Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
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To analyze malpractice litigation trends to better understand the causes and outcomes of suits involving otologic surgeries to prevent future litigation and improve physician awareness. ⋯ Obtaining an appropriate diagnosis, thoroughly discussing all options and potential risks, presenting realistic expectations, and executing the surgery correctly are crucial to patient care. Understanding the reasons surgeons go to trial may assist in mitigating risk for potential lawsuits.
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This manuscript describes a case in which, based on clinical observations, we hypothesize that a change in a cochlear implant recipient's electrode impedance and performance was attributed to a change in the recipient's physiology rather than a device failure. Of particular note was the finding that electrode impedances decreased after a period of nonuse of the implant as well as after steroid treatment. ⋯ Atypical fluctuations in electrode impedance were observed with periods of CI use and nonuse. Additionally, after a 10-month period of constant fluctuation of electrode impedances with atypical morphology, electrode impedances stabilized to normal levels with a typical morphology within 3 days of steroid treatment. Given these observations, we hypothesized that the change in this recipient's electrode impedance as well as the decrease in this implant recipient's performance may be attributed to his physiology rather than to the device failure. Changes in electrode impedance accompanied by a decrease in this patient's performance were successfully addressed by a period of nonuse of the implant, provision of steroids, and an increase in the pulse width of the biphasic pulsatile signal used for stimulation. It should be noted that the results of this case are anecdotal in nature and may not apply to all cochlear implant recipients experiencing electrode impedance changes and/or deterioration in performance.
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A high-fidelity, inexpensive middle ear simulator could be created to enhance surgical training that would be rated as having high face validity by experts. ⋯ Most experts found the SMS to be accurate, but there was a large discrepancy in rating of individual components. Most found it to be very useful for training of novice surgeons. With these results, we are encouraged to proceed with further refinements that will strengthen the SMS as a training tool for otologic surgery.
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Minimal access approaches for cochlear implants have recently gained popularity, offering a smaller incision and minimal hair shave. The current generation of thinner internal receiver stimulators is adaptable for these approaches. However, conventional bony fixation of the internal receiver stimulator is difficult through this limited exposure, and some minimal access techniques rely on soft tissue fixation only. Inadequate fixation can result in device migration, extrusion, and electrode migration. We compare wound complications and electrode migration for a group undergoing conventional exposure and device fixation using a bone well and sutures with a group undergoing minimal access with plate fixation. ⋯ Cochlear implant surgery using the minimal access with plate fixation results in a similar wound complication rate as the conventional approach.
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Surgical approaches for epidermoid cysts of the cerebellopontine angle (CPA) are dictated by tumor location. Previous reports have advocated the sacrifice of usable hearing to achieve maximal tumor resection in a single operation. The aim of the current study is to demonstrate the applicability of hearing preservation approaches in the neurotologic management of epidermoids of the CPA. ⋯ Hearing preservation approaches for epidermoids of the CPA is a feasible option for long-term control of these tumors. Resection from a retrosigmoid approach can provide years of useful hearing, and the majority of patients do not require reoperation.