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PubMed1996

Monitoring and analysis of outcome studies.

Monitoring technology appears to be advancing at a rare that exceeds our ability to assess its effectiveness. RCTs are often poorly designed and lacks statistical power. Even high-quality RCTs may not provide inferences that can be generalized across all patient populations. Alternative methods of technology assessment, such as closed claims analysis, meta-analysis, and statistical process control, also have limitations. PORTs using a standard model of combined techniques are beginning to solve some of the more common methodological problems. The future of technology assessment relies on the ability to conduct large-scale cohort studies from routine practice settings. In terms of intraoperative monitors, this may require production of a complete and valid database of all monitored variables that can compared to a complete and valid database of all monitored variables that can be compared to a complete and valid database of appropriate outcome indicators. National standard for collection of data need to be developed. At this time, professional societies should focus more on developing guidelines for technology assessment than on guidelines for technology utilization.

Cohort Studies↗

PubMed2007

Minimally invasive parathyroidectomy using the lateral focused mini-incision technique without intraoperative parathyroid hormone monitoring.

BACKGROUND: Minimally invasive parathyroidectomy (MIP) involves scan-directed removal of a single adenoma through a 2.0-cm mini-incision without intraoperative monitoring. The aim of this study was to analyse the outcomes of MIP using such a simplified technique. METHODS: The study group comprised 500 consecutive patients undergoing MIP via a lateral mini-incision from August 2000 to September 2005. Levels of parathyroid hormone (PTH) were measured after operation solely to aid informed discharge. RESULTS: Some 97.4 per cent of patients were initially cured by MIP. Eight patients remained hypercalcaemic and a further five were normocalcaemic on the day after surgery but became hypercalcaemic again within 3 months of the procedure. Eleven of these patients were cured with subsequent re-exploration. Analysis of postoperative PTH data indicated that, at best, the use of intraoperative PTH measurement during surgery would have increased the cure rate by only a further 1 per cent. Three (0.6 per cent) of 500 patients had permanent recurrent laryngeal nerve palsy after MIP. CONCLUSION: MIP performed by the lateral focused mini-incision technique, without the use of intraoperative PTH monitoring, is a safe and effective procedure that results in outcomes equal to those of bilateral neck exploration.

Adenoma↗

PubMed1987

Intraoperative CT monitoring during stereotactic brain surgery.

This paper reports our experience in performing the entire stereotactic surgical procedure with a CT scanner, which shows that target shifting can occur as the probe approaches the target. Therefore, when sampling of small targets or specific sites within larger targets is desired. CT confirmation of the probe's position ensures that the specific area seen on CT is biopsied.

Adolescent↗

PubMed1984

Somatosensory evoked potentials during reversible spinal cord ischemia in man.

Somatosensory evoked potentials (SEPs) from peroneal nerve were recorded continuously on 13 patients undergoing extensive aortic replacement of thoracic, abdominal, or thoracico-abdominal aneurysms. During this surgical procedure, the descending aorta is completely occluded, and circulation to the spinal cord may thus be compromised, causing a risk of postoperative paraplegia. This risk may be minimized if changes in the SEP seen during intraoperative monitoring prove to correlate well with clinical outcome. Changes in the SEP observed during complete occlusion of the aorta and subsequent restoration of blood flow included: (1) progressive latency prolongation within the first 10 min of occlusion, (2) coincident and progressive amplitude depression, (3) eventual loss of the SEP, (4) rapid reversal of these changes with restoration of circulation, and (5) preservation of the lumbar response when the cephalic response became abnormal. The degree of prolongation of latency after restoration of blood flow appeared related to the duration of aortic occlusion and to the duration of SEP absence. These findings indicate that conduction through the spinal pathways that mediate the SEP is sensitive to ischemia produced by aortic occlusion. Intraoperative monitoring of SEPs as a means of reducing the neurological morbidity of extensive aortic replacement is discussed.

Adult↗

PubMed2000

Association of intraoperative transcranial doppler monitoring variables with stroke from carotid endarterectomy.

