HSC Section 8_April 2017

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Otology and Neurotology

Home Study Course

Hsc Home Study Course

Section 8 April 2017

© 2017 American Academy of Otolaryngology—Head and Neck Surgery Foundation Empowering otolaryngologist-head and neck surgeons to deliver the best patient care

THE HOME STUDY COURSE IN OTOLARYNGOLOGY — HEAD AND NECK SURGERY

April 2017

SECTION 8

Otology and Neurotology

SECTION FACULTY: Cliff Megerian, MD ** J. Thomas Roland, Jr., MD**

Mark L. Bennett, MD Daniel H. Coelho, MD John C. Goddard, MD Darius Kohan, MD Daniel M. Zeitler, MD

American Academy of Otolaryngology - Head and Neck Surgery Foundation

Section 8 exam deadline: June, 12, 2017 Expiration Date: August 4, 2017; CME credit not available after that date

Introduction The Home Study Course is designed to provide relevant and timely clinical information for physicians in training and current practitioners in otolaryngology - head and neck surgery. The course, spanning four sections, allows participants the opportunity to explore current and cutting edge perspectives within each of the core specialty areas of otolaryngology. The Selected Recent Material represents primary fundamentals, evidence-based research, and state of the art technologies in otology and neurotology. The scientific literature included in this activity forms the basis of the assessment examination. The number and length of articles selected are limited by editorial production schedules and copyright permission issues, and should not be considered an exhaustive compilation of knowledge on otology and neurotology. The Additional Reference Material is provided as an educational supplement to guide individual learning. This material is not included in the course examination and reprints are not provided. Needs Assessment AAO-HNSF’s education activities are designed to improve healthcare provider competence through lifelong learning. The Foundation focuses its education activities on the needs of providers within the specialized scope of practice of otolaryngologists. Emphasis is placed on practice gaps and education needs identified within eight subspecialties. The Home Study Course selects content that addresses these gaps and needs within all subspecialties. Target Audience The primary audience for this activity is physicians and physicians-in-training who specialize in otolaryngology-head and neck surgery. Outcomes Objectives The participant who has successfully completed this section should be able to: 1. Use diagnostic criteria for vestibular migraine and management options. 2. Review the diagnostic criteria and medical and surgical management options for Ménière’s disease. 3. Discuss the radiologic evaluation essential to rule out treatable pathologies causing pulsatile tinnitus. 4. Manage and treat fungal and bacterial malignant otitis externa. 5. Evaluate the recurrence rate after cholesteatoma surgery and the use of diffusion-weighted MRI in diagnosing recurrence. 6. Discuss the hearing outcome results of the U.S. Hybrid L trial and understand candidacy criteria and hearing preservation outcomes. 7. Describe the potential benefits of the Baha Attract system for patients with mixed and conductive hearing losses. 8. Articulate the hearing rehabilitative options for patients with single-sided deafness (SSD) and the superior benefits obtained with cochlear implant when compared to CROS and BAHA systems. 9. Recognize that there is no difference in hearing in noise between the CROS and BAHA systems. 10. Agree that stereotactic radiation is an effective treatment for intracranial and intratemporal facial nerve schwannomas. 11. Relate the advantages of the middle fossa approach for the management of facial nerve paralysis after trauma. 12. Explain the use of electroneuronography to determine the need for surgical intervention in acute facial palsy. 13. Review the typical clinical otologic findings in temporal bone fractures in children.

