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OBJECTIVE Compare outcomes of middle cranial fossa approach (MCF) to vestibular schwannoma (VS) resection in patients 60 years of age and older to patients under 60. STUDY DESIGN Retrospective case series. SETTING Tertiary referral center. PATIENTS Charts of 216 consecutive VS patients over 18 years of age were reviewed to identify 67 patients who underwent MCF approach to VS resection between 2006 and 2017. INTERVENTION(S) Age at time of surgery. MAIN OUTCOME MEASURE(S) Measured outcomes included postoperative hearing results, facial nerve function, length of hospital stay, wound complications, cerebrospinal fluid leak, myocardial infarction, cerebrovascular accident, seizure, deep vein thrombosis, 30-day readmission, and return to operating room. RESULTS Sixty-seven patients underwent VS resection via MCF approach including 16 patients > = 60 years (mean 64.4 SD 3.3) and 51 patients

Objective Determine whether elevated body mass index (BMI) is associated with postoperative complications after vestibular schwannoma (VS) surgery. Study design Retrospective case series. Setting Tertiary referral center. Patients Two hundred six patients undergoing surgery for VS between 2010 and 2017, grouped into obese and nonobese patients. Intervention Surgery for VS resection. Main outcome measures Postoperative facial nerve outcomes, length of hospital stay, presence of postoperative cerebrospinal fluid leak, 30-day readmission, return to the operating room, wound complications, cardiovascular and thromboembolic complications. Results After excluding 1 patient for missing BMI, our cohort included 205 patients. Seventy-nine patients (38.5%) were obese (mean BMI 36.2 kg/m, range 30-55.1) and the remaining 126 (61.5%) were nonobese (mean BMI 25.0, range 18.8-29.8 kg/m). Compared with nonobese patients, obesity was not associated with postoperative cerebrospinal fluid leak (OR 1.1, 95% CI 0.93-1.1), length of hospital stay (OR 0.98, 95% CI 0.65-1.47), 30-day readmission rates (1.04, 95% CI 0.95-1.14), return to operating room (OR 1.05, 95% CI 0.98-1.11), or other wound-related complications (OR 0.99, 95% CI 0.94-1.04). Conclusion In this cohort, elevated BMI was not associated with an increased risk for postoperative complications after VS surgery. Our findings may mitigate concerns associated with surgical management of VS in obese patients.

Objective Evaluate the safety and efficacy of the ultrasonic bone aspirator (UBA) during middle cranial fossa (MCF) approach to vestibular schwannoma (VS). Study design Retrospective case series. Setting Tertiary referral center. Patients Charts of 192 consecutive VS patients over 18 years of age were reviewed to identify 65 patients who underwent MCF approach to VS resection between 2006 and 2017. A combination of UBA and high-speed drill (HSD) was used to decompress the internal auditory canal (IAC) in 25 patients and HSD alone was used in the other 40 patients. Intervention(s) Use of UBA during vestibular schwannoma surgery via MCF approach for decompression of the IAC. Main outcome measure(s) Postoperative facial nerve outcomes assessed by the House-Brackmann (HB) facial nerve grading scale. Rates of gross total resection (GTR) and cerebrospinal fluid (CSF) leak. Results There were no significant differences in postoperative facial nerve function, in rate of GTR of tumor, or in rate of CSF leak. In the UBA group 24/25 (96%) had postoperative HB grade I-II compared with 36/40 (90%) in the HSD group (p-value = 0.66). GTR was achieved in 25/25 (100%) in the UBA group compared with 38/40 (95%) in the HSD group (p-value = 1). In the UBA group, there were 0/25 (0%) cases of CSF leak compared with 1/40 (2.5%) in the HSD group (p-value = 1). Conclusions UBA use is a safe and effective alternative or adjunct to HSD during MCF approach to expose the IAC contents. This surgical tool allows for bone removal with low risk of injury to adjacent structures.

Noise reduction algorithm (NRA) in speech processing strategy has positive impact on speech perception among cochlear implant (CI) listeners. We sought to evaluate the effect of NRA on music enjoyment.Prospective analysis of music enjoyment.Academic medical center.Normal-hearing (NH) adults (N = 16) and CI listeners (N = 9).Subjective rating of music excerpts.NH and CI listeners evaluated country music piece on three enjoyment modalities: pleasantness, musicality, and naturalness. Participants listened to the original version and 20 modified, less complex versions created by including subsets of musical instruments from the original song. NH participants listened to the segments through CI simulation and CI listeners listened to the segments with their usual speech processing strategy, with and without NRA.Decreasing the number of instruments was significantly associated with increase in the pleasantness and naturalness in both NH and CI subjects (p 0.05). However, there was no difference in music enjoyment with or without NRA for either NH listeners with CI simulation or CI listeners across all three modalities of pleasantness, musicality, and naturalness (p 0.05): this was true for the original and the modified music segments with one to three instruments (p 0.05).NRA does not affect music enjoyment in CI listener or NH individual with CI simulation. This suggests that strategies to enhance speech processing will not necessarily have a positive impact on music enjoyment. However, reducing the complexity of music shows promise in enhancing music enjoyment and should be further explored.