 Hz alone may minimize the incidence of MRIs performed that do not diagnose a vestibular schwannoma. QUESTION 2: What is the expected diagnostic yield for vestibular schwannomas when using an MRI to evaluate patients with asymmetric tinnitus, as defined as either purely unilateral tinnitus or bilateral tinnitus with subjective asymmetry? TARGET POPULATION: These recommendations apply to adults with subjective complaints of asymmetric tinnitus. RECOMMENDATION: Level 3: It is recommended that MRI be used to evaluate patients with asymmetric tinnitus. However, this practice is low yielding in terms of vestibular schwannoma diagnosis (<1%). QUESTION 3: What is the expected diagnostic yield for vestibular schwannomas when using an MRI to evaluate patients with a sudden sensorineural hearing loss? TARGET POPULATION: These recommendations apply to adults with a verified sudden sensorineural hearing loss on an audiogram. RECOMMENDATION: Level 3: It is recommended that MRI be used to evaluate patients with a sudden sensorineural hearing loss. However, this practice is low yielding in terms of vestibular schwannoma diagnosis (<3%).  The full guideline can be found at: https://www.cns.org/guidelines/guidelines-management-patients-vestibular-schwannoma/chapter_2.

2 Guideline Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Hearing Preservation Outcomes in Patients With Sporadic Vestibular Schwannomas. 2018

Carlson, Matthew L / Vivas, Esther X / McCracken, D Jay / Sweeney, Alex D / Neff, Brian A / Shepard, Neil T / Olson, Jeffrey J. ·Department of Otorhinolaryngology, Mayo Clinic, School of Medicine, Rochester, Minnesota. · Department of Neurologic Surgery, Mayo Clinic, School of Medicine, Rochester, Minnesota. · Department of Otolaryngology-Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia. · Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia. · Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas. ·Neurosurgery · Pubmed #29309683.

ABSTRACT: Question 1: What is the overall probability of maintaining serviceable hearing following stereotactic radiosurgery utilizing modern dose planning, at 2, 5, and 10 yr following treatment? Recommendation: Level 3: Individuals who meet these criteria and are considering stereotactic radiosurgery should be counseled that there is moderately high probability (>50%-75%) of hearing preservation at 2 yr, moderately high probability (>50%-75%) of hearing preservation at 5 yr, and moderately low probability (>25%-50%) of hearing preservation at 10 yr. Question 2: Among patients with AAO-HNS (American Academy of Otolaryngology-Head and Neck Surgery hearing classification) class A or GR (Gardner-Robertson hearing classification) grade I hearing at baseline, what is the overall probability of maintaining serviceable hearing following stereotactic radiosurgery, utilizing modern dose planning, at 2, 5, and 10 yr following treatment? Recommendation: Level 3: Individuals who meet these criteria and are considering stereotactic radiosurgery should be counseled that there is a high probability (>75%-100%) of hearing preservation at 2 yr, moderately high probability (>50%-75%) of hearing preservation at 5 yr, and moderately low probability (>25%-50%) of hearing preservation at 10 yr. Question 3: What patient- and tumor-related factors influence progression to nonserviceable hearing following stereotactic radiosurgery using ≤13 Gy to the tumor margin? Recommendation: Level 3: Individuals who meet these criteria and are considering stereotactic radiosurgery should be counseled regarding the probability of successful hearing preservation based on the following prognostic data: the most consistent prognostic features associated with maintenance of serviceable hearing are good preoperative word recognition and/or pure tone thresholds with variable cut-points reported, smaller tumor size, marginal tumor dose ≤12 Gy, and cochlear dose ≤4 Gy. Age and sex are not strong predictors of hearing preservation outcome. Question 4: What is the overall probability of maintaining serviceable hearing following microsurgical resection of small to medium-sized sporadic vestibular schwannomas early after surgery, at 2, 5, and 10 yr following treatment? Recommendation: Level 3: Individuals who meet these criteria and are considering microsurgical resection should be counseled that there is a moderately low probability (>25%-50%) of hearing preservation immediately following surgery, moderately low probability (>25%-50%) of hearing preservation at 2 yr, moderately low probability (>25%-50%) of hearing preservation at 5 yr, and moderately low probability (>25%-50%) of hearing preservation at 10 yr. Question 5: Among patients with AAO-HNS class A or GR grade I hearing at baseline, what is the overall probability of maintaining serviceable hearing following microsurgical resection of small to medium-sized sporadic vestibular schwannomas early after surgery, at 2, 5, and 10 yr following treatment? Recommendation: Level 3: Individuals who meet these criteria and are considering microsurgical resection should be counseled that there is a moderately high probability (>50%-75%) of hearing preservation immediately following surgery, moderately high probability (>50%-75%) of hearing preservation at 2 yr, moderately high probability (>50%-75%) of hearing preservation at 5 yr, and moderately low probability (>25%-50%) of hearing preservation at 10 yr. Question 6: What patient- and tumor-related factors influence progression to nonserviceable hearing following microsurgical resection of small to medium-sized sporadic vestibular schwannomas? Recommendation: Level 3: Individuals who meet these criteria and are considering microsurgical resection should be counseled regarding the probability of successful hearing preservation based on the following prognostic data: the most consistent prognostic features associated with maintenance of serviceable hearing are good preoperative word recognition and/or pure tone thresholds with variable cut-points reported, smaller tumor size commonly less than 1 cm, and presence of a distal internal auditory canal cerebrospinal fluid fundal cap. Age and sex are not strong predictors of hearing preservation outcome. Question 7: What is the overall probability of maintaining serviceable hearing with conservative observation of vestibular schwannomas at 2, 5, and 10 yr following diagnosis? Recommendation: Level 3: Individuals who meet these criteria and are considering observation should be counseled that there is a high probability (>75%-100%) of hearing preservation at 2 yr, moderately high probability (>50%-75%) of hearing preservation at 5 yr, and moderately low probability (>25%-50%) of hearing preservation at 10 yr. Question 8: Among patients with AAO-HNS class A or GR grade I hearing at baseline, what is the overall probability of maintaining serviceable hearing with conservative observation at 2 and 5 yr following diagnosis? Recommendation: Level 3: Individuals who meet these criteria and are considering stereotactic radiosurgery should be counseled that there is a high probability (>75%-100%) of hearing preservation at 2 yr, and moderately high probability (>50%-75%) of hearing preservation at 5 yr. Insufficient data were available to determine the probability of hearing preservation at 10 yr for this population subset. Question 9: What patient and tumor-related factors influence progression to nonserviceable hearing during conservative observation? Recommendation: Level 3: Individuals who meet these criteria and are considering observation should be counseled regarding probability of successful hearing preservation based on the following prognostic data: the most consistent prognostic features associated with maintenance of serviceable hearing are good preoperative word recognition and/or pure tone thresholds with variable cut-points reported, as well as nongrowth of the tumor. Tumor size at the time of diagnosis, age, and sex do not predict future development of nonserviceable hearing during observation.  The full guideline can be found at: https://www.cns.org/guidelines/guidelines-manage-ment-patients-vestibular-schwannoma/chapter_3.

