Tophaceous gout of the middle ear is a rare occurrence that presents as a granular white-colored mass. It is frequently misdiagnosed as cholesteatoma or tympanosclerosis in patients who otherwise may not manifest any clinical or biochemical signs of gout. While uncommon, it can lead to clinically significant disease such as conductive hearing loss. The present report describes 2 cases of middle ear gouty tophi initially mistaken for another entity. Both patients underwent surgery, and the diagnosis of gout was revealed after final histopathological analysis. A review of the literature is also presented.

Functional neuroimaging can provide insight into the neurobiological factors that contribute to the variations in individual hearing outcomes following cochlear implantation. To date, measuring neural activity within the auditory cortex of cochlear implant (CI) recipients has been challenging, primarily because the use of traditional neuroimaging techniques is limited in people with CIs. Functional near-infrared spectroscopy (fNIRS) is an emerging technology that offers benefits in this population because it is non-invasive, compatible with CI devices, and not subject to electrical artifacts. However, there are important considerations to be made when using fNIRS to maximize the signal to noise ratio and to best identify meaningful cortical responses. This review considers these issues, the current data, and future directions for using fNIRS as a clinical application in individuals with CIs. This article is part of a Special Issue entitled .

Objective

Otogenic brain abscess is a well-recognized clinical condition that describes brain abscess secondary to an ear infection or mastoiditis. Current evidence remains limited on risk factors associated with mortality as most data are from case series. We aimed to 1) report the mortality rate among patients who did and did not receive mastoidectomy 2) identify factors associated with inpatient mortality.

Study design

Retrospective cohort study.

Setting

Multi-institutional.

Patients

We identified a cohort of patients for years 2008 to 2014 who in their inpatient hospitalization carried the diagnoses of both brain abscess and infectious ear disease.

Interventions

Inpatient neurotology and neurosurgical procedures.

Main outcome measures

A multivariable logistics regression model was built to identify the factors associated with inpatient mortality.

Results

The final analysis included 252 patients, of which 84 (33.3%) underwent mastoidectomy. The rate of inpatient morbidity and mortality were 17.5% and 4.0%, respectively. The rate of mortality in patients without mastoidectomy versus those with mastoidectomy was 4.2% versus 3.6%, respectively (p > 0.99). The odds of inpatient mortality were significantly increased for every 10-year increase in age (odds ratio [OR] 2.73, 95% confidence interval [CI]: 1.39-7.01, p = 0.011) and for Black compared to White patients (OR: 45.81, 95% CI: 4.56-890.92, p = 0.003).

Conclusion

Older age and Black race were associated with increased odds of inpatient mortality and there were no significant differences in mortality between mastoidectomy cohorts. This research serves to generate further hypotheses for larger observational studies to investigate the association between sociodemographic factors and surgical variables with outcomes among this surgical population.