Oral Presentations P87 Results: Two hundred and ten consecutive patients (ages 2-47) underwent atresia repair between 2007-2011. Preoperative Jahrsdoerfer Scale was 9 (26%), 8 (47%), 7 (21%), 6 (3%), and 5 or less (4%). The facial nerve was found to have an abnormal course in 39% of the cases and not identified in 1%. It was congenitally dehiscent in 53% of cases and was surgically exposed in 10%. The most common site of congenital dehiscence was in the tympanic segment (57%). Facial-stapes contact was found in 11% of cases. A single patient had a transient postoperative mild paresis (House-Brackmann 2) as a consequence of surgery. Conclusion: Atresia repair remains one of the most challenging procedures in otology. Despite modern preoperative imaging, the facial nerve remains at risk given the variable development of the first and second branchial arches. Thorough knowledge of anatomical variations and meticulous surgical technique are mandatory to safely perform these surgeries. Otology/Neurotology Healthcare Delivery for Sudden Sensorineural Hearing Loss Anh T. Nguyen Huynh, MD, PhD (presenter); Mark J. Furin, MD Objective: 1) Determine how healthcare delivery for idiopathic sudden sensorineural hearing loss (ISSHL) is affected by delay in seeking care, initial response from healthcare provider, and timing of diagnostic audiogram and otolaryngologic consultation. 2) Determine how the above factors affect hearing recovery. Method: Retrospective analysis of 118 ISSHL cases at Kaiser Permanente Northwest, 2001-2010. Hearing outcome was measured as percentage of recovery with pure-tone average of the unaffected ear as benchmark for 100% recovery. Variables include timing of initial contact, type of provider, initial diagnosis, action, timing for audiogram, consultation, and steroid treatment. Results: Patients with at least 50% recovery received steroid at 9.0 ± 15.2 days whereas those with less recovery received steroid at 13.9 ± 15.0 days. Delay in seeking care differed little between the 2 groups. 15% of initial encounters involved audiologists or otolaryngologists, and 85% involved other MDs, PAs, NPs, or RNs. The former were all diagnosed correctly and averaged 70% hearing recovery, whereas the latter averaged 50% recovery. In this group, only 29% were correctly diagnosed, 34% were diagnosed incorrectly with conductive hearing loss, and 31% did not receive referral for follow-up with audiology or otolaryngology. Conclusion: Since elapsed time adversely affects hearing recovery in ISSHL, we have identified areas in healthcare delivery where improvements can be made to facilitate timely diagnosis and management. A key objective would be better recognition of ISSHL vs conductive hearing loss among healthcare providers who triage hearing loss complaints. Otology/Neurotology Hearing Improvement after CO2 Laser Myringoplasty Marisa A. Ryan, MD (presenter); David Kaylie, MD Objective: 1) Report hearing improvement after CO2 laser myringoplasty using handheld fiber. 2) Describe method for CO2 laser myringoplasty. Method: Retrospective study of hearing over a 4-year period of patients with atelectacic TM and hearing loss. CO2 laser myringoplasty performed using handheld fiber to contract TM at 2W 100-msec pulse. Attempts to reinflate the retraction pocket were performed using Valsalva, hydrodissection, or manual dissection. Tympanostomy tubes were placed in all patients. Results: Laser myringoplasty was performed on 60 ears of 43 patients. The average preoperative ABG was 15 dB. The average postoperative ABG was significantly improved at 7 dB (P < .001). Hearing improvement remained significantly improved in 17 patients with greater than 2 years follow-up with final ABG of 7 dB (P = .007). The presence of effusion on hearing was assessed. Patients with effusion had worse preoperative ABG (19 dB) compared to dry ears (12 dB) (P = .02), however, postoperative ABG and long-term ABG was not significantly different in the 2 groups (P = .3). Patients with myringostapediopexy that could not be elevated did not experience significant hearing improvement. Conclusion: Laser myringoplasty for treatment of TM retraction using a CO2 laser with handheld flexible fiber significantly improves hearing immediately and in long term follow-up. This system allows precise control of energy delivery to the TM. It also allows for laser delivery outside of direct line of sight. Patients with hearing loss and no effusion had significant immediate hearing improvement. Patients with effusions experience the greatest hearing improvement. Patients with TM adherence to ossicles that cannot be elevated with Valsalva are at greater risk for suboptimal hearing results. Otology/Neurotology INFα and Ototoxicity Shahriar M.R. Sharifian, MD (presenter); Mehdi Bakhshaee, MD; Hamid Sima; Shima Kamandi, MD; Reza Afshari, MD; Mohammad R. Tale, MD Objective: INFα is a common standard drug for the treatment of hepatitis B and C. Although a variety of related complications have been discussed, possible ototoxic effects of this mediation are not well described. Method: In a descriptive cross-sectional before and after study, 24 patients who received INFα for treatment of hepatitis B and C were included. Subjective and objective ototoxicity evaluations via questionnaire, high-frequency audiometry, and measuring transiently evoked otoacoustic emissions (TEOAEs) were performed before, 1 week, and a month after starting the medication. Downloaded from oto.sagepub.com by guest on February 15, 2016 ORAL PRESENTATIONS Method: Retrospective review of 210 consecutive atresia cases treated between 2007 and 2011 at a subspecialty private practice. Descriptive analysis of intraoperative findings.
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