3 Review Cochlear Implantation in Adults. 2020

Carlson, Matthew L. ·From the Department of Otolaryngology-Head and Neck Surgery and the Department of Neurologic Surgery, Mayo Clinic, Rochester, MN. ·N Engl J Med · Pubmed #32294347.

ABSTRACT: -- No abstract --

4 Review Labyrinthine Sequestrum: A Case Report and Review of the Literature. 2018

Guerin, Julie B / Vork, Diana L / Eguiguren, Lourdes / Marston, Alexander P / Driscoll, Colin L W / Carlson, Matthew L / Henry, Nancy K / Lane, John I. ·Department of Diagnostic Radiology. · Mayo Medical School. · Department of Pediatric and Adolescent Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota. · Department of Otorhinolaryngology. ·Otol Neurotol · Pubmed #29337715.

ABSTRACT: OBJECTIVE: To report the presentation, diagnosis, management, and convalescence of labyrinthine sequestrum (LS) and summarize all previously published cases. PATIENT(S): Eleven-year-old female with LS. INTERVENTION(S): Multidisciplinary diagnostic evaluation and treatment. MAIN OUTCOME MEASURES: Imaging and laboratory findings, medical and surgical treatment. RESULTS: We describe a case of LS secondary to medically recalcitrant suppurative otitis media in an 11-year-old female and review all eight previously reported cases. The index patient presented after 6 months of otitis media, profound unilateral hearing loss, with symptoms suggesting meningitis. Temporal bone CT demonstrated marked bony destruction of the left otic capsule. Gadolinium-enhanced MRI showed an enhancing process with evidence of meningitis and subdural empyema. The patient was treated with surgical debridement and culture directed antibiotic therapy. Posttreatment imaging showed resolution of intracranial infection with fibrous bony healing of the otic capsule resembling fibrous dysplasia. CONCLUSION: LS is a rare form of labyrinthitis characterized by centrifugal destruction of the otic capsule. The current index case highlights the importance of combined medical and surgical treatment and describes for the first time in the literature the fibrous ossification of the otic capsule following disease resolution.

5 Review Management of sporadic vestibular schwannoma. 2015

Carlson, Matthew L / Link, Michael J / Wanna, George B / Driscoll, Colin L W. ·Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. Electronic address: carlson.matthew@mayo.edu. · Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA; Department of Neurologic Surgery, Mayo Clinic School of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA. · Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, TN 37232, USA. ·Otolaryngol Clin North Am · Pubmed #25886814.

ABSTRACT: Vestibular schwannomas (VS) comprise 8% of all intracranial tumors and 90% of cerebellopontine angle and internal auditory canal neoplasms. Secondary to the widespread adoption of screening protocols for asymmetrical hearing loss and the increasing use of advanced imaging, the number of VS diagnosed each year continues to rise, while the average size has declined. Microsurgery remains the treatment of choice for large tumors, however the management of small- to medium-sized VS remains highly controversial with options including observation, radiotherapy, or microsurgery. Within this chapter, the authors provide an overview of the contemporary management of VS, reviewing important considerations and common controversies.

6 Review Implantable hearing devices: the Ototronix MAXUM system. 2014

Pelosi, Stanley / Carlson, Matthew L / Glasscock, Michael E. ·Department of Otolaryngology, The New York Eye and Ear Infirmary, 310 East 14th Street, New York, NY 10003, USA. Electronic address: spelosi@nyee.edu. · Department of Otolaryngology, Vanderbilt University Medical Center, 7209 Medical Center East-South Tower, 1215 21st Avenue South, Nashville, TN 37232, USA. ·Otolaryngol Clin North Am · Pubmed #25293787.

ABSTRACT: For many hearing-impaired individuals, the benefits of conventional amplification may be limited by acoustic feedback, occlusion effect, and/or ear discomfort. The MAXUM system and other implantable hearing devices have been developed as an option for patients who derive inadequate assistance from traditional HAs, but who are not yet candidates for cochlear implants. The MAXUM system is based on the SOUNDTEC Direct System technology, which has been shown to provide improved functional gain as well as reduced feedback and occlusion effect compared to hearing aids. This and other implantable hearing devices may have increasing importance as future aural rehabilitation options.

7 Review Middle ear implants for rehabilitation of sensorineural hearing loss: a systematic review of FDA approved devices. 2014

Kahue, Charissa N / Carlson, Matthew L / Daugherty, Julie A / Haynes, David S / Glasscock, Michael E. ·Department of Otolaryngology-Head and Neck Surgery, The Bill Wilkerson Center for Otolaryngology and Communication Sciences, Vanderbilt University, Nashville, Tennessee, U.S.A. ·Otol Neurotol · Pubmed #24643033.

ABSTRACT: OBJECTIVE: To systematically review the safety and efficacy of the 3 Food and Drug Administration-approved middle ear implant (MEI) systems currently in use for the rehabilitation of sensorineural hearing loss. DATA SOURCES: MEDLINE and Cochrane Library databases were systematically searched by 2 independent reviewers. STUDY SELECTION: An initial search yielded 3,020 articles that were screened based on title and abstract. A full manuscript review of the remaining 80 articles was performed, of which 17 unique studies satisfied inclusion criteria and were evaluated. DATA EXTRACTION: Variables including functional gain, speech recognition score improvement, audiometric threshold shift following surgery, adverse events, and patient reported outcome measures were recorded. Study quality was appraised according to author conflict of interest, prospective or retrospective study design, inclusion criteria, number of patients, proper use of study controls, outcome measures reported, length of follow-up, and level of evidence. DATA SYNTHESIS: Heterogeneous outcome reporting precluded meta-analysis; instead a structured review was performed using best available data. CONCLUSION: The majority of studies evaluating the safety and efficacy of MEIs are retrospective in nature with limited follow-up. To date, no prospective randomized controlled trial exists comparing contemporary air conduction hearing aid performance and MEI outcomes. Based on available data for patients with sensorineural hearing loss, functional gain and word recognition improvement seems similar between conventional hearing aids and MEIs, whereas patient-perceived outcome measures suggest that MEIs provide enhanced sound quality and eliminate occlusion effect.

8 Review Primary inner ear schwannomas: a case series and systematic review of the literature. 2013

Van Abel, Kathryn M / Carlson, Matthew L / Link, Michael J / Neff, Brian A / Beatty, Charles W / Lohse, Christine M / Eckel, Laurence J / Lane, John I / Driscoll, Colin L. ·Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota 55905, USA. ·Laryngoscope · Pubmed #23335152.

