Otology & Neurotology最新文献

Objective: We sought to apply a previously developed transimpedance (TIM) heatmap pattern classification scheme in patients with no known risk factors for cochlear anomalies, in addition to patients implanted in the revision setting, to better understand the incidence of pattern variants, and potential clinical implications.

Study design: Single-center retrospective review.

Setting: Tertiary referral centre.

Patients: Patients older than 6 months of age who underwent cochlear implantation between June 2020 and June 2024 with normal gross cochlear anatomy and no concern for fibrosis that had intraoperative TIM testing completed. Patients undergoing revision implantation were also included as a separate cohort.

Intervention: None.

Main outcome measures: The number of patients with normal and variant TIM patterns was evaluated for each cohort. TIM patterns were subsequently compared with the electrode position found on intraoperative x-ray.

Results: There were 321 ears that underwent implantation and subsequent intraoperative TIM assessment meeting inclusion criteria. Of these, 310 (96.6%) were in the primary surgery setting, and 11 (3.4%) were in the revision surgical setting. In the primary surgical setting, 86.4% (n=268) of the implants demonstrated a normal TIM heatmap. Compared with the primary surgical setting, where only 45.5% (n=5) of revision surgery TIM heatmaps were interpreted as normal. One patient in the revision setting had a newly identified "double X" pattern corresponding to a normal electrode position on x-ray.

Conclusions: There is a decreased incidence of previously developed TIM heatmap pattern variants in CI recipients with normal gross cochlear anatomy.

Objective: Transimpedance matrