Abdulbaki, Hasan; Mo, Jonathan; Limb, Charles J.; Jiam, Nicole T.
Publication date 28-09-2023
Objective Musical rehabilitation has been used in clinical and nonclinical contexts to improve postimplantation auditory processing in implanted individuals. This systematic review aimed to evaluate the efficacy of music rehabilitation in controlled experimental and quasi-experimental studies on cochlear implant (CI) user speech and music perception.
Databases reviewed Pub Med/MEDLINE, EMBASE, Web of Science, PsycARTICLES, and PsycINFO databases through July 2022.
Methods Controlled experimental trials and prospective studies were included if they compared pretest and posttest data and excluded hearing aid-only users. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were then used to extract data from 11 included studies with a total of 206 pediatric and adult participants. Interventions included group music therapy, melodic contour identification training, auditory-motor instruction, or structured digital music training. Studies used heterogeneous outcome measures evaluating speech and music perception. Risk of bias was assessed using the National Heart, Lung, and Blood Institute Quality Assessment Tool.
Results A total of 735 studies were screened, and 11 met the inclusion criteria. Six trials reported both speech and music outcomes, whereas five reported only music perception outcomes after the intervention relative to control. For music perception outcomes, significant findings included improvements in melodic contour identification (five studies, p < 0.05), timbre recognition (three studies, p < 0.05), and song appraisal (three studies, p < 0.05) in their respective trials. For speech prosody outcomes, only vocal emotion identification demonstrated significant improvements (two studies, p < 0.05).
Conclusion Music rehabilitation improves performance on multiple measures of music perception, as well as tone-based characteristics of speech (i.e., emotional prosody). This suggests that rehabilitation may facilitate improvements in the discrimination of spectrally complex signals.
Puiggrós, Ignacio Viza; Moreno, Esther Granell; Dotu, César Orús; Agustí, Miquel Quer i; Díaz, Francesc Larrosa
Publication date 20-09-2023
Objectives The purpose of this study is to evaluate the reliability of temporal bone density measurements for diagnosing otosclerosis.
Materials and methods A retrospective case-control study is presented. Bone density was measured in Hounsfield units (HUs) by using high-resolution computed tomography in eight regions of interest (ROI) where otosclerotic foci are usually localized. The density of 113 otosclerotic ears was compared with that of 33 nonotosclerotic ears to determine sensitivity and specificity. Furthermore, the binormal receiver operating characteristic curve of each ROIs density was calculated to estimate the diagnostic value for osteosclerosis. In addition, the radiological density of seven cases—where radiological visual examination exhibited no findings but surgery confirmed stapes fixation—was compared with nonotosclerotic controls.
Results ROI densities were significantly lower in otosclerotic patients compared with nonotosclerotic controls. The area under the curve of the fissula ante fenestram (FAF) presented the highest diagnostic performance: 1,871 HU cut-off value (area under the curve = 0.986), 96.64% sensitivity, and 100% specificity. Significantly lower densities in the FAF area were observed in the seven cases with negative radiology but intraoperatively confirmed otosclerosis.
Conclusion The high-resolution computed tomography density of the FAF is a reliable measurement for diagnosing otosclerosis. A value less than 1,871 HU exhibited the highest sensitivity and specificity in a European Caucasian population.
Ohira, Shinya; Komori, Manabu; Tsuna, Yukari; Nakamura, Mitsuto; Yamaguchi, Yusei; Matsuura, Kentaro; Osafune, Hiroshi; Wada, Kota
Publication date 19-10-2023
Objective This study evaluated the therapeutic effect of hyperbaric oxygen therapy (HBOT) combined with steroid therapy to treat sudden hearing loss and examined the index associated with excellent therapeutic effect.
Methods We included 109 patients with sudden hearing loss. Patients were divided into the HBOT combination group (59 sides) treated with HBOT and steroid therapy and HBOT noncombination group (50 sides) involving steroid therapy only. The recovery rate of each group was compared according to the severity of hearing loss. Blood samples were evaluated and inflammatory markers, such as neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR), were calculated and compared by severity. We evaluated the usefulness of inflammatory markers for predicting recovery rate, and calculated cutoff values were also evaluated.
Results The HBOT combination group exhibited a higher overall recovery rate than the HBOT noncombination group, particularly in severe cases. However, there was no significant difference in the severity of hearing loss based on various inflammatory markers. NLR and PLR are useful for predicting the effect in patients treated with concomitant HBOT. By setting 2.43 and 146.67 as cutoff values for NLR and PLR, respectively, we observed that lower values resulted in better recovery rates.
Conclusion The use of HBOT is effective for severe cases and early blood flow disorders with low NLR and PLR and less inflammation. When determining treatment, not only should the severity of hearing loss be considered, but also the NLR and PLR should be evaluated and examined based on the cutoff values.
Walia, Amit; Shew, Matthew A.; Lefler, Shannon M.; Ortmann, Amanda J.; Durakovic, Nedim; Wick, Cameron C.; Herzog, Jacques A.; Buchman, Craig A.
Publication date 15-09-2023
Objective To evaluate the impact of preoperative and perioperative factors on postlinguistic adult cochlear implant (CI) performance and design a multivariate prediction model.
Study Design Prospective cohort study.
Setting Tertiary referral center.
Patients and Interventions Two hundred thirty-nine postlinguistic adult CI recipients.
Main Outcome Measure(s) Speech-perception testing (consonant-nucleus-consonant CNC, Az Bio in noise +10-dB signal-to-noise ratio) at 3, 6, and 12 months postoperatively; electrocochleography–total response (ECochG-TR) at the round window before electrode insertion.