ABSTRACT: OBJECTIVES/HYPOTHESIS: To describe the natural history of primary inner ear schwannomas (PIES) and evaluate management outcomes and relationship between PIES location, clinical presentation, and time to diagnosis. STUDY DESIGN: Retrospective chart review and systematic review of the literature. METHODS: Vestibular schwannoma confined to or arising from the inner ear were included. PIES classification was based on anatomic subsite(s) involved. Detailed clinical history and outcomes were recorded. RESULTS: In a systematic review (1933-2011), including 14 patients from the authors' institution (1999-2009), a total of 72 studies comprising 234 patients were evaluated. Mean follow-up was 32.8 ± 39.1 months (range, 0-183 months). The cochlea was the most commonly involved subsite (51%). Hearing loss was the most frequent presenting symptom (99%). Vertigo and abnormal balance were more common among tumors involving the vestibular system (P < .01). Average delay between symptom onset and diagnosis was 7.0 ± 8.0 years (median, 5 years; range, 0-40 years). Recent onset hearing loss was more likely to elicit an earlier diagnosis (P = .01). The majority of patients were observed without treatment (53%). Tumor progression was seen in 52% of patients. CONCLUSIONS: PIES are rare tumors and most commonly involve the cochlea. Tumor location is often associated with clinical presentation and correlates with delay between symptom onset and diagnosis. A watch-and-scan approach is the management strategy of choice in the absence of intractable vertigo or extensive tumor growth. The majority of patients report stable or improved symptoms over time, regardless of treatment.

9 Review Cochlear implantation: current and future device options. 2012

Carlson, Matthew L / Driscoll, Colin L W / Gifford, René H / McMenomey, Sean O. ·Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA. ·Otolaryngol Clin North Am · Pubmed #22115692.

ABSTRACT: Today most cochlear implant users achieve above 80% on standard speech recognition in quiet testing, and enjoy excellent device reliability. Despite such success, conventional designs often fail to provide the frequency resolution required for complex listening tasks. Furthermore, performance variability remains a vexing problem, with a select group of patients performing poorly despite using the most recent technologies and processing strategies. This article provides a brief history of the development of cochlear implant technologies, reviews current implant systems from all 3 major manufacturers, examines recently devised strategies aimed at improving device performance, and discusses potential future developments.

10 Review A hemorrhagic vestibular schwannoma presenting with rapid neurologic decline: a case report. 2010

Carlson, Matthew L / Driscoll, Colin L W / Link, Michael J / Inwards, Carrie Y / Neff, Brian A / Beatty, Charles W. ·Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, MN, USA. ·Laryngoscope · Pubmed #21225802.

ABSTRACT: INTRODUCTION: Vestibular schwannomas (VS) account for approximately 8% of all intracranial neoplasms and nearly 80% of all cerebellopontine angle tumors. Spontaneous intratumoral hemorrhage (ITH) remains a rare entity with only 10 published reports existing in the international literature. In the present case, we discuss the clinical presentation, radiographic evaluation and management of a 66-year-old male with a histologically confirmed spontaneous hemorrhagic VS. STUDY DESIGN: Case Report. SETTING: Tertiary referral center. RESULTS: A 66-year-old male with a history of prodromal left sided sensorineural hearing loss presented for evaluation after experiencing a rapid onset severe left sided headache, projectile vomiting and vertigo that woke him from sleep. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a left sided 2 X 2 cm cerebellopontine angle mass consistent with a VS. Local mass effect resulted in 4th ventricle effacement and hydrocephalus. Areas of T2 hypointensity and corresponding increased attenuation on CT confirmed an acute ITH. Hematology and coagulation laboratory studies were normal. The patient subsequently underwent a left suboccipital craniotomy with complete resection of a histologically confirmed hemorrhagic VS. CONCLUSION: Spontaneous hemorrhage into a VS is an extremely rare event. In contrast to the insidious progression typified by nonhemorrhagic VSs, those with gross intratumoral bleeding most often present with acute cranial neuropathies and symptoms of subarachnoid hemorrhage. In surgically fit patients, we advocate urgent microsurgical resection. Simple observation with serial radiography may risk repeated hemorrhage while the role of radiosurgery is not yet defined.

11 Review Skull base manifestations of Camurati-Engelmann disease. 2010

Carlson, Matthew L / Beatty, Charles W / Neff, Brian A / Link, Michael J / Driscoll, Colin L W. ·Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. ·Arch Otolaryngol Head Neck Surg · Pubmed #20566907.

ABSTRACT: OBJECTIVE: To describe presenting symptoms, evaluation findings, and surgical management of cranial base hyperostosis in patients with Camurati-Engelmann disease (CED). DESIGN: Retrospective study and literature review. SETTING: The Mayo Clinic, Rochester, Minnesota. PATIENTS: A total of 306 patients diagnosed as having CED, including 12 primarily evaluated at our institution between 1968 and 2008, and 294 identified in the international literature. MAIN OUTCOME MEASURES: Presenting symptoms, methods of diagnosis, treatment strategies, and patient outcomes. RESULTS: One hundred seventy-three of 306 patients (56.5%) had radiographically proven skull base hyperostosis, whereas less than one-fourth were symptomatic. The most common manifestations of cranial base involvement were hearing loss (19.0%), headache (10.4%), exophthalmos (8.2%), and frontal bossing (7.2%); less common were vision changes, vertigo, facial weakness, symptomatic brainstem compression, facial numbness, and hyposmia. Although corticosteroids and bisphosphates may treat torso and extremity involvement, they demonstrate no benefit for symptomatic skull base disease. In select symptomatic patients, aggressive decompression surgery may provide the only means of treatment. Decompression surgery is more challenging with thick sclerotic bone, loss or obscuration of bony landmarks, and decreased supratentorial space. Patients must be counseled on the increased risks associated with surgery and the potential for redeposition of bone and recurrence of symptoms. CONCLUSIONS: Physicians should include CED in the differential diagnosis for patients with radiographic evidence of skull base thickening and synchronous cranial neuropathies or symptoms of elevated intracranial pressure. In mild forms of the disease, the clinical course of patients should be followed with serial examination, audiometric testing, and radiography. In select patients with progressive cranial base symptoms, aggressive wide decompression of involved neurovascular structures may provide benefit.

12 Clinical Trial Intraoperative Cochlear Implant Device Testing Utilizing an Automated Remote System: A Prospective Pilot Study. 2018

Lohmann, Amanda R / Carlson, Matthew L / Sladen, Douglas P. ·Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota. ·Otol Neurotol · Pubmed #29342050.

ABSTRACT: INTRODUCTION: Intraoperative cochlear implant device testing provides valuable information regarding device integrity, electrode position, and may assist with determining initial stimulation settings. Manual intraoperative device testing during cochlear implantation requires the time and expertise of a trained audiologist. The purpose of the current study is to investigate the feasibility of using automated remote intraoperative cochlear implant reverse telemetry testing as an alternative to standard testing. METHODS: Prospective pilot study evaluating intraoperative remote automated impedance and Automatic Neural Response Telemetry (AutoNRT) testing in 34 consecutive cochlear implant surgeries using the Intraoperative Remote Assistant (Cochlear Nucleus CR120). In all cases, remote intraoperative device testing was performed by trained operating room staff. A comparison was made to the "gold standard" of manual testing by an experienced cochlear implant audiologist. Electrode position and absence of tip fold-over was confirmed using plain film x-ray. RESULTS: Automated remote reverse telemetry testing was successfully completed in all patients. Intraoperative x-ray demonstrated normal electrode position without tip fold-over. Average impedance values were significantly higher using standard testing versus CR120 remote testing (standard mean 10.7 kΩ, SD 1.2 vs. CR120 mean 7.5 kΩ, SD 0.7, p < 0.001). There was strong agreement between standard manual testing and remote automated testing with regard to the presence of open or short circuits along the array. There were, however, two cases in which standard testing identified an open circuit, when CR120 testing showed the circuit to be closed. Neural responses were successfully obtained in all patients using both systems. There was no difference in basal electrode responses (standard mean 195.0 μV, SD 14.10 vs. CR120 194.5 μV, SD 14.23; p = 0.7814); however, more favorable (lower μV amplitude) results were obtained with the remote automated system in the apical 10 electrodes (standard 185.4 μV, SD 11.69 vs. CR120 177.0 μV, SD 11.57; p value < 0.001). CONCLUSION: These preliminary data demonstrate that intraoperative cochlear implant device testing using a remote automated system is feasible. This system may be useful for cochlear implant programs with limited audiology support or for programs looking to streamline intraoperative device testing protocols. Future studies with larger patient enrollment are required to validate these promising, but preliminary, findings.

13 Article Cochlear Place of Stimulation Is One Determinant of Cochlear Implant Sound Quality. 2019

Dorman, Michael F / Cook Natale, Sarah / Baxter, Leslie / Zeitler, Daniel M / Carlson, Mathew L / Noble, Jack H. ·College of Health Solutions, Speech and Hearing Science, Arizona State University, Tempe, Arizona, USA, mdorman@asu.edu. · College of Health Solutions, Speech and Hearing Science, Arizona State University, Tempe, Arizona, USA. · Clinical Neuropsychology, Mayo Clinic Arizona, Phoenix, Arizona, USA. · Otolaryngology/Head-Neck Surgery, Virginia Mason Medical Center, Seattle, Washington, USA. · Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA. · Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, USA. ·Audiol Neurootol · Pubmed #31661682.

ABSTRACT: OBJECTIVE: Our aim was to determine the effect of acute changes in cochlear place of stimulation on cochlear implant (CI) sound quality. DESIGN: In Experiment 1, 5 single-sided deaf (SSD) listeners fitted with a long (28-mm) electrode array were tested. Basal shifts in place of stimulation were implemented by turning off the most apical electrodes and reassigning the filters to more basal electrodes. In Experiment 2, 2 SSD patients fitted with a shorter (16.5-mm) electrode array were tested. Both basal and apical shifts in place of stimulation were implemented. The apical shifts were accomplished by current steering and creating a virtual place of stimulation more apical that that of the most apical electrode. RESULTS: Listeners matched basal shifts by shifting, in the normal-hearing ear, the overall spectrum up in frequency and/or increasing voice pitch (F0). Listeners matched apical shifts by shifting down the overall frequency spectrum in the normal-hearing ear. CONCLUSION: One factor determining CI voice quality is the location of stimulation along the cochlear partition.

14 Article Jugular Paraganglioma Presenting With Collet-Sicard Syndrome. 2019

Dey, Jacob K / Carlson, Matthew L. ·Head & Neck Surgery, Department of Otolaryngology, Mayo Clinic, Rochester, MN. · Head & Neck Surgery, Department of Otolaryngology, Mayo Clinic, Rochester, MN. Electronic address: carlson.matthew@mayo.edu. ·Mayo Clin Proc · Pubmed #31486382.

ABSTRACT: -- No abstract --

15 Article Surgery of the lateral skull base: a 50-year endeavour. 2019

Zanoletti, E / Mazzoni, A / Martini, A / Abbritti, R V / Albertini, R / Alexandre, E / Baro, V / Bartolini, S / Bernardeschi, D / Bivona, R / Bonali, M / Borghesi, I / Borsetto, D / Bovo, R / Breun, M / Calbucci, F / Carlson, M L / Caruso, A / Cayé-Thomasen, P / Cazzador, D / Champagne, P-O / Colangeli, R / Conte, G / D'Avella, D / Danesi, G / Deantonio, L / Denaro, L / Di Berardino, F / Draghi, R / Ebner, F H / Favaretto, N / Ferri, G / Fioravanti, A / Froelich, S / Giannuzzi, A / Girasoli, L / Grossardt, B R / Guidi, M / Hagen, R / Hanakita, S / Hardy, D G / Iglesias, V C / Jefferies, S / Jia, H / Kalamarides, M / Kanaan, I N / Krengli, M / Landi, A / Lauda, L / Lepera, D / Lieber, S / Lloyd, S L K / Lovato, A / Maccarrone, F / Macfarlane, R / Magnan, J / Magnoni, L / Marchioni, D / Marinelli, J P / Marioni, G / Mastronardi, V / Matthies, C / Moffat, D A / Munari, S / Nardone, M / Pareschi, R / Pavone, C / Piccirillo, E / Piras, G / Presutti, L / Restivo, G / Reznitsky, M / Roca, E / Russo, A / Sanna, M / Sartori, L / Scheich, M / Shehata-Dieler, W / Soloperto, D / Sorrentino, F / Sterkers, O / Taibah, A / Tatagiba, M / Tealdo, G / Vlad, D / Wu, H / Zanetti, D. ·Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy. · Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France. · Gruppo Otologico, Piacenza-Rome, Italy. · Academic Neurosurgery, Department of Neuroscience DNS, University of Padova Medical School, Padova, Italy. · Neurosurgery, Bellaria Hospital, Bologna, Italy. · AP-HP, Groupe Hôspital-Universitaire Pitié-Salpêtrière, Neuro-Sensory Surgical Department and NF2 Rare Disease Centre, Paris, France. · Sorbonne Université, Paris, France. · ENT and Skull-Base Surgery Department, Department of Neurosciences, Ospedale Papa Giovanni XXIII, Bergamo, Italy. · Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Italy. · Neurosurgery, Maria Cecilia Hospital, Cotignola (RA), Italy. · Department of Neurosurgery, Julius Maximilians University Hospital Würzburg, Bavaria, Germany. · Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA. · Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA. · The Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. · Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. · Department of Neuroscience DNS, Section of Human Anatomy, Padova University, Padova, Italy. · Department of Neuroradiology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy. · Department of Radiation Oncology, University Hospital Maggiore della Carità, Novara, Italy. · Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy. · Unit of Audiology, Department of Clinical Sciences and Community Health, University of Milano, Italy. · Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy. · Department of Neurosurgery, Eberhard Karls University Tübingen, Germany. · Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA. · Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, "Julius-Maximilians" University Hospital of Würzburg, Bavaria, Germany. · Department of Neurosurgery, Cambridge University Hospital, Cambridge, UK. · Oncology Department, Cambridge University Hospital, Cambridge, UK. · Department of Otolaryngology Head and Neck Surgery, Shanghai Ninh People's Hospital, Shanghai Jiatong University School of Medicine, China. · Department of Neurosciences, King Faisal Specialist Hospital & Research Center, Alfaisal University, College of Medicine, Riyadh, KSA. · ENT & Skull-Base Department, Ospedale Nuovo di Legnano, Legnano (MI), Italy. · Department of Neuro-Otology and Skull-Base Surgery Manchester Royal Infirmary, Manchester, UK. · Department of Neuroscience DNS, Audiology Unit, Padova University, Treviso, Italy. · University Aix-Marseille, France. · Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Italy. · Mayo Clinic School of Medicine, Rochester, MN, USA. · Department of Neuro-otology and Skull Base Surgery, Cambridge University Hospital, Cambridge, UK. · ENT Department, Treviglio (BG), Italy. ·Acta Otorhinolaryngol Ital · Pubmed #31130732.