Medium Used The Home Study Course is available in electronic or print format. The activity includes a review of outcomes objectives, selected scientific literature, and a online self-assessment examination. Method of Physician Participation in the Learning Process The physician learner will read the selected scientific literature, reflect on what they have read, and complete the online self-assessment exam. After completing this section, participants should have a greater understanding of otology and neurotology, as well as useful information for clinical application. Accreditation Statement The American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Credit Designation The AAO-HNSF designates this enduring material for 40.0 AMA PRA Category 1 Credit(s) ™. Physicians should claim credit commensurate with the extent of their participation in the activity. ALL PARTICIPANTS must achieve a post-test score of 70% or higher for a passing completion to be recorded and a transcript to be produced. Residents; results will be provided to the Training Program Director. Disclosure The American Academy of Otolaryngology Head and Neck Surgery/Foundation (AAO-HNS/F) supports fair and unbiased participation of our volunteers in Academy/Foundation activities. All individuals who may be in a position to control an activity’s content must disclose all relevant financial relationships or disclose that no relevant financial relationships exist. All relevant financial relationships with commercial interests 1 that directly impact and/or might conflict with Academy/Foundation activities must be disclosed. Any real or potential conflicts of interest 2 must be identified, managed, and disclosed to the learners. In addition, disclosure must be made of presentations on drugs or devices, or uses of drugs or devices that have not been approved by the Food and Drug Administration. This policy is intended to openly identify any potential conflict so that participants in an activity are able to form their own judgments about the presentation. [1] A “Commercial interest” is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. 2 “Conflict of interest” is defined as any real or potential situation that has competing professional or personal interests that would make it difficult to be unbiased. Conflicts of interest occur when an individual has an opportunity to affect education content about products or services of a commercial interest with which they have a financial relationship. A conflict of interest depends on the situation and not on the character of the individual. Estimated time to complete this activity: 40.0 hours PHYSICIANS ONLY : In order to receive Credit for this activity a post-test score of 70% or higher is required . Two retest opportunity will automatically available if a minimum of 70% is not achieved.

2016-17 Section 8 OTOLOGY AND NEUROTOLOGY FACULTY

** Co-Chairs: Cliff Megerian, MD , The Julius McCall Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine; The Richard and Patricia Pogue Endowed Chair, President University Hospitals Physician Services, Chief Medical Officer Physician Practices, University Hospitals Health System, Cleveland, Ohio. Disclosure: Salary: Cochlear Corporation. Royalty: Grace Medical. J. Thomas Roland, Jr., MD , Mendik Foundation Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery; Professor of Neurosurgery; New York University Langone Medical Center, New York, New York. Disclosure: Faculty: Mark L. Bennett, MD , Associate Professor, Otology and Neuro-otology, Quality Officer QSRP, Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Disclosure: Leadership Role: Oticon. Daniel H. Coelho, MD , G. Douglas Hayden Associate Professor, Department of Otolaryngology ‐ Head & Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia. Disclosure: Consultanting fee: MedEl. John C. Goddard, MD , Otology, Neurotology, Skull Base Surgery; Department of Otolaryngology-Head and Neck Surgery; Northwest Permanente, PC, Kaiser Permanente-Northwest , Clackamas, Oregon . Disclosure: No relationships to disclose. Darius Kohan, MD , Associate Professor, Otolaryngology Department, New York University School of Medicine, New York, New York; private practice; New York, New York. Disclosure: No relationships to disclose. Daniel M. Zeitler, MD, The Listen for Life Center, Department of Otolaryngology-Head and Neck Surgery, Virginia Mason Medical Center, Seattle, WA; Clinical Instructor, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA Disclosure: Surgical Advisory Board: Med-El Corporation Consulting Fee: Cochlear Americas Other: Advisor: Cochlear America. Other: Advisor: Advanced Bionics.

Planner(s): Linda Lee, AAO─HNSF Education Senior Manager Stephanie Wilson, Stephanie Wilson Consulting, LLC; Production Manager Richard V. Smith, MD, chair, Education Steering Committee Brad Kesser, MD, Chair, Otology & Neurotology Education Committee Mark L. Bennett, MD, Chair elect, Otology & Neurotology

No relationships to disclose No relationships to disclose

Disclosure: Expert Witness: Various legal firms

Disclosure: Royalty: Nasco, Inc

Disclosure: Leadership Role: Oticon.

Education Committee

This 2016-17 Section 8 Home Study Course includes discussion of off-label uses of the following drugs and devices which have not been approved by the United States Food and Drug Administration:

Name of Drug(s) or Device(s)

Nature of Off-label Discussion

Cochlear Implant

Use of CI for single -sided deafness; not-approved FDA indication

Disclaimer The information contained in this activity represents the views of those who created it and does not necessarily represent the official view or recommendations of the American Academy of Otolaryngology – Head and Neck Surgery Foundation.

June 12, 2017: August 4, 2017.

Suggested section 8 Exam submission deadline ; course closes

EVIDENCE BASED MEDICINE The AAO-HNSF Education Advisory Committee approved the assignment of the appropriate level of evidence to support each clinical and/or scientific journal reference used to authenticate a continuing medical education activity. Noted at the end of each reference, the level of evidence is displayed in this format: [EBM Level 3] .

