Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P102

Otology/Neurotology

P102
Otolaryngology-Head and Neck Surgery 163(1S)
Presentation schedule is subject to change. The Official Program Abstracts supplement does not reflect changes made after August 10, 2020.
purpose of this study was to identify the incidence of preopas a marker of aerosolization. Photoanalysis was performed
erative vestibular weakness in cochlear implant candidates
with the ImageJ processing program.
and to use the information to determine the preferred side of
Results: No splatter was observed during transcanal otoimplantation.
logic procedures. As expected, mastoidectomy provided a draMethods: A total of 132 patients who underwent preoperamatic and widespread pattern of aerosolization.
tive videonystagmography (VNG) prior to cochlear implantaConclusions: The risk of spreading particulate material durtion between 2017 and 2019 were identified. Sixty-seven
ing otologic procedures is minimal in the absence of highpatients had either asymmetric caloric weakness (38, or
speed drill use. Findings suggest routine transcanal procedures
28.8%) or bilateral vestibular hypofunction (29, or 22.0%)
likely pose low aerosolization risk.
prior to implantation. Twenty-five patients had both an audiologic and vestibular asymmetry. The weaker hearing ear corMyosin Mutations and Sudden Sensorineural
responded to the weaker vestibular side in 17 of 25 patients
Hearing Loss: Results of Whole Exome
(68%). Thirteen patients had vestibular asymmetry with equal
Sequencing
hearing on both sides.
Madeleine Drusin, MD (Presenter); Rahul Kamal Sharma;
Results: Postoperatively, only 11.0% (15/132) of all the
Joseph Hostyk; Evan H. Baugh; David Goldstein;
patients had long-term dizziness and/or balance (vestibular
Ana H. Kim, MD
symptoms) following cochlear implantation. Patients who had
Objectives: Idiopathic sudden sensorineural hearing loss
caloric weakness preoperatively were more likely to develop
(ISSNHL) affects 66,000 patients per year in the United States
vestibular symptoms postoperatively as compared with
without an identifiable etiology or predictor of steroid effipatients with normal preoperative vestibular function (17.9%
cacy. Mutations in certain genes have been associated with
vs 4.6%, P < .02). Implantation of the weaker or stronger vesprogressive hearing loss; however, genetic mutations associtibular ear did not change the rate of postoperative vestibular
ated with ISSNHL have not been identified.
symptoms (16.0% vs 7.7%, P = .47).
Methods: A cohort study was conducted of adults >18 years
Conclusions: Preoperative caloric weakness is prevalent in
old presenting with ISSNHL at a tertiary academic medical
cochlear implant candidates and may be a predictor of postopcenter between March 2016 and December 2019. Wholeerative dizziness. Such information could be used in counselexome sequencing (WES) was conducted using Genome
ing of the postoperative course. In cases in which the hearing
Analysis Toolkit best practices. An initial diagnostic screen
thresholds in both ears are similar, caloric testing can help
was conducted across all genes with no specific targets to idenguide the side of implantation. Further studies are needed to
tify variants. Variants were crossed-referenced with 92 known
evaluate the utility of VNG in medical decision making in
hearing loss-associated genes. A variety of models were
cochlear implantation.
employed placing multiple different allele frequency filters.
Results: Twenty-nine patients with ISSNHL were screened
Modeling of Aerosolization Risk During
using WES. The average age of patients was 53 ± 17.1 years,
Common Otologic Procedures in the Era of
and most patients were Caucasian (62%) and male (55%). The
COVID-19
mean pure tone average was 64.8 ± 31.3 dB for the affected
Jacob C. Lucas, MD (Presenter); Helena Wichova, MD;
ear. Using a 0.1% allele frequency screen, 12 (41%) cases had
Christopher Neal, PhD; Hinrich Staecker, MD PhD; Jim Lin, MD
a mutation in any of the 9 selected myosin genes. When
Objectives: (1) Synthesize data available on aersolization and
restricted to singletons (allele frequency = 0%), 21% (n = 6) of
particulate spread during otologic surgery. (2) Demonstrate the
cases had qualifying variants, whereas only 3.8% (n = 481) of
relative risk of aerosolization of transcanal and transmastoid
12,577 healthy controls carried qualifying variants (P < .01).
procedures. (3) Implement common sense protocols for otologic
Most mutations (80%) were missense mutations. Of the novel
procedures, in both the operating room and clinical setting.
mutations, 1 was a frameshift mutation, 2 were stop-gained
Methods: Three formalin-fixed cadaveric temporal bone
function, and 3 were missense mutations.
specimens were used to simulate common otologic proceConclusions: Myosin mutations may be associated with
dures. An operating room with simulated otologic surgical
ISSNHL. However, larger population screening is needed to
conditions, including a standard surgical microscope, was
confirm the association of myosin mutation with ISSNHL as
used. Previously harvested temporal bones were infused with
well as degree of steroid responsiveness.
fluorescein solution through the tegmen tympani and mastoideum via a middle fossa approach. Four conditions were simNarcotic Usage and Pain Control for Otologic
ulated: suctioning the middle ear space through (1) a
Procedures in the Postoperative Period
myringotomy and (2) a subtotal perforation, (3) placement
Matthew J. Stewart (Presenter); Eric Mastrolonardo; Joann
and then suctioning through a pressure equalization tube, and
Butkus; Rebecca C. Chiffer, MD; Thomas O. Willcox, MD
(4) performing a complete mastoidectomy. The area and pattern of spread were measured using a backdrop with preObjectives: There are currently no pain management guidemarked concentric and 4-quadrant measurements. Blue light
lines for patients who receive otologic surgery. With increasing
illumination was then used to visualize the fluorescein splatter
concern for opioid misuse, we sought to survey our patients on

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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