BACKGROUND AND PURPOSE: The outcomes of carotid endarterectomy (CEA) are, in addition to patient baseline characteristics, highly dependent on the safety of the surgical procedure. During the successive stages of the operation, transcranial Doppler (TCD) monitoring of the middle cerebral artery (MCA) was used to assess the association of cerebral microembolism and hemodynamic changes with stroke and stroke-related death. METHODS: By use of data pooled from 2 hospitals in the United States and the Netherlands, including 1058 patients who underwent CEA, the association of various TCD emboli and velocity variables with operative stroke and stroke-related death was evaluated by univariable and multivariable logistic regression analyses in combination with receiver operating characteristic (ROC) curve analyses. The impact of basic patient characteristics, such as age, sex, preoperative cerebral symptoms, and ipsilateral and contralateral internal carotid artery stenosis, on the prediction of operative stroke was also evaluated. RESULTS: We observed 31 patients with ischemic and 8 patients with hemorrhagic operative strokes. Four of these patients died. Emboli during dissection (odds ratio [OR] 1.5, 95% CI 0.8 to 2.9) and wound closure (OR 2.3, 95% CI 1.2 to 4.4) as well as > or =90% decrease of MCA peak systolic velocity at cross-clamping (OR 3.3, 95% CI 1.3 to 8.5) and > or =100% increase of the pulsatility index of the Doppler signal at clamp release (OR 7.1, 95% CI 1.4 to 35.7) were independently associated with stroke. The ROC area of this model was 0.69. Of the patient characteristics, only preoperative cerebral ischemia (OR 1.9, 95% CI 1.0 to 3.7) and > or =70% ipsilateral internal carotid artery stenosis (OR 0.5, 95% CI 0.2 to 0.9) were associated with stroke. Adding these patient characteristics to the model, the area under the ROC curve increased to 0.73. CONCLUSIONS: In CEA, TCD-detected microemboli during dissection and wound closure, > or =90% MCA velocity decrease at cross-clamping, and > or =100% pulsatility index increase at clamp release are associated with operative stroke. In combination with the presence of preoperative cerebral symptoms and > or =70% ipsilateral internal carotid artery stenosis, these 4 TCD monitoring variables reasonably discriminate between patients with and without operative stroke. This supports the use of TCD as a potential intraoperative monitoring modality to alter the surgical technique by enhancing a decrease of the risk of stroke during or immediately after the operation.

Aged↗

PubMed2005

Preservation of hearing in patients undergoing microsurgery for vestibular schwannoma: degree of meatal filling.

OBJECT: Preservation of hearing has become a standard goal in selected patients undergoing surgery for a vestibular schwannoma (VS). This study was aimed at analyzing the role played by filling of the internal auditory canal (IAC) as well as those played by preoperative hearing quality, and tumor size in the postoperative preservation of serviceable hearing (SH). METHODS: Three hundred eighty-six patients with VS were treated. Hearing preservation was attempted in 128 cases (33.2%) by using intraoperative monitoring and following a retrosigmoid approach. The maximal extrameatal size of the tumor, its extension within the IAC, and pre- and postoperative hearing quality, according to the Gardner-Robertson classification, were evaluated. Preservation of SH was achieved in 24.2% of the 128 patients. With respect to tumor size, SH was preserved in 39% of 77 patients harboring a tumor 15 mm wide or smaller and in 2% of 51 patients with lesions 16 mm wide or larger (p < 0.001). With regard to filling of the IAC, among 63 patients harboring a tumor 15 mm or smaller, in whom magnetic resonance images were available, SH was preserved in 52.8% of 36 patients with partial filling and in 25.9% of 27 patients with complete filling (p = 0.032). Concerning preoperative hearing quality, in the patients with tumors 15 mm or smaller, SH was preserved in 46.5% of 43 patients with Gardner-Robertson Class I hearing and 29.4% of 34 patients with Class II hearing (p = 0.126). Both tumor size and the extent of IAC filling proved statistically significant in a multivariable analysis (p < 0.001 and p = 0.026, respectively). CONCLUSIONS: Incomplete filling of the IAC and a tumor size of 15 mm or smaller are independent favorable factors in SH preservation. Excellent preoperative hearing appears to have a positive impact but does not have statistical significance. Intraoperative monitoring is useful in guiding the dissection; however, the surgeon's knowledge of topographical landmarks and meticulous surgical technique remain the essential factors of success.

Adult↗

PubMed1985

A cerebral effect of carotid sinus stimulation. Observation during intraoperative electroencephalographic monitoring.

