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Objective To study the emergency management of esophageal jujube pit ingestion. Study Design Retrospective case series. Methods A retrospective study of 114 consecutive cases of jujube pits esophageal impaction during 3 months was performed. Results One hundred and fourteen cases were confirmed as jujube pit esophageal impaction using contrast‐enhanced radiography. All jujube pits were retrieved using rigid esophagoscopy under general anesthesia as outpatients, except one case where a direct laryngoscope was used. In four cases, esophageal perforation was found, the patients were treated with conservative measures, and none died. Conclusion Jujube pit esophageal impaction is characterized by a high incidence of perforation. The conservative management of cervical perforation is effective in this study. Rigid esophagoscopy under general anesthesia is safe for jujube pit esophageal impaction. Level of Evidence 4., This manuscript describes our experience with management of jujube pit esophageal impactions and showed that rigid esophagoscopy would be a safe and effective method for removing jujube pits.

Objectives: In recent years, with the incidence of bilateral cochlear implantation (CI) increasing, understanding the impact of CI on otolith function is of greater necessity. This study aims to investigate the development of gross motor and otolith function in patients with inner ear malformations (IEMs) by vestibular evoked myogenic potentials (VEMP). Materials and Methods: A total of 78 patients with sensorineural hearing loss (SNHL) (age 5.7±4.1 years) were divided into two groups based on the presence (IEM group, n=39) or absence (control group, n=39) of IEMs. VEMP was conducted before and 1–3 months after CI, and gross motor development assessed. Results: The mean ages of head control and independent walking were delayed in the IEM group compared with control group ( p=0.02). The preoperative cVEMP and oVEMP response rates were higher in the control groups (60% and 86.95%) than in the IEM group (57.69% and 74.35%) ( pp=0.017). Saccular and utricular functions after CI were lost by 40% and 31.75%, respectively, in group of patients present preoperatively VEMPs waveform (n=25). Conclusions: Balance development is more reduced in patients with SNHL and IEMs than in patients without IEMs. The otolith-vestibular nerve conduction pathway can be affected by CI and lead to otolith function impairment. As such, evaluating the otolith and balance functions before CI is necessary and should be considered in clinical practice.

Cochlear nerve deficiency (CND) is often combined with modiolar deficiency-type inner ear malformations, which cause variable cochlear implantation (CI) outcomes. We aimed to assess the postoperative development of auditory and speech perception in CND patients with modiolar deficiency-type malformations after 3 years of follow-up to determine the factors correlated with CI outcomes.Sixty-seven CND patients with modiolar deficiency-type malformations who underwent CI surgery were retrospectively reviewed. Modiolar deficiency-type malformations included common cavity (CC), cochlear hypoplasia (CH) (including CH-I and CH-II) and incomplete partition-I (IP-I). Categorical auditory performance (CAP) and the infant-toddler meaningful auditory integration scale (MAIS) were used to assess auditory ability. The speech intelligibility rating (SIR) and meaningful use of speech scale (MUSS) were used to assess the speech intelligibility of these CI patients. The CI outcomes were evaluated at 0, 12, 24 and 36 months after implant activation.All patients demonstrated improvements in auditory ability and speech intelligibility after CI. There were no significant differences in CI outcomes at any time point according to the malformation type. The number of nerve bundles within the internal auditory canal (IAC) showed significant differences at 12, 24 and 36 months after CI (p0.05). Patients with one nerve bundle had relatively poor CI outcomes.CND patients with modiolar deficiency-type malformations showed continuous improvement in auditory and speech abilities after CI. Compared with malformations, the number of nerve bundles should be given more attention when selecting the side for CI.

Purpose Air-bone gap (ABG) is an essential indicator of middle ear transfer function after myringoplasty. However, there is still uncertainty about the mechanisms behind unexplained ABGs in patients post-myringoplasty. The present study investigated these mechanisms using cadaveric temporal bone (TB) measurement and finite element (FE) modeling. Methods Three conditions of tympanic membrane (TM) perforation were modeled with a perforated area of 6%, 24%, and 50% of the total TM area to simulate a small, medium, or large TM perforation of TB model. A piece of paper was used to patch the TM perforation to simulate the situation post-myringoplasty. In the FE model for post-operation, the material properties at the perforation area were changed. Measurement of TM vibration at the umbo was undertaken with a laser Doppler vibrometer (LDV). Results As the perforated area increased vibration of the TM at the umbo decreased in both the TB and FE models. But the reduction of TM vibration is more minor in the FE model than in the TB model. After the perforation was repaired, the displacement of TM at the umbo could not be recovered totally in the TB and FE models. In the FE model, the displacement of TM at the umbo decreased markedly when the cone shape of TM flattened, and the reduction was almost the same as that in the TB model in the condition of large perforation. Conclusion The material properties and the anatomical shape of the repaired TM could influence the TM’s modal motion and wave motion. Except for appearance and shape current clinical instruments are unable to resolve factors that affect TM motion. Consequently the ABG seen post-myringoplasty remains unexplained.

