Publication date 24-09-2024
No abstract available
Pubmed PDF WebArriaga, Moises
Publication date 01-12-2024
No abstract available
Pubmed PDF WebSlattery, William H. III; Andalibi, Ali; Angeli, Simon; Babu, Seilesh; Bolt, Kristina; Britt, William; Buckey, Jay C. Jr; Butman, John; Chandrasekhar, Sujana; Fernandez, Katharine; Haynes, David; Hertzano, Ronna; Hirose, Keiko; Hoa, Michael; Hodge, Sarah; Howard, Marissa; Lalwani, Anil; Liotta, Lance; Luchini, Alessandra; de Oliveira Penido, Norma; Parham, Kourosh; Plontke, Stefan; Quesnel, Alicia; Rauch, Steven Douglas; Saunders, James; Schlingensiepen, Reimar; Schwartz, Seth; Stewart, Douglas R.; Vambutas, Andrea; Westerberg, Brian; Andresen, Nick
Publication date 28-10-2024
No abstract available
Pubmed PDF WebLaredo, Jonathan; Torres-Small, Sofia; Wu, Lin; Makishima, Tomoko; Richard, Celine
Publication date 25-10-2024
Introduction Sickle cell disease (SCD) often leads to sensorineural hearing loss due to vaso-occlusive events in the cochlear vasculature. Although the vestibule and cochlea share a blood supply, information on vestibulopathy in SCD is limited. This systematic review aims to consolidate current knowledge on vestibular dysfunction in SCD patients.
Methods This study, registered on PROSPERO, involved a thorough electronic search using MEDLINE-Ovid, Embase, Google Scholar, The Cochrane Library, and Scopus databases from inception to December 2023. Data extraction adhered to PRISMA guidelines. Authors independently assessed bias and evidence quality using NIH Study Quality Assessment tools. Inclusion criteria covered articles mentioning vestibular symptoms in SCD patients, whereas exclusion criteria comprised non-English articles and vestibular symptoms limited to treatment side effects.
Results Out of 2,495 studies, only 12 met the criteria. Among SCD patients undergoing head imaging, 19% reported inner ear complaints, and 70% experienced dizziness/imbalance. In a group of SCD children, there was a significant relationship between endothelial dysfunction and vertigo duration. The recommended imaging sequence was T1-weighted thin-section temporal bone MRIs, which revealed abnormal findings even without clinical symptoms. Imaging showed labyrinthine hemorrhage and labyrinthitis ossificans, mostly unilateral. Vestibular symptoms emerged with older age, suggesting cortical compensation kept most subjects asymptomatic. In asymptomatic adult SCD patients, there was no significant difference compared with controls in tracking test batteries and positional tests; however, saccadic latency was longer in SCD patients.
Conclusion The existing data on vestibulopathy in SCD were limited and often of poor quality. Although a connection between SCD and vestibular symptoms was noted, information on treatment approaches was scant. Further research in this area could contribute to the early diagnosis of vestibular dysfunction, potentially enhancing outcomes for SCD patients.
Neukam, Jonathan D.; Kunnath, Ansley J.; Patro, Ankita; Gifford, René H.; Haynes, David S.; Moberly, Aaron C.; Tamati, Terrin N.
Publication date 01-12-2024
Introduction Cochlear implants (CIs) provide access to sound and help mitigate the negative effects of hearing loss. As a field, we are successfully implanting more adults with greater amounts of residual hearing than ever before. Despite this, utilization remains low, which is thought to arise from barriers that are both intrinsic and extrinsic. A considerable body of literature has been published in the last 5 years on barriers to adult CI uptake, and understanding these barriers is critical to improving access and utilization. This scoping review aims to summarize the existing literature and provide a guide to understanding barriers to adult CI uptake.
Methods Inclusion criteria were limited to peer-reviewed articles involving adults, written in English, and accessible with a university library subscription. A cutoff of 20 years was used to limit the search. Barriers uncovered in this review were categorized into an ecological framework.
Results The initial search revealed 2,315 items after duplicates were removed. One hundred thirty-one articles were reviewed under full-text, and 68 articles met the inclusion criteria.
Discussion Race, ethnicity, and reimbursement are policy and structural barriers. Public awareness and education are societal barriers. Referral and geographical challenges are forms of organizational barriers. Living context and professional support are interpersonal barriers. At the individual level, sound quality, uncertainty of outcome, surgery, loss of residual hearing, and irreversibility are all barriers to CI uptake. By organizing barriers into an ecological framework, targeted interventions can be used to overcome such barriers.
Lee, Lawrance; Islam, Albina S.; Sterlin, Lauren; Coelho, Daniel H.
Publication date 21-10-2024
Background The gold-standard assessment of asymmetric sensorineural hearing loss (ASNHL) is contrast-enhanced MRI. Although rates of identifying a vestibular schwannoma are low (<5%), it is generally accepted as cost-effective. Yet, the impact of incidentalomas is rarely considered. This study aims to characterize the incidence of incidentalomas in the workup of ASNHL and quantify the associated socioeconomic burden.
Study Design Retrospective cohort study.
Setting Single academic institution in a midsized city in the United States.
Methods Radiology records were queried for MRIs ordered for ASNHL between January 2012 and November 2022. Results were characterized as “group 1: normal,” “group 2: abnormal read/normal variant,” “group 3: abnormal—likely cause of ASNHL,” or “group 4: abnormal—follow-up needed.” Subsequent costs of workup for group 4 were estimated using Medicare Physician Fee Schedule for Medicare costs, US Congressional Budgeting Office data for private insurer costs, and USC-Brookings Schaeffer Initiative for Health Policy estimates for uninsured individuals.
Results Six hundred patients met the inclusion criteria. Eighteen (3.0%) were categorized in group 3, whereas 40 (6.7%) were categorized in group 4. Of these patients, 7.5% (n = 3) had interventions to manage their incidental findings. Estimated per patient cost for further workup of incidental findings amounted to approximately $744, $1,534, and $2,260 for Medicare, private insurance, and uninsured costs, respectively.
Conclusion Incidentalomas occur over twice as often as retrocochlear pathologies responsible for ASNHL. Although the number of patients requiring treatment for incidentaloma is low, the economic impact is not insubstantial and should be considered for both individual patients and health system payers.
Terhaar, Samantha; Patel, Dhruv; Fung, Ethan; Mansour, Febronia; Wallace, Josh F.; Corsten, Martin; McDonald, James Ted; Johnson-Obaseki, Stephanie; Quimby, Alexandra E.
Publication date 21-10-2024
Objective Estimate the prevalence of hearing loss and hearing assistance device use among older adults in the United States, and assess for associations with select social determinants of health (SDOH).