Oxford Centre for Evidence-based Medicine Levels of Evidence (May 2001) Level 1

Randomized 1 controlled trials 2 or a systematic review 3 (meta-analysis 4 ) of randomized controlled trials 5 . Prospective (cohort 6 or outcomes) study 7 with an internal control group or a systematic review of prospective, controlled trials. Retrospective (case-control 8 ) study 9 with an internal control group or a systematic review of retrospective, controlled trials. Case series 10 without an internal control group (retrospective reviews; uncontrolled cohort or outcome studies).

Level 2

Level 3

Level 4

Expert opinion without explicit critical appraisal, or recommendation based on physiology/bench research.

Level 5

Two additional ratings to be used for articles that do not fall into the above scale. Articles that are informational only can be rated N/A , and articles that are a review of an article can be rated as Review. All definitions adapted from Glossary of Terms, Evidence Based Emergency Medicine at New York Academy of Medicine at www.ebem.org . 1 A technique which gives every patient an equal chance of being assigned to any particular arm of a controlled clinical trial. 2 Any study which compares two groups by virtue of different therapies or exposures fulfills this definition. 3 A formal review of a focused clinical question based on a comprehensive search strategy and structure critical appraisal. 4 A review of a focused clinical question following rigorous methodological criteria and employing statistical techniques to combine data from independently performed studies on that question. 5 A controlled clinical trial in which the study groups are created through randomizations. 6 This design follows a group of patients, called a “cohort”, over time to determine general outcomes as well as outcomes of different subgroups. 7 Any study done forward in time. This is particularly important in studies on therapy, prognosis or harm, where retrospective studies make hidden biases very likely. 8 This might be considered a randomized controlled trial played backwards. People who get sick or have a bad outcome are identified and “matched” with people who did better. Then, the effects of the therapy or harmful

exposure which might have been administered at the start of the trial are evaluated. 9 Any study in which the outcomes have already occurred before the study has begun. 10 This includes single case reports and published case series.

OUTLINE Section 8 Otology and Neurotology April 2017

I.

Vestibular Disorders

A. Migraine and vertigo B. Ménière’s disease C. Pulsatile tinnitus

II.

External Auditory Canal and Middle Ear A. Acute otitis externa B. Cholesteatoma Hearing Loss A. Sensorineural hearing loss B. Conductive and mixed hearing loss C. Single-sided deafness Temporal Bone/Skull Base A. Temporal bone and skull base lesions B. Skull base and ear trauma

III.

IV.

V.

Facial Nerve

T ABLE OF C ONTENTS Selected Recent Materials - Reproduced in this Study Guide

SECTION 8: OTOLOGY and NEUROTOLOGY APRIL 2017

ADDITIONAL REFERENCE MATERIAL .....................................................................................i - iv CYCLE 2016-2017 INDEX ...................................................................................... I-1 - I-18

I.

Vestibular Disorders

A. Migraine and vertigo Chang TP, Lin YW, Sung PY, et al. Benign paroxysmal positional vertigo after dental procedures: a population-based case-control study. PLOS One . 2016; 11(4):e0153092. EBM level 3..........................................................................................................................................1-8 Summary : This is a population-based study using case-control design to look at the prevalence of benign paroxysmal positional vertigo (BPPV) in patients who had a recent dental procedure as compared to age- and gender-matched controls. It showed a significant increased odds ratio for BPPV after certain dental procedures. Summary : This is a narrative review of diagnosis and management of vestibular migraine. It discusses the diagnostic criteria and main differential diagnosis, and reviews the various medications and treatment options for vestibular migraine. Friedland DR, Tarima S, Erbe C, Miles A. Development of a statistical model for the prediction of common vestibular diagnoses. JAMA Otolaryngol Head Neck Surg . 2016; 142(4):351-356. EBM level 4............................................................................................................................17-22 Summary : This report details a statistical model based on utility of four to five variables for diagnosis of most common peripheral vestibular disorders, including Ménière’s disease, benign paroxysmal positional vertigo (BPPV), and vestibular migraine. Based on an intake questionnaire, the study showed that there was good sensitivity and specificity for diagnosis of BPPV and Ménière’s disease but less specificity for vestibular migraine. This information can help otological practices in terms of efficient management of patients referred for dizziness. B. Ménière’s disease Crowson MG, Patki A, Tucci DL. A systematic review of diuretics in the medical management of Ménière’s disease. Otolaryngol Head Neck Surg . 2016; 154(5);824-834. EBM level 3......................................................................................................................................23-33 Summary : This is systematic review of all articles from 1962 to 2012 with level 4 evidence or higher discussing the use of oral diuretics in the medical management of Ménière’s disease. The 19 articles selected investigated isosorbide, hydrochlorothiazide, acetazolamide, chlorthalidone, betahistine, HCTZ-triamterene, and nimodipine. Forty-two percent of studies reported hearing improvement and 79% reported vertigo improvement. In 53% of reports there were no side effects, but 21% noted abdominal discomfort. Dieterich M, Obermann M, Celebisoy N. Vestibular migraine: the most frequent entity of episodic vertigo. J Neurol . 2016; 263 Suppl 1:S82-S89. EBM level 5.................................9-16