ABSTRACT: -- No abstract --

16 Article Improvement or Recovery From Sudden Sensorineural Hearing Loss With Steroid Therapy Does Not Preclude the Need for MRI to Rule Out Vestibular Schwannoma. 2019

Puccinelli, Cassandra / Carlson, Matthew L. ·Department of Otolaryngology-Head and Neck Surgery. · Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota. ·Otol Neurotol · Pubmed #31083098.

ABSTRACT: OBJECTIVE: There is a common misconception that improvement in sudden sensorineural hearing loss (SSNHL) after treatment with steroid therapy effectively excludes the diagnosis of a vestibular schwannoma (VS) and such cases do not warrant an MRI. Paralleling this, steroids are commonly withheld for SSNHL in patients with an existing diagnosis of VS, believing that this condition is not steroid-responsive. This study seeks to underscore that improvement or recovery of SSNHL with steroid therapy does not exclude the diagnosis of VS and does not preclude the need for magnetic resonance imaging. METHODS: A retrospective chart review was performed (2002-2017) of patients with previously untreated sporadic VS who developed SSNHL that improved after steroid treatment. A clinically significant audiometric improvement was defined as an increase of more than or equal to 15% in word recognition score (WRS) and/or decrease of more than or equal to 15 dB in 4-frequency pure-tone average (PTA). To supplement these data, a separate population of patients with incomplete or missing audiometric data, who reported unequivocal subjective improvement in hearing after steroid treatment, were also described to reinforce the study objective. Patient demographics, tumor characteristics, steroid regimen, and data regarding treatment response were recorded. RESULTS: A total of 29 patients (55% women; median age of 47 yr) met inclusion criteria. Fourteen (48%) cases had objective audiometric documentation of SSNHL, while 15 (52%) had either subjective report only or incomplete audiometric data available. Eighteen (62%) had a single event, while 11 (38%) had more than one episode of SSNHL that was treated with steroids. For all patients, the median time between SSNHL and diagnosis of VS was 1.3 months (range, 0.13-148.4 mo). At the time of diagnosis, 15 tumors were purely intracanalicular, while 15 tumors had cerebellopontine angle extension. Of the latter, the median cisternal tumor size was 15.9 mm (range, 5.3-33). Twenty-six (90%) cases received oral steroid therapy alone, two (9%) had intratympanic steroid therapy alone, and one (3%) required combination therapy. The median PTA improvement with steroid therapy was 21 dB HL (range, -10-101.2) and the median WRS improvement was 40% (range, 4-100%). CONCLUSION: A therapeutic response to steroid therapy for SSNHL does not exclude the diagnosis of VS. All patients with SSNHL should undergo appropriate diagnostic imaging to prevent delays in diagnosis and potential treatment.

17 Article Influence of Selection Bias in Survey Studies Derived From a Patient-Focused Organization: A Comparison of Response Data From a Single Tertiary Care Center and the Acoustic Neuroma Association. 2019

Prummer, Christoph M / Kerezoudis, Panagiotis / Tombers, Nicole M / Peris-Celda, Maria / Link, Michael J / Carlson, Matthew L. ·Department of Otolaryngology - Head and Neck Surgery. · Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota. ·Otol Neurotol · Pubmed #30870367.

ABSTRACT: BACKGROUND: The Acoustic Neuroma Association (ANA) is a national, nonprofit organization, focused on the education and support of patients with vestibular schwannoma (VS). The aim of the present study is to characterize the profile of ANA survey respondents and compare them with non-ANA patients evaluated at a single tertiary academic referral center to investigate the potential influence of selection bias. METHODS: A prospectively maintained VS quality-of-life (QOL) database, comprised of patients evaluated at the authors' center and members of the ANA, was queried. Demographic variables, patient-reported symptoms and tumor characteristics, as well as patient-reported outcome scores were captured. Health-related QOL was evaluated using the disease-specific Penn Acoustic Neuroma QOL (PANQOL) questionnaire. Multivariable regression models were fitted for PANQOL domain and total scores as well as satisfaction with treatment adjusting for baseline demographics, symptoms, and PANQOL scores. RESULTS: A total of 1,060 patients (802 [76%] ANA respondents) were analyzed. Overall, ANA patients were slightly younger (mean age: 59 vs 60 yr, p = 0.145), more likely to be women (72 vs 55%, p < 0.001), and had a larger tumor size (overall p < 0.001). Furthermore, a significantly higher proportion of ANA patients were more likely to undergo microsurgery (57 vs 21%) or radiation (21 vs 8%) and less likely to be managed with observation (16 vs 65%, overall p < 0.001). A significantly higher proportion of ANA patients reported hearing loss (95 vs 88%, p < 0.001), tinnitus (80 vs 73%, p = 0.034), dizziness (78 vs 64%, p < 0.001), headache (56 vs 45% p = 0.003), and facial paralysis (37 vs 12%, p < 0.001). On multivariable analysis, ANA respondents exhibited significantly lower PANQOL scores for hearing (OR: 0.47, 95% CI: 0.35-0.64, p < 0.001), balance (OR: 0.51, 95% CI: 0.38-0.70, p < 0.001), pain (OR: 0.63, 95% CI: 0.46-0.86, p = 0.004), facial function (OR: 0.58, 95% CI: 0.42-0.80, p = 0.001), energy (OR: 0.44, 95% CI: 0.32-0.59, p < 0.001), anxiety (OR: 0.54, 95% CI: 0.40-0.74, p < 0.001), general (OR: 0.72, 95% CI: 0.53-0.98, p = 0.03), and total QOL (OR: 0.40, 95% CI: 0.30-0.55, p < 0.001). No statistically significant difference was seen with regard to treatment satisfaction.To determine the true clinical relevance of these differences, the two groups were compared using the minimal clinically important difference (MCID) for each domain. MCID is defined as the smallest difference in score in the domain of interest that patients perceive as important, either beneficial or harmful. The domains for hearing, balance, energy, anxiety, and total QOL reached their respective MCID thresholds, indicating that the ANA cohort has QOL scores that are clinically, perceptually worse for these domains compared to the non-ANA group. CONCLUSION: These data help delineate some of the inherent limitations and biases associated with survey studies incorporating data from national patient support organizations. The population profile of ANA survey respondents likely differs significantly from the greater population of patients with VS that may be encountered at a tertiary referral center.