Surgical manipulation in the region of the carotid sinus resulted in diffuse electroencephalographic slowing in two patients, despite the absence of bradycardia or hypotension. Direct observation confirmed the absence of carotid compression. The effect was abolished by infiltration of lidocaine hydrochloride into the carotid sinus area. Carotid clamping in one patient failed to produce similar electroencephalographic changes. We believe that this is the first observation of an influence of carotid sinus stimulation on human cerebral activity not attributable to reflex cardiovascular changes or complicated by the possibility of carotid compression.

Adult↗

PubMed1998

Somatosensory- and motor-evoked potential monitoring without a wake-up test during idiopathic scoliosis surgery. An accepted standard of care.

STUDY DESIGN: This was a retrospective study of 500 patients undergoing corrective surgery between 1987 and 1997 for spinal deformity caused by idiopathic scoliosis. OBJECTIVES: To report the sensitivity and specificity of somatosensory-evoked and neurogenic motor-evoked potentials monitoring and the requirements for an intraoperative wake-up test for all idiopathic scoliosis surgeries at a single institution. SUMMARY OF BACKGROUND DATA: Intraoperative monitoring is recommended for use during corrective spinal surgery. Accepted monitoring standards and requirements for an intraoperative wake-up test are still debated. METHODS: The study group consisted of 500 patients undergoing corrective surgery for idiopathic scoliosis between 1987 and 1997. All patients were monitored using somatosensory-evoked and neurogenic motor-evoked potential techniques, using a standard protocol developed at this institution. RESULTS: The false-positive rate (significant data change without postoperative neurologic deficit) was 0.014% (n = 7). The true-positive rate (degradation of data that met warning criteria, with a corresponding postoperative neurologic deficit) was 0.004% (n = 2). No false-negative results (normal data during with a postoperative neurologic deficit) were seen. The sensitivity of combined somatosensory-evoked and neurogenic motor-evoked potential data in predicting neurologic status was 98.6%, and the specificity of normal data predicting normal findings in a neurologic examination was 100%. CONCLUSION: Combined somatosensory-evoked and neurogenic motor-evoked potentials monitoring during idiopathic scoliosis surgery represents a standard of care that obviates the need for an intraoperative wake-up test when reliable data are obtained and maintained.

Adolescent↗

PubMed1996

Intraoperative multiplane vs biplane transesophageal echocardiography for the assessment of cardiac surgery.

This study was undertaken to test whether multiplane transesophageal echocardiography (TEE) offers advantages in comparison with biplane TEE in the intraoperative monitoring during cardiac surgery. A diagnostic multiplane TEE was performed in 400 patients in the immediate preoperative and postoperative periods. We systematically acquired cardiac images from the gastric fundus, lower esophagus, and upper esophagus; complete views of the descending aorta were also recorded. Usefulness of the different views in providing essential additional clinical information compared with exclusive transverse (0 to 20 degrees) and longitudinal (70 to 110 degrees) planes of the biplane TTE was assessed assuming that with manipulation of a biplane probe, a 20 degrees are could be added to the conventional horizontal and vertical planes. A high success rate of each view was demonstrated; anatomy and pathologic condition were best visualized in oblique planes. The method proved to be particularly useful in the preoperative and postoperative phases of aortic dissection (27 cases), aortic (65 cases) and mitral (35 cases) valve replacement, mitral valve repair (38 cases), left ventricular aneurysmectomy (25 cases), bleeding from proximal suture of an aortic heterograft (2 cases), and positioning of left ventricular hemopump (2 cases). Additional regional wall motion abnormalities of the right (four cases) and left ventricle (six cases) not appreciated in 0 to 20 degrees or 70 to 110 degrees planes were detected. Multiplane TEE is a useful clinical tool during intraoperative monitoring of cardiac surgery. Most structures of the heart and great vessels lie on oblique planes, while other views are optimized with the aid of slight angle corrections. This method improves the evaluation of anatomy and pathologic condition of the heart and great vessels, of native and prosthetic valves, and of left and right ventricular function.

Adolescent↗

PubMed1992

Evoked potential monitoring in carotid surgery: a review of 994 cases.

Intraoperative monitoring of brain function is desirable in carotid artery surgery to detect possible complications, but the monitoring methods must be simple to perform, sensitive, and reliable. Median nerve somatosensory evoked potential (SEP) monitoring fulfills these criteria. Between 1985 and 1990, we performed 994 operations of the carotid artery with SEP monitoring. In 92% of the cases, we were able to obtain viable SEP tracings. In seven cases, irreversible SEP loss was followed by a new neurologic deficit. In one case only, neurologic complications ensued without SEP loss. Although immediate intraoperative therapeutic options are limited, the monitoring enhances patient security by allowing intraoperative detection and postoperative analysis of complications. SEP monitoring appears to be at least as effective as conventional EEG monitoring. The viability, sensitivity, and reliability of newer methods, such as modified spectral EEG analysis, must be measured by this established procedure.

