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Hearing Disorders: HELP
Articles by Lloyd B. Minor
Based on 8 articles published since 2009
(Why 8 articles?)
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Between 2009 and 2019, Lloyd B. Minor wrote the following 8 articles about Hearing Disorders.
 
+ Citations + Abstracts
1 Review Canal dehiscence. 2011

Chien, Wade W / Carey, John P / Minor, Lloyd B. ·Department of Otolaryngology-Head & Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. wchien1@jhmi.edu ·Curr Opin Neurol · Pubmed #21124219.

ABSTRACT: PURPOSE OF REVIEW: The aim is to review canal dehiscence involving the superior, lateral, and posterior semicircular canals. The main focus will be on superior semicircular canal dehiscence. RECENT FINDINGS: Canal dehiscence involving the superior, lateral, and posterior semicircular canal can have different etiologies, including developmental abnormality, congenital defect, chronic otitis media with cholesteatoma, and high-riding jugular bulb. However, their clinical presentation can be very similar, with patients complaining of vertigo, oscillopsia, and sometimes hearing loss. Canal dehiscence causes an abnormal communication between the inner ear and the surrounding structures. This creates a third mobile window within the inner ear, disrupting its normal mechanics and causing symptoms. SUMMARY: Superior semicircular canal dehiscence is now a well-established entity in the medical literature. Surgical repair is effective at relieving patients' vestibular symptoms. Lateral semicircular canal dehiscence is usually associated with chronic otitis media. Posterior semicircular canal dehiscence is a rare entity, with similar clinical presentations and treatment options as the other canal dehiscences.

2 Article Long-Term Patient-Reported Outcomes After Surgery for Superior Canal Dehiscence Syndrome. 2017

Alkhafaji, Mohammed S / Varma, Sanskriti / Pross, Seth E / Sharon, Jeffrey D / Nellis, Jason C / Santina, Charles C Della / Minor, Lloyd B / Carey, John P. ·*Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland †Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco ‡Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California. ·Otol Neurotol · Pubmed #28902804.

ABSTRACT: OBJECTIVE: Evaluate the long-term patient-reported outcomes of surgery for superior canal dehiscence syndrome (SCDS). STUDY DESIGN: Cross-sectional survey. SETTING: Tertiary referral center. PATIENTS: Adults who have undergone surgery for SCDS with at least 1 year since surgery. MAIN OUTCOME MEASURE(S): Primary outcome: change in symptoms that led to surgery. SECONDARY OUTCOMES: change in 11 SCDS-associated symptoms, change in psychosocial metrics, and willingness to recommend surgery to friends with SCDS. RESULTS: Ninety-three (43%) respondents completed the survey with mean (SD) time since surgery of 5.3 (3.6) years. Ninety-five percent of respondents reported the symptoms that led them to have surgery were "somewhat better," "much better," or "completely cured." Those with unilateral symptoms were more likely to report improvement than those with bilateral symptoms. There was no difference between those with short (1-5 yr) versus long (5-20 yr) follow-up. Each of the SCDS-associated symptoms showed significant improvement. The largest improvements were for autophony, pulsatile tinnitus, audible bodily sounds, and sensitivity to loud sound. Headaches, imbalance, dizziness, and brain fog showed the least improvements. Most patients reported improvements in quality of life, mood, and ability to function at work and socially. Ninety-five percent of patients would recommend SCDS surgery. CONCLUSIONS: Respondents demonstrated durable improvements in the symptoms that led them to have surgery. Auditory symptoms had the greatest improvements. Headaches, imbalance, dizziness, and brain fog showed the least improvements. Nearly, all patients would recommend SCDS surgery to others. These results can be used to counsel patients regarding the lasting benefits of surgery for SCDS.

3 Article Intraoperative neuromonitoring for superior semicircular canal dehiscence and hearing outcomes. 2015

Wenzel, Angela / Ward, Bryan K / Ritzl, Eva K / Gutierrez-Hernandez, Sergio / Della Santina, Charles C / Minor, Lloyd B / Carey, John P. ·*Departments of Otolaryngology-Head and Neck Surgery, and †Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland; and ‡Stanford University School of Medicine, Stanford, California, U.S.A. ·Otol Neurotol · Pubmed #25333320.

