A new device for the removal of cochlear schwannoma: A temporal bone study

BackgroundIntralabyrinthine schwannoma (ILS) is a rare, mostly unilateral disease that causes deafness. Different intralabyrinthine sites of ILS can occur and can be removed by different surgical approaches. Cochlear ILSs are frequently partially hidden by the modiolus and therefore difficult to extirpate. Surgical techniques can be traumatic, offer limited surgical control during removal, and are time-consuming. The aim of this present study was to demonstrate the performance and handling of a newly developed device for the removal of cochlear intralabyrinthine schwannoma in the temporal bone.MethodsIn a temporal bone study with a prepared posterior tympanotomy, an enlarged round window approach, and additional second turn access, a stiffened device with silicone rings was inserted and extracted gradually from the second turn access until the rings were visible in the second turn access.ResultsInsertion and extraction of the second cochlear access were easily performed. Pulling and pushing the silicone rings through the modiolus and hidden parts of the basal turn was possible and worked like a pipe cleaner.ConclusionThis newly developed tissue removal device in combination with the proposed surgical handling offers a new and less traumatic way to remove cochlear ILS

Recurrent respiratory papillomatosis (RRP)-time for a reckoning?

Kin Cho Goon P, Scholtz L-U, Sudhoff H. Recurrent respiratory papillomatosis (RRP)-time for a reckoning? Laryngoscope Investigative Otolaryngology. 2017;2(4):184-186

Case Report: Inflamed Jacobson nerve: an uncommon cause of persisting otalgia after an acute otitis media

Camurdan A, Kilgué A, Scholtz L-U, Todt I. Case Report: Inflamed Jacobson nerve: an uncommon cause of persisting otalgia after an acute otitis media. Frontiers in Surgery. 2024;11. **Introduction** Otalgia can have multiple causes. Mostly otalgia is caused by a tubal dysfunction or an acute middle ear infection. This case describes a patient with an inflammation of the Jacobson's nerve causing severe persistent otalgia after an acute otitis media. The patients complaints completely disappeared after neurolysis of the Jacobson's nerve. **Case presentation** We describe a case of a 21-year-old female caucasian patient with acute otitis media and persistent intractable otalgia. Infection was first successfully controlled by antibiotics. But the patient reported a persistent otalgia not responding to analgetics. We performed a CT scan, which exhibited a regular aerated middle ear finding, and a diagnostic tympanoscopy to examine the middle ear structures particularly the tympanic Jacobson's nerve as a possible cause for persistent pain. The following neurolysis of Jacobson's nerve under general anaesthesia led to a resolution of otalgia. **Conclusion** An inflamed tympanic Jacobson's nerve is a rare observation and a persisting otalgia after an acute otitis media not responding to conservative treatment can be treated by a neurolysis. </p

Translabyrinthine Petrous Apex Cholesteatoma Surgery with Hearing Preservation

Sudhoff H, Klingebiel R, Scholtz L-U, Todt I. Translabyrinthine Petrous Apex Cholesteatoma Surgery with Hearing Preservation. Case Reports in Otolaryngology. 2021;2021:1-4.Objective. To introduce a novel surgical approach to petrous apex lesion (PA) with superior semicircular canal plugging for hearing preservation. Patient. A 63-year-old patient presented with a recurrent cholesteatoma of the left petrous apex. The patient had a long-term history of cholesteatoma and MRI with diffusion-weighted imaging (DWI) detected a suspicious lesion in the left petrous apex on follow-up. Intervention. The cholesteatoma could be completely removed from the petrous apex with partial superior semicircular canal plugging and removal with hearing preservation. Outcomes. Cholesteatomas of the temporal bone are managed by surgery with complete excision of the lesion. Results. The translabyrinthine approach, generally useful in nonhearing ears, could be utilized with the additional technique of superior semicircular canal plugging to preserve hearing in this patient. Conclusions. This case highlights the possibility of a hearing preservation strategy for PA cholesteatomas using a translabyrithine approach

Quality Control after Intracochlear Intralabyrinthine Schwannoma Resection and Cochlear Implantation