Study Design Cross-sectional US population-based study using National Health and Nutrition Examination Survey (NHANES) 2017–March 2020 (pre-pandemic) data.
Setting Non-institutionalized civilian adult US population.
Methods US adults aged ≥70 years who completed NHANES audiometry exams were included. Sample weights were applied to provide nationally representative prevalence estimates of hearing loss and hearing assistance device use. Logistic regression analyses assessed associations between SDOH and both hearing loss and hearing assistance device use.
Results The overall prevalence of hearing loss was 73.7%. Among those with nonprofound hearing loss, the prevalence of hearing assistance device use was 31.3%. Older individuals (odds ratio OR, 6.3 3.668–10.694 comparing ages 80+ versus 70–74 yr) and with lower education (OR, 3.8 1.455–9.766 comparing
Johns, J. Dixon; Adadey, Samuel Mawuli; Strepay, Dillon; Olszewski, Rafal; Hoa, Michael
Publication date 16-10-2024
Hypothesis Hearing instability in Slc26a4-insufficiency mice may be due to differential expression of genes related to ion homeostasis and activated macrophages.
Background Hearing instability (HI) disorders, defined by either hearing fluctuation or sudden loss, remain incompletely understood. Recent studies have described a Slc26a4 (pendrin)-insufficiency mouse model (DE17.5) that offers a genetically driven model for HI, although deep audiometric and immunohistologic phenotyping of this model remains poorly characterized.
Methods Homozygous DE17.5 mice with (F) and without (NF) HI were delineated by serial auditory brainstem responses (ABR) between postnatal days 30 and 60 and compared with adult phenotypically wild-type Slc26a4-heterozygous controls without evidence of HI (Het). HI was defined as a change in threshold of at least 15 dB in at least two frequencies or at least 20 dB in at least one frequency from the previous week. Stria vascularis (SV) cell type–specific gene expression, endolymphatic hydrops (EH), endocochlear potential (EP), and macrophage activation were analyzed and compared between the cohorts.
Results F mice demonstrated significant reductions in the expression of cell type–specific genes related to ion homeostasis and increased macrophage activation within the SV compared with NF and Het cohorts. Both F and NF DE17.5 homozygous mice demonstrated reductions in EP and increased EH compared with the Het cohort.
Conclusions Deep phenotyping of DE17.5 mice demonstrates changes in EP and EH compared with control; however, the HI phenotype was associated with differential ion homeostasis gene expression and increased macrophage activation in the SV. This provides potential further insights into the underlying pathogenesis and possible immunologic contributions of HI in humans.
Macielak, Robert J.; Richard, Celine; Malhotra, Prashant S.; Adunka, Oliver F.; Findlen, Ursula M.
Publication date 25-09-2024
Objective To assess the usage rate of pediatric patients undergoing cochlear implantation (CI) for single-sided deafness (SSD).
Study Design Retrospective cohort study.
Setting Tertiary care pediatric referral center.
Patients Pediatric patients who underwent CI for SSD.
Interventions CI with requisite audiometric follow-up.
Main Outcome Measures Device use and audiometric testing.
Results Sixty-six patients were implanted for SSD between 8/2015 and 7/2023 at a median age of 4.7 years (interquartile range, 1.7–7.7 yr). The cause of hearing loss was unknown in the majority of cases (28 patients, 42%), with cytomegalovirus being the most common known cause (17 patients, 26%). Hearing loss was prelingual in 38 patients (58%). Post-implantation, 12 patients (18%) were identified as lost to follow-up. For the remaining 54 patients, the median length of audiometric follow-up was 1.4 years (interquartile range, 0.9–2.2 yr). At last evaluation, only 10 of these 54 patients (19%) were designated as users (≥6 h per day), and 13 patients (24%) were designated as limited users (>2 but <6 h per day). Of patients capable of performing speech-in-noise testing (n = 13), 11 patients (85%) showed improvement on BKB-SIN SNR-50 testing with their implant on versus off with a mean improvement of 3 dB. Notably, 4 of these 11 patients (36%) were categorized as nonusers despite this benefit.
Conclusions Despite audiometric benefit from CI in the pediatric SSD population, usage rates over time remain markedly lower than anticipated at a high-volume, well-resourced tertiary care pediatric center. No influencing factors were identified, warranting critical assessment to ensure appropriate resource allocation.
Martins, Pedro Goiana; Luís, Leonel; Segovia-Martinez, Manuel; Molaee-Ardekani, Behnam
Publication date 01-12-2024
Objective This study assesses the electrically evoked stapedius reflex threshold (eSRT) as an objective method for generating auditory maps in individuals with pulse-width-modulation cochlear implants (CIs). It investigates the impact of both single- and multiple-electrode stimulations on eSRT detection rates and their association with patients comfort loudness levels (C-levels). Despite eSRT exploration by several CI brands incorporating pulse-amplitude-modulation stimulation technology, there is a lack of information on systems using pulse-width modulation.
Approach The eSRT was measured in 19 ears ipsilaterally and contralaterally in response to stimulations in groups of 1, 3, and 5 electrodes across five distinct cochlear regions, spanning from apical to basal. For each group, the eSRT detection rate and its correlation with the C-levels were analyzed both regionally and overall.
Main results In both contralateral and ipsilateral sides, higher electrically evoked stapedius reflex (eSR) detection rates were obtained for multielectrode (67%, 47%) than for single-electrode (41%, 23%) stimulation. Invoking eSR in the apical and basal regions was easier than in the middle region. The multiple stimulation just increased slightly the correlation coefficients between eSRT and C-levels from 0.73 to 0.77 and from 0.77 to 0.85 (p < 0.05) for the contralateral and ipsilateral ears, respectively.
Significance Our research indicates that using a multielectrode stimulation approach enhances the detection rate of eSRT and slightly improves the correlation coefficient between eSRT and C-levels. It is found preferable to obtain measurements from the contralateral side due to its higher detection rate, although the ipsilateral side yields a marginally higher correlation coefficient. The findings suggest that eSRTs obtained from pulse width modulation implants could aid audiologists in programming the device.
Teramura, Atsumu; Kashio, Akinori; Sahara, Toshihito; Koyama, Hajime; Kamogashira, Teru; Urata, Shinji; Ueha, Rumi; Yamasoba, Tatsuya
Publication date 25-10-2024
Objective To evaluate the morphology of the crista fenestra (CF) using three-dimensional reconstruction based on high-resolution computed tomography (HRCT) and to examine the influence of CF height on the insertion approach used for CI632/532 implants.
Study design Retrospective study Setting Tertiary referral center Patients Forty-five ears of 37 patients who received CI632/532 implants were included.