Goebel JA. 2015 Equilibrium Committee Amendment to the 1995 AAO-HNS Guidelines for the Definition of Ménière's Disease. Otolaryngol Head Neck Surg . 2016; 154(3):403-404. EBM level 5............................................................................................................................34-35 Summary : This article presents an expert opinion regarding the evolving definition of Ménière's disease, and describes the amendment to the 1995 AAO-HNS criteria for diagnosis of Ménière's disease. Gürkov R, Pyykö I, Zou J, Kentala E. What is Ménière’s disease? A contemporary re- evaluation of endolymphatic hydrops. J Neurol . 2016; 263 Suppl 1:S71-S81. EBM level 5......................................................................................................................................36-46 Summary : This is a narrative review of pathophysiology, clinical features, and diagnostic criteria for Ménière’s disease. The authors review the gadolinium-based MRI diagnosis of endolymphatic hydrops and discuss the grading system. They propose a new classification of hydropic disorder of inner ear. Summary : This study is a retrospective case review on management of intractable Ménière’s disease after intratympanic injection of gentamicin (ITG). Class A and B control was achieved by ITG in 90% of patients. Exploratory tympanotomy and gentamicin application (ETG) over the round and oval windows had a 71% success rate of class A outcome in patients who failed ITG. Labyrinthectomy and vestibular neurectomy were still needed in select patients who failed all other therapeutic modalities. Sood AJ, Lambert PR, Nguyen SA, Meyer TA. Endolymphatic sac surgery for Ménière’s disease: a systematic review and meta-analysis. Otol Neurotol . 2014; 35(6):1033-1045. EBM level 3a....................................................................................................................................54-66 Summary : This study is a systematic review and meta-analysis of endolymphatic sac surgery in Ménière’s disease from 1970 to 2013. Endolymphatic sac decompression and/or shunt, with or without silastic, was equally effective long term in over 75% of patients who failed medical therapy for vertigo of Ménière’s disease. The authors found that once the sac is opened, inserting silastic into the sac does not improve vertigo control and may diminish audition. C. Pulsatile tinnitus Ahsan SF, Seidman M, Yaremchuk K. What is the best imaging modality in evaluating patients with unilateral pulsatile tinnitus? Laryngoscope . 2015; 125(2):284-285. EBM level 5......................................................................................................................................67-68 Summary : This article is a review of five previous journal articles presenting evaluation methods for patients with pulsatile tinnitus. The authors review and identify the different methods of evaluation and their sensitivity and specificity for diagnosis, and include an evaluation tree for workup of pulsatile tinnitus. Rah YC, Han JJ, Park J, et al. Management of intractable Ménière’s disease after intratympanic injection of gentamicin. Laryngoscope . 2015; 125(4):972-978. EBM level 4....................47-53

Madani G, Connor SE. Imaging in pulsatile tinnitus. Clin Radiol . 2009; 64(3):319-328. EBM level 5......................................................................................................................................69-78

Summary : This article is a review series of radiologic evaluation of pulsatile tinnitus. The authors review previous articles describing anatomical abnormalities including tumors and percentages seen in previous studies. Included is an evaluation tree describing the workup of pulsatile tinnitus and images of anatomical abnormalities.

