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Objective: The aim was to evaluate vestibular function in patients with unilateral vestibular schwannoma before and in the short and medium term after surgical treatment to analyze vestibular compensation. The identification of the prognostic factors determining incomplete and slower balance recovery was assessed. Methods: Forty-five patients with unilateral vestibular schwannoma treated surgically through the middle cranial fossa and translabyrinthine approach were enrolled in this study. The data were collected in the period between April 2022 and August 2023. The clinical data, vestibular tests (video head impulse test, sensory organization test) and the dizziness handicap inventory (DHI) before and after surgery were evaluated. Results: One month after surgery, a temporary deterioration in the DHI results occurred (DHI total score before surgery 24.36 vs. one month after surgery 31.64); however, a significant increase was found only by analyzing the functional subscale (p = 0.0395) for the DHI functional, emotional and physical subscale results; in addition, the total score before and three months after the surgery did not differ significantly. No statistically significant differences between the preoperative sensory organization test and the test one month after the surgery were found, while a significant improvement in the vestibular parameters was observed three months after the surgery compared to the preoperative results (C5 0.0306, C6 0.0002, VEST 0.0294, COMP 0.0023). A negative correlation was found between the DHI total score and C5 (−0.3198, −0.3266), C6 (−0.3448, −0.46379), VEST (−0.3100, −0.3252) and COMP (−0.4018, −0.4854) one and three months after the surgery, respectively. A significant deterioration was found between the LSC gain results on the tumor side (p < 0.001) and on the healthy side before the surgery vs. one month afterwards (p = 0.0079) and before the surgery vs. three months afterwards (p = 0.0419). The middle cranial fossa or translabyrinthine approach had no influence on the postoperative results. Conclusions: In the postoperative period, vestibular compensation occurs spontaneously. The results show that the functional level deteriorates one month after surgery but then improves significantly three months after the surgery, which confirms that compensation occurs gradually. The DHI functional subscale results before surgery and three months afterwards did not differ significantly, which demonstrates that functional recovery after vestibular denervation should take place within that time. In the present study, no predictive factors for unsatisfactory functional postoperative outcomes were found. [ABSTRACT FROM AUTHOR]

Background: A vestibular schwannoma (VS) is a benign tumor, causing audiological and vestibular symptoms. This study aimed to propose a comprehensive audio-vestibular test battery protocol for diagnosis and follow-up monitoring in patients with unilateral VSs undergoing surgical removal. Methods: The detailed interpretation of audiological and vestibular findings was presented in two example cases. The surgery was performed through the middle cranial fossa (#1) and translabyrinthine approach (#2). The participants were evaluated with tonal, speech, and impedance audiometry, ABR, caloric test, vHIT, cVEMP, oVEMP, SOT, and DHI. Patient and tumor characteristics were retrieved from the patient's history. Results: In the postoperative period, the reduction in gain of the lateral semicircular canal was observed in the vHITs of both patients. The DHI in case #1 increased after surgery, while it decreased in case #2. The improvement in postural performances compared to the preoperative SOT (CON 5, CON 6, composite score) and immediately after the procedure was observed. Conclusions: A specific diagnostic protocol is necessary to compare the results of different surgical techniques and approaches. Diagnostic tests performed before the surgery should be repeated within a specific time frame during postoperative follow-up to enable the comparison of results. The proposed protocol can help us better understand the processes ongoing during tumor growth and postoperative vestibular compensation. [ABSTRACT FROM AUTHOR]

Introduction: Congenital inner ear malformations resulting from embryogenesis may be visualized in radiological scans. Many attempts have been made to describe and classify the defects of the inner ear based on anatomical and radiological findings. Aim: The aim was to propose and discuss computed tomography multi-planar and 3D image assessment protocols for detailed analysis of inner ear malformations in patients undergoing cochlear implantation counseling. Material and methods: A retrospective analysis of 22 malformed inner ears. CT scans were analyzed using the Multi-Planar Reconstruction (MPR) option and 3D reconstruction. Results: The protocol of image interpretation was developed to allow reproducibility for evaluating each set of images. The following malformations were identified: common cavity, cochlear hypoplasia type II, III, and IV, incomplete partition type II and III, and various combinations of vestibule labyrinth malformations. All anomalies have been presented and highlighted in figures with appropriate descriptions for easier identification. Figures of normal inner ears were also included for comparison. 3D reconstructions for each malformation were presented, adding clinical value to the detailed analysis. Conclusions: Properly analyzing CT scans in cochlear implantation counseling is a necessary and beneficial tool for appropriate candidate selection and preparation for surgery. As proposed in this study, the unified scans evaluation scheme simplifies the identification of malformations and reduces the risk of omitting particular anomalies. Multi-planar assessment of scans provides most of the necessary details. The 3D reconstruction technique is valuable in addition to diagnostics influencing the decision-making process. It can minimize the risk of misdiagnosis. Disclosure of the inner ear defect and its precise imaging provides detailed anatomical knowledge of each ear, enabling the selection of the appropriate cochlear implant electrode and the optimal surgical technique. [ABSTRACT FROM AUTHOR]

Introduction: In chronic otitis media, the reconstruction of the middle ear's sound conducting system involves repairing the tympanic membrane and filling the space between ossicular chain remnants. The final shape of the prosthesis is usually determined intraoperatively. However, the ossicular chain may be preoperatively measured using computed tomography (CT) scans, and an individualized prosthesis can be designed. Custom 3D printing seems to be an attractive solution for optimal adjustment. Aim: Our study aimed to assess the 3D-printed custom prosthesis movability and compare it to the original ossicular chain. Material and methods: Five fresh-frozen temporal bone specimens were used. Using Cone-Beam CT scans, the incus model was designed individually and 3D-printed. The ossicular chain was reconstructed inside the cadaveric temporal bone. Acoustic stimuli were applied to the external ear canal one frequency at a time. The laser Doppler vibrometer (LDV) measured the intact and 3D-printed prosthesis reconstructed ossicular chain vibrations. Results: At all stimulation frequencies, there was no significant difference in velocity values between the intact and reconstructed ossicular chain at the intensity of 80 dB SPL. The obtained values of the velocity gain were: -7.9 (SD-19) dB, -6.8 (SD- 8.12) dB, -10,9 (SD-5.3) dB, -7.4 (SD-8.16) dB for 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz, respectively. The vibration threshold shift values ranged between --0.57 dB at 500 Hz and 3.81 dB at 2000 Hz. Conclusions: This study analyzed the movability of individualized 3D-printed custom ossicular prostheses using LDV. Compared to the intact ossicular chain, the reconstructed ossicular chain movability was characterized by statistically insignificant reduced movability at all tested frequencies. Because the prosthesis's new design conception as custom 3D individualized printing allows for patient-specific ossiculoplasty, it represents a promising new direction for ossicular chain reconstruction. It seems to be an attractive solution for prosthesis optimal adjustment and, hopefully, better hearing results. [ABSTRACT FROM AUTHOR]