Interventions HRCT images were reconstructed into three-dimensional images, and CF structures were identified.
The patients were divided into two group based on the insertion approach: round window approach (RW; n = 27) and extended round window approach (eRW; n = 18). To evaluate CF interference, 10 cases in the eRW group in which the sheath or electrode did not pass through the RW before widening the RW niche (nRW group) were specifically included in the analysis.
Main outcome measure The identified CF cross-sections were confirmed by HRCT axial sectioning, and CF heights were measured.
Results The mean CF height was significantly greater in the nRW group than in the RW group (0.97 vs. 0.78 mm).
Conclusion CF was identified using three-dimensional computer graphics (3DCG) and the CF height on the HRCT axial sections. Thus, measuring the CF height using 3DCG reconstruction can facilitate the preoperative selection of the electrode insertion approach.
Fan, Caleb J.; Lucas, Jacob C.; Conway, Robert M.; Kato, Masanari G.; Babu, Seilesh C.
Publication date 11-09-2024
Objective To analyze the outcomes of exoscopic versus microscopic ossicular chain reconstruction (OCR).
Study Design Retrospective chart review.
Setting Tertiary care otology-neurotology practice.
Patients Adult subjects with a diagnosis of ossicular discontinuity from 2018 to 2022.
Interventions Exoscopic or microscopic primary OCR (without mastoidectomy) with a partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP).
Main Outcome Measures Audiometric outcomes at 3 months and 1 year postoperatively including bone and air pure tone averages (PTA), air-bone gap (ABG), change in ABG, speech reception threshold (SRT), and word recognition score (WRS). Secondary outcomes included operative time and complication rates of primary and delayed graft failure, tympanic membrane lateralization, prosthesis extrusion, cerebrospinal fluid leak, facial nerve injury, profound hearing loss, persistent tinnitus, and persistent vertigo.
Results Sixty ears underwent primary OCR and were subdivided based on prosthesis type (PORP and TORP) and surgical approach (exoscope vs microscope). Exoscopic OCR was performed on 30 ears (21 PORP, 9 TORP), and microscopic OCR was performed on 30 ears (19 PORP, 11 TORP). In the overall group (PORP + TORP) and in the PORP and TORP subgroups, there were no significant differences in 1) demographics, 2) intraoperative findings, and 3) audiometric outcomes of bone and air PTA, ABG, change in ABG, SRT, and WRS at 1 year postoperatively. Operative time was 64.7 and 59.6 minutes for the exoscopic and microscopic group, respectively (p = 0.4, 95% CI −16.4, 6.1, Cohens D = 0.2).
Conclusions Audiometric and surgical outcomes after exoscopic and microscopic OCR are comparable.
Bulbul, Mustafa G.; Jafary, Zulkifl; Kellermeyer, Brian M.; Shapiro, Scott B.
Publication date 01-12-2024
Objective Investigate whether nonopioid analgesics (NOA) provide adequate pain control after otologic surgery.
Study Design Retrospective multicenter cohort.
Setting Two quaternary academic medical centers.
Patients Patients over 12 years old who underwent otologic surgery involving the middle ear and/or mastoid at two centers over a 5-month period.
Interventions Patients were prescribed acetaminophen and ibuprofen postoperatively and instructed to contact the surgical team if pain control was inadequate, in which case an opioid medication was prescribed. Level of pain and medication use were assessed with a standardized questionnaire, 1 week after surgery.
Main Outcome Measures Postoperative pain levels during the first week after surgery (0–10); proportion of patients requiring opioid medication.
Results Sixty-seven patients were included. Of these, 37% underwent tympanomastoidectomy, 27% cochlear implant, 19.5% postauricular tympanoplasty, 10.5% transcanal tympanoplasty, and 6% had a different surgery. The median of the average level of pain in the first 7 days was 5/10 (IQR 3–6). The median highest level of pain was 5 (IQR 4–8). The median current level of pain was 3 (IQR 1–5). Seven patients (10%) required breakthrough opioid pain medication. The remaining 90% utilized NOA only. One week after surgery, 60% were taking nonopioid analgesics only while the remaining 40% were not taking any pain medication at all. Although opioids were required infrequently, there were no significant differences in medication use between the two centers.
Conclusions NOA provide adequate pain control for most patients after middle ear and mastoid otologic surgery. Opioid analgesics do not routinely need to be prescribed.
Ahanotu, Adaobi Eleanor; Oslin, Kimberly; Rasooly, Marjohn; Eisenman, David J.
Publication date 21-10-2024
Objective To assess the long-term outcomes of sigmoid sinus wall reconstruction (SSWR) in patients with pulsatile tinnitus (PT) with sigmoid sinus wall anomalies (SSWAs).
Study Design Single-center retrospective review.
Setting Tertiary referral center.
Patients Patients who underwent SSWR for PT with SSWAs more than 5 years prior to study initiation.
Intervention(s) Therapeutic—all patients underwent sinus wall reconstruction for pulsatile tinnitus with sigmoid sinus anomalies.
Main Outcome Measure(s) The primary outcomes were complete or partial resolution of PT lasting at least 5 years postoperatively and short-term relief from PT after surgery with long-term recurrence as determined by a self-assessment questionnaire and corroborated by the medical record.
Results Thirty-five patients (37 ears) out of 58 eligible patients 5 years postoperatively from SSWR completed the survey. Short-term and long-term success rates of SSWR are 97.3% (36/37 ears) and 83.8% (31/37 ears), respectively. Of the patients, 13.5% (5/37 ears) experienced recurrence of PT on the same side following initial resolution. Of our patients, 8.6% had a confirmed diagnosis of idiopathic intracranial hypertension (IIH) after a follow-up period of more than 5 years.
Conclusions Sinus wall reconstruction is an effective procedure for long-term control of PT in patients with SSWAs, with an acceptable safety profile and very low additional risk of exacerbating or provoking complications associated with IIH.
Szeto, Betsy; Kesser, Bradley
Publication date 03-09-2024
Objective Dizziness is a debilitating multifactorial disorder commonly affecting the elderly. Daytime somnolence and sleep apnea have been linked to dizziness, but previous studies were limited by small sample sizes. The purpose of this study was to examine the relationship between dizziness and daytime somnolence and sleep-disordered breathing, in a nationally representative sample of elderly adults, while adjusting for possible confounders and mediators.
Study Design Data from the National Health and Nutrition Examination Study (NHANES; 2017–2020 prepandemic data) were analyzed in a cross-sectional manner using survey methods.
Setting Community-based setting in the United States.
Participants A total of 1,490 nationally representative participants aged ≥70 years.