Weinreich H, Carey JP. Prevalence of pulsatile tinnitus among patients with migraine. Otol Neurotol . 2016; 37(3):244-247. EBM level 4.......................................................................79-82

Summary : This is a retrospective evaluation of patients with diagnosis codes of both migraine and pulsatile tinnitus. Of the 145 patients evaluated with both diagnoses, patients with objective tinnitus were excluded from evaluation, leaving 16 patients for evaluation. Patients were prescribed a migraine diet +/- migraine prophylaxis. Patients were then evaluated for improvement in tinnitus and headaches. The majority of patients received improvement with the diet whereas the medication made little difference, but this may be due to the fact that these patients were more severe cases. The study highlights the importance of treatment modalities, but doesn’t describe complications. Hobson CE, Moy JD, Byers KE, et al. Malignant otitis externa: evolving pathogens and implications for diagnosis and treatment. Otolaryngol Head Neck Surg . 2014; 15(1):112-116. EBM level 4............................................................................................................................83-87 Summary : This is a retrospective chart review of 20 patients with malignant otitis externa (MOE) treated at a tertiary care institution between 1995 and 2012. Forty-five percent of patients had culture-positive Pseudomonas aeruginosa , and 15% grew methicillin-resistant Staphylococcus aureus (MRSA). Signs and symptoms were similar across groups. However, all P. aeruginosa patients had diabetes, but only 33% of MRSA patients were diabetic. Patients with MRSA required on average 4.7 more weeks of therapy with antibiotics versus non-MRSA patients. The study highlights the evolving pathogens in MOE even in nondiabetic patients. Loh S, Loh WS. Malignant otitis externa: an Asian perspective on treatment outcomes and prognostic factors. Otolaryngol Head Neck Surg . 2013; 148(6):991-996. EBM level 3......................................................................................................................................88-93 review from 2006 to 2011 on 19 MOE patients who received 6 weeks of intravenous ceftazidime combined with oral fluoroquinolone. They did not discuss concurrent topical therapy. Disease resolved in 63% of patients, and mortality was 21%. Age, diabetic control, time delay in diagnosis, cranial nerve involvement, and inflammatory markers were not predictors of prognosis. Erythrocyte sedimentation rate and C reactive protein levels correlated with disease activity and were used to monitor progress. Clivus involvement implied persistent disease. Sixty-three percent of cultures were positive, usually Pseudomonas aeruginosa , and 33% of isolates were multi-drug resistant. Culture-directed therapy did not affect outcome. Summary : This is a review article on malignant otitis externa (MOE) treatment, outcome, and prognostic factors from an Asian perspective. The authors performed a retrospective chart

II.

External Auditory Canal and Middle Ear A. Acute otitis externa

Tarazi AE, Al-Tawfiq JA, Abdi RF. Fungal malignant otitis externa: pitfalls, diagnosis, and treatment. Otol Neurotol . 2012; 33(5):769-773. EBM level 4.............................................94-98

Summary : This study reviews literature on malignant otitis externa (MOE), including fungal infections, and reports the findings as a series of case presentations on patients with Aspergillus MOE. Oral voriconazole was found to be a viable alternative treatment to intravenous vancomycin and amphotericin B. The authors discuss pitfalls, diagnosis, and treatment of MOE associated with Pseudomonas aeruginosa as well as to fungi. B. Cholesteatoma Crowson MG, Ramprasad VH, Chapurin N, et al. Cost analysis and outcomes of a second-look tympanoplasty-mastoidectomy strategy for cholesteatoma. Laryngoscope . 2016; 126(11):2574- 2579. EBM level 4...............................................................................................................99-104 Summary : This article examines a single institution’s experience managing patients with cholesteatoma through an intact canal wall tympanoplasty with mastoidectomy. The authors explore differences in hearing outcomes, disease recidivism, and overall costs between patients undergoing a single-stage surgical procedure and a second-look operative approach. Hearing outcomes were similar between these groups, while costs were considerably lower with the single-stage group and disease recidivism was higher for the group undergoing a second-look procedure. The article stresses the need for individualizing the approach based on the level of disease present at the time of the initial surgery. Kerckhoffs KG, Kommer MB, van Strien TH, et al. The disease recurrence rate after the canal wall up or canal wall down technique in adults. Laryngoscope . 2016; 126(4):980-987. EBM level 3..................................................................................................................................105-112 Summary : This is a systematic review article that examines the literature on the topic of disease recidivism following canal wall up and canal wall down mastoidectomy for acquired cholesteatoma. The article highlights the variability in the available literature, but demonstrates that recidivistic disease is more likely in canal wall up mastoidectomy techniques. While both canal wall up and canal wall down techniques are associated with recidivistic disease, residual cholesteatoma is more common in canal wall up techniques, while recurrent disease is more common in canal wall down techniques. Migirov L, Wolf M, Greenberg G, Eyal A. Non-EPI DW MRI in planning the surgical approach to primary and recurrent cholesteatoma. Otol Neurotol . 2014; 35(1):121-125. EBM level 4..................................................................................................................................113-117 Summary : This article assesses the accuracy of non-echo planar, diffusion-weighted MRI for assessing primary and recurrent/residual cholesteatoma in a cohort of 50 patients. The authors compared preoperative MRI findings with intraoperative findings to determine the degree of accuracy, with a finding of 98% concordance.

