Although malpositioning of the cochlear implant (CI) electrode array is rare in patients with normal anatomy, when occurring it may result in reduced hearing outcome. In addition to intraoperative electrophysiologic tests, imaging is an important modality to assess correct electrode array placement. The purpose of this report was to assess the incidence and describe cases in which intraoperative plain radiographs detected a malpositioned array. Intraoperative anti-Stenver’s view plain X-rays are conducted routinely in all CI surgeries in our tertiary center before awakening the patient and breaking the sterile field. Data of patients undergoing 399 CI surgeries were retrospectively analyzed. A total of 355 had normal inner ear and temporal bone anatomy. Patients with intra or extracochlear malpositioned electrode arrays demonstrated in the intraoperative X-ray were described. There were four cases of electrode array malposition out of 355 implantations with normal anatomy (1.1%): two tip fold-overs, one extracochlear placement and one partial insertion. All electrodes were reinserted immediately; repeated radiographs were normal and the patients achieved good hearing function. Intraoperative plain anti-Stenver’s view X-rays are valuable to confirm electrode array location, allowing correction before the conclusion of surgery. These radiographs are cheaper, faster, and emit much less radiation than other imaging options, making them a viable cost-effective tool in patients with normal anatomy.

Background: Endoscopic Dacryocystorhinostomy (DCR) has become an acceptable alternative to the open approach, with considerable data demonstrating comparable success rates and advantages such as avoiding skin incisions. Drug-eluting bio-absorbable materials are relatively new innovation in sinus surgery, the usefulness of such materials in Endoscopic DCR is yet to be described. Methods: A retrospective analysis of 253 endoscopic DCR procedures performed by a single surgical team from September 2011 to June 2020 was performed. At the end of 2013, a surgical modification took place with the introduction of steroid-eluting Spongostan to the intranasal surgical bed. As a result, 2 cohorts were compared before and after the modification. The first cohort consisted of 55 patients, and the second consisted of 187 patients, respectively. Patient demographics, clinical features, complications and outcomes were examined. Results: A total of 242 procedures were evaluated after exclusion. In the first cohort of 55 patients (48 adults and 7 children), the overall and adult functional success rates were 83.6% and 83.3%, respectively. In the second cohort of 187 patients (167 adults and 20 children), where steroid-eluting Spongostan was used, the overall and adult functional success rates were 92.5% and 93.4%, respectively. These differences were statistically significant. Conclusion: This is a unique study presenting a single surgical team’s experience over a 9-year period where a novel technique involving drug-eluted bio-absorbable material (Spongostan) was introduced midway through, creating 2 cohorts to compare. Success rates were significantly higher after applying steroid eluted Spongostan to our endoscopic DCR technique.

OBJECTIVES: The accepted treatment for idiopathic sudden sensorineural hearing loss (ISSNHL) consists of oral or intratympanic steroids. The time from onset to treatment is considered as an important prognostic factor, although there is no clear cutoff point when treatment is no longer beneficial. This study aimed to assess the efficacy of treatment with oral or intratympanic steroids and carbogen, in patients presenting 21 days or later after the onset of hearing loss. MATERIALS and METHODS: A total of 895 patients with ISSNHL was seen in our center between 2010 and 2018. The study cohort included 103 patients treated with oral or intratympanic steroids or both with carbogen 21 days or longer after experiencing hearing loss. Retrospective analysis of files and audiometry was conducted, and pre- and post-treatment audiograms were compared. Improvement was defined by SRT (≥15 dB improvement), discrimination (≥15% improvement), or 15 dB improvement at specific frequencies (250-500, 4000-6000 Hz). RESULTS: Hearing improvement, according to the study definition, was seen in 22.3% (23/103) of patients within the time period of the treatment. All the 23 patients had functional hearing after treatment and 16 of them returned to their baseline or normal hearing. While the time from onset of ISSNHL to treatment varied, most patients demonstrating improvement were treated 21-30 days after onset. CONCLUSION: In this patient cohort treated late for sudden sensorineural hearing loss (SSNHL), a small but significant number of patients improved during the time of treatment. Although the lack of a control group makes it difficult to prove that the improvement resulted from the treatment, we recommend not to rule out treatment systematically in patients presenting late after ISSNHL. Additional prospective studies are warranted. Cite this article as: Chen I, Cohen O, Shaul C, Sichel JY, Perez R. Is it Beneficial to Treat Patients Presenting Three Weeks or Longer after the Onset of Sudden Sensorineural Hearing Loss? J Int Adv Otol 2020; 16(3): 323-7.

The main treatment approaches for sudden sensorineural hearing loss (SSNHL) involve oral and intratympanic corticosteroids, but their efficacy remains controversial. The study objective was to evaluate the benefit of oral corticosteroids followed by intratympanic salvage treatment. This was conducted by comparing the hearing results of post-treatment patients arriving early and pretreatment patients arriving late over the same time points after the onset of HL. A cohort of 776 patients with SSNHL was classified into four groups by time from onset of symptoms to the initiation of treatment (weeks). The post-treatment audiometry of those patients presenting during the first and second week post-HL was compared to the pretreatment audiometry of those presenting in weeks three and four. The post-treatment audiometry of week one and pretreatment audiometry of week three was conducted 17.2 ± 4 and 19.4 ± 3 (p = 0.13) days post-HL onset, respectively. The post-treatment audiometry of week two and pretreatment audiometry of week four was conducted on days 24.6 ± 4 and 25.2 ± 3 (p = 0.32). The pure-tune average for week one and three groups was 36.7 ± 28 and 37.5 ± 19 dB (p = 0.55), and for weeks 2 and 4, it was 31.7 ± 22 and 36.6 ± 23 dB (p = 0.1). Similarly, no significant differences in speech recognition threshold and speech discrimination were found. These results question the benefit of corticosteroid treatment for SSNHL and suggest that improvements may be due to the natural healing process.

Background: Auricular arteriovenous malformations (AVMs) are rare vascular anomalies, being the second most prevalent after cheek AVMs. Their management presents challenges. Objective: We aim to explore the clinical presentation of ear AVMs, highlighting a unique pattern of focal auricular AVM. Methods: A retrospective review was conducted over 7 years, focusing on patients diagnosed with focal auricular AVMs. Exclusions included non-AVM diagnosis, adjacent anatomical site extensions, and lack of patient information or photos. Results: Twenty-two patients with auricular AVMs were identified, 13/22 with isolated focal AVMs, 8/13 females, 5/13 males, 5/13 with right ear involvement, and 8/13 with left ear involvement. A consistent presentation involving the upper 2/3 of the pinna while sparing the root of the helix/tragus/antitragus/concha and lobule was noticed. Conclusion: This study focuses on focal auricular AVMs, revealing a uniform pattern while sparing specific structures. Embryological evaluation, vascular supply analysis, and angiosome theory shed light on potential tissue layers as the nidus in those cases.