Results ECochG-TR strongly correlated with CNC word score at 6 months (r = 0.71, p < 0.0001). A multivariable linear regression model including age, duration of hearing loss, angular insertion depth, and ECochG-TR did not perform significantly better than ECochG-TR alone in explaining the variability in CNC. Az Bio in noise at 6 months had moderate linear correlations with Montreal Cognitive Assessment (MoCA; r = 0.38, p < 0.0001) and ECochG-TR (r = 0.42, p < 0.0001). ECochG-TR and MoCA and their interaction explained 45.1% of the variability in Az Bio in noise scores.
Conclusions This study uses the most comprehensive data set to date to validate ECochG-TR as a measure of cochlear health as it relates to suitability for CI stimulation, and it further underlies the importance of the cochlear neural substrate as the main driver in speech perception performance. Performance in noise is more complex and requires both good residual cochlear function (ECochG-TR) and cognition (MoCA). Other demographic, audiologic, and surgical variables are poorly correlated with CI performance suggesting that these are poor surrogates for the integrity of the auditory substrate.
Fabie, Joshua E.; Shannon, Christian M.; Schvartz-Leyzac, Kara; Dubno, Judy R.; McRackan, Theodore R.
Publication date 20-09-2023
Objective Previous research has demonstrated that realistic patient expectations are a critical factor in determining cochlear implant (CI) candidacy. The current study uses the validated Cochlear Implant Quality of Life–Expectations (CIQOL-Expectations) instrument to determine expectations of potential CI users and the degree to which their pre-CI expectations are met after implantation.
Study Design Prospective cohort study.
Setting Tertiary medical center.
Patients Sixty adult CI patients.
Interventions/Main Outcome Measures Pre-CI aided and post-CI consonant-nucleus-consonant word and Az Bio sentence scores, pre-CI CIQOL-Expectations, and pre-CI and 3/6/12-month post-CI CIQOL-35 Profile scores.
Results Mean pre-CI CIQOL-Expectations exceeded 12-month mean CIQOL-35 Profile scores for the global measure and the communication, environment, and listening effort domains (d = 0.65–0.97). The communication and listening effort domain scores had the largest discrepancy between expected and actual post-CI improvement (actual scores, 15.1 and 16.3 points lower than expected d = 0.93–0.97, respectively). For 42% of patients, pre-CI global expectations exceeded 12-month post-CI CIQOL-35 Profile global scores, 49% met their expectations, and actual scores exceeded expectations for only 10% of patients. Similar patterns were seen for all CIQOL domains except emotional.
Conclusions Post-CI functional abilities seem to fall short of pre-CI expectations for a substantial percentage of CI users, which was most apparent for the communication and listening effort CIQOL domains. These results may help clinicians direct personalized counseling toward common misconceptions, which can aid shared decision making and potentially minimize the mismatch between expected and realized outcomes.
Level of Evidence: III.
IRB Pro00073019, approved December 20, 2017 (Medical University of South Carolina).
Nix, Evan P.; Thompson, Nicholas J.; Brown, Kevin D.; Dedmon, Matthew M.; Selleck, A. Morgan; Overton, Andrea B.; Canfarotta, Michael W.; Dillon, Margaret T.
Publication date 28-09-2023
Objectives To investigate the incidence of electrode contacts within the functional acoustic hearing region in cochlear implant (CI) recipients and to assess its influence on speech recognition for electric–acoustic stimulation (EAS) users.
Study Design Retrospective review.
Setting Tertiary referral center.
Patients One hundred five CI recipients with functional acoustic hearing preservation (≤80 dB HL at 250 Hz)Interventions Cochlear implantation with a 24-, 28-, or 31.5-mm lateral wall electrode array.
Main Outcome Measures Angular insertion depth (AID) of individual contacts was determined from imaging. Unaided acoustic thresholds and AID were used to calculate the proximity of contacts to the functional acoustic hearing region. The association between proximity values and speech recognition in quiet and noise for EAS users at 6 months postactivation was reviewed.
Results Sixty percent of cases had one or more contacts within the functional acoustic hearing region. Proximity was not significantly associated with speech recognition in quiet. Better performance in noise was observed for cases with close correspondence between the most apical contact and the upper edge of residual hearing, with poorer results for increasing proximity values in either the basal or apical direction (r14 = 0.48, p = 0.043; r18 = −0.41, p = 0.045, respectively).
Conclusion There was a high incidence of electrode contacts within the functional acoustic hearing region, which is not accounted for with default mapping procedures. The variability in outcomes across EAS users with default maps may be due in part to electric-on-acoustic interference, electric frequency-to-place mismatch, and/or failure to stimulate regions intermediate between the most apical electrode contact and the functional acoustic hearing region.
Oh, Heonjeong; Kim, Yehree; Lee, Seung Jae; Carandang, Marge; Song, Jae-Jin; Choi, Byung Yoon
Publication date 20-09-2023
Objective Precise electrode positioning is crucial for achieving optimal audiological outcomes in cochlear implantation. The slim modiolar electrode (SME), a thin, flexible, and precurved electrode, exhibits favorable modiolar proximity. However, tip fold-over can affect optimal electrode placement. Herein, we share our experiences with tip fold-over in SMEs and present an analysis of conditions that may predispose to tip fold-over.
Study Design Retrospective medical record review.
Patients In total, 475 patients (671 ears) underwent cochlear implantation using SMEs (Nucleus CI532 or CI632 from Cochlear) performed by a single surgeon at a tertiary center between June 14, 2018, and December 1, 2022.
Interventions Intraoperative x-ray scans (cochlear view), operative records, and cochlear duct length (CDL) were reviewed.
Main Outcome Measures Tip fold-over patterns on plain x-ray images (proximal versus distal).
Results Electrode tip fold-over was observed in 18 (2.7%) of the 671 ears with SMEs. This fold-over occurred more frequently in cases with long CDL (>36 mm). Among the 14 cases with available initial x-rays before correction of the tip fold-over, half were classified as proximal and the other half as distal. A predilection for proximal tip fold-over was found in those with a CDL of 36 mm or longer, and longer CDLs were observed for proximal cases than for distal cases. Our pilot data suggest that identifying the type of tip fold-over can aid in correcting it more efficiently.