18 Article Cochlear implantation for single-sided deafness in children and adolescents. 2019

Zeitler, Daniel M / Sladen, Douglas P / DeJong, Melissa D / Torres, Jennifer H / Dorman, Michael F / Carlson, Matthew L. ·Listen for Life Center, Department of Otolaryngology-Head and Neck Surgery, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA, 98101, USA. Electronic address: daniel.zeitler@virginiamason.org. · Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. · Denver Ear Associates, 401 W. Hampden Place #240, Englewood, CO, 80110, USA. · Department of Speech and Hearing Science, Arizona State University, PO Box 870102, Tempe, AZ, 85287, USA. ·Int J Pediatr Otorhinolaryngol · Pubmed #30623849.

ABSTRACT: OBJECTIVE: To evaluate outcomes in pediatric and adolescent patients with single-sided deafness (SSD) undergoing cochlear implantation. METHODS: A retrospective cohort design at two tertiary level academic cochlear implant centers. The subjects included nine children ages 1.5 to 15 years-old with single-sided deafness (SSD) who had undergone cochlear implantation in the affected ear. Objective outcome measures included were speech reception testing in quiet and noise, bimodal speech reception threshold testing in noise, tinnitus suppression, and device usage. RESULTS: Nine pediatric and adolescent patients with SSD were implanted between 2011 and 2017. The median age at implantation was 8.9 years (range, 1.5-15.1) and the children had a median duration of deafness 2.9 years (range, 0.8-9.5). There was variability in testing measures due to patient age. Median pre-operative aided word recognition scores on the affected side were <30% regardless of the testing paradigm used. Six patients had pre-operative word testing (4 CNC, median score 25%; 2 MLNT, 8% and 17%). Four patients had pre-operative sentence testing (3 AzBio, median score 44%; 1 HINT-C, 57%). Median post-implantation follow-up interval was 12.3 months (range, 3-27.6 months). Six subjects had post-operative word recognition testing (CNC median, 70%; MLNT 50%, 92%) with a median improvement of 45.5% points. Five subjects had post-operative sentence testing (AzBio, median 82%; HINT, median 76%), with a median improvement of 40.5% points. Eight patients are full time users of their device. Tinnitus and bimodal speech reception thresholds in noise were improved. CONCLUSION: Pediatric subjects with SSD benefit substantially from cochlear implantation. Objective speech outcome measures are improved in both quiet and noise, and bimodal speech reception thresholds in noise are greatly improved. There is a low rate of device non-use.

19 Article Isolated Internal Auditory Canal Diverticula: A Normal Anatomic Variant Not Associated with Sensorineural Hearing Loss. 2018

Mihal, D C / Feng, Y / Kodet, M L / Lohse, C M / Carlson, M L / Lane, J I. ·From the Departments of Radiology (D.C.M., J.I.L.). · Otolaryngology-Head and Neck Surgery (Y.F., M.L.K., M.L.C.). · Health Sciences Research (C.M.L.), Mayo Clinic, Rochester, Minnesota. · From the Departments of Radiology (D.C.M., J.I.L.) Lane.John@mayo.edu. ·AJNR Am J Neuroradiol · Pubmed #30442698.

ABSTRACT: BACKGROUND AND PURPOSE: Bony internal auditory canal diverticula are relatively common, occurring in approximately 5% of temporal bone CTs. Internal auditory canal diverticula have historically been considered incidental; however, a recent publication reported that internal auditory canal diverticula are associated with sensorineural hearing loss. The objective of this study was to further characterize this potential association in a large cohort of patients. MATERIALS AND METHODS: A total of 1759 patients undergoing high-resolution temporal bone CT were collected during a 6-year interval, and audiometric data were obtained from those with internal auditory canal diverticula. To assess any association of isolated internal auditory canal diverticula with sensorineural hearing loss, we excluded from further analysis patients with concomitant otosclerosis and bilateral diverticula and those without audiometric data, leaving 22 index cases. Audiometric data for the ear with a diverticulum was compared with that in the contralateral ear, to serve as an internal control. RESULTS: Of 1759 patients, 82 (4.7%) had either unilateral ( CONCLUSIONS: This study did not find a statistically significant association between ears with internal auditory canal diverticula and worsening sensorineural hearing loss or word recognition. Internal auditory canal diverticula most likely represent a normal anatomic variant in ears without otosclerosis.

20 Article Superior Canal Dehiscence Involving the Superior Petrosal Sinus: A Novel Classification Scheme. 2018

Sweeney, Alex D / O'Connell, Brendan P / Patel, Neil S / Tombers, Nicole M / Wanna, George B / Lane, John I / Carlson, Matthew L. ·Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery and Department of Neurosurgery, Baylor College of Medicine. · Division of Otolaryngology, Texas Children's Hospital, Houston, Texas. · Department of Otolaryngology-Head and Neck Surgery, The Otology Group of Vanderbilt University, Nashville, Tennessee. · Department of Otolaryngology-Head and Neck Surgery. · Departments of Otolaryngology and Neurosurgery, New York Eye & Ear Infirmary of Mount Sinai and Mount Sinai Beth Israel, New York, New York. · Department of Radiology. · Department of Neurosurgery, Mayo Clinic School of Medicine, Rochester, Minnesota. ·Otol Neurotol · Pubmed #30199501.

ABSTRACT: OBJECTIVES: To highlight superior semicircular canal dehiscence (SSCD) involving the superior petrosal sinus (SPS), and to propose a novel classification system for SPS associated SSCD with potential surgical implications. STUDY DESIGN: Multicenter retrospective review. SETTING: Three tertiary referral centers. PATIENTS: All patients diagnosed with SPS associated SSCD (1/2000 to 8/2016). Radiographic findings and clinical symptoms were analyzed. INTERVENTION: Surgical repair or observation. MAIN OUTCOME MEASURE: Radiographic findings and clinical symptoms were analyzed. RESULTS: Thirty-three dehiscences (30 patients) involving the SPS were identified. The average age at the time of presentation was 52.5 years (median, 56.9; range, 4.9-75.3 yr), and 53.3% of patients were men. Three patients had bilateral SPS associated SSCD. The most common associated symptoms at presentation were episodic vertigo (63.6%), subjective hearing loss (60.6%), and aural fullness (57.6%). Four distinct types of dehiscence were identified: class Ia. SSCD involving a single dehiscence into an otherwise normal appearing SPS; class Ib. SSCD involving a single dehiscence into an apparent venous anomaly of the SPS; class IIa. SSCD involving two distinct dehiscences into the middle cranial fossa and the SPS; class IIb. SSCD involving a single confluent dehiscence into the middle cranial fossa and the SPS. CONCLUSIONS: SSCD involving the SPS represents a small but distinct subset of SSCD cases. This scenario can create a unique set of symptoms and surgical challenges when intervention is sought. Clinical findings and considerations for surgical intervention are provided to facilitate effective diagnosis and management.