Main Outcomes Multivariable logistic regression was used to examine the relationship between dizziness and daytime somnolence, snoring, and apnea, while adjusting for covariates (gender, age, body mass index, and various medical conditions that may confound this relationship).
Results Frequent daytime somnolence five or more times monthly (odds ratio, 2.13; 95% confidence interval, 1.49–3.06) and presence of apnea (odds ratio, 1.65; 95% confidence interval, 1.20–2.27) were found to be associated with greater odds of dizziness when adjusting for medical comorbidities. A significant association was not found between snoring and dizziness.
Conclusions and Relevance In the elderly, daytime somnolence and apnea were independently associated with increased odds of dizziness, even after adjusting for medical comorbidities. Daytime somnolence and sleep apnea should be added to the differential diagnosis in this patient population. Optimizing sleep may help reduce symptoms of dizziness in this population, but prospective studies would be required to confirm these findings.
Level of evidence: 4
Aboueisha, Mohamed A.; Manayan, Regan; Tie, Kevin; Issa, Peter P.; Al-Hamtary, Mohamed A.; Huang, Victoria; Naples, James G.
Publication date 06-09-2024
Importance Microsurgical resection is one of the treatments for vestibular schwannomas (VS). While several factors have been linked to increased length of stay (LOS) for VS patients undergoing microsurgery, a better understanding of these factors is important to provide prognostic information for patients.
Objective Determine predictors of increased LOS for VS patients undergoing microsurgical resection.
Design Retrospective analysis using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2010 to 2020.
Setting Database review Participants All patients who underwent microsurgery (CPT codes 61520, 61526/61596) for the management of vestibular schwannoma (ICD9 and ICD10 codes 225.1, D33.3) were included.
Main Outcomes and Measures Analyzing perioperative factors that can predict prolonged hospital stay Results A total of 2096 cases were identified and 1,188 (57%) of these patients were female. The mean age was 51.0 ± 14.0 years. Factors contributing to prolonged LOS included African American race (OR = 2.11, 95% CI: 1.32–3.36, p = 0.002), insulin-dependent diabetes mellitus (OR = 2.12, 95% CI: 1.09–4.4.11, p = 0.026), hypertension (OR = 1.26, 95% CI: 1–1.58, p = 0.046), functional dependency (OR = 5.22, 95% CI: 2.31–11.79, p = 0.001), prior steroid use (OR = 1.96, 95% CI: 1.18–3.15, p = 0.009), ASA class III (OR = 2.06, 95% CI: 1.18–3.6, p < 0.011), ASA class IV (OR = 6.34, 95% CI: 2.62–15.33, p < 0.001), and prolonged operative time (OR = 2.14, 95% CI: 1.76–2.61). Microsurgery by a translabyrinthine (TL) approach compared to a retrosigmoid (RSG) approach had lower odds of prolonged LOS (OR = 0.67, 95% CI: 0.54–0.82, p < 0.001). In a separate analysis regarding patients receiving reoperation, operative time was the only predictor of prolonged LOS (OR = 2.77, 95% CI: 1.39–5.53, p = 0.004.)Conclusions and Relevance Our analysis offers an analysis of the factors associated with a prolonged LOS for the surgical management of VS. By identifying healthcare disparities, targeting modifiable factors, and applying risk stratification based on demographics and comorbidities, we can work toward reducing disparities in LOS and enhancing patient outcomes.
Carlson, Matthew L.; Babajanian, Eric E.; Lohse, Christine M.; Tombers, Nicole M.; Link, Michael J.
Publication date 09-10-2024
Objective To evaluate the long-term changes in sporadic vestibular schwannoma (VS) disease-specific quality-of-life (QOL) outcomes.
Study Design Prospective longitudinal study using the Penn Acoustic Neuroma Quality of Life (PANQOL) Scale.
Setting National survey.
Patients Patients with sporadic VS who completed a baseline survey before treatment and at least one follow-up survey recruited through the authors’ center and through the Acoustic Neuroma Association.
Interventions Observation, microsurgery, radiosurgery.
Main Outcome Measures Changes in PANQOL scores from baseline to most recent survey.
Results Among 445 eligible patients the mean duration of follow-up was 4.4 (SD, 2.3) years, including 122, 218, and 105 in the observation, microsurgery, and radiosurgery groups, respectively. Patients managed with observation (p = 0.03) or microsurgery (p < 0.001) demonstrated improvement in anxiety scores. Changes in facial function scores differed significantly by management group (p = 0.01), with patients undergoing microsurgery demonstrating a mean decline of 10 points in facial function scores compared with mean declines of 3 for those managed with observation or radiosurgery. Hearing loss scores decreased similarly over time for all three groups (p = 0.3). There were minimal changes in total PANQOL scores over time across all management groups (p = 0.5).
Conclusions Long-term changes in total QOL among VS management groups are not significantly different. Microsurgery may continue to confer an advantage regarding improvement in anxiety postoperatively, but with a greater decline in facial function when compared to observation or radiosurgery. Long-term declines in hearing loss scores were not statistically significantly different among groups.
Totten, Douglas J.; Cumpston, Evan C.; Schneider, William; Yates, Charles W.; Shah, Mitesh V.; Nelson, Rick F.
Publication date 16-10-2024
Objective To assess growth rates of residual vestibular schwannoma after subtotal and near-total surgical resection and establishing staging system for risk of residual tumor growth.
Study Design Retrospective cohort study.
Setting Tertiary referral center.
Patients Patients with residual vestibular schwannoma after surgical resection from 2011 to 2023 identified on postoperative MRI defined as near-total resection (NTR, less than 5 mm of remaining tumor), subtotal resection (STR; 5–10 mm) and debulking (>10 mm).
Main Outcome Measures Tumor growth of 2 mm or more after subtotal or near-total surgical resection of vestibular schwannoma.
Results A total of 56 patients (54% female; mean, standard deviation SD age 51 17 yr) had residual tumor. Mean preoperative tumor size was 3.0 (1.1) cm, and residual tumors involved both sides with similar frequency (right: 52%). Quantitatively, 29% were NTR, 32% were STR, and 39% were debulking. With an average follow-up of 27 (SD 31) months, tumor growth occurred in 11 (20%), tumor shrinkage occurred in 16 (29%), and tumors were unchanged in 29 (51%) cases. Growing residual tumors were treated with radiation (7 patients) or a second surgical resection (4 patients). Multivariable analysis identified lower patient age, larger preoperative tumor size, and larger residual tumor size in risk of residual growth. A residual VS tumor staging system (Age, Tumor, Residual ATR) is proposed with most tumors in stage II (22, 42%) or stage III (23, 44%), whereas 7 (14%) tumors are stage I.
