A subgroup of patients with CPA and IAC masses who present with radiologic findings diagnostic of VS will have an alternative histopathologic diagnosis. Optimal radiologic imaging and experienced interpretation can improve diagnostic accuracy. The most common tumors that mimic VS despite ideal radiologic imaging are facial schwannomas, meningiomas, and hemangiomas.

The distribution of cochlin and its associated basement membrane proteins (collagen IV, collagen II, laminin-β2, and nidogen-1) was evaluated in the vestibular endorgans of subjects with Meniere’s disease and compared to normal specimens. Cochlin mRNA expression in vestibular endorgans from Meniere’s disease specimens was also investigated. Specimens were obtained from patients with Meniere’s disease who underwent ablative labyrinthectomy. Control specimens were obtained from both autopsy specimens with documented normal audiovestibular function and from patients undergoing labyrinthectomy for acoustic neuroma excision. In the normal control specimens, cochlin immunoreactivity was found evenly distributed in the stroma of the cristae ampullaris and maculae of the utricle. In Meniere’s specimens, cochlin immunoreactivity was markedly increased, which was associated with an increase in cochlin mRNA expression on real-time RT-PCR. Collagen IV and laminin-β2 immunoreactivity was significantly decreased in Meniere’s specimens. Nidogen-1 and collagen II immunoreactivity were unchanged in Meniere’s specimens when compared with normal specimens. Cochlin upregulation has been implicated in the hereditary audiovestibulopathy, DFNA9. The increased expression of cochlin and decreased expression of collagen IV and laminin in Meniere’s disease are suggestive that overexpression of cochlin may contribute to the dysfunctional inner ear homeostasis seen in Meniere’s disease.

Objectives 1. Evaluate the otolithic membrane in patients with endolymphatic hydrops (EH) and vestibular drop attacks (VDA) undergoing ablative labyrinthectomy. 2. Correlate intraoperative findings to archival temporal bone specimens of patients with EH. Study Design Retrospective case review Setting Tertiary referral center Specimen source 1. Patients undergoing labyrinthectomy for incapacitating Meniere’s disease (MD), delayed EH, VDA, or acoustic neuroma (AN) between 2004 and 2011. 2. Archival temporal bone specimens of patients with MD. Interventions Ablative labyrinthectomy Main outcome measures Examination of the utricular otolithic membrane. Results The otolithic membrane of the utricle was evaluated intraoperatively in 28 patients undergoing labyrinthectomy. 7 (25%) had a history of VDA, 6 (21%) had delayed EH, 9 (32%) had MD, and 6 (21%) had AN. All patients with VDA showed evidence of a disrupted utricular otolithic membrane, whereas only 50% and 56% of patients with delayed EH and MD respectively, demonstrated otolithic membrane disruption (p = 0.051). None of the patients with AN showed otolithic membrane disruption (p = 0.004). The mean thickness of the otolithic membrane in 5 archival temporal bone MD specimens was 11.45 micrometers versus 38 micrometers in normal specimens (p=0.001). Conclusions The otolithic membrane is consistently damaged in patients with VDA. In addition, there is a significantly higher incidence of otolithic membrane injury in patients with MD and delayed EH compared to patients without hydrops, suggesting that the underlying pathophysiology in VDA results from injury to the otolithic membrane of the saccule and utricle, resulting in free-floating otoliths and atrophy.

Objectives/Hypothesis Evaluate technical success, tolerability, and safety of lidocaine iontophoresis and tympanostomy tube placement for children in an office setting. Study Design Prospective individual cohort study. Methods This prospective multicenter study evaluated in‐office tube placement in children ages 6 months through 12 years of age. Anesthesia was achieved via lidocaine/epinephrine iontophoresis. Tube placement was conducted using an integrated and automated myringotomy and tube delivery system. Anxiolytics, sedation, and papoose board were not used. Technical success and safety were evaluated. Patients 5 to 12 years old self‐reported tube placement pain using the Faces Pain Scale–Revised (FPS‐R) instrument, which ranges from 0 (no pain) to 10 (very much pain). Results Children were enrolled into three cohorts with 68, 47, and 222 children in the Operating Room (OR) Lead‐In, Office Lead‐In, and Pivotal cohorts, respectively. In the Pivotal cohort, there were 120 and 102 children in the <5 and 5‐ to 12‐year‐old age groups, respectively, with a mean age of 2.3 and 7.6 years, respectively. Bilateral tube placement was indicated for 94.2% of children <5 and 88.2% of children 5 to 12 years old. Tubes were successfully placed in all indicated ears in 85.8% (103/120) of children <5 and 89.2% (91/102) of children 5 to 12 years old. Mean FPS‐R score was 3.30 (standard deviation [SD] = 3.39) for tube placement and 1.69 (SD = 2.43) at 5 minutes postprocedure. There were no serious adverse events. Nonserious adverse events occurred at rates similar to standard tympanostomy procedures. Conclusions In‐office tube placement in selected patients can be successfully achieved without requiring sedatives, anxiolytics, or papoose restraints via lidocaine iontophoresis local anesthesia and an automated myringotomy and tube delivery system. Level of Evidence 2b Laryngoscope, 130:S1–S9, 2020