21 Article Cochlear Implantation in Adults With Asymmetric Hearing Loss: Speech Recognition in Quiet and in Noise, and Health Related Quality of Life. 2018

Sladen, Douglas P / Carlson, Matthew L / Dowling, Brittany P / Olund, Amy P / DeJong, Melissa D / Breneman, Alyce / Hollander, Sara / Beatty, Charles W / Neff, Brian A / Driscoll, Colin L. ·Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota. ·Otol Neurotol · Pubmed #29683995.

ABSTRACT: OBJECTIVE: To examine the possible speech recognition and health related quality of life (HRQoL) benefits of cochlear implantation among adults with asymmetric sensorineural hearing loss. STUDY DESIGN: Retrospective chart review, single-subject design. METHODS: A total of 45 adult cochlear implant recipients with asymmetric sensorineural hearing loss where performance for the best-aided condition exceeded 60% correct open set sentence recognition in quiet, and the implanted ear met traditional candidacy criteria. End point testing of the implanted ear was evaluated with use of the Consonant-Vowel Nucleus-Consonant (CNC) word test and AzBio sentence test materials in quiet, and bimodally with the AzBio sentence test materials in noise at +5 dB signal-to-noise ratio (SNR). HRQoL was measured using the Nijmegen Cochlear Implant Questionnaire (NCIQ). RESULTS: Measured in quiet, with the non-implanted ear plugged, the average CNC word scores increased from 9.1% preoperatively to 55.7% (p < 0.01) at the 6-month post-activation test interval. Similarly, average AzBio sentence scores in quiet, with the non-implanted ear plugged, increased from 13.9% preoperatively to 73.4% (p < 0.01) at the 6-month post-activation test interval. Finally, in the bilateral/bimodal condition, the AzBio sentence score in +5 dB SNR improved from an average of 26.8% preoperatively to 52.4% (p < 0.01) at the 6-month test interval. Results of the NCIQ showed improved scores on all six subdomains. CONCLUSIONS: These data demonstrate significant benefit of cochlear implantation among a group of postlingually deafened adults whose preoperative hearing and aided speech recognition fell outside of the currently specified Food and Drug Administration candidacy guidelines. Results of this study support the evaluation of a candidate's speech recognition in noise in the best-aided condition to adequately assess candidacy for a cochlear implant.

22 Article MRI screening of the internal auditory canal: Is gadolinium necessary to detect intralabyrinthine schwannomas? 2018

Valesano, Johnathan C / Carr, Carrie M / Eckel, Laurence J / Carlson, Matthew L / Lane, John I. ·Department of Radiology, Mayo Clinic, Rochester, MN, USA. · Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA. · Department of Radiology, Mayo Clinic, Rochester, MN, USA. Electronic address: lane.john@mayo.edu. ·Am J Otolaryngol · Pubmed #29273441.

ABSTRACT: OBJECTIVE: Non-contrast MRI of the internal auditory canal (IAC) using high-resolution T2WI (T2 weighted image) has been proposed as the primary screening study in patients with sudden or asymmetric sensorineural hearing loss (ASNHL). However, there are concerns that non-contrast MRI may not detect labyrinthine pathology, specifically intralabyrinthine schwannomas (ILSs). The purpose of this study was to determine if non-contrast high-resolution T2WI alone are adequate to exclude these uncommon intralabyrinthine tumors. METHODS: 31 patients with ILSs and 36 patients without inner ear pathology that had dedicated MRI of the IAC performed with both non-contrast T2WI and post-contrast T1WI (T1 weighted image) were identified. Three board-certified neuroradiologists reviewed only the T2WI from these 67 cases. When an ILS was identified, its location and size were recorded. Sensitivity, specificity, and accuracy were calculated using the post-contrast T1WI as the "gold standard." A consensus review of cases with discordant results was conducted. RESULTS: The sensitivity, specificity, and accuracy were 1.0, 1.0, and 1.0 for Observer 1; 0.84, 1.0, and 0.96 for Observer 2; 0.90, 1.0, and 0.98 for Observer 3. The 5 ILSs with discordant results were correctly identified upon consensus review. The median size of the ILSs was 4.4mm (±2.9mm) and most (18/31) were intracochlear in location. CONCLUSION: Non-contrast high-resolution T2WI alone can detect ILSs with 84-100% sensitivity, suggesting that gadolinium may be unnecessary to exclude ILSs on screening MRI. These findings have implications for reducing cost, time, and adverse events associated with gadolinium administration in patients presenting with sudden or ASNHL. LEVEL OF EVIDENCE: 4.

23 Article Survey of the American Neurotology Society on Cochlear Implantation: Part 1, Candidacy Assessment and Expanding Indications. 2018

Carlson, Matthew L / Sladen, Douglas P / Gurgel, Richard K / Tombers, Nicole M / Lohse, Christine M / Driscoll, Colin L. ·Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota. · Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah. ·Otol Neurotol · Pubmed #29210952.

ABSTRACT: OBJECTIVE: To examine practice variance of cochlear implant candidacy assessment and off-label indications across centers in the United States. METHODS: Cross-sectional survey of the American Neurotology Society (ANS). RESULTS: A total of 81 surveys were returned from ANS members who report regular involvement in cochlear implant care. Overall there was a broad distribution in age and clinical experience, with most respondents reporting ACGME accreditation in neurotology and employment at an academic center. The annual volume of cochlear implant surgeries varied considerably across centers.Seventy-eight percent of respondents performed cochlear implantation for at least one of the following indications within the last 2 years: profound hearing loss in children less than 12 months of age (35, 43%), children with asymmetrical hearing loss where at least one ear was better than performance cutoff for age (25, 31%), adults with asymmetrical hearing where at least one ear was better than the performance cutoff for adult criteria (49, 61%), single-sided deafness (37, 46%), and ipsilateral vestibular schwannoma (28, 35%). Centers with a higher annual implant volume more frequently performed off-label implantation in all queried populations (all, p≤0.001), and performed surgery on infants with congenital deafness at a younger age (p = 0.013), compared with centers with lower surgical volume.When surveyed regarding speech perception testing practices for adult candidacy assessment, 75 (100%) respondents who answered this question reported routine use of AzBio sentences, 42 (56%) CNC word scores, and 26 (35%) HINT testing; only 7 (9%) reported using BKB-SIN testing and 6 (8%) reported using CUNY scores. Fifty-one (68%) reported routine use of speech-in-noise testing to determine adult cochlear implant candidacy, 21 (28%) reported selective use only when patient scores were borderline in quiet, and 3 (4%) reported that their center does not currently use testing in noise for candidacy determination. Nineteen (26%) solely used +10 dB signal-to-noise ratio (SNR), 12 (16%) solely used +5 dB SNR, and 41 (55%) used both +10 and +5 dB SNR. Overall, 19% (N = 14) only perform unilateral implantation in the Medicare population, while 81% (N = 58) consider bilateral implantation. CONCLUSION: Significant variation in cochlear implant candidacy assessment and off-label implantation exists across centers and providers in the United States resulting in healthcare inequities. The high percentage of surgeons performing implantations for off-label or nontraditional indications reflects the overly restrictive and dated status of current implant guidelines. With greater adoption of more difficult speech perception testing in noise, careful clinical judgment is needed to maintain a favorable risk-benefit balance for prospective implant candidates.