Conclusions Approximately 80% of residual VS are stable or shrink in size. Initial observation is advocated after incomplete resection and long-term follow up is needed. Patient age less than 55 years, larger preoperative tumor size, and larger postoperative residual tumor size appear predictive of residual tumor growth.
Level of Evidence: 4
Schiel, Viktoria; Eftekharian, Kourosh; Xia, Anping; Bekale, Laurent A.; Bhattacharya, Ritwija; Santa Maria, Peter L.
Publication date 06-09-2024
Objective We propose a selection process to identify a small molecule inhibitor to treat NLRP3-associated sensory hearing loss.
Background The NLRP3 inflammasome is an innate immune sensor and present in monocytes and macrophages. Once the inflammasome is activated, a cleavage cascade is initiated leading to the release of proinflammatory cytokines IL-1β and IL-18. The NLRP3 inflammasome has been implicated in many causes of hearing loss, including autoimmune disease, tumors, and chronic suppurative otitis media. Although the target has been identified, there is a lack of available therapeutics to treat NLRP3-associated hearing loss.
Methods We created a target product profile with specific characteristics that are required for a compound to treat sensory hearing loss. We then looked at available small molecule NLRP3 inhibitors at different stages of development and selected compounds that fit that profile best. Those compounds were then tested for cell toxicity in MTT assays to determine the dosage to be used for efficacy testing. We tested efficacy of a known NLRP3 inhibitor, MCC950, in a proof-of-concept screen on reporter monocytes.
Results Six compounds were selected that fulfilled our selection criteria for further testing. We found the maximum tolerated dose for each of those compounds that will be used for further efficacy testing. The proof-of-concept efficacy screen on reporter monocytes confirmed that those cells can be used for further efficacy testing.
Conclusion Our selection process and preliminary results provide a promising concept to develop small molecule NLRP3 inhibitors to treat sensory hearing loss.
Ubbink, Sander W. J.; Hofman, Rutger; van Dijk, Pim; van Dijk, J. Marc C.
Publication date 18-09-2024
Objective To evaluate the diagnostic application of external ear canal sound measurements in pulsatile tinnitus (PT).
Study Design Retrospective chart review on a prospective series of sound measurements.
Setting Tertiary referral center.
Patients A cohort of 171 PT patients with sound measurements during diagnostic workup for PT (2016–2023).
Main Outcome Measure The percentages of PT patients per pathology and diagnosis, with PT objectified by sound measurements.
Results In 57% of the patients, an identifiable etiology that could explain the PT was identified using various imaging modalities. The PT could be detected with a sound measurement in the ear canal in 48% of these patients. In absence of an identifiable etiology, an objective PT was found in only 15% of the cases. PT was more often detected for patients with arterial pathologies than venous or nonvascular pathologies (73% vs 50% and 22%, respectively). Particularly, in PT patients with a DAVF, an objective PT was found for all patients (100%). The sound measurements were found to be more sensitive than auscultation in detecting bruits in PT patients.
Conclusion A sound recording can objectify PT in almost half of the cases with a diagnosis as determined by imaging. In patients where the PT cannot be detected, arterial pathologies (particularly DAVFs) are less likely. Combined with a thorough clinical evaluation and proper imaging studies, sound measurements can be of added value in the clinical pathway of PT patients.
Liu, George S.; Parulekar, Sharad; Lee, Melissa C.; El Chemaly, Trishia; Diop, Mohamed; Park, Roy; Blevins, Nikolas H.
Publication date 28-10-2024
Objective Develop an artificial intelligence (AI) model to track otologic instruments in mastoidectomy videos.
Study Design Retrospective case series.
Setting Tertiary care center.
Subjects Six otolaryngology residents (PGY 3–5) and one senior neurotology attending.
Interventions Thirteen 30-minute videos of cadaveric mastoidectomies were recorded by residents. The suction irrigator and drill were semi-manually annotated. Videos were split into training (N = 8), validation (N = 3), and test (N = 2) sets. YOLOv8, a state-of-the-art AI computer vision model, was adapted to track the instruments.
Main Outcome Measure(s) Precision, recall, and mean average precision using an intersection over union cutoff of 50% (mAP50). Drill speed in two prospectively collected live mastoidectomy videos by a resident and attending surgeon.
Results The model achieved excellent performance for tracking the drill (precision 0.93, recall 0.89, and mAP50 0.93) and low performance for the suction irrigator (precision 0.67, recall 0.61, and mAP50 0.62) in test videos. Prediction speed was fast (~100 milliseconds per image). Predictions on prospective videos revealed higher mean drill speed (8.6 ± 5.7 versus 7.6 ± 7.4 mm/s, respectively; mean ± SD; p 15 mm/s; p < 0.05) in attending than resident surgery.
Conclusions An AI model can track the drill in mastoidectomy videos with high accuracy and near–real-time processing speed. Automated tracking opens the door to analyzing objective metrics of surgical skill without the need for manual annotation and will provide valuable data for future navigation and augmented reality surgical environments.
Pender, Daniel J.
Publication date 09-10-2024
Hypothesis If otolithiasis can be demonstrated to affect multiple species, it may be possible to identify an experimental animal for prospective study of this entity.
Background Otolithiasis refers to dislodged otolithic matter within the confines of the membranous labyrinth that has the potential to cause clinical symptoms. The mechanism involves separation of free-floating otoconia that can affect the hearing and balance functions of the ear. While this process is known to occur in humans, it is uncertain if other species are affected.
Methods The published images of 37 whole-mount specimens of mammalian labyrinths were identified for retrospective examination. These were evaluated stereographically for the presence of calcareous material in abnormal locations within the membranous labyrinth.
Results Thirty normal labyrinth specimens were found, exemplified by that of the Cape sea lion. Seven pathologic specimens were found, including a human, a black ape, a yellow-faced baboon, a hocheur monkey, a collie dog, a common sheep, and a common hare. Abnormal accumulations of calcareous material were found at one or more sites, more frequently in the utricle and canal system and less frequently in the endolymphatic and cochlea ducts.
Conclusions Otolithiasis appears to occur in other animal species besides the human. Abnormal calcareous material was found in various locations within the membranous labyrinth of affected animals. One or more of these might serve as an animal model to prospectively study the phenomenon of otolithiasis.
Mohammed, Hoda A.O.; Reavis, Kelly M.; Thapa, Samrita; Thielman, Emily J.; Helt, Wendy J.; Carlson, Kathleen F.; Hughes, Charlotte K.
Publication date 30-10-2024
Objective Examine the association between military blast exposure and functional status among veterans with a focus on functional disability as a proxy for quality of life and explore the potential modifying effect of hearing loss on this association.
Study Design Prospective cohort.
