Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P92

Otology/Neurotology

P92		
Otolaryngology-Head and Neck Surgery 163(1S)
Presentation schedule is subject to change. The Official Program Abstracts supplement does not reflect changes made after August 10, 2020.
undergone ipsilateral CI were identified along with demoConclusions: BDET under local anesthesia is effective in treatgraphic information, preimplantation and postimplantation
ing obstructive ETD, and the results are durable with a mean
audiometry, consonant-nucleus vowel-consonant (CNC), and
follow-up of more than 2 years. Patients tolerate the procedure
AzBio scores in quiet. MRI volumetric analysis was used to
well with a precise anesthesia protocol. Results are comparable
measure tumor volume preimplantation and postimplantation.
with the procedure performed under general anesthesia.
Results: Six patients with ipsilateral AN and CI were identified. Preoperative tumor volume was 0.11 cm³ to 0.56 cm³.
Comparison of Staged Surgery Versus
Four subjects were implanted with straight electrodes and
Diffusion-Weighted MRI in Cholesteatoma
2 subjects with perimodiolar electrodes. The pure tone averRecidivism
age was 91 dB (SD 14) and 62 (SD 41) for the ipsilateral and
Aaron Tverye (Presenter); Daniel E. Killeen, MD;
contralateral ear, respectively. Of subjects with 3 months (n =
Kamlesh Jobanputra, MD; Marco Pinho; Jacob B. Hunter, MD;
5) listening experience, CNC word scores improved from an
J. Walter Kutz, MD
average of 7% to 38% (SD 17) in CI alone and 19% to 49%
Objectives: Cholesteatoma may be treated with primary sur(SD 24) in bimodal listening conditions. AzBio in quiet also
gery/reconstruction with diffusion-weighted magnetic resoimproved at 3 months (n = 3). Of subjects with serial preopnance imaging (DW-MRI) used for surveillance or with staged
erative and postoperative MRI, volumetric analysis demonsurgery/reconstruction. This study compared these treatments
strated no tumor growth.
for residual or recurrent disease.
Conclusions: CI is a successful option for subjects with nonMethods: A retrospective study was conducted enrolling patients
growing ANs. All subjects demonstrated improved perforwith cholesteatoma treated with canal wall up tympanomastoidmance postoperatively. ANs may be observed with MRI given
ectomy in 2010 to 2018 and stratified based on the decision to
increasing MRI compatibility among CI manufacturers and
perform a staged second-look surgery (SSLS) or primary reconability to assess cerebellopontine angle (CPA) extension despite
struction plus DW-MRI (PR+DW-MRI). Primary end points
implant artifact. As patients are followed during the next 6 to 12
were residual or recurrent cholesteatoma. DW-MRI images
months, there will be increasing hearing outcome data.
were reviewed by 2 blinded neuroradiologists independently
and by consensus.
Comparison of Outcomes for Balloon
Results: Thirty-three patients were enrolled in the PR+DWDilation of the Eustachian Tube Under Local
MRI group, and 47 patients were enrolled in the SSLS group.
Anesthesia Versus General Anesthesia
The median follow-up period was 33 months (range, 10-59
Joonas Toivonen, MD (Presenter); Marc Dean, MD; Kosuke
months) for the PR+DW-MRI group and 29 months (range,
Kawai, ScD; Dennis S. Poe, MD
5-78 months) for the SSLS group. Oval window involvement
Objectives: Balloon dilation of the Eustachian tube (BDET)
(odds ratio [OR] 3, P = .05) and malleus erosion (OR 9.5, P =
is a treatment for persistent obstructive Eustachian tube dys.003) were significantly predictive of the decision to stage surfunction (OETD) that may be performed in the operating
gery on multivariate analysis. Residual disease was identified
room under general anesthesia or in an office setting under
in 3 patients (9.1%) on DW-MRI and in 17 patients (36.2%)
local anesthesia. Benefits of the office include convenience,
during second-look surgery (P = .006). Cholesteatoma
avoidance of general anesthesia, and reduced costs. Efficacy
recurred in 3 patients (9.1%) in the PR+DW-MRI group and
between these settings has not been previously assessed.
12 patients (25.5%) in the SSLS group (P = .06). On multiMethods: Consecutive patients aged ≥18 years with persisvariate analysis, SSLS (OR 10.6, P = .005) and protympanum
tent OETD having failed adequate medical therapy underwent
involvement (OR 20.2, P = .03) were significantly predictive
BDET between 2013 and 2018 under general or local anestheof residual cholesteatoma when controlling for prior surgery,
sia at an academic-affiliated multispecialty practice. Inclusion
age, sex, laterality, and involvement of oval window, sinus
criteria were persistent type B or C tympanograms with symptympani, and aditus ad antrum.
toms or type A with barochallenge. Objective outcome meaConclusions: The surgeon's decision to stage cholesteatoma
sures were the need for additional intervention (revision
resection and protympanum involvement were significantly
dilation, tympanostomy tube), changes in assessment of middle
predictive of residual cholesteatoma.
ear function (tympanometry, pure tone average), and otoscopy.
Results: Seventy-seven patients (138 ETs), aged 19 to
Complications in Cochlear Implantation:
84 years (mean 53.8) underwent BDET; 47 patients (61%)
A Comparison of Children Less Than
were female, and 38 patients (49%) underwent BDET under
12 Months of Age With Older Pediatric
local anesthesia. Mean follow-up was 2.7 years (SD 2.4).
Patients
Tympanograms improved to type A in 79% at 1 year and 84%
Alyssa J. Smith, MD (Presenter); Cynthia Chweya, MD;
at 2 years. The probability of being failure free at 5 years was
Matthew M. May, MD; Brian A. Neff, MD; Colin L.W.
81% (95% CI, 64%-91%) in the general anesthesia group vs
Driscoll, MD; Matthew L. Carlson, MD
87% (95% CI, 74%-93%) in the local anesthesia group. Risk
Objectives: Current Food and Drug Administration labeling
of failure did not significantly differ between the groups (7/70
for cochlear implantation (CI) excludes children younger than
general anesthesia vs 8/68 local anesthesia; P = .55).
Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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