24 Article Diagnosing Large Vestibular Aqueduct: Radiological Review of High-Resolution CT Versus High-Resolution Volumetric MRI. 2017

Deep, Nicholas L / Carlson, Matthew L / Weindling, Steven M / Barrs, David M / Driscoll, Colin L W / Lohse, Christine M / Lane, John I / Hoxworth, Joseph M. ·*Department of Otorhinolaryngology, Mayo Clinic, Phoenix, Arizona †Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota ‡Neuroradiology Division, Department of Radiology, Mayo Clinic, Jacksonville, Florida §Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota ||Neuroradiology Division, Department of Radiology, Mayo Clinic, Rochester, Minnesota ¶Neuroradiology Division, Department of Radiology, Mayo Clinic, Phoenix, Arizona. ·Otol Neurotol · Pubmed #28604576.

ABSTRACT: OBJECTIVES: To compare the diagnostic yield of high-resolution volumetric T2-weighted MRI (HRT2-MRI) with high-resolution computed tomography (HRCT) for diagnosis of large vestibular aqueduct (LVA). STUDY DESIGN: Three board-certified neuroradiologists performed an independent, blinded radiological review for diagnosing LVA with 2:1 age-matched controls on patients with both HRCT and HRT2-MRI imaging. SETTING: Tertiary referral center. PATIENTS: All patients between 2002 and 2016 with hearing loss who underwent both HRCT and HRT2-MRI and were diagnosed with LVA on either modality. MAIN OUTCOME MEASURES: Concordance rate for LVA between HRCT and HRT2-MRI. RESULTS: Concordance rate for HRCT and HRT2-MRI for diagnosing LVA was 88% (124/141) when assessing both the midpoint and external aperture diameters. Fifteen ears had LVA on computed tomography (CT), but not on magnetic resonance imaging (MRI); in comparison, two ears had LVA on MRI, but not on CT (p = 0.002). Excellent inter-rater reliability among the three radiologists was demonstrated. CONCLUSION: Historically, HRCT has been the imaging modality of choice for diagnosing LVA. Although a higher concordance rate of HRT2-MRI was found compared with previous studies utilizing earlier MRI technology, HRCT still detected a larger number of patients with clinically significant hearing loss compared with MRI. Given the high concordance rate and efficacy of both modalities in diagnosing LVA, the ultimate decision of which modality to choose may depend on other patient-specific and clinical factors.

25 Article Hearing Preservation in Pediatric Cochlear Implantation. 2017

Carlson, Matthew L / Patel, Neil S / Tombers, Nicole M / DeJong, Melissa D / Breneman, Alyce I / Neff, Brian A / Driscoll, Colin L W. ·Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota. ·Otol Neurotol · Pubmed #28538468.

ABSTRACT: OBJECTIVE: Currently, there is a paucity of literature evaluating hearing preservation outcomes in children following cochlear implantation. The objective of the current study is to report pediatric hearing preservation results following cochlear implantation with conventional full-length electrodes. STUDY DESIGN: Retrospective review (2000-2016). SETTING: Tertiary referral center. PATIENTS: All pediatric patients with a ≤ 75 dB preoperative low-frequency pure tone average (LFPTA; 250-500 Hz average), who underwent cochlear implantation with a conventional length electrode. INTERVENTION(S): Cochlear implantation. MAIN OUTCOME MEASURE(S): Complete, partial, minimal, or no hearing preservation following cochlear implantation (Skarzynski et al., 2013); maintenance of functional low frequency hearing (≤85 dB LFPTA). RESULTS: A total of 43 ears, in 35 pediatric patients, met inclusion criteria. The mean age at time of implantation was 8.6 years (range, 1.4-17.8 yr), 20 (57.1%) patients were female, and 25 (58.1%) cases were left-sided.The mean preoperative ipsilateral low frequency PTA and conventional four-frequency PTA (500, 1000, 2000, 3000 Hz average) were 54.2 dB (range, 15-75 dB) and 82.2 dB (range, 25-102.5 dB), respectively. The mean low frequency PTA and conventional four-frequency PTA shifts comparing the pre- and first postoperative audiogram were Δ25.2 dB (range, -5 to 92.5 dB) and Δ18.3 dB (range, -8.8 to 100 dB), respectively. Overall, 17 (39.5%) ears demonstrated complete hearing preservation, 19 (44.2%) ears partial hearing preservation, 0 minimal hearing preservation, and 7 (16.3%) exhibited no measurable acoustic hearing after surgery. In total, 28 (65.1%) ears maintained functional low-frequency hearing (i.e., ≤85 dB LFPTA) based on the initial postoperative audiogram. There was no statistically significant difference in the initial low frequency PTA shift comparing lateral wall and perimodiolar electrodes (Δ22.2 versus Δ28.1 respectively; p = 0.44), cochleostomy and round window insertions (Δ25.2 vs. Δ24.7 respectively; p = 0.95), or statistically significant association between age at implantation and low frequency PTA shift (r = 0.174; p = 0.26).In total, 22 ears in 19 patients had serial audiometric data available for review. Over a mean duration of 43.8 months (range, 2.6-108.3 mo) following surgery, the mean low frequency PTA and conventional four-frequency PTA shift comparing the initial postoperative and most recent postoperative audiogram was Δ9.7 dB (range, -27.5 to 57.5 dB) and Δ8.1 dB (range, -18.8 to 31.9 dB), respectively. CONCLUSIONS: Varying levels of hearing preservation with conventional length electrodes can be achieved in most pediatric subjects. In the current study, 82% of patients maintained detectable hearing thresholds and 65% maintained functional low-frequency acoustic hearing. These data may be used to guide preoperative counseling in pediatric patients with residual acoustic hearing. Additionally, the favorable rates of hearing preservation achieved in children provide further evidence for the expansion of pediatric cochlear implant candidacy to include patients with greater degrees of residual hearing.

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