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OBJECTIVE Review current literature and guidelines for malignant hyperthermia in the context of neurotologic surgery. PATIENT A case of malignant hyperthermia during vestibular schwannoma surgery, in a patient previously exposed to anesthesia. INTERVENTIONS Excision of vestibular schwannoma, acute management of malignant hyperthermia. MAIN OUTCOME MEASURES Knowledge of the basic pathophysiology, clinical manifestations, and treatment protocols for malignant hyperthermia. RESULTS Rapid termination of the procedure and appropriate modifications in surgical technique permitted expeditious treatment of malignant hyperthermia and prevented its lethality. CONCLUSIONS Malignant hyperthermia is a rare and lethal condition that may arise in neurotologic surgery, even in patients who have previously received general anesthesia. The neurotologic surgeon has a role in early recognition and expeditious termination of surgery to help reduce its mortality.

OBJECTIVE To compare preoperative and postoperative sound localization and surgical outcomes in patients with a history of osseointegrated hearing device (OHD) placement who underwent cochlear implantation for severe to profound sensorineural hearing loss in one ear and normal cochlear function in the contralateral ear (single-sided deafness [SSD]). STUDY DESIGN Case series. STUDY SETTING Tertiary care center, cochlear implant (CI) program. PATIENTS Five patients with a previously placed OHD, implanted at our institution between late 2012 and late 2013, who were undergoing cochlear implantation to address SSD. Causes of their initial SSD included iatrogenic sudden sensorineural hearing loss, and perilymphatic fistula. Indications for cochlear implantation included a desire for binaural hearing, surgical treatment for tinnitus, and staging for treatment of contralateral conductive hearing loss. INTERVENTIONS Cochlear implantation; intraoperative and postoperative antibiotics. MAIN OUTCOME MEASURES Accuracy of sound localization for environmental sounds presented in a mixture for three device conditions: monaurally with the acoustic hearing ear only, OHD in addition to the acoustic hearing ear, and CI in addition to the acoustic hearing ear. Complications. Continued use of CI. RESULTS Modestly improved sound localization with CI compared with monaural listening or listening with an OHD (p < 0.0001). Wound dehiscence and infection with our first two patients; none with the use of perioperative and postoperative antibiotics (three patients). Four patients continued to use their CI for at least 4 months after activation (mean, 13 mo) and expressed satisfaction with the device; one was lost to follow-up. CONCLUSION Cochlear implantation for this population of patients produced modestly improved localization accuracy, and most patients expressed satisfaction with this intervention. In this series of cochlear implantation after OHD, our first two patients had wound infection and dehiscence. We recommend perioperative and postoperative antibiotics to prevent this complication.