Overrated
The level of evidence supporting microvascular decompression for treatment of tinnitus & vertigo.
What is low ?
DOI: 10.3171/2016.8.JNS16992
DOI: 10.3171/2016.2.JNS152913
Medicare's September 2022 expanded National Coverage Determination (NCD) for Cochlear Implantation excluded what FDA-approved indications?
What are "single-sided deafness and asymmetrical hearing loss" ?
https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&ncaid=306
A 2022 meta-analysis found that the osteotome technique for exostosis surgery was associated with higher overall risk of tympanic membrane perforation, while drill canaloplasty was associated with 3-4% increased risk of stenosis and this complication.
What is sensorineural hearing loss?
DOI: 10.1177/00034894221147804
In 1861, at the French Academy of Medicine, this individual presented a series of patients with episodic vertigo and hearing loss, postulating that inner ear dysfunction was the cause.
Who was Prosper Meniere?
doi:10.1001/archneur.58.7.1151
The incidence of VS has increased in the last 2 decades, to this single-digit-range per 100,000 person-years.
What is 3 to 5?
DOI: 10.1016/j.otc.2023.02.003
The incidence of AICA vascular loops in both patients with localizing symptoms and patients with no symptoms.
What is between 1/4 and 1/5 ?
DOI: 10.1097/MAO.0000000000000279
DOI: 10.1097/00005537-199811000-00027
DOI: 10.3174/ajnr.A8486
The incidence of unmasking vestibular symptoms after stapedotomy in a person with otosclerosis and radiographic semicircular canal dehiscence.
What is 10-33% ?
DOI: 10.1097/MAO.0000000000002897
DOI: 10.1097/MAO.0000000000003429
Surgical intervention for spontaneous CSF otorrhea and encephaloceles has this effect on the pure tone average, according to a recent systematic review and meta-analysis.
What is improves (or reduces)?
(By approximately 9 decibels in the pooled analysis, although subgroup analysis was not possible.)
DOI: 10.1097/MAO.0000000000004587
Comparative studies of surgical exposure with or without incision, and steroid application to this inner ear structure have found conflicting results.
What is the endolymphatic sac?
DOI: 10.1016/j.amjoto.2017.01.023
DOI: 10.1097/MAO.0000000000001810
VS size and growth rate have this association with symptom severity.
What is no association?
DOI: 10.1016/j.otc.2023.02.003
A 2016 systematic review found this diagnostic study to have little benefit in establishing a diagnosis of otosclerosis, and recommended it only for special cases or out of legal necessity.
What is a CT scan?
DOI: 10.1097/MAO.0000000000000924
This medication significantly reduced the risk of developing otic barotrauma versus placebo (RR: 0.55; 95% CI: 0.48-0.66) and consistently lowered ear pain (RR: 0.51), blockage (RR: 0.50), and hearing loss (RR: 0.49) in a meta-analysis of 3 RCT from the 1990s.
What is pseudoephedrine?
Notably, intranasal oxymetazoline (2 trials) showed only modest benefit (RR: 0.75; 95% CI: 0.57-0.99; P=0.05; I²=53%) with variable symptom effects.
DOI: 10.1097/MAO.0000000000004905
True or False: Cardiac interventions portend an increased risk of developing unilateral or sudden sensorineural hearing loss.
What is True?
Notable in patients with intermediate embolic risk (atrial fibrillation, TIA, stroke without anticoagulation); high embolic risk on with anticoagulation; dialysis-dependence; and procedures under general anesthesia. Open valve replacement and open bypass did not significantly increase risk of hearing loss compared to lesser invasive interventions.
DOI: 10.1097/MAO.0000000000004890
In subjects with medically-refractory Meniere's disease, at 48 months post-injection, a randomized, double-blinded comparative effectiveness trial of intratympanic gentamicin (40 mg/mL) versus methylprednisolone (62.5 mg/mL) found superior vertigo control using this drug.
What is neither of the two ?
DOI: 10.1097/MAO.0000000000002108
DOI: 10.1016/S0140-6736(16)31461-1
(extra; DOI: 10.1007/s12070-024-04749-x)
A 2024 systematic review found this number needed to treat (NNT) for vestibular schwannomas to benefit from radiosurgery, by comparing 10-year tumor control outcomes to untreated patients.
What is 4 (95% CI: 3.619-4.210).
The number was the same for vestibular schwannomas with documented linear growth prior to treatment: NNT= 4 (3.395, 95% CI: 2.966-3.968), with an absolute risk reduction of 29.4%.
DOI: 10.1093/noajnl/vdae191
One of these is not consistently related to pediatric tympanoplasty outcomes: patient age, status of contralateral ear, recurrent otitis media, and surgeon experience.
What is patient age?
https://doi.org/10.1002/lary.26052
https://doi.org/10.1016/j.joto.2024.04.001
Ear pain and hearing loss can occur after pulling one's finger or a tight-fitting plug from the ear canal, typically caused by fractures of this ossicle.
What is the malleus?
DOI: 10.1002/lary.30962
Approximately this proportion of people with sudden sensorineural hearing loss experience early spontaneous recovery.
What is one-third?
DOI: 10.1097/MAO.0000000000004923
A recent systematic review and meta-analysis found this (%) to be the risk of developing contralateral Ménière's disease, with a mean time to conversion of 8.2 years (95% CI, 5.9–10.6).
What is 13%?
DOI: 10.1097/MAO.0000000000004491
This commonly prescribed antihyperglycemic agent with various pharamacologic effects may reduce the growth of vestibular schwannomas.
What is metformin ?
DOI: 10.1002/lary.30601
True or False: Neither myringoplasty nor tympanoplasty appear to possess a clinically meaningful advantage over the other in terms of perforation closure success rate, even when stratified by perforation size of greater than and less than 50% of the TM.
What is True?
DOI: 10.1002/ohn.191
Incidental findings occur over twice as often as retrocochlear pathologies when imaging is obtained for this common indication.
What is asymmetric sensorineural hearing loss?
DOI: 10.1097/MAO.0000000000004353
Gene and cell-based approaches are transforming auditory regenerative medicine, with clinical validation of adeno-associated virus-mediated restoration of hearing after replacement of this single gene, which causes autosomal-recessive deafness 9 (DFNB9).
What is OTOFERLIN (OTOF) ?
DOI: 10.1007/s00405-025-09957-x
DOI: 10.1002/advs.202306788
In selected patients with both refractory vestibular symptoms and sensorineural hearing loss meeting criteria for cochlear implantation, simultaneous performance of this procedure reduced frequency and severity of vertigo in a case-controlled study of 99 subjects.
What is endolymphatic sac decompression?
DOI: 10.1097/MAO.0000000000004788
A large multicenter case-control study (VISAS) and randomized clinical trial (V-REX) found this difference in serviceable hearing preservation between SRS and observation at 4 years?
What is no difference?
DOI: 10.1001/jama.2023.12222
DOI: 10.1016/j.ijrobp.2024.04.004