Conclusions Tip fold-over of SME does not occur uniformly and is more common in ears with long CDL. This tendency is particularly pronounced for the proximal type of tip fold-over. Therefore, preoperative measurement of the CDL and meticulous examination of intraoperative imaging are essential for customized correction.
Dorismond, Christina; Patro, Ankita; Holder, Jourdan T.; Perkins, Elizabeth L.
Publication date 10-10-2023
Objective To study the relationship between Cochlear Implant Quality of Life-10 Global (CIQOL-10) scores and speech recognition scores 6 and 12 months after cochlear implantation (CI) and to compare CIQOL-10 scores for patients who met the benchmark speech recognition scores with those who did not.
Study Design Retrospective review.
Setting Tertiary referral center.
Patients One hundred twenty-four adults who underwent CI between 2018 and 2021 and completed a CIQOL-10 questionnaire at their 6- and/or 12-month postoperative visit.
Main Outcome Measure(s) CIQOL-10, Consonant-Nucleus-Consonant (CNC) word, and Az Bio in quiet and noise scores.
Results At 6 months, weak positive correlations were found between CIQOL-10 and CNC (n = 78, r = 0.234, p = 0.039) and Az Bio in quiet (n = 73, r = 0.293, p = 0.012) scores but not Az Bio in noise scores (n = 39, r = 0.207, p = 0.206). At 12 months, weak positive correlations were found between CIQOL-10 and CNC (n = 98, r = 0.315, p = 0.002), Az Bio in quiet (n = 88, r = 0.271, p = 0.011), and Az Bio in noise (n = 48, r = 0.291, p = 0.045) scores. Patients who met the benchmark CNC scores had notably higher CIQOL-10 scores than those who did not at 6 months (52.0 vs 45.5, p = 0.008) and 12 months (52.0 vs 45.5, p = 0.003). A similar relationship was found for those who met the benchmark Az Bio in quiet scores at both 6 months (52.0 vs 44.0, p = 0.006) and 12 months (52.0 vs 46.5, p = 0.011).
Conclusion CIQOL-10 scores have weak positive correlations with postoperative speech recognition outcomes at 6 and 12 months. This highlights the need for the continued use of quality-of-life measures, such as the CIQOL-10, in assessing CI outcomes to gain a more comprehensive understanding of patients experiences.
Adams, Jason K.; Marinelli, John P.; DeJong, Russell W.; Spear, Samuel A.; Erbele, Isaac D.
Publication date 20-09-2023
Objective With ongoing national expansions in cochlear implantation (CI) candidacy criteria, more patients qualify for CI today than ever before. Among US veterans and military service members, the prevalence of qualifying degrees of hearing loss secondary to occupational noise exposure exceeds the general population. The primary aim of the current work was to evaluate CI trends across the military health system.
Study Design Database review.
Setting Military and civilian practices.
Patients Department of Defense (DoD) beneficiaries who underwent CI.
Main Outcome Measures CI rates between 2010 and 2019.
Results A total of 3,573 cochlear implant operations were performed among DoD beneficiaries from 2010 to 2019. A majority of patients (55%) were older than 64 years, with the next most commonly implanted age group being 0 to 4 years of age (14%). From 2010 to 2019, annual CI increased at a rate of 7.9% per year for all implantation over the study period (r = 0.97, p < 0.0001); there was a statistically significant difference of this rate compared with tympanoplasty, which was used as a reference procedure (rate, −1.9%; p = 0.03). This trend was similar for beneficiaries implanted both in military (11.9% per year, r = 0.77, p = 0.009) and civilian facilities (7.7% per year, r = 0.96, p < 0.0001); there was no statistically significant difference between the annual growth rates of these groups (p = 0.68).
Conclusions Although the number of devices implanted is rapidly increasing among DoD beneficiaries, reported national utilization rates remain low. This disparity likely exists in the general public, considering the aging demographic in the West and continual expansions in US Federal Drug Administration labeling. These data suggest that widespread expansion of the procedure to general otolaryngology practices will be required to meet current and future demands for CI. For this reason, CI should be considered for “key indicator” designation among residency training programs.
Huang, Emily Y.; Hairston, Tai K.; Walsh, Jonathan; Ballard, Megan E.; Boss, Emily F.; Jenks, Carolyn M.
Publication date 28-09-2023
Objective Parents often experience uncertainty during decision-making for their child’s cochlear implantation (CI) surgery, and online forums provide insight on parental opinions that might not be expressed in clinic. This study aims to evaluate parental perspectives and concerns about pediatric CI using social media analysis.
Study Design Qualitative study.
Setting Three online forums involving parental posts about pediatric CI.
Intervention/Methods Forums were queried using keywords (e.g., “cochlear implant”) to gather all U.
S. parent-initiated posts about pediatric CI from 2006 to 2021. Thematic content analysis was performed to classify posts by overarching domain, themes, and subthemes. Posts were reviewed for thematic synthesis and double coded. Descriptive statistics were calculated for each theme by unique users.
Results A total of 79 posts by 41 unique users were analyzed. Themes relating to decision for CI included facilitators, inhibitors, resources, and feelings. Parents posted about lack of benefit from hearing aids promoting decision for CI and high cost as an inhibitor. Some expressed concern about making a major decision for a minor. Parents often mentioned their child’s healthcare providers and social media as resources.
Conclusion Through social media posts, parental priorities and concerns for decision-making of CI surgery were identified. Findings may guide discussions between physicians and parents and facilitate shared decision-making about CI.
Eitutis, Susan T.; Vickers, Deborah A.; Tebbutt, Karen; Thomas, Tisa; Jiang, Dan; de Klerk, Anel; Clemesha, Jennifer; Chung, Mark; Bance, Manohar L.
Publication date 27-10-2023
Objective To determine if there is a difference in hearing outcomes or stimulation levels between Advanced Bionics straight and precurved arrays.