Setting Multi-institutional tertiary referral centers.
Patients 540 veterans.
Exposure Self-reported military blast exposure with and without tinnitus; high-frequency hearing loss (yes/no).
Main Outcome Measure WHO Disability Assessment Schedule 2.0 questionnaires at baseline and annually over 5 years.
The odds of membership into three functional disability trajectory groups: low functional disability, moderate functional disability, and high functional disability.
Results Of 540 veterans, 197 (36.5%) self-reported a blast exposure history, and 106 of 197 (53.8%) reported tinnitus as a direct result of the blast. Blast exposure without tinnitus increased the odds of moderate functional disability compared with low functional disability (odds ratio OR = 1.5; 95% confidence interval CI, 0.92–2.51), which strengthened among those with blast with tinnitus (OR, 3.6; 95% CI, 2.1–6.1). Blast exposure without tinnitus also increased the odds of membership to high functional disability versus low functional disability (OR, 2.2; 95% CI, 1.1–4.8). Hearing loss further increased the odds of reporting functional disability. The probability of low functional disability was approximately 60% if there was no history of blast or hearing loss, dropping to 20% if there was blast, tinnitus, and hearing loss history.
Conclusions Blast exposure negatively affects the quality of life of veterans, especially when compounded with tinnitus and hearing loss.
Fujiwara, Rance J.T.; Tan, Donald; Kutz, Joe Walter Jr
Publication date 30-10-2024
Objective To characterize national practice patterns and geographic variations in intratympanic injections among Medicare providers.
Study Design Retrospective cross-sectional analysis of intratympanic injections performed in the Medicare fee-for-service population from 2013 to 2021.
Setting Center for Medicare & Medicaid Services Physician and Other Practitioners database.
Participants Providers performing outpatient intratympanic injections, documented by Current Procedural Terminology code 69801.
Intervention(s) Intratympanic injections.
Main Outcome Measure(s) The number of intratympanic injections performed by individual providers, states, and geographic regions, as well as reimbursements, was analyzed annually.
Results A total of 159,236 in-office intratympanic injections were performed. The Center for Medicare & Medicaid Services reimbursed $25,407,086; out-of-pocket patient costs were $6,591,514. The mean Medicare reimbursement rate and out-of-pocket cost per injection were $159.56 and $41.38, respectively. From 2013 to 2021, the number of intratympanic injections increased from 13,117 to 20,711 injections, representing a 57.9% increase. On linear regression, an additional 989.9 injections were performed each year (95% CI 766.4–1,213.4, p < 0.001). The number of providers performing injections also increased from 1,828 to 2,834 from 2013 to 2021 (b = 125.6 95% CI 111.3–140.0, p < 0.001). The population-controlled annual mean number of injections varied substantially across the United States, ranging from 12.0 injections per 100,000 beneficiaries in Oklahoma to 255.2 injections per 100,000 beneficiaries in Alabama.
Conclusions The number of intratympanic injections administered in the Medicare population has increased from 2013 to 2021. There is variability in practice patterns and utilization of intratympanic injections among otolaryngologists in the United States.
Mouzourakis, Maggie; Steinwald, Peter; Maxwell, Anne K.; Saravia, Ari; Master, Adam; Mankowski, Nicholas; Saunders, James E.; Materne, Grace M.; Noonan, Kathryn
Publication date 28-10-2024
Objective Lateral skull base defects (LSBD) pose a diagnostic challenge; however, early recognition and treatment are important to avoid sequelae. This study examines the impact of health care disparities associated with time to diagnosis and treatment for patients with LSBD.
Study Design, Setting, Patients, Intervention, Outcome Measures Multi-institutional retrospective cohort study at four U.
S. tertiary centers from 2000 to 2022. Adult patients with a primary diagnosis of CSF leak or encephalocele were included. Multivariate regressions used to analyze how age, sex, race/ethnicity, insurance, language, zip code, distance to medical center, referral patterns, diagnostic workup, and clinical course affected time to diagnosis and treatment.
Results In 127 patients with LSBD, mean time to treatment of CSF leak or encephalocele was 13.9 months. On average, patients waited 10.6 months from initial assessment to diagnosis and saw 2 providers prior to diagnosis. Approximately 91% (115) of patients had a CT scan, and 75% (95) had an MRI. Imaging did not influence time to treatment. Older age, public insurance, and number of providers seen were associated with delays. Non-English speakers (5% of 127) encountered treatment delays, although this was not statistically significant. Fifty-eight (46%) people had private insurance. The average traveled distance for care was 62.6 miles. Clinical presentation, race, zip code, imaging, myringotomy, beta-2 transferrin, and ED workup were not found to be associated with delays to care.
Conclusion There are significant delays in diagnosis and management of LSBD. Referral patterns did influence care. Health care disparities did not impact care; however, disparities and language barriers need to be studied further to determine contributions to delays in care.
Liu, Yali; Ma, Guowei; Wu, Yuanyuan
Publication date 21-10-2024
No abstract available
Pubmed PDF WebZhang, Di; Li, Daibo; Chen, Ting; Feng, Xuefei; Zhang, Juan
Publication date 21-10-2024
No abstract available
Pubmed PDF WebShi, Julia J.; Fujiwara, Rance J. T.; Pinho, Marco C.; Isaacson, Brandon
Publication date 21-10-2024
No abstract available
Pubmed PDF WebSorkin, Donna; Leyzac, Kara; Moberly, Aaron C.
Publication date 01-12-2024
No abstract available
Pubmed PDF WebNishikawa, Javier K.; Sánchez, Pablo J.
Publication date 01-12-2024
Congenital CMV infection is the leading nongenetic cause of sensorineural hearing loss worldwide, yet most parents have never heard of it. The majority of infected newborns have no clinical signs of infection, although a substantial proportion may have hearing loss at birth or develop it later in life. As antiviral treatment with ganciclovir or valganciclovir initiated in the first month of age improves audiologic outcomes, there is an urgent need for timely identification of infected neonates. A targeted approach that tests neonates who refer on the newborn hearing screen has been implemented in many states and hospital programs, but it fails to identify about 40% of children who experience CMV-related hearing loss. A universal screening approach is optimal given the prevalence of congenital CMV infection, its associated sequelae, the availability of a simple saliva screening tool, the available antiviral treatment, and the directed therapies for hearing impairment.
Pubmed PDF WebWarren, Sarah E.; Coco, Laura; Allen, Iris; Flinner, Gretchen Nibert; Coffelt, Jordan Alyse; Ladner, Kathryn; Holloway, C. Alise; Yawn, Robert J.
Publication date 01-12-2024
Objective The objective of this article is to introduce the concept of community-based participatory research as a means to understand barriers to cochlear implant access racially minoritized populations.