III.

Hearing Loss A. Sensorineural hearing loss

Briggs R, Van Hasselt A, Luntz M, et al. Clinical performance of a new magnetic bone conduction hearing implant system: results from a prospective, multicenter, clinical investigation. Otol Neurotol . 2015; 36(5):834-841. EBM level 2b.................................118-125 Summary : Twenty-seven patients with mixed, conductive, and single-sided hearing loss who received the Baha Attract System were studied for 9 months. Patient benefit, soft-tissue status, device retention, and safety were monitored. Results demonstrated significant improvement in audibility and speech understanding in noise and quiet when compared to preoperative unaided hearing. Roland JT Jr, Gantz BJ, Waltzman SB, et al. United States multicenter clinical trial of the cochlear nucleus hybrid implant system. Laryngoscope . 2016; 126(1):175-181. EBM level 2b................................................................................................................................126-132 Summary : This article discusses U.S. trials for the Cochlear Nucleus Hybrid L24 implant at ten investigational sites. The study included 50 patients with low-frequency hearing intact. Mean improvements in consonant-nucleus-consonant and AzBio were seen in nearly all patients. Hearing preservation rate (as defined as any measurable hearing) at 6 months was 66%. B. Conductive and mixed hearing loss Marino R, Lampacher P, Dittrich G, et al. Does coupling and positioning in vibroplasty matter? A prospective cohort study. Otol Neurotol . 2015; 36(7):1223-1230. EBM level 2..................................................................................................................................133-140 Summary : This is a prospective cohort study evaluating the audiological outcomes in patients with conductive/mixed hearing loss who underwent vibroplasty surgery using three different coupling techniques (direct to round window [RW], soft-tissue RW coupling, and stapes/incus coupling). Patients with soft tissue interposed between the floating mass transducer and RW showed the poorest coupling efficiency. Direct RW coupling was significantly better than with soft-tissue RW coupling. Vibroplasty directly to the ossicular chain provided the best coupling efficiency outcomes. Wegner I, van Waes AMA, Bittermann AJ, et al. A systematic review of the diagnostic value of CT imaging in diagnosing otosclerosis. Otol Neurotol . 2016; 37(1):9-15. EBM level 3..................................................................................................................................141-147 Summary : This article is a systematic review of the utility of CT in the diagnosis of otosclerosis in patients with conductive hearing loss. In patients with a strong clinical suspicion of otosclerosis, the positive and negative predictive value of CT is relatively high. In patients with a low suspicion for otosclerosis, positive and negative predictive values of CT were much lower. CT imaging for conductive hearing loss is only recommended for suspected pathology other than otosclerosis when preparing for middle ear surgery.

C. Single-sided deafness Finbow J, Bance M, Aiken S, et al. A comparison between wireless CROS and bone-anchored hearing devices for single-sided deafness: a pilot study. Otol Neurotol . 2015; 36(5):819-825. EBM level 2........................................................................................................................148-154 Summary : This study compared outcomes with a wireless contralateral routing of signal (CROS) hearing aid to those with a bone-anchored hearing device (BAHD) in patients with single-sided deafness. A within-subject design was used to compare the two devices with regard to head shadow effect reduction, speech perception in quiet and noise, and self- assessment questionnaires. Results showed no significant difference between the two devices on either objective or subjective outcome measures. Summary : This article is a multicenter retrospective review of a cohort of pediatric and adult patients who underwent cochlear implantation for single-sided deafness of a variety of etiologies. Pre- and postoperative testing was performed using both word and sentence testing in quiet in the implanted ear alone, and sentence recognition in noise in the binaural condition. Word and sentence scores for the implanted ear alone improved significantly by 3 months postoperatively, while speech recognition in noise in the binaural condition did not change significantly. The majority of patients reported reduction in tinnitus in the implanted ear. Zeitler DM, Dorman MF, Natale SJ, et al. Sound source localization and speech understanding in complex listening environments by single-sided deaf listeners after cochlear implantation. Otol Neurotol . 2015; 36(9):1467-1471. EBM level 2.......................................................161-165 Summary : This article investigates sound localization ability and speech comprehension in complex noise environments in patients who had unilateral cochlear implantation for single- sided deafness (SSD) as compared to three control groups: normal hearing (NH) young adults, NH older adults, and bilateral cochlear implant (BCI) users. All SSD-CI users showed poorer- than-normal sound localization, typically performing as well as BCI subjects, with some subjects localizing close to the 95 th percentile of NH listeners. Speech understanding was significantly improved in ambient noise with signal presented to the CI ear in the SSD-CI listeners. McRackan TR, Wilkinson EP, Brackmann DE, Slattery WH. Stereotactic radiosurgery for facial nerve schwannomas: meta-analysis and clinical review. Otol Neurotol . 2015; 36(3): 393-398. EBM level 3........................................................................................................166-171 Summary : In this thorough meta-analysis, 10 studies are included comprising 45 patients with at least a 2-year follow up. Of these patients, 93% had tumor control, 67% had stable facial nerve function, 21% had improved function, and 13% had worsened facial nerve function. Hearing results are not as favorable. The authors conclude that stereotactic radiosurgery is an effective and reasonable option for treating facial schwannomas, though hearing loss is a substantial risk. Sladen DP, Frisch CD, Carlson ML, et al. Cochlear implantation for single-sided deafness: a multicenter study. Laryngoscope . 2017; 127(1):223-228. EBM level 4.........................155-160 Temporal Bone/Skull Base A. Temporal bone and skull base lesions