ABSTRACT: BACKGROUND: Recent findings in patients with superior semicircular canal dehiscence (SCD) have shown an elevated ratio of summating potential (SP) to action potential (AP), as measured by electrocochleography (ECochG). Changes in this ratio can be seen during surgical intervention. The objective of this study was to evaluate the utility of intraoperative ECochG and auditory brainstem response (ABR) as predictive tools for postoperative hearing outcomes after surgical plugging via middle cranial fossa approach for SCD syndrome (SCDS). METHODS: This was a review of 34 cases (33 patients) in which reproducible intraoperative ECochG recordings were obtained during surgery. Diagnosis of SCDS was based on history, physical examination, vestibular function testing, and computed tomography imaging. Simultaneous intraoperative ECochG and ABR were performed. Pure-tone audiometry was performed preoperatively and at least 1 month postoperatively, and air-bone gap (ABG) was calculated. Changes in SP/AP ratio, SP amplitude, and ABR wave I latency were compared with changes in pure-tone average and ABG before and after surgery. RESULTS: Median SP/AP ratio of affected ears was 0.62 (interquartile range [IQR], 0.45-0.74) and decreased immediately after surgical plugging of the affected canal to 0.42 (IQR, 0.29-0.52; p < 0.01). Contralateral SP/AP ratio before plugging was 0.33 (IQR, 0.25-0.42) and remained unchanged at the conclusion of surgery (0.30; IQR, 0.25-0.35; p = 0.32). Intraoperative changes in ABR wave I latency and SP amplitude did not predict changes in pure-tone average or ABG after surgery (p > 0.05). CONCLUSION: This study confirmed the presence of an elevated SP/AP ratio in ears with SCDS. The SP/AP ratio commonly decreases during plugging. However, an intraoperative decrease in SP/AP does not appear to be sensitive to either the beneficial decrease in ABGs or the mild high-frequency sensory loss that can occur in patients undergoing surgical plugging of the superior semicircular canal. Future work will determine the value of intraoperative ECochG in predicting changes in vestibular function.

4 Article Hearing outcomes after surgical plugging of the superior semicircular canal by a middle cranial fossa approach. 2012

Ward, Bryan K / Agrawal, Yuri / Nguyen, Elena / Della Santina, Charles C / Limb, Charles J / Francis, Howard W / Minor, Lloyd B / Carey, John P. ·Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA. bward15@jhmi.edu ·Otol Neurotol · Pubmed #22935810.

ABSTRACT: OBJECTIVE: To determine postoperative hearing outcomes after surgical plugging via middle cranial fossa approach for superior semicircular canal dehiscence syndrome (SCDS). STUDY DESIGN: Clinical review. SETTING: Tertiary care medical center. PATIENTS: Forty-three cases of SCDS based on history, physical examination, vestibular function testing, and computed tomography imaging confirming the presence of a dehiscence. All patients underwent surgical plugging of the superior semicircular canal via middle cranial fossa approach. INTERVENTION: Pure tone audiometry was performed preoperatively and at 7 days and at least 1 month postoperatively. MAIN OUTCOME MEASURES: Change in air-bone gap (ABG) and pure tone average (PTA). RESULTS: Preoperative average ABG across 0.25, 0.5, 1, and 2 kHz was 16.0 dB (standard deviation [SD], 7.5 dB). At 7 days postoperatively, average ABG was 16.5 dB (SD, 11.1; p = 0.42), and at greater than 1 month was 8.1 dB (SD, 8.4; p < 0.001). 53% (95% confidence interval, 33-69) of affected ears had greater than 10 dB increase in their 4-frequency (0.5, 1, 2, and 4 kHz) PTA measured by bone-conduction (BC) threshold 7 days postoperatively and 25% (95% confidence interval, 8-39) at greater than 1 month postoperatively. Mean BC PTA of affected ears was 8.4 dB hearing loss (HL) (SD, 10.4) preoperatively. Compared with baseline, this declined to 19.2 dB HL (SD, 12.6; p < 0.001) at 7 days postoperatively and 16.4 dB HL (SD, 18.8; p = 0.01) at greater than 1 month. No significant differences in speech discrimination score were noted (F = 0.17). CONCLUSION: Low-frequency air-bone gap decreases after surgical plugging and seems to be due to both increased BC thresholds and decreased AC thresholds. Surgical plugging via a middle cranial fossa approach in SCDS is associated with mild high-frequency sensorineural hearing loss that persists in 25% but no change in speech discrimination.