Carotid Arteries↗

PubMed2002

[Intraoperative parathyroid hormone monitoring in neck exploration for renal hyperparathyroidism?].

INTRODUCTION: In operations for renal hyperparathyroidism the value of intraoperative parathormone monitoring was investigated. PATIENTS AND METHODS: Intraoperative intact parathyroid hormone levels were determined (PTH Quick assay) in 40 patients undergoing first cervical exploration and in two patients with graft-dependent recurrence of renal hyperparathyroidism. RESULTS: In 33 patients, total parathyroidectomy with autotransplantation was carried out. The median parathormone levels decreased from 652 pg/ml to 120 pg/ml (19% of initial level) 5 min after total parathyroidectomy. In seven patients, fewer than 4 parathyroid glands each were identified during cervical exploration and "total parathyroidectomy (?)" without autotransplantation was performed. Intraoperatively median parathormone level decreased from 1193 pg/ml to 116 pg/ml (10% of initial level). In one of these seven patients, hyperparathyroidism persisted due to an ectopic fourth gland within the carotid sheath. In two of these patients, hypoparathyroidism occurred and a delayed autotransplantation of cryopreserved parathyroid tissue was carried out. On the first day after total parathyroidectomy with autotransplantation and "total parathyroidectomy (?)", median levels of intact parathyroid hormone were 1.9 pg/ml and 82.5 pg/ml, respectively. CONCLUSION: Intraoperative monitoring is not useful in first cervical exploration for renal hyperparathyroidism because it cannot predict complete resection of parathyroid tissue. The parathormone level on the first postoperative day allows precise evaluation of the efficacy of the surgical procedure.

Chronic Kidney Disease-Mineral and Bone Disorder↗

PubMed2006

The application of vestibular-evoked myogenic potentials in otoneurosurgery.

OBJECTIVE: To evaluate the applicability of vestibular-evoked myogenic potentials (VEMPs) in the diagnostics, intraoperative monitoring, and postoperative follow-up of patients in otoneurosurgery. STUDY DESIGN: A prospective study of patients who underwent either cochlear implantation (CI, n = 18) or were diagnosed with an acoustic neuroma (AN, n = 9) or with neuro(micro)vascular compression of the VIIIth nerve (NVC, n = 27) in the period 2002 to 2004. The follow-up was 1 year for all patients. SETTING: A tertiary-referral unit. RESULTS: VEMPs could be recorded in 64% of all patients before CI and in 22% after surgery. The patients with AN had normal VEMPs in 22% of all cases when first diagnosed. Normal VEMPs were found in 37% of those patients with NVC. From the 5 AN patients who had to be operated, only 1 had intact VEMPs after surgery. In contrast, after microvascular decompression all patients (4) had normal VEMPs. CONCLUSIONS: VEMPs are helpful in diagnosing patients with vertigo to better identify saccular defects. They are highly sensitive in the early diagnosis of retrocochlear lesions. SIGNIFICANCE: VEMPs can help to reliably identify patients with a retrocochlerar lesion at an early stage and can be used in intraoperative, neurophysiological monitoring. EBM RATING: C-4.

Adolescent↗

PubMed2005

Pulse total-hemoglobinometer provides accurate noninvasive monitoring.