Study design Retrospective chart review across three implant centers.
Setting Tertiary centers for cochlear and auditory brainstem implantation.
Patients One hundred fifteen pediatric and 205 adult cochlear implants (CIs) were reviewed. All patients were implanted under the National Institute for Health and Care Excellence 2009 guidelines with a Hi Res Ultra SlimJ or Mid-Scala electrode array.
Main outcome measures Hearing preservation after implantation, as well as CI-only listening scores for Bamford-Kowal-Bench sentences were compared 1 year after implantation. Stimulation levels for threshold and comfort levels were also compared 1 year after implantation.
Results Hearing preservation was significantly better with the SlimJ compared with the Mid-Scala electrode array. Bamford-Kowal-Bench outcomes were not significantly different between the two arrays in any listening condition. Stimulation levels were not different between arrays but did vary across electrode contacts. At least one electrode was deactivated in 33% of implants but was more common for the SlimJ device.
Conclusion Modern straight and precurved arrays from Advanced Bionics did not differ in hearing performance or current requirements. Although hearing preservation was possible with both devices, the SlimJ array would still be the preferred electrode in cases where hearing preservation was a priority. Unfortunately, the SlimJ device was also prone to poor sound perception on basal electrodes. Further investigation is needed to determine if deactivated electrodes are associated with electrode position/migration, and if programming changes are needed to optimize the use of these high-frequency channels.
Hidaka, Hiroshi; Tarasawa, Kunio; Fujimori, Kenji; Obara, Taku; Fushimi, Kiyohide; Shimamura, Akihiro; Iwai, Hiroshi
Publication date 19-10-2023
Objective Data on risk factors for otogenic intracranial complications including cerebral abscess have been limited. Using a nationwide database, the aim was to identify the factors related to mortality and delayed discharge.
Study Design Retrospective.
Setting Nationwide database using the Diagnostic Procedure Combination database.
Main Outcome Measures Data of 145 patients were extracted from a Japanese inpatient database between 2012 and 2020. The main outcome was survival at discharge. In a subgroup analysis of the 137 surviving patients, the second outcome was delayed discharge.
Results The mortality rate was 5.5% (8 of 145). Logistic regression analyses identified intracerebral complications (adjusted odds ratio OR, 3.09) and more than 2-day delay of the first surgery after admission (adjusted OR, 4.68) as risk factors for mortality. Specifically, consciousness level evaluated by the Japan Coma Scale (JCS) was significantly related to prolonged hospitalization or mortality: JCS I (adjusted OR, 3.40) and JCS ≥II (adjusted OR, 25.1).
Conclusions Although otogenic intracranial complications are rare, and their mortality is decreasing because of the progress in imaging and clinical strategies, they remain the most severe complications of suppurative otitis media and/or cholesteatoma. Consciousness level at admission, comorbid diabetes mellitus, and a greater than 2-day delay of surgical intervention were related to prolonged hospitalization or mortality.
Kim, Jayoon; Jeong, Mincheol; Yang, Seungjoon; Han, Jung Ho; Bae, Seong Hoon
Publication date 20-09-2023
Objectives Congenital corpus callosum agenesis (CCA) is one of the congenital anomalies in newborns, which usually presents with syndromic features. It can be asymptomatic or have variable neurological deficits. Some studies demonstrated that hearing loss can occur in patients with CCA; however, the exact prevalence remains unclear. Therefore, we aimed to investigate the prevalence of hearing loss in CCA using data from newborn hearing screening in a single tertiary referral center.
Methods A total of 126 patients with CCA combined with hearing loss diagnosed at our hospital from November 2005 to November 2022 were retrospectively included in our study. All patients had at least one screening or diagnostic auditory brainstem response result. Brain ultrasonography and magnetic resonance imaging were used to diagnose CCA.
Results Among 126 patients, 93 had automated auditory brainstem response within a month from birth. Of the 93 patients, 20 (21.5%) had a “refer” result in the screening tests in at least one ear. The final incidence of hearing loss in patients with CCA was 16.1%. We observed no hearing loss in 22 patients with isolated CCA.
Conclusions Patients with CCA have a higher incidence of hearing loss. However, this is likely related to the concurrent condition of patients. CCA seems not to be a risk factor for hearing loss.
Wiboonsaksakul, Kantapon Pum; Della Santina, Charles C.; Cullen, Kathleen E.
Publication date 28-08-2023
Hypothesis Prosthetic electrical stimulation can evoke compensatory eye and head movement despite vestibular implant electrode insertion occurring years after prior labyrinthectomy.
Background Vestibular implants sense head rotation and directly stimulate the vestibular nerve, bypassing damaged end organs. Animal research and current clinical trials have demonstrated the efficacy of this approach. However, candidacy criteria for vestibular implants currently require presence of a patent labyrinth in the candidate ear and at least aidable hearing in the opposite ear, thus excluding patients who have undergone prior labyrinthectomy for unilateral Menières disease that later progressed to bilateral vestibular hypofunction.
Methods Eight years after right unilateral labyrinthectomy, we implanted stimulating electrodes in the previously exenterated right ear ampullae of a rhesus macaque monkey. The left labyrinth had long-standing hypofunction due to intratympanic gentamicin injection and surgical disruption. We used three-dimensional video-oculography to measure eye movement responses to prosthetic electrical stimulation. We also measured head-movement responses to prosthetic stimulation with the head unrestrained.
Results Bilateral vestibular hypofunction was confirmed by absence of vestibuloocular reflex responses to whole-body rotation without prosthetic stimulation. For a subset of the implanted electrodes, prosthetic vestibular stimulation evoked robust compensatory eye and head movements. One electrode reliably elicited responses aligned with the implanted ears anterior canal nerve regardless of the return electrode used. Similarly, a second electrode also elicited responses consistent with excitation of the horizontal canal nerve. Responses grew quasilinearly with stimulation rate and current amplitude.
