Articles and Abstracts by Dr. Shohet

This is the first article to report in vivo measures of ossicular mobility. These data help to understand the micromechanics of ossicular motion as well as the use and limitations of LDV. This information may lead to a prescreening process for implanted middle ear devices that function by overdriving the stapes.

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Ankylosis of the stapes was first described by Valsalva in 1704. Toynbee described fixation of the stapes to the margins of the oval window in 1841 and found similar cases in 136 of 1,000 temporal bone dissections.^[1] The histologic features of otosclerosis were demonstrated by Politzer, who identified the problem as an otic capsule disorder characterized by abnormal new bone formation.

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Implantable middle ear devices were developed to treat primarily sensorineural hearing loss, but some have been modified to address mixed hearing losses as well.

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Objective: This study seeks to assess the efficacy of the Envoy Esteem totally implantable hearing device in treating profound high-frequency sensorineural hearing loss.

Patients: Five patients with profound high-frequency hearing loss participating in a prospective, multi-center, nonrandomized Food and Drug Administration clinical trial.

Intervention: Implantation with Esteem totally implantable hearing device and comparison to baseline unaided and aided conditions.

Main Outcome Measure: Speech reception threshold and word recognition scores (WRS) at 50 dB HL presentation level.

Results: Preoperative speech reception threshold improved from an unaided 65 dB and aided 48 dB average to 26 dB with the Esteem at 12 months. WRS at 50 dB scores improved from an unaided 10% and aided 23% average to 78% postoperatively.

Conclusion: The Esteem totally implantable middle ear hearing device provides appreciable functional gain and improvement in WRS to rehabilitate hearing in patients with a profound high-frequency sensorineural hearing loss.

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The study objective was to assess outcomes of the Envoy Esteem Totally Implantable Hearing System as measured by hearing results compared with preimplant baseline unaided (BLU) and best-fit aided conditions (BLA) and (2) to determine safety of the device. Speech reception thresholds (SRTs) improved from BLA of 41.2 dB to 29.4 dB with the Esteem (P = .001). Word recognition score (WRS) at 50 dB hearing level (HL) improved from BLA of 46.3% to 68.9% with the Esteem. Pure tone averages improved by 27 ± 1 dB (confidence interval, 30-25).

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This article was presented at the 2010 AAO-HNSF Annual Meeting & OTO EXPO, Scientific Oral Presentations; September 29, 2010; Boston, Massachusetts.

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Read about two of Dr. Shohet’s patients, a brother and sister, who underwent the Esteem surgery and had excellent results

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Background: Migraine is a disease characterized by periodic headaches, but patients often experience other symptoms, including dizziness. In some patients, dizziness can be the only symptom. Since the 19th century, repeated references have been made to the clinical association of migraine and dizziness. Over the years, several syndromes have been reported of episodic vertigo associated with migraine. Some of these syndromes include benign paroxysmal vertigo of childhood and benign recurrent vertigo in adults. Some authors have even suggested an association between migraine and Ménière disease.

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Cholesteatomas have been recognized for decades as a destructive lesion of the skull base that can erode and destroy important structures within the temporal bone. Its potential for causing central nervous system complications (eg, brain abscess, meningitis) makes it a potentially fatal lesion.

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Ankylosis of the stapes was first described by Valsalva in 1704. Toynbee described fixation of the stapes to the margins of the oval window in 1841 and found similar cases in 136 of 1,000 temporal bone dissections. The histologic features of otosclerosis were demonstrated by Politzer, who identified the problem as an otic capsule disorder characterized by abnormal new bone formation.

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Cerebellopontine angle (CPA) tumors are the most common neoplasms in the posterior fossa, accounting for 5-10% of intracranial tumors. Most CPA tumors are benign, with over 85% being vestibular schwannomas (acoustic neuromas), lipomas, vascular malformations, and hemangiomas. The most frequent nonacoustic CPA tumors are meningiomas, epidermoids (primary cholesteatomas), and facial or lower cranial nerve schwannomas. Primary malignancies or metastatic lesions account for less than 2% of neoplasms in the CPA.

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Background: Toulmouche was probably the first physician to report a case of malignant external otitis (MEO), in 1838.
In 1959, Meltzer reported a case of pseudomonal osteomyelitis of the temporal bone.

In 1968, Chandler discussed the clinical characteristics of MEO and defined it as a distinct clinical disease. He described this external otitis as malignant because he observed an aggressive clinical behavior, poor treatment outcome, and a high mortality rate for the patients affected by this disease.

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History of the Procedure: The earliest recorded attempt to reestablish a connection between the tympanic membrane and the oval window in the case of a missing ossicle was in 1901. Since then, numerous materials have been used to recreate the middle ear sound-conducting mechanism. Many materials have been used for ossicular substitution or reconstruction, including both biologic and alloplastic materials. Biologic materials include autograft or homograft ossicles, cortical bone, teeth, and cartilage.

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Hearing loss affects up to 10% of the population in the United States. The prevalence increases with age and over one third of people older than 65 years have a significant hearing loss. Only approximately 20% of people with hearing loss seek assistance from hearing aids. Of these, as many as 16.2% do not wear their devices.

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The temporal bone is the most complex bone in the human body. It houses many vital structures, including the cochlear and vestibular end organs and the facial nerve, carotid artery, and jugular vein. Involvement of none or all of these structures in temporal bone fractures is possible. A thorough understanding of the epidemiology, classification, complications, and treatment of these fractures is mandatory for health care professionals involved in the care of individuals with such injuries.

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Background: External ear infections require otoscopic examination that must be performed in conjunction with evaluation of related structures such as the external ear and the head and neck. For example, examine the auricle for swelling, deformity, and erythema; the face for evidence of facial nerve paresis or other cranial neuropathy; and the neck for masses.

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Background: The term presbycusis refers to sensorineural hearing impairment in elderly individuals. Characteristically, it involves bilateral high-frequency hearing loss associated with difficulty in speech discrimination and central auditory processing of information. However, other patterns of presbycusis exist. The association between advanced age and high-tone deafness was first described by Zwaardemaker in 1899. Since then, extensive research has attempted to determine the pathologic changes of presbycusis, but the exact mechanisms remain unknown.

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Background: The human osseous labyrinth is comprised of endosteal, enchondral, and periosteal layers. The endosteal layer consists of bone lined with a single thin layer of cells that have numerous gaps separating them. The enchondral layer is unique in that it reaches adult size by 23 weeks gestation and undergoes minimal remodeling after age 2 years. The periosteal layer consists of lamellar bone and is capable of remodeling and repair.

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Pediatric cholesteatoma can be congenital or acquired. The two types appear to be separate and distinct entities based on molecular studies and clinical course. Pediatric cholesteatoma behaves differently from cholesteatomas in the adult. This may have more to do with anatomic and physiologic differences than with the molecular structure of the cholesteatoma. Treatment requires an individualized approach taking into account the experience of the operative surgeon and the high risk of recidivism of this disease.

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Preview: Otorrhea can signal the presence of a common infection, such as otitis media, or a more serious condition, such as cerebrospinal fluid leak. Color of the draining fluid, accompanying otologic symptoms, and other factors are clues to the source of the problem. Drs Shohet and Scherger discuss key questions to ask on history taking and specific physical findings to look for. Then they describe the various disorders often associated with otorrhea and the treatment options available.

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Preview: Loss of hearing is a national health problem with significant physical and psychological repercussions. Although there is no cure for certain forms of hearing loss, many patients can be helped, especially when the problem is recognized early. The authors discuss the important role of primary care physicians in early identification, management, and counseling of hearing-impaired patients.

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