Objectives To determine the feasibility of endoscopic-assisted surgery for lesions involving the perilabyrinthine recesses, and develop and validate a technique for this kind of lesions that increases the possibility of preserving the labyrinth and cochlea. Study design Observational study. Setting Referral center. Cases Five patients who underwent endoscopy-assisted surgery for lateral skull base pathology involving the perilabyrinthine recesses between July 2010 and March 2016 were reviewed. Interventions Clinical data of the five patients were collected. Main outcomes measures Hearing level and recurrence. Results Three of the five patients (three women, two men) had petrous bone cholesteatomas, one a facial neurofibroma, and one a petrous bone cholesterol granuloma. Complete excision with labyrinth and cochlea preservation was achieved using an endoscopic-assisted technique in all patients. Four had preoperative conductive hearing loss and one was totally deaf. In one patient, the postoperative air-bone gap was 30 dB lower than preoperatively levels, one stayed the same, and one was 30 dB because of closing of the external ear canal. After an average follow-up of 62.9 months, no patient had recurrence. Conclusions Endoscope-assisted surgery is feasible for lesions involving the perilabyrinthine recesses and increases the likelihood to preserve the structure and function of labyrinth/cochlea, which may provide chances for artificial hearing devices implantation.

The presigmoid retrolabyrinthine approach (PRA) for small vestibular schwannoma (VS) has unique advantages. Combination with partial labyrinthectomy further makes up its defect of high demand for anatomy.Aimed to describe our use of the PRA with partial labyrinthectomy in VS surgery.We retrospectively analyzed 10 patients diagnosed with VS who underwent PRA between September 2017 and November 2020. Their perioperative data were analyzed.Six tumors were on the left and three were on the right. One case was due to neurofibromatosis type 2 with bilateral involvement and underwent internal auditory canal decompression by PRA without tumor removal; all other patients underwent total tumor resection. Four patients underwent cochlear implantation simultaneously because of hearing loss that was detected during surgery. Three patients underwent partial labyrinthectomy. Five patients achieved hearing preservation, and one experienced hearing improvement. One of the three patients who underwent partial labyrinthectomy maintained hearing. All patients' pre- and postoperative facial nerve functions were House-Brackmann grade I. After a median follow-up time of 13 months, no tumors recurred.PRA for small VS is a safe and effective surgery that can achieve facial nerve and hearing preservation. Combination with partial labyrinthectomy can also preserve hearing.

No cochlear otosclerosis in infants with congenital bilateral SNHL has been reported.We report an infant male with bilateral cochlear otosclerosis, suggesting that cochlear otosclerosis may be a congenital disease and to further analyze the etiology of and genetic expression in congenital bilateral cochlear otosclerosis. We also describe the clinical characteristics and experience of patients with bilateral cochlear otosclerosis treated with cochlear implants (CIs).Seven patients, including an infant, who were diagnosed with cochlear otosclerosis underwent CI surgery. Their medical records, audiological and radiological results, surgical procedures, and CI outcomes were collected and reviewed.The median age at hearing loss was 38 years, ranging from 0 to 47 years. The child had bilateral hearing loss at birth and received a CI at 1 year of age. He also had growth retardation and was diagnosed with 3q+/3p- syndrome. All patients (8 ears) had better postoperative auditory performance than that preoperatively.Although cochlear otosclerosis often starts at middle age and progresses slowly, it may be a congenital disease that is related to chromosome abnormality. This disease presents with SNHL or MHL, and treatment with a CI is beneficial.

Objectives/Hypothesis Cochlear implantation for patients with common cavity deformity (CCD) can be difficult, with a higher incidence of intra- and postoperative complications; outcomes with CCD patients are also highly variable. In this study, surgical time was compared between the traditional facial recess approach (TFRA) and the transmastoid slotted labyrinthotomy approach (TSLA). Audiological outcomes and the benefit of using customized electrode arrays for CCD patients are also discussed. Study Design Retrospective review of 13 cochlear implant (CI) patients with CCD. Methods Six patients were implanted with the TFRA using traditional electrodes, and seven patients were implanted with the TSLA using customized electrodes. Intra- and postoperative complications were reviewed. Audiological outcomes were measured 3 months to 2 years after CI activation. Results The mean surgical time for TSLA group was nearly half as long as for the TRFA group (P .05). Conclusions For CCD patients, TSLA for cochlear implantation is recommended due to shortened surgical time; customized electrode arrays may be additionally advantageous in terms of audiological outcomes. Level of Evidence 4. Laryngoscope, 2017