Conclusion Prosthetic electrical stimulation targeting the vestibular nerve can be effective years after labyrinthectomy, if at least some parts of the vestibular nerves ampullary branches remain despite destruction or removal of the membranous labyrinth.
Sassi, Tyuana Sandim da Silveira; Bucuvic, Erika Cristina; Castiquini, Eliane Aparecida Techi; Chaves, Juliana Nogueira; Kimura, Marcia; Buzo, Byanka Cagnacci; Lourençone, Luiz Fernando Manzoni
Publication date 02-11-2023
Introduction Bone-conduction hearing device (BCHD) uses natural sound transmission through bone and soft tissue, directly to the cochlea, via an external processor that captures and processes sound, which is converted into mechanical vibrations. Key parameters, as maximum power output (MPO) and broader frequency range (FR), must be considered when indicating a BCHD because they can be decisive for speech recognition, especially under listening challenge conditions.
Objectives Compare hearing performance and speech recognition in noise of two sound processors (SPs), with different features of MPO and FR, among BCHD users.
Materials and Methods This single-blinded, comparative, observational study evaluated 21 individuals Baha 4 system users with conductive or mixed hearing impairment. The free-field audiometry and speech recognition results were blindly collected under the following conditions: unaided, with Baha 5, and with Baha 6 Max SP.
Results In free-field audiometry, significant differences were observed between the SP at 0.25, 3, 4, 6, and 8 k Hz, with Baha 6 Max outperforming Baha 5. The Baha 6 Max provided significantly better speech recognition than Baha 5 under all the speech in noise conditions evaluated. Separating the transcutaneous from the percutaneous users, Baha 6 Max Attract SP provided the best results and significantly lowered the free-field thresholds than Baha 5 Attract. The Baha 6 Max also significantly improved speech recognition in noise, among both Attract and Connect users.
Conclusion The present study revealed that the greater MPO and broader FR of the Baha 6 Max device helped increase high-frequency gain and improved speech recognition in BCHD-experimented users.
Kim, Eric K.; Hum, Maxwell; Sharon, Jeffrey D.
Publication date 15-09-2023
Objective Investigate the relationship between Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI) scores and daily dizziness symptoms.
Study Design Prospective cohort analysis of 52 patients with vestibular migraine (VM).
Setting Tertiary referral center.
Patients Fifty-two patients diagnosed with VM or probable VM according to Barany Society criteria.
Interventions Subjects reported their dizzy symptoms (on a scale of 0 no symptoms, 1 mild, 2 moderate, and 3 severe) every day for 1 month via automated text messaging linked to a cloud-based research database. Subjects completed VM-PATHI and Dizziness Handicap Inventory (DHI) scores at the end of the month. We examined the correlation between a composite of daily dizziness scores with VM-PATHI and DHI scores through linear regression and correlation analysis.
Main Outcome Measures Pearson correlation coefficient, R2 value.
Results VM-PATHI showed a moderate correlation with daily dizziness symptoms (correlation coefficient, 0.51). DHI showed a lower correlation with daily dizziness (correlation coefficient, 0.38). VM-PATHI score was a strong predictor of daily dizziness with univariate linear regression (R2 = 0.26, p = 0.001). In a multiple linear regression model with age, history of anxiety and/or depression, and VM-PATHI, the VM-PATHI score was the only statistically significant predictor of daily dizziness (p < 0.001).
Conclusions Daily dizziness symptoms are better correlated with VM-PATHI score than the DHI, providing further validation of VM-PATHI as a disease-specific outcome measure for patients with VM.
Johns, J. Dixon; Olszewski, Rafal; Strepay, Dillon; Lopez, Ivan A.; Ishiyama, Akira; Hoa, Michael
Publication date 20-09-2023
Hypothesis Analysis of human temporal bone specimens of patients with Menière’s disease (MD) may demonstrate altered expression of gene products related to barrier formation and ionic homeostasis within cochlear structures compared with control specimens Background MD represents a challenging otologic disorder for investigation. Despite attempts to define the pathogenesis of MD, there remain many gaps in our understanding, including differences in protein expression within the inner ear. Understanding these changes may facilitate the identification of more targeted therapies for MD.
Methods Human temporal bones from patients with MD (n = 8) and age-matched control patients (n = 8) were processed with immunohistochemistry stains to detect known protein expression related to ionic homeostasis and barrier function in the cochlea, including CLDN11, CLU, KCNJ10, and SLC12A2. Immunofluorescence intensity analysis was performed to quantify protein expression in the stria vascularis, organ of Corti, and spiral ganglion neuron (SGN).
Results Expression of KCNJ10 was significantly reduced in all cochlear regions, including the stria vascularis (9.23 vs 17.52, p = 0.011), OC (14.93 vs 29.16, p = 0.014), and SGN (7.69 vs 18.85, p = 0.0048) in human temporal bone specimens from patients with MD compared with control, respectively. CLDN11 (7.40 vs 10.88, p = 0.049) and CLU (7.80 vs 17.51, p = 0.0051) expression was significantly reduced in the SGN.
Conclusion The results of this study support that there may be differences in the expression of proteins related to ionic homeostasis and barrier function within the cochlea, potentially supporting the role of targeted therapies to treat MD.
Verrecchia, Luca; Jansson, Karl-Johan Fredén; Reinfeldt, Sabine; Håkansson, Bo
Publication date 10-10-2023
Introduction A simultaneous recording of cervical and ocular vestibular evoked myogenic potential (sVEMP) to unilateral air-conducted (AC) stimulation reduces the test time and halves the sound load.
Materials and Methods The sVEMP has been compared with the conventional sequential unilateral AC cervical and ocular VEMP in a consecutive cohort of 120 subjects attending the vestibular laboratory. The stimulus was a 500-Hz 6-ms tone burst, at 130 dB peSPL for sequential recordings but at 125 dB for the added sVEMP, for cumulative sound load containment. Amplitudes, latencies, and amplitude asymmetry ratios (ARs) were the parameters included in analysis.