Background Black adults living in the United States experience unique barriers to cochlear implantation. Community-based research approaches can be used to understand and address these barriers.
Application The Memphis SOUND Project is a community-based research initiative that seeks to address hearing health disparities by examining utilization of hearing healthcare among Black adults. Preliminary findings introduce motivators and barriers related to CI intervention in this population.
Conclusion This Memphis SOUND Project provides valuable insights to the benefits of community-based research in understanding and addressing CI utilization disparities.
Dornhoffer, James R.; Marinelli, John P.; Lohse, Christine M.; Cottrell, Justin; McMenomey, Sean O.; Roland, J. Thomas Jr; Thompson, Nicholas J.; Brown, Kevin D.; Lucas, Jacob C.; Babu, Seilesh C.; Lindquist, Nathan R.; Perkins, Elizabeth L.; Rahne, Torsten; Plontke, Stefan K.; Tan, Donald; Hunter, Jacob B.; Harvey, Erin; Deep, Nicholas L.; Cerasiello, Samantha Y.; Kircher, Matthew L.; Espahbodi, Mana; Tooker, Evan L.; Lloyd, Simon K.W.; Carlson, Matthew L.
Publication date 01-12-2024
Objective To compare cochlear implant (CI) speech perception outcomes in patients with sporadic vestibular schwannoma (VS) managed with observation, radiosurgery, or microsurgery.
Study Design Retrospective review.
Setting Eleven tertiary academic medical centers.
Patients One hundred patients with sporadic VS who received an ipsilateral CI.
Interventions Ipsilateral cochlear implantation.
Main Outcome Measures Pure-tone thresholds, monosyllabic speech perception testing scores, and rates of open-set speech acquisition.
Results Of the 100 patients studied, 54 underwent microsurgery, 26 underwent radiosurgery, 19 continued observation, and 1 underwent multimodal therapy. Among all patients, the median post-implantation pure-tone average was 31 dB (interquartile range IQR 25–39 dB) and the median monosyllabic speech perception score was 30% (IQR 0–60%) at a median of 12 months (IQR 5–25 months) post-implantation. Patients who were managed with microsurgery (median speech perception score 11%, IQR 0–52%) exhibited poorer implant outcomes overall compared with those managed with observation (median speech perception score 52%, IQR 40–72%) or radiosurgery (median speech perception score 30%, IQR 16–60%). Open-set speech perception was achieved in 61% of patients managed with microsurgery, 100% with observation, and 80% with radiosurgery. In a multivariable setting, those managed with observation (p = 0.02) or who underwent radiosurgery (p = 0.04) were significantly more likely to achieve open-set speech perception compared with patients who underwent microsurgery.
Conclusions Cochlear implants offer benefit in selected patients with sporadic VS. Although achieved in over half of people after microsurgery, open-set speech perception is more reliably attained in patients who are treated with observation or radiosurgery compared with microsurgical resection. These data may inform patient counseling and VS tumor management in people who may benefit from implantation.
Dornhoffer, James R.; DeJong, Melissa D.; Driscoll, Colin L.W.; Saoji, Aniket A.
Publication date 01-12-2024
Objective To review audiological experiences and early hearing outcomes from the early feasibility study of a fully implanted cochlear implant.
Study Design Prospective cohort.
Setting Tertiary academic medical center.
Patient Three adults (two—male, one female) with bilateral sensorineural hearing loss.
Interventions Implantation with a fully implanted cochlear implant as part of an early feasibility study.
Outcomes Postoperative unaided and aided pure-tone audiometry, tympanometry, mapping parameters, speech perception, battery life, and quality-of-life assessment.
Results All patients in the early feasibility study of this fully implanted cochlear implant now use their devices regularly. Preoperative and postoperative audiometric measurements showed that their residual hearing in the implanted ear decreased slightly after surgery but was preserved. All patients had type A tympanograms after their transient middle ear effusion resolved. Electrical stimulation levels were comparable to those routinely used in traditional cochlear implants. Two of the three patients use a hearing aid in the implanted ear for additional gain and show significant improvement in speech perception since implantation. Average battery life before recharging is 4 days. All patients are regular users with two showing improvement in quality-of-life metrics after receiving the fully implanted cochlear implant.
Conclusion The patient experience and hearing outcomes from the early feasibility study of a novel fully implanted cochlear implant are detailed in this study and demonstrate ease of operation and daily use by all participants. All patients obtained hearing, but two of three use a hearing aid with their device to overcome unanticipated implant circuitry noise and achieve improved speech perception scores. Current work is focused on reducing this system noise to allow for the device to be used as intended, without a hearing aid.
Holcomb, Meredith A.; Smeal, Molly R.
Publication date 01-12-2024
Objective To evaluate the implementation of a new streamlined service delivery model for cochlear implant (CI) patients at a mature academic CI program.
Setting Tertiary referral center.
Patients CI candidates and CI users.
Interventions Implementation of a new CI service delivery model.
Main Outcome Measures CI surgical numbers, conversion rate from CI evaluation to surgery, documentation time, number of visits for new versus established CI users, ratio of CI clinical full-time equivalency to CI surgical numbers, time from CI referral to CI evaluation, patient travel burden.
Results De-identified data from the electronic health record (EHR) were used to develop an efficiency improvement plan. With the old clinical model, audiologists schedules were at capacity, wait for CI evaluation appointments was prolonged, and CI surgical numbers were declining. The new model implemented an interactive electronic medical record, a de-escalated postoperative programming schedule, inclusion of telehealth pre-CI surgery, and an evidence-based approach to CI programming. After a 4-year time period (2019–2022) of implementing clinical improvement strategies, the postoperative CI programming schedule in the first year after activation was reduced from 10 visits (unilateral CI user) and 16 visits (bilateral CI user) to 4 visits total. This saved the patient up to 16 hours of time at the clinic, reduced travel burden, and opened 19 weeks of appointment slots for new patients. Increased utilization of the EHR and telehealth increased the conversion rate from CI evaluation to CI surgery by 33% and decreased the no-show rate by 5%. Annual CI surgical numbers subsequently increased by 45% with the new model, which increased our programs CI utilization rate and reduced our role as a barrier to CI care.
Conclusion If CI programs wish to be instrumental in improving CI utilization rates, clinical care models need to be adapted now in preparation for the projected rise in the number of potential CI candidates. This streamlined clinical efficiency model serves as an example of patient-centered CI care that can be recreated at other institutions. Outcomes from our 4-year strategic initiative will add to the scarcity of literature in this area.