Background: The combination of intralabyrinthine schwannoma (ILS) removal and cochlear implantation is the standard of care after surgical resection for audiological rehabilitation. Intracochlear ILS is not only the most frequent tumor in this group of schwannomas, but it is also, to some degree, surgically the most challenging because of its position behind the modiolus. Recent developments in the knowledge of implant position, implant magnet choice, and magnetic resonance imaging (MRI) sequences make an MRI follow-up after surgical removal possible. Thus far, no results are known about the surgical success and residual rate of these kind of tumors. The aim of the present study was to perform an early MRI follow-up for the evaluation of residual or recurrent intracochlear ILS after surgical removal and cochlear implantation. Methods: In a retrospective study, we evaluated seven patients after an intracochlear ILS removal and single-stage cochlear implantation with a mean period of 13.4 months post surgery with a 3T T1 GAD 2 mm sequence for a residual ILS. Patients were operated on using an individualized technique concept. Results: In six out of seven cases, 3 T T1 GAD 2 mm MRI follow-up showed no residual or recurrent tumor. In one case, a T1 signal indicated a tumor of the upper inner auditory canal (IAC) at the MRI follow up. Conclusion: MRI follow-up as a quality control tool after ILS removal and cochlear implantation is highly important to exclude residual tumors. Long-term MRI evaluation results are needed and can be obtained under consideration of implant position, implant magnet, and MRI sequence choice. A preoperative MRI slice thickness less than 2 mm can be recommended to visualize possible modiolar and IAC expansion

Osteopetrosis of the Temporal Bone

Abdel-Aziz T, Upile T, Scholtz L-U, Sudhoff H. Osteopetrosis of the Temporal Bone. Otology &amp; Neurotology. 2012;33(6):e45-e46

Quality Control after Intracochlear Intralabyrinthine Schwannoma Resection and Cochlear Implantation

Sudhoff H, Scholtz LU, Gehl HB, Todt I. Quality Control after Intracochlear Intralabyrinthine Schwannoma Resection and Cochlear Implantation. Brain Sciences. 2021;11(9): 1221.Background: The combination of intralabyrinthine schwannoma (ILS) removal and cochlear implantation is the standard of care after surgical resection for audiological rehabilitation. Intracochlear ILS is not only the most frequent tumor in this group of schwannomas, but it is also, to some degree, surgically the most challenging because of its position behind the modiolus. Recent developments in the knowledge of implant position, implant magnet choice, and magnetic resonance imaging (MRI) sequences make an MRI follow-up after surgical removal possible. Thus far, no results are known about the surgical success and residual rate of these kind of tumors. The aim of the present study was to perform an early MRI follow-up for the evaluation of residual or recurrent intracochlear ILS after surgical removal and cochlear implantation. Methods: In a retrospective study, we evaluated seven patients after an intracochlear ILS removal and single-stage cochlear implantation with a mean period of 13.4 months post surgery with a 3T T1 GAD 2 mm sequence for a residual ILS. Patients were operated on using an individualized technique concept. Results: In six out of seven cases, 3 T T1 GAD 2 mm MRI follow-up showed no residual or recurrent tumor. In one case, a T1 signal indicated a tumor of the upper inner auditory canal (IAC) at the MRI follow up. Conclusion: MRI follow-up as a quality control tool after ILS removal and cochlear implantation is highly important to exclude residual tumors. Long-term MRI evaluation results are needed and can be obtained under consideration of implant position, implant magnet, and MRI sequence choice. A preoperative MRI slice thickness less than 2 mm can be recommended to visualize possible modiolar and IAC expansion

Recurrent respiratory papillomatosis (RRP)

$\textbf {Objectives:}$ Recurrent respiratory papillomatosis (RRP) is a rare disease, but one with severe morbidity and occasional mortality. The aetiological agent is human papillomavirus (HPV), and HPV types 6 and 11 account for over 90% of all cases. In the active phase of the disease, patients require multiple hospital admissions for surgical removal or ablation of these benign tumors, which are likely to obstruct the airways if left unchecked. Long-term sequelae include scarring of the vocal cords, change in voice timbre, or even muteness if a tracheostomy is required. The aim of this study was to determine if adjuvant vaccination with the quadrivalent HPV L1 vaccine ($Gardasil^{TM}$) would decrease numbers of surgical treatments postvaccination. $\textbf {Methods:}$ A prospective pilot study following a cohort of 12 RRP patients, all of whom gave fully informed consent to participate. All patients had their papillomas typed and if they were found to have types 6 or 11, were vaccinated at the time of first surgical treatment in the hospital, according to the manufacturer’s protocols. Patients were followed up closely with 3 or 6 month follow-up visits. Standard surgical treatments were given and were not affected by whether they participated in the study. $\textbf {Results:}$ We found a >7-fold decrease in the incidence rates of papillomatosis requiring surgical intervention from the pre-vaccination period (47.44/1000 patient-months) compared to the post-vaccination period (6.71/1000 patientmonths). $\textbf {Discussion:}$ Surgical treatments for RRP are robust markers for papillomata which require treatment because of the dangers of obstruction of the airway. Despite the small size of this cohort (due to the rarity of this disease), the data suggests that adjuvant use of quadrivalent HPV L1 vaccine imparts significant benefit to this group of patients. A large multi-center randomized placebo controlled trial is required to definitively establish whether this hypothesis is true and can become the new standard of therapy