Results Relevant results were as follows: 1) significantly lower amplitudes in sVEMP versus VEMP (ocular recordings, median = 2.90 IQR = 0–4.98 vs. 4.15 1.73–8.98 μV, p < 0.001; cervical, 0.84 0.30–1.69 vs. 1.36 0.60–2.30, p < 0.001; electromyography scaled values); 2) 10% lower response rate at cervical recordings and 11% at ocular recordings in sVEMP, particularly in older subjects; 3) significant correlations between cervical amplitudes (rs = 0.88, p < 0.001), ocular amplitudes (rs = 0.71, p < 0.001), peak latencies (rs = 0.36–0.67, p < 0.001), and ARs (ocular, rs = 0.56; cervical, rs = 68, p < 0.001); and 4) good agreement in pathological AR detection (cervical recordings, Cohen’s κ = 0.649, p < 0.001; ocular, κ = 0.589, p < 0.001).
Discussion AC sVEMP showed good correlation/agreement with sequential AC VEMP. Test time containment and halved sound load are clinical adds in sVEMP, opening to its use as laboratory standard. However, AC sVEMP presented reduced amplitudes and response rates, secondary to the reduced AC stimulation used in this study to allow checking of the null responses and the pathological ARs at AC sVEMP with conventional AC VEMP.
Elms, Hunter L.; Straka, David M.; Abouelella, Dina K.; Francis, Howard W.; Kaylie, David M.; Cunningham, Calhoun D. III
Publication date 06-09-2023
Objective Characterize the incidence, risk factors, and patient outcomes of dural venous sinus thrombosis identified on postoperative imaging after retrosigmoid or translabyrinthine craniotomy for vestibular schwannoma resection.
Study Design Retrospective cohort study.
Setting Single tertiary academic referral center.
Patients Eighty-one patients 19 to 82 years of age with vestibular schwannomas, 58% female.
Interventions Retrosigmoid or translabyrinthine craniotomy with postoperative magnetic resonance imaging/magnetic resonance venography.
Main Outcome Measures Association between operative approach, age, sex, body mass index, tumor size, dominant sinus, operative time, laterality, and perioperative cerebrospinal fluid (CSF) leaks with rate of thrombosis.
Results Translabyrinthine craniotomy was associated with the highest relative risk of thrombosis (odds ratios OR = 19.82, 95% confidence interval CI = 1.75–224, p = 0.007), followed by male sex (OR = 5.53, 95% CI = 1.63–18.8, p = 0.035). Other patient and demographic risk factors were not associated with increased rates of dural venous thrombosis, nor was there an association with postoperative CSF leak. 81% (25/31) of thrombi had resolved within 3 years of surgery.
Conclusions Translabyrinthine approach and male sex most strongly predicted postoperative dural venous thrombosis after postauricular craniotomy for vestibular schwannoma resection.
Professional Practice Gap and Educational Need Better understanding of risk factors and management of dural venous thrombosis after vestibular schwannoma surgery.
Learning Objective Characterize clinically significant risk factors for dural venous thrombosis in vestibular schwannoma surgery.
Desired Result Identification of patient and operative risk factors for dural venous thrombosis.
Level of Evidence III.
Indicate IRB or IACUC Exempt.
Nisenbaum, Eric; Wiefels, Matthew; Telischi, Julia; Marasigan, Mikhail; Kanumuri, Vivek; Pena, Stefanie; Thielhelm, Torin; Bracho, Olena; Bhatia, Rita; Scaglione, Tricia; Telischi, Fred; Fernandez-Valle, Cristina; Liu, Xue-Zhong; Luther, Evan; Morcos, Jacques; Ivan, Michael; Dinh, Christine T.
Publication date 19-10-2023
Background The vestibular schwannoma (VS) secretome can initiate monocyte recruitment and macrophage polarization to M1 (proinflammatory) and/or M2 (protumorigenic) phenotypes, which in turn secrete additional cytokines that contribute to the tumor microenvironment. Profiling cyst fluid and cerebrospinal fluid (CSF) in cystic VS provides a unique opportunity to understand mechanisms that may contribute to tumor progression and cyst formation.
Hypothesis Cystic VSs secrete high levels of cytokines into cyst fluid and express abundant M1 and M2 macrophages.
Methods Tumor, CSF, and cyst fluid were prospectively collected from 10 cystic VS patients. Eighty cytokines were measured in fluid samples using cytokine arrays and compared with normal CSF from normal donors. Immunofluorescence was performed for CD80+ M1 and CD163+ M2 macrophage markers. Demographic, audiometric, and radiographic information was obtained through retrospective chart review.
Results Cyst fluid expressed more osteopontin and monocyte chemotactic protein-1 (MCP-1; p < 0.0001), when compared with normal CSF. Cyst fluid also expressed more protein (p = 0.0020), particularly MCP-1 (p < 0.0001), than paired CSF from the same subjects. MCP-1 expression in cyst fluid correlated with CD80+ staining in VS tissue (r = 0.8852; p = 0.0015) but not CD163+ staining.
Conclusion Cyst fluid from cystic VS harbored high levels of osteopontin and MCP-1, which are cytokines important in monocyte recruitment and macrophage polarization. MCP-1 may have a significant role in molding the tumor microenvironment, by polarizing monocytes to CD80+ M1 macrophages in cystic VS. Further investigations into the role of cytokines and macrophages in VS may lead to new avenues for therapeutic intervention.
Lee, Andrew S.; Teh, Bing M.; Alexiades, George
Publication date 26-08-2023
Objective We document the first successful transmastoid surgical treatment of facial nerve palsy for a patient with craniometaphyseal dysplasia (CMD), a rare genetic disease.