5 Article Superior canal dehiscence size: multivariate assessment of clinical impact. 2012

Chien, Wade W / Janky, Kristen / Minor, Lloyd B / Carey, John P. ·Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. wchien1@jhmi.edu ·Otol Neurotol · Pubmed #22664896.

ABSTRACT: OBJECTIVE: To examine the association between dehiscence length in patients with superior semicircular canal dehiscence syndrome and their clinical findings, including objective audiometric and vestibular testing results. STUDY DESIGN: Retrospective study. SETTING: Tertiary referral center. PATIENTS: Patients included in this study were diagnosed with superior semicircular canal dehiscence syndrome and underwent surgical repair of the dehiscence through middle fossa craniotomy. The dehiscence length was measured intraoperatively in all cases. MAIN OUTCOME MEASURES: Correlation between dehiscence length with pure-tone average (PTA), average bone-conduction threshold, maximal air-bone gap, cervical vestibular evoked myogenic potential thresholds, and presenting signs and symptoms. RESULTS: The correlation between dehiscence length and maximal air-bone gap was statistically significant on both univariate and multivariate regression analyses. The correlations between dehiscence length and PTA, average bone-conduction threshold, cervical vestibular evoked myogenic potential threshold, and presenting signs and symptoms were not statistically significant. CONCLUSION: The dehiscence length correlated positively with the maximal air-bone gap in patients with superior semicircular canal dehiscence. The correlation was statistically significant. The dehiscence length did not correlate with the other variables examined in this study.

6 Article Second-side surgery in superior canal dehiscence syndrome. 2012

Agrawal, Yuri / Minor, Lloyd B / Schubert, Michael C / Janky, Kristen L / Davalos-Bichara, Marcela / Carey, John P. ·Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. ·Otol Neurotol · Pubmed #22158019.

ABSTRACT: OBJECTIVE: Bilateral superior canal (SC) dehiscence syndrome poses a challenge because bilateral SC dehiscence (SCD) plugging might be expected to result in oscillopsia and disability. Our aims were as follows: 1) to evaluate which symptoms prompted patients with bilateral SCD syndrome (SCDS) to seek second-side surgery, and 2) to determine the prevalence of disabling imbalance and oscillopsia after bilateral SC plugging. STUDY DESIGN: Prospective observational study. SETTING: Tertiary referral center. PATIENTS: Five patients with bilateral SCDS based on history, audiometric and physiologic testing, and computed tomographic findings. This includes all of our patients who have had second-side plugging surgery to date. INTERVENTION(S): Bilateral sequential middle fossa craniotomy and plugging of SCs. MAIN OUTCOME MEASURE(S): Cochleovestibular symptoms, cervical and ocular vestibular-evoked myogenic potential testing, dizziness handicap inventory, short-form 36 Health Survey, dynamic visual acuity testing. RESULTS: The most common symptoms prompting second-side surgery were sound- and pressure-induced vertigo and autophony. Three of the 5 patients reported that symptoms shifted to the contralateral ear immediately after plugging the first side, whereas in 2 patients, contralateral symptoms developed several years after the first SC plugging. Two of 4 patients experienced ongoing oscillopsia after bilateral SCDS surgery; however, all patients reported relief from their SCD symptoms and were glad that they had pursued bilateral surgery. CONCLUSION: In patients with bilateral SCDS, sound- and pressure-induced vertigo most commonly prompted second-side surgery. Despite some degree of oscillopsia after bilateral SCDS surgery, patients were very satisfied with second-side surgery, given their relief from other SCDS symptoms.