OBJECTIVE: Rapid noninvasive measurement of total hemoglobin would be extremely useful for various clinical situations. This study determined the clinical accuracy and utility for a pulse total-hemoglobinometer using four wavelengths: 660 nm (reduced hemoglobin), 805 nm (isosbestic point), 940 nm (oxygenated hemoglobin), and 1300 nm (water density). DESIGN: Clinical trial. SETTING: University school of medicine. PATIENTS: Patients were 122 individuals (age, 18-82 yrs; 49.4 +/- 16.0 yrs [mean +/- SD]), including 71 healthy volunteers, 24 patients undergoing surgery, and 27 patients undergoing hemodialysis. INTERVENTIONS: The hemoglobinometer probe, which simultaneously indicated peripheral oxygen saturation, pulse rate, and hemoglobin, was placed on the fingertip similarly to a regular pulse oximeter. The hemoglobin values were compared with those obtained by the co-oximeter or the sodium lauryl sulfate-methemoglobin method. Those hemoglobin values were assigned to either the training set or the validation set for statistical evaluation. MEASUREMENTS AND MAIN RESULTS: Multiple regression analysis including the ratio of the pulsatile optical density (phi(ij)) derived from the four wavelengths and other factors demonstrated that the mean value of the normalized pulse wave obtained from the photodiode at 805 nm (DC805) and the ratios of DC940 and DC1300 (DC940/DC1300) were the pivotal factors in the hemoglobinometer's increased accuracy in the clinically useful range. The coefficient of determination between both methods was r2 = .81 (p < .0001) in the training set and r2 = .75 (p < .0001) in the validation set. When the cutoff value of anemia was set at 10 g/dL, and anemia was defined as <10 g/dL, the respective sensitivity and specificity of hemoglobinometer values to detect anemia in intraoperative patients were 84.3% and 84.6% (n = 20). CONCLUSIONS: The data demonstrated the necessity for consideration of light scattering in red blood cells for pulse-spectrophotometric hemoglobin measurement. This was accomplished with additional factors, such as DC805 and DC940/DC1300. With these improvements, the pulse hemoglobinometer provided noninvasive, clinically acceptable measurement of hemoglobin. The pulse hemoglobinometer is a versatile tool that might be useful for routine health checkups of neonates and young children, intraoperative monitoring of bleeding, and emergency care.

Adult↗

PubMed2000

Long-term results of facial nerve function after acoustic neuroma surgery--clinical benefit of intraoperative facial nerve monitoring.

The goals in acoustic neuroma surgery should be the total removal of tumor and preservation of facial nerve function. The aim of this study is to establish the benefit of intraoperative monitoring for the total removal of tumor and the long-term result of facial nerve function after surgery. Thirty-two patients, who were operated on between 1985 and 1995, were divided into two groups: an unmonitored (n = 14) and a monitored (n = 18) group. Postoperative facial nerve function was followed by a modified House-Brackmann grading (H&B) immediately (initial), and at 1 week, 1 month, 6 months and 1 year (final) after surgery. A final H&B grade of I/II was taken as the preservation of facial nerve function. Facial nerves were preserved anatomically in all cases. A total tumor removal was accomplished in 21% of unmonitored group and in 72% of monitored group patients. Final H&B (I/II) was achieved in 36% of unmonitored group and in 83% of monitored group patients. All 9 patients with initial H&B (I/II) had final H&B (I/II). None of 5 patients with initial H&B (V/VI) had final H&B (I/II). However, 3 patients showed late-recovery of facial weakness at 6 months after surgery. Eighteen patients with initial H&B (III/IV) had various degrees of final facial weakness. Among them, 12 patients showed early-recovery at 1 month after surgery. In conclusion, facial nerve monitoring during acoustic neuroma surgery is useful to improve the rates of total removal of tumor and functional preservation of facial nerve. We can expect final degrees of facial weakness by initial degrees in conjunction with sequential changes in postoperative facial weakness.

Action Potentials↗

PubMed1988

Intraoperative EEG monitoring: (I). Parametric representation of processed EEG during anesthesia.

One of the most common techniques of EEG monitoring during operations is to produce a three dimensional image by displaying the frequency distributions with respect to time as in compressed spectral array (CSA) and density-modulated spectral array (DSA). In order to characterize these images by numerical parameters, we defined two parameters; the percent spectral edge frequency as the frequency at which the one-sided-power sum reaches the designated percentage of the total; and the mean frequency as the power-weighted mean within the interval that includes a dominant spectrum in the frequency distribution. These parameters were superimposed on displays to characterize EEG changes, and they proved to be a very powerful tool to quantitate variations in data among anesthetic techniques and thus efficiently control the depth and duration of anesthesia. We report a number of actual cases.

Adult↗

PubMed1977

Monitoring of intraoperative heparinization and blood loss following cardiopulmonary bypass surgery.

