Shapiro, Scott

Objective: To evaluate for equivalence in postoperative changes of speech recognition scores in a veteran patient population undergoing cochlear implantation (CI) compared to matched nonveteran patients. Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: A total of 83 veteran patients who underwent CI at a single Veterans Affairs Medical Center (VA cohort) were matched to 83 nonveteran patients from the Health Insurance Portability and Accountability Act-secure, Encrypted, Research, Management and Evaluation Solution database (HERMES cohort) based on age, sex, and baseline Consonant–Nucleus–Consonant (CNC) scores. Intervention: Patients underwent CI. Main Outcome Measures: Comparison of postoperative CNC and Arizona Biomedical Institute recognition scores. Results: The mean difference and lower confidence interval of CNC scores between matched Veterans Affairs and HERMES cohorts were within a −ΔNI boundary of −15% at the 3-month (mean = 6.15, lower confidence interval = −2.38), 6-month (mean = 7.36, lower confidence interval = −2.21), and 12-month (mean = 4.03, lower confidence interval = −4.88) postoperative time points. The mean difference and lower confidence interval of Arizona Biomedical Institute scores between cohorts were within the −ΔNI boundary of −30% at 3 months (mean = 1, lower confidence interval = −8.71), 6 months (mean = 0.31, lower confidence interval = −12.30), and 12 months (mean = 0.72, lower confidence interval = −10.48). Conclusion: Our veteran population demonstrated improvements in speech recognition scores after CI comparable to a matched nonveteran population. Although veterans face unique factors that affect their hearing, access to medical care, and baseline general health, these findings affirm appropriate veteran candidates should be offered CI.

Objective To characterize the viability and volume of autologous free fat grafts over time, determine clinical/patient factors that may affect free fat graft survival and assess the clinical impact of free fat graft survival on patient outcomes in the translabyrinthine approach for lateral skull base tumor resection. Study Design Retrospective chart review. Setting Tertiary neurotologic referral center. Patients Forty-two adult patients who underwent translabyrinthine craniotomy for resection of a lateral skull base tumor with the mastoid defect filled by autologous abdominal fat graft and subsequently underwent more than one postoperative magnetic resonance imaging (MRI) scans of the brain. Intervention(s) Mastoid obliteration with abdominal fat after craniotomy, postoperative MRI Main Outcome Measure(s) Rate of fat graft volume loss, fraction retention of original fat graft volume, initial fat graft volume, time to steady-state fat graft retention, rate of postoperative cerebrospinal fluid (CSF) leak, and/or pseudomeningocele formation. Results Patients were followed postoperatively with MRI for a mean of 31.6 months with a mean of 3.2 postoperative MRIs per patient. Initial graft size was a mean of 18.7 cm3 with a steady-state fat graft retention of 35.5%. Steady-state graft retention (<5% loss per year) was achieved at a mean of 24.96 months postoperatively. No significant association was found in multivariate regression analysis of clinical factors impact on fat graft retention and CSF leak/pseudomeningocele formation. Conclusions In the use of autologous abdominal free fat graft for filling mastoid defects after translabyrinthine craniotomy, there is a logarithmic decline in fat graft volume over time, reaching steady state in 2 years. Rates of CSF leak or pseudomeningocele formation were not significantly affected by initial volume of the fat graft, rate of fat graft resorption, nor the fraction of original fat graft volume at steady state. In addition, no analyzed clinical factors significantly influenced fat graft retention over time.

Objective: Determine if changes in middle ear absorbance measured with wide-band tympanometry (WBT) occur following hearing-preservation cochlear implantation (CI). Such measures may provide insight into the mechanisms of acoustic hearing loss postimplantation. Study Design: Clinical capsule report. Setting: Tertiary academic referral center. Design: WBT absorbance was measured bilaterally during pre- and postoperative clinical office visits in five unilaterally-implanted cochlear implant recipients. Pre- and postoperative WBT measures were compared within each subject in the implanted and contralateral, unimplanted ears. Results: In general, WBT absorbance measurements show a broad spectral pattern including two or three distinct peaks measured over a frequency range of 226 to 8000 Hz. Grand average and linear mixed model comparisons between the pre- and postoperative WBT patterns show significantly reduced (p < 0.05) low-frequency absorbance in the implanted ears in the frequency region over 0.6 to 1.1 kHz, but not in the unimplanted ears. The maximum effect occurred at 1 kHz with absorbance decreasing from ∼0.8 to ∼0.5 after implantation. The limited data are consistent with expected relationships between WBT absorbance and air- and bone-conduction thresholds, assuming an increased air-bone gap reflects conductive hearing loss. Conclusion: Cochlear implantation can result in reduction of low-frequency acoustic absorbance as measured by WBT. WBT may be a useful and sensitive tool for monitoring the mechanical status of the middle and inner ears following cochlear implantation.