Warrick, Mallory; Sherman, Sophie; King, Kaylene; LaRosa, Angela; McRackan, Theodore R.; Coker-Bolt, Patty; Schvartz-Leyzac, Kara C.
Publication date 01-12-2024
Objective Conduct a pilot clinical improvement project to effectively screen children with hearing loss for developmental delays. Children with hearing loss and cochlear implants (CIs) are at risk for additional developmental delays; however, screening to aid in early identification and referral for developmental delays is not routinely performed at CI centers. It is important to consider all aspects of child development to maximize CI outcomes and access to language.
Study Design Caregivers of 31 children completed the Ages and Stages Questionnaire (ASQ) and the Sensory Profile-2 (SP2), which are standardized questionnaires that assess developmental milestones in areas of communication, gross motor, fine motor, problem solving, personal–social, and sensory integration.
Setting Participants were prospectively evaluated at a CI center in a tertiary medical center.
Patients Participants included children, aged ≤5 years old with bilateral hearing loss who use CIs or who were CI candidates, and their families.
Main Outcome Measures Scores on ASQ and SP2 questionnaires.
Results Thirty-one children were screened, and approximately 40 to 50% screened positive for risk of developmental delay in areas excluding communication and received referrals for evaluations in occupational therapy (n = 16; 51.6%), physical therapy (n = 13; 41.9%), and developmental pediatrics (n = 13; 41.9%). Of children referred and seen for evaluations, six were diagnosed with developmental delays in at least one developmental area beyond the communication domains.
Conclusions Routine screening in children with significant hearing loss can successfully detect developmental delays, which may go unnoticed. This proactive approach enables timely and comprehensive treatment for developmental delays beyond those solely related to communication.
Reinhart, Paul; Parkinson, Aaron; Gifford, René H.
Publication date 01-12-2024
Introduction Electric–acoustic stimulation (EAS) provides cochlear implant (CI) recipients with preserved low-frequency acoustic hearing in the implanted ear affording auditory cues not reliably transmitted by the CI including fundamental frequency, temporal fine structure, and interaural time differences (ITDs). A prospective US multicenter clinical trial was conducted examining the safety and effectiveness of a hybrid CI for delivering EAS.
Materials and Methods Fifty-two adults (mean age 59.9 yr) were enrolled in the study and followed up to 5 years postactivation. Testing included unaided and aided audiometric thresholds, speech perception (Consonant–Nucleus–Consonant CNC words in quiet and Az Bio sentences +5 dB SNR), and patient-reported outcomes (Speech, Spatial, and Qualities of Hearing Scale).
Results Functionally aidable hearing, defined as low-frequency pure-tone average (125–500 Hz) <80 dB HL, was maintained for 77% of patients through 1 year, with 66.7% maintaining through 5 years. Speech perception was significantly improved at all postoperative timepoints compared with preoperative performance with hearing aid(s), and patient-reported outcomes indicated significantly improved subjective speech understanding, spatial hearing, and sound quality. Participants with preserved acoustic hearing using EAS reported significantly higher subjective spatial hearing and sound quality than participants with electric-only hearing in the implanted ear.
Discussion Patients with high-frequency hearing loss demonstrate significant long-term benefit with a hybrid CI including high rates of functional hearing preservation, significantly improved speech perception, and subjective patient-reported outcomes. EAS with binaural acoustic hearing affords benefit for subjective spatial hearing and sound quality beyond CI listening configurations using monaural acoustic hearing.
Holder, Jourdan T.; Hoffman, Jennifer; Williams, Haley; Gifford, René H.
Publication date 01-12-2024
Objective To compare electrically evoked stapedial reflex thresholds (eSRTs) measured at 1 month post-activation to upper stimulation levels used for programming adult cochlear implant (CI) recipients over time in a large clinical population.
Study Design Review of prospectively collected clinical database.
Setting Large CI program at an academic medical center.
Patients Postlingually deafened adult CI recipients (n = 439).
Main Outcome Measure(s) eSRTs recorded in the medical record and upper stimulation levels derived from the programming software at 1 and 6 months post-activation.
Results The correlation between eSRTs and upper stimulation levels was strong for all three manufacturers (r = 0.80–0.86). On average, upper stimulation levels were set 15.4 clinical levels below eSRT for Cochlear using a pulse width of 25 microseconds, 13.4 clinical levels below eSRT for Cochlear using a pulse width of 37 microseconds, 11.3 clinical units below eSRT for Advanced Bionics, and 0.1 charge unit above eSRT for MED-EL. eSRTs were found to be elicited at similar levels for different electrodes/frequencies across the array. After upper stimulation levels were set based on eSRT at 1 month post-activation, there was no significant change in upper stimulation levels between 1 and 6 months post-activation.
Conclusions eSRTs and upper stimulation levels are highly correlated. Average differences between eSRTs and upper stimulation levels reported herein can be used to guide programming in the clinic. Further, when eSRTs are used to program upper stimulation levels, upper stimulation levels should be relatively similar across channels and stable over time.
Tejani, Viral; Piper, Robin; Murray, Gail; Manzoor, Nauman F.; Mowry, Sarah; Semaan, Maroun; Rivas, Alejandro
Publication date 01-12-2024
Objective Evaluate the sensitivity and financial costs of Trans-Impedance Matrix recordings, Spread of Excitation functions, and x-rays in detecting cochlear implant tip foldovers Setting Tertiary academic medical center Patients 113 ears of 108 patients Interventions Following cochlear implantation and before concluding surgery, intraoperative Trans-Impedance Matrix recordings, Spread of Excitation functions, and x-rays were conducted to evaluate presence of tip foldover.
Main Outcome Measures Presence of tip foldover; recording time necessary for and costs of Trans-Impedance Matrix, spread of excitation, and x-rays.
Results There were six tip foldovers. Trans-Impedance Matrix showed 100% sensitivity, 100% specificity, 100% positive predictive value, and 100% negative predicative value in detecting tip foldovers. Spread of excitation showed 29% sensitivity, 99% specificity, 67% positive predictive value, and 95% negative predicative value. Trans-Impedance Matrix recordings were completed significantly faster than spread of excitation and x-rays. Elimination of x-rays from our intraoperative workflow results in a twofold cost reduction.
Conclusion Trans-Impedance Matrix recordings have potential great clinical utility in evaluating proper CI placement intraoperatively and reducing costs of surgery while not compromising patient care. Given the low tip foldover rate, a multicenter study is in progress to evaluate the sensitivity, specificity, positive predictive value, and negative predicative value of Trans-Impedance Matrix in a larger dataset. This can provide better guidance to cochlear implant clinics interested in evaluating the impact of using Trans-Impedance Matrix on patient care as well as the economics of reducing use of intraoperative imaging.