7 Article Functional variants in NOS1 and NOS2A are not associated with progressive hearing loss in Ménière's disease in a European Caucasian population. 2011

Gazquez, Irene / Lopez-Escamez, Jose A / Moreno, Antonia / Campbell, Colleen A / Meyer, Nicole C / Carey, John P / Minor, Lloyd B / Gantz, Bruce J / Hansen, Marlan R / Della Santina, Charles C / Aran, Ismael / Soto-Varela, Andres / Santos, Sofia / Batuecas, Angel / Perez-Garrigues, Herminio / Lopez-Nevot, Alicia / Smith, Richard J H / Lopez-Nevot, Miguel A. ·Otology and Neurotology Group CTS495, GENYO, Centro de Genómica e Investigación Oncológica-Pfizer, Universidad de Granada, Junta de Andalucía, Granada, Spain. ·DNA Cell Biol · Pubmed #21612410.

ABSTRACT: Hearing loss in Ménière's disease (MD) is associated with loss of spiral ganglion neurons and hair cells. In a guinea pig model of endolymphatic hydrops, nitric oxide synthases (NOS) and oxidative stress mediate loss of spiral ganglion neurons. To test the hypothesis that functional variants of NOS1 and NOS2A are associated with MD, we genotyped three functional variants of NOS1 (rs41279104, rs2682826, and a cytosine-adenosine microsatellite repeat in exon 1f) and the CCTTT repeat in the promoter of NOS2A gene (rs3833912) in two independent MD sets (273 patients in total) and 550 controls. A third cohort of American patients was genotyped as replication cohort for the CCTTT repeat. Neither allele nor genotype frequencies of rs41279104 and rs2682826 were associated with MD, although longer alleles of the cytosine-adenosine microsatellite repeat were marginally significant (corrected p = 0.05) in the Mediterranean cohort but not in a second Galicia cohort. Shorter numbers of the CCTTT repeat in NOS2A were significantly more frequent in Galicia controls (OR = 0.37 [CI, 0.18-0.76], corrected p = 0.04), but this finding could not be replicated in Mediterranean or American case-control populations. Meta-analysis did not support an association between CCTTT repeats and risk for MD. Severe hearing loss (>75 dB) was also not associated with any functional variants studied. Functional variants of NOS1 and NOS2A do not confer susceptibility for MD.

8 Article Improvement in autophony symptoms after superior canal dehiscence repair. 2010

Crane, Benjamin T / Lin, Frank R / Minor, Lloyd B / Carey, John P. ·Johns Hopkins School of Medicine, Baltimore, Maryland, USA. craneb@gmail.com ·Otol Neurotol · Pubmed #20050268.

ABSTRACT: OBJECTIVE: Autophony, or the unusually loud or disturbing sound of a patient's own voice, can be a prominent and disabling symptom of superior canal dehiscence (SCD) syndrome. The current study measures autophony symptoms before and after SCD plugging to quantify the benefits of surgery. STUDY DESIGN: Patients undergoing SCD plugging between September 2007 and October 2008 completed a questionnaire before and 3 months after surgery. The questionnaire consisted of 26 statements to assess the disability caused by the sound of the patient's own voice. Patients graded each item on a scale from 0 (never) to 4 (almost always) to how often they noted a symptom or experience. Typical statements included "hearing my voice has interfered with my ability to work" and "hearing my voice has caused me to avoid social situations." An autophony index (AI) was generated to grade patient symptoms. SETTING: Tertiary referral center. PATIENTS: Nineteen adults with SCD. INTERVENTION: Superior canal dehiscence plugging via a middle fossa approach. OUTCOME MEASURES: Change in AI. RESULTS: Preoperatively, the mean AI was 42 +/- 27 (mean +/- SD; range, 0-86; 1 patient had no autophony symptoms). Postoperative AI decreased 89% to 9 +/- 22, a significant (p < 0.01) decline. Of the 18 patients with preoperative autophony, 13 had complete postoperative resolution. In 3 remaining patients, the AI decreased but did not resolve. One of these had bilateral SCD with contralateral autophony. One patient's mild autophony remained unchanged, and another patient with coexisting patulous eustachian tube AI increased after SCD plugging. CONCLUSION: In patients with significant autophony symptoms, SCD plugging improved 94% of patients. A simple 5-item AI is provided that will be useful in grading autophony symptoms.