IV.

Wanna GB, Sweeney AD, Haynes DS, Carlson ML. Contemporary management of jugular paragangliomas. Otolaryngol Clin North Am . 2015; 48(2):331-341. EBM level 3.........172-182

Summary : This is a well-written, comprehensive review of jugular paragangliomas, discussing epidemiology, clinical presentation, genetics, and management. The extensive experience at the Otology Group of Vanderbilt is discussed. Wise SC, Carlson ML, Tveiten ØV, et al. Surgical salvage of recurrent vestibular schwannoma following prior stereotactic radiosurgery. Laryngoscope . 2016; 126(11):2580-2586. EBM level 3..................................................................................................................................183-189 Summary : This article presents a case-control study of 37 patients who underwent surgical resection of sporadic vestibular schwannoma following failed radiation therapy. Controls were patients who underwent primary microsurgery without having received prior radiation. Complications are reported. At follow up, 73% had satisfactory facial nerve function (HBI-II), which was not different from controls. However, a significantly higher percentage of patients had less-than-complete resection. B. Skull base and ear trauma Cannon RB, Thomson RS, Shelton C, Gurgel RK. Long-term outcomes after middle fossa approach for traumatic facial nerve paralysis. Otol Neurotol . 2016; 37(6):799-804. EBM level 4..................................................................................................................................190-195 Summary : This article examines the long-term facial nerve outcomes after a middle fossa approach for traumatic facial paralysis. Patients with both intact and irreversibly injured facial nerves were included. Using the House-Brackmann facial nerve grading system, facial nerve outcomes are provided at 1 year following surgical intervention, with all patients achieving at least a grade III result. Medina M, Di Lella F, Di Trapani G, et al. Cochlear implantation versus auditory brainstem implantation in bilateral total deafness after head trauma: personal experience and review of the literature. Otol Neurotol . 2014; 35(2):260-270. EBM level 4.........................................196-206 Summary : This article examines hearing outcomes in patients treated with cochlear implants after bilateral temporal bone fractures with hearing loss. Open-set word recognition was obtained in patients undergoing primary cochlear implant placement, and the article identifies the advantage of this technique over auditory brainstem implantation in posttraumatic hearing loss, regardless of fracture location/etiology (with the exception of loss of cochlear nerve continuity).

Schell A, Kitsko D. Audiometric outcomes in pediatric temporal bone trauma. Otolaryngol Head Neck Surg . 2016; 154(1):175-180. EBM level 4.....................................................207-212

Summary : This article reviews the hearing outcomes of pediatric patients who sustained temporal bone fractures during a 13-year period. A distinction between otic capsule–sparing and otic capsule–violating fractures is made, based on CT findings, and this serves as a basis for comparing the observed hearing results. While otic capsule–violating fractures were associated with severe hearing loss, most cases with otic capsule–sparing fractures demonstrated near- normal hearing by 6 weeks post-injury.