Two protocols of heparin management during cardiopulmonary bypass were compared to assess the role of the activated clotting time (ACT) in relation to postoperative blood loss. The study was divided into two groups: Group I, the control group, in which 3 mg. of heparin per kilogram was given as the initial dose and maintained at a dose of 1.5 mg. per kilogram every 45 minutes during cardiopulmonary bypass, and Group II, in which the initail dose of heparin was 2 mg. per kilogram and additional dosage were based upon the ACT. We found a striking decrease in postoperative blood loss as well as a decrease in the amount of heparin administered during cardiopulmonary during cardiopulmonary bypass in Group II patients. In addition, less protamine was required to neutralize the heparin in the second group after bypass. Thus, when patients are given too much heparin, as in our control group, the effectiveness of protamine is decreased. We would like to stress the value of the ACT in controlling heparin administration as well as postoperative blood loss in cardiopulmonary bypass surgery.

Blood Coagulation↗

PubMed1995

[Changes with age in EEG during anesthesia].

The number of older persons who have to undergo surgical procedures is steadily growing. For these patients the risks of anaesthesia are often increased because of their past medical history and their restricted physiological resources. Apart from parameters of the cardiovascular system, the electroencephalogram (EEG) represents a supplementary method for intraoperative monitoring, because cerebral alterations caused by anaesthetics or narcotics are directly reflected in the EEG. In routinely conducted registrations of the EEG in the operating theatre it appeared that the EEG of older persons differed from the EEG of younger patients. The aim of the present study was to further investigate the effect of patients' age on the EEG during anaesthesia. METHODS. Three data sets from different EEG registrations were analysed. The first data set consisted of inductions of anaesthesia with 7 mg/kg body weight thiopental in 43 patients from 17 to 80 years of age (mean 53.6 +/- 16.7 years) using derivations C3-P3 and Cz-A1. The second data set included 69 EEG registrations of general anaesthesia induced with barbiturates and maintained with enflurane in patients from 16 to 83 years (mean 51.4 +/- 17.7 years). The third data set comprised inductions of anaesthesia with 2 mg/kg body weight propofol. EEGs of the second and third data set were recorded with the EEG monitor 'Narkograph' using derivation C3-P3 and derivations C3-P3/C4-P4, respectively. Classification of the EEGs was performed according to the proposals of Kugler [12]. The basis for the statistical analysis of all data sets was formed by parameters from the power spectra of the EEG recordings. RESULTS. The data from inductions of anaesthesia with thiopental and propofol showed EEG patterns from alpha-EEG to burst suppression activity, whereby periods with burst suppressions could more often be observed in the EEG of older people. Under thiopental burst suppression activity occurred in 20% of patients up to 50 years, in 47% of those between 50 and 70 years and in 89% over 70 years. The corresponding figures for propofol were 0%, 5% and 54%, respectively. Figure 2 depicts the correlation between age and power for the thiopental data. The power decreases with increasing age of the patients. This result led to further investigations of the effect of patients' age on the power in different EEG stages. Of special interest were deep stages of anaesthesia, because especially in these stages visual inspections revealed smaller amplitudes of the EEG signal for older patients than for younger persons. Figure 3 shows the power in the delta frequency band in deep stages of barbiturate-induced enflurane anaesthesia for patients of different age groups. The power in the delta frequency band distinctly decreases for geriatric patients. The same effect could be observed for the propofol data (Fig. 4). CONCLUSIONS. The EEG represents an important method for effective intraoperative monitoring and contributes to an individually adjusted course of anaesthesia, especially for geriatric patients. In these patients, clinical signs such as parameters of the cardiovascular system, which are usually used to judge the depth of anaesthesia, are often altered by the patient's past medical history or by drugs. Furthermore, geriatric patients show a reduced need for narcotic agents. However, the variation of the required dosage is greater in older than in younger persons. The results of the present study show that with regard to an automatic classification of the EEG during anaesthesia, alterations of the EEG with age have to be taken into account.

Adolescent↗

PubMed1994

Intraoperative facial nerve monitoring in chronic ear surgery: a resident training experience.

Intraoperative facial nerve monitoring has been accepted as a valuable adjunctive modality to be employed in a variety of neurotologic and skull base surgical procedures. However, the role that electrical or mechanical stimulation assessment plays in chronic ear surgery is less well defined, especially in a residency training program. In this study, 250 consecutive operative cases of chronic otitis media, with and without cholesteatoma were monitored with the Xomed-Treace Nerve Integrity Monitor, NIM-2 system. Data regarding electrophysiologic monitoring parameters; electromechanical artifact, including system failure; and surgical outcome were analyzed. Although not a substitute for anatomic identification of the facial nerve, intraoperative monitoring provides an additional technique to optimize resident surgical education.

Adolescent↗