Simultaneous bilateral cochlear implantation is often seen as the gold-standard intervention for many people with bilateral deafness. However, this intervention is not as commonly performed in China. This paper presents the surgical technique and the peri- and postoperative safety results from simultaneous bilateral implantation and compares them with those from sequential bilateral implantation. Twenty nine children (aged 12‒18 months) met the inclusion/exclusion criteria and took part in this study. 10 participants received a unilateral cochlear implantation; 19 participants received simultaneous bilateral cochlear implantation. The same standard surgical technique (transmastoid facial recess approach with round window insertion) was used in all implantations. Safety was assessed via monitoring peri- and postoperative adverse events. The helpfulness of select surgical tools was assessed via questionnaire. No adverse events were reported for any participants. All queried surgical tools were helpful in all 244 recorded responses. Simultaneous bilateral cochlear implantation can be performed using the same surgical technique as unilateral implantation and poses no increased safety risk for children aged 1‒2 years.

Background During skull base tumor surgery, temporomandibular joint (TMJ) dissection is commonly performed. The impact of this procedure on patients' postoperative diet and TMJ function is a matter of concern to surgeons. Methods We reviewed the Craniomandibular Index (CMI) for 32 patients (15 men and 17 women) who underwent TMJ dissection during surgery for skull base tumors between August 2015 and May 2018. Results Fifteen patients underwent removal of the mandibular condyle, and 17 had the condyle preserved. Twenty-one patients mainly underwent infratemporal fossa approach, and 11 underwent extended temporal bone resection. No significant difference between pre- and postoperative diet was observed in any group. Significant differences in CMI index were seen in all groups. The highest score was 0.115 of Dysfunction Index, observed postoperatively in the group that underwent condyle removal. Conclusions For skull base tumor surgery, TMJ dissection has no significant impact on postoperative diet. Patients who underwent removal of the mandibular condyle have significantly worse postoperative TMJ function.

Background During surgical treatment of lesions involving the skull base, conductive hearing is often sacrificed due to tympanum destruction. This study aimed to develop a method for tympanum reconstruction using a sternocleidomastoid (SCM) flap to preserve conductive hearing during lateral skull base surgery. Methods This study included five patients with lateral skull base lesions who underwent surgery including tympanum reconstruction with an SCM flap between July 2015 and November 2017. Results Three patients seen with facial nerve schwannoma, and two had paraganglioma of the head and neck. All patients' inferior and posterior tympanic walls were resected; the tympanum and ossicular chain were reconstructed with an SCM flap and prosthesis. The mean postoperative air-bone gap was 14 dB. No lesion recurrences were observed until the last follow-up. Conclusion The SCM flap is effective in preserving conductive hearing through reconstruction of the inferior and posterior tympanic walls in lateral skull base surgery.

OBJECTIVE To compare imaging and outcome data in cochlear implant (CI) patients with and without cochlear nerve deficiency (CND). STUDY DESIGN Retrospective study comparing presurgical imaging (via high-resolution computed tomography and three-dimensional magnetic resonance imaging) to postsurgical auditory outcomes in CI patients with and without CND. PATIENTS Forty-three CI patients with CND diagnosed according to preoperative imaging were included in the CND group. A control group (non-CND; n = 43) was matched to the CND group in terms of age at implantation, CI device type, preoperative hearing threshold, and sex. RESULTS Across all subjects, internal auditory canal (IAC) diameter, cochlear nerve canal (CNC) diameter, and the number of nerve bundles were significantly correlated with all auditory outcome measures (p

Cochlear implantation for patients with common cavity deformity (CCD) can be difficult, with a higher incidence of intra- and postoperative complications; outcomes with CCD patients are also highly variable. In this study, surgical time was compared between the traditional facial recess approach (TFRA) and the transmastoid slotted labyrinthotomy approach (TSLA). Audiological outcomes and the benefit of using customized electrode arrays for CCD patients are also discussed.Retrospective review of 13 cochlear implant (CI) patients with CCD.Six patients were implanted with the TFRA using traditional electrodes, and seven patients were implanted with the TSLA using customized electrodes. Intra- and postoperative complications were reviewed. Audiological outcomes were measured 3 months to 2 years after CI activation.The mean surgical time for TSLA group was nearly half as long as for the TRFA group (P .05). Although mean audiological outcomes were better for the TSLA group, there was no significant difference between groups (P .05).For CCD patients, TSLA for cochlear implantation is recommended due to shortened surgical time; customized electrode arrays may be additionally advantageous in terms of audiological outcomes.4. Laryngoscope, 128:468-472, 2018.