Waissbluth S, Ywakim R, Al Qassabi B, et al. Pediatric temporal bone fractures: a case series. Int J Pediatr Otorhinolaryngol . 2016; 84:106-109. EBM level 4....................................213-216

Summary : This article provides a retrospective review of all pediatric patients who presented with temporal bone fractures during a 14-year period at a tertiary referral center. It discusses the typical otologic clinical findings in pediatric patients with temporal bone fracture and highlights commonly observed concomitant fractures/injuries. Facial Nerve Lee DH. Clinical efficacy of electroneurography in acute facial paralysis. J Audiol Otol . 2016; 20(1):8-12. EBM level 5...........................................................................................................217-221 Summary : This article is a wonderful summary of facial paralysis and describes tests used for studying facial paresis including electromyography, electroneurography (ENoG), nerve excitability testing, and the maximal stimulatory test. It further describes facial nerve injury, classification systems, and expected test results. This paper spends the majority of effort on describing ENoG and its utility. While a review article, it is deeply insightful and a great comprehensive summary article that highlights various testing modalities.

V.

2016-17 SECTION 8 ADDITIONAL REFERENCES

Adunka OF, Giardina CK, Formeister EJ, et al. Round window electrocochleography before and after cochlear implant electrode insertion. Laryngoscope . 2016; 126(5):1193-1200.

Albu S, Amadori M, Babighian G. Predictors of hearing preservation in the management of labyrinthine fistulas positioned on the semicircular canals. Ann Otol Rhinol Laryngol . 2013; 122(8):529-534.

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Reprinted by permission of PLOS One. 2016; 11(4):e0153092.

RESEARCH ARTICLE Benign Paroxysmal Positional Vertigo after Dental Procedures: A Population-Based Case- Control Study Tzu-Pu Chang 1,2 ☯ , Yueh-Wen Lin 3 , Pi-Yu Sung 4 , Hsun-Yang Chuang 5 , Hsien- Yang Chung 6 ☯ , Wen-Ling Liao 4 * 1 Department of Neurology/Neuro-Medical Scientific Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan, 2 School of Medicine, Tzu Chi University, Hualien, Taiwan, 3 Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan, 4 Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan, 5 Department of research, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan, 6 Department of Dentistry, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan Background Benign paroxysmal positional vertigo (BPPV), the most common type of vertigo in the gen- eral population, is thought to be caused by dislodgement of otoliths from otolithic organs into the semicircular canals. In most cases, however, the cause behind the otolith dislodge- ment is unknown. Dental procedures, one of the most common medical treatments, are con- sidered to be a possible cause of BPPV, although this has yet to be proven. This study is the first nationwide population-based case-control study conducted to investigate the corre- lation between BPPV and dental manipulation. Methods Patients diagnosed with BPPV between January 1, 2007 and December 31, 2012 were recruited from the National Health Insurance Research Database in Taiwan. We further identified those who had undergone dental procedures within 1 month and within 3 months before the first diagnosis date of BPPV. We also identified the comorbidities of the patients with BPPV, including head trauma, osteoporosis, migraine, hypertension, diabetes, hyper- lipidemia and stroke. These variables were then compared to those in age- and gender- matched controls. Results In total, 768 patients with BPPV and 1536 age- and gender-matched controls were recruited. In the BPPV group, 9.2% of the patients had undergone dental procedures within 1 month before the diagnosis of BPPV. In contrast, only 5.5% of the controls had undergone dental treatment within 1 month before the date at which they were identified ( P = 0.001). ☯ These authors contributed equally to this work. * wling00921@gmail.com Abstract

OPEN ACCESS

Citation: Chang T-P, Lin Y-W, Sung P-Y, Chuang H- Y, Chung H-Y, Liao W-L (2016) Benign Paroxysmal Positional Vertigo after Dental Procedures: A Population-Based Case-Control Study. PLoS ONE 11 (4): e0153092. doi:10.1371/journal.pone.0153092 Editor: Gururaj Arakeri, Navodaya Dental College and Hospital, mantralayam Road, INDIA

Received: December 23, 2015

Accepted: March 23, 2016

Published: April 4, 2016

Copyright: © 2016 Chang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: This study used data from the National Health Insurance Research Database (NHIRD) in Taiwan. The dataset was managed by the National Health Research Institutes (NHRI). Requests for the data could be sent to the Center for Biomedical Resources of NHRI (Email: nhird@nhri.org.tw ), and data will be available upon request to all interested researchers through reviewing and approving by the NHRI. Funding: The authors have no support or funding to report.

PLOS ONE | DOI:10.1371/journal.pone.0153092 April 4, 2016

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