Patient A 9-month-old girl with bilateral facial nerve palsies and conductive hearing loss. Genetic testing made a diagnosis of CMD, and imaging showed narrowing of the facial nerve canals and ossicular fixation.
Intervention Right transmastoid facial nerve decompression and ossicular chain reconstruction.
Main Outcome Measure Facial nerve function (House-Brackmann grade).
Results Facial nerve function initially worsened, then improved within 12 months from House-Brackmann grade IV–V to grade III.
Conclusion Surgical cranial nerve decompression of and ossicular chain reconstruction may be effective treatments for patients with CMD.
Ziv, Oren; Hazout, Chen; Goldberg, Nitzan; Tavdi, Alex; Zholkovsky, Ariel; Kordeluk, Sofia; El-Saied, Sabri; Dinur, Anat Bahat; Ben-Zion, Joshua; Muhanna, Nidal; Ungar, Omer J.
Publication date 13-10-2023
Purpose To investigate the effect of Bells palsy (BP) presenting as polycranial neuropathy (PCN) compared with BP caused by isolated facial nerve (CNVII).
Methods We carried out a retrospective cohort study of the medical records of all consecutive patients who were diagnosed with BP at a single tertiary referral center between 2010 and 2017. Included were patients 18 years or older who were clinically diagnosed with BP and completed 7 days of systemic steroidal treatment and at least 6 months of follow-up. The patients were divided into two groups according to whether the BP derived from a monocranial neuropathy or a PCN. Demographics and BP severity and outcome were compared between these groups. A systematic literature review using Medline via “Pub Med,” “Embase,” and “Web of Science” was conducted.
Results In total, 321 patients with BP were enrolled. The median (interquartile range) age at presentation was 44 (33–60) years. Sex distribution showed male predominance of 57.6% (n = 185) versus 42.4% (n = 136), and 21.2% (n = 68) had PCN. The most concomitantly affected cranial nerve (CN) was the trigeminal (CNV; n = 32, 47%), followed by the glossopharyngeal nerve (CNIX; n = 14, 21%) and the audiovestibular nerve (CNVIII; n = 10, 15%). Age, House-Brackmann score on presentation, and diabetes mellitus (DM) were independent predictors for PCN etiology (p = 0.001, p = 0.034, and p < 0.001, respectively). Each increase in 1 year of age was associated with additional odds ratio (95% confidence interval) of 0.97 (0.95–0.99) for PCN. The odds ratio (95% confidence interval) associated with DM was 8.19 (4.02–16.70). Our systematic literature review identified 1,440 patients with the PCN type of BP. The most commonly affected CN was the trigeminus (25–48%), followed by the glossopharyngeal and audiovestibular nerves (2–19% and 0–43%, respectively).
Conclusion The severity of facial weakness on initial presentation among PCN patients was significantly higher compared with the monocranial neuropathy–type BP patients. The authors believe that the significant association and prevalence rate ratio between DM and PCN warrant that a patient presenting with PCN undergo screening for DM.
Carlson, Matthew L.; Lohse, Christine M.; Agazzi, Siviero; Babu, Seilesh C.; Barker, Frederick G.; Barnett, Samuel; Bi, Wenya Linda; Biggs, Nigel; Boahene, Kofi D.; Breen, Joseph T.; Brown, Kevin D.; Cayé-Thomasen, Per; Cosetti, Maura K.; Deep, Nicholas L.; Dey, Jacob K.; Dornhoffer, James R.; Forner, David; Gurgel, Richard K.; Hansen, Marlan R.; Hunter, Jacob B.; Kalamarides, Michel; Kim, Irene A.; King, Andrew T.; Kircher, Matthew L.; Lassaletta, Luis; Link, Michael J.; Lloyd, Simon K.W.; Lund-Johansen, Morten; Marinelli, John P.; Matthies, Cordula; Mehta, Vikas; Moore, Eric J.; Nassiri, Ashley M.; Neff, Brian A.; Nelson, Rick F.; Olson, Jeffrey J.; Patel, Neil S.; Celda, Maria Peris; Plitt, Aaron R.; Price, Daniel L.; Thomas Roland, J. Jr; Sweeney, Alex D.; Tasche, Kendall K.; Tatagiba, Marcos; Tveiten, Øystein; Van Gompel, Jamie J.; Vrabec, Jeffrey T.; Wanna, George B.; Weisskopf, Peter A.
Publication date 25-10-2023
Objective The objective of the current study was to present the results of an international working group survey identifying perceived limitations of existing facial nerve grading scales to inform the development of a novel grading scale for assessing early postoperative facial paralysis that incorporates regional scoring and is anchored in recovery prognosis and risk of associated complications.
Study Design Survey.
Setting A working group of 48 multidisciplinary clinicians with expertise in skull base, cerebellopontine angle, temporal bone, or parotid gland surgery.
Results House-Brackmann grade is the most widely used system to assess facial nerve function among working group members (81%), although more than half (54%) agreed that the system they currently use does not adequately estimate the risk of associated complications, such as corneal injury, and confidence in interrater and intrarater reliability is generally low. Simplicity was ranked as the most important attribute of a novel postoperative facial nerve grading system to increase the likelihood of adoption, followed by reliability and accuracy. There was widespread consensus (91%) that the eye is the most critical facial region to focus on in the early postoperative setting.
Conclusions Members were invited to submit proposed grading systems in alignment with the objectives of the working group for subsequent validation. From these data, we plan to develop a simple, clinically anchored, and reproducible staging system with regional scoring for assessing early postoperative facial nerve function after surgery of the skull base, cerebellopontine angle, temporal bone, or parotid gland.
Li, Marwin; Perlov, Natalie M.; Patel, Jena; Amin, Dev; Kumar, Ayan; Urdang, Zachary D.; Willcox, Thomas O.; Chiffer, Rebecca C.
Publication date 19-10-2023
Objective To test the hypothesis that use of cigarettes or other products with either cigarette-like smoke profile or high nicotine content by young populations increases the odds of developing sensorineural hearing loss (SNHL).
Study Design Retrospective cohort study.
Setting Tri NetX US Collaborative Network (2003–2022).
Patients Approximately 3.6 million patients at least 18 years old.
Intervention None.
Main Outcome Measures The primary outcome of interest was diagnosis of SNHL, defined using medical billing codes (International Classification of Diseases, Tenth Revision, Current Procedural Terminology, etc.). Cohort inclusion criteria included electronic health record entry after 2003, age 18 to 54 or 55+ years at index, and status of cigarette, noncigarette nicotine, or cannabis use. Covariates were controlled via 1:1 propensity score matching for SNHL-related conditions, including diabetes mellitus and ischemic diseases. Odds for developing SNHL were calculated against control subjects aged 18 to 54 years who have no record of nicotine/cannabis use.
Results Odds for developing SNHL are higher for people 18 to 54 years old who use any nicotine product (odds ratio 95% confidence interval, 5.91 5.71–6.13), cigarettes only (4.00 3.69–4.33), chewing tobacco only (9.04 7.09–11.63), or cannabis only (3.99 3.60–4.44) compared with control. People 55+ years old who use no products also showed increased odds for SNHL (4.73 4.63–4.85).
Conclusions Both nicotine and smoke exposure seem to be strongly associated with increased odds for developing SNHL, with chewing tobacco having the strongest association.
"Baruah, Paramita; Marshall, Jennifer; Jones, Philip N.; Major, Triin; Pucino, Valentina; ONeil, John D.; Nefla, Meriam; McGettrick, Helen; Monksfield, Peter; Irving, Richard; Buckley, Christopher D."
Publication date 15-09-2023
Background and aim Vestibular schwannomas (VSs), despite being histologically benign, cause significant morbidity because of their challenging intracranial location and the propensity for growth. The role of the stroma and particularly fibroblasts, in the progression of VS, is not completely understood. This study examines the profile of fibroblasts in VS.
Methods Seventeen patients undergoing surgical excision of VS were recruited into the study. Reverse transcription with quantitative polymerase chain reaction (RT-qPCR) was performed on VS tissue samples and fibroblast-associated molecules examined. Immunofluorescence and immunohistochemistry in VS tissue were used to study the expression of fibroblast markers CD90 and podoplanin in situ. Fibroblast cultures were established from VS, and RT-qPCR analysis was performed on a panel of fibroblast markers on VS and control tissue fibroblasts.
Results Several fibroblast-associated molecules including members of galectin family and matrix metalloproteinases were found to be expressed in VS tissue on RT-qPCR analysis. In situ, expression of CD90 and podoplanin was observed in VS tissue both on immunohistochemistry and immunofluorescence. RT-qPCR analysis of fibroblasts from VS and control vestibular neuroepithelium (NE) showed a higher expression of several molecules of the galectin and matrix metalloproteinases family on VS fibroblasts compared with NE fibroblasts.
Conclusion This work examines fibroblasts from VS and shows qualitative differences from NE fibroblasts on RT-qPCR. Further understanding of the fibroblast function in the progression of VS will potentially unveil new targets to manage VS growth.
Berlot, Ashley A.; Moskowitz, Howard S.; Lin, Juan; Liu, Jianyou; Sehanobish, Esha; Jerschow, Elina; Ow, Thomas J.; Sussman, Elyse S.
Publication date 29-09-2023
Objective To evaluate long-term effects of COVID-19 on auditory and vestibular symptoms in a diverse cohort impacted by the initial 2020 COVID-19 infection in the pandemics epicenter, before vaccine availability.
Study Design Cohort study of individuals with confirmed COVID-19 infection, diagnosed in the March–May 2020 infection wave. A randomized, retrospective chart review of 1,352 individuals was performed to identify those with documented new or worsening auditory (aural fullness, tinnitus, hyperacusis, hearing loss) or vestibular (dizziness, vertigo) symptoms. Those with documented symptoms (613 of the 1,352 initial cohort) were contacted for a follow-up telephone survey in 2021–2022 to obtain self-report of aforementioned symptoms.
Setting Academic tertiary hospital system in Bronx, NY.
Patients Adults 18 to 99 years old with confirmed COVID-19 infection, alive at time of review. One hundred forty-eight charts were excluded for restricted access, incomplete data, no COVID-19 swab, or deceased at time of review.
Intervention Confirmed COVID-19 infection, March to May 2020.
Main Outcomes Measures Auditory and vestibular symptoms documented in 2020 medical records and by self-report on 2021 to 2022 survey.
Results Among the 74 individuals with documented symptoms during the first 2020 COVID-19 wave who participated in the 2021 to 2022 follow-up survey, 58% had documented vestibular symptoms initially in 2020, whereas 43% reported vestibular symptoms on the 2021 to 2022 survey (p = 0.10). In contrast, 9% had documented auditory symptoms initially in 2020 and 55% reported auditory symptoms on the 2021 to 2022 survey (p < 0.01).
Conclusions COVID-19 may impact vestibular symptoms early and persistently, whereas auditory effects may have more pronounced long-term impact, suggesting the importance of continually assessing COVID-19 patients.
Oh, Melissa S.; Govil, Nandini; Alfonso, Kristan; Todd, Norman Wendell Jr
Publication date 01-12-2023
No abstract available
Pubmed PDF WebShaida, Zara; Magos, Tiarnan; Kanona, Hala; Shaida, Azhar
Publication date 01-12-2023
No abstract available
Pubmed PDF WebKobayashi, Masumi; Yoshida, Tadao; Sugimoto, Satofumi; Naganawa, Shinji; Sone, Michihiko
Publication date 15-08-2023
No abstract available
Pubmed PDF Web"Warren, DeAndre A.; Steele-Bomeisl, Erica; Mowry, Sarah"
Publication date 20-09-2023
No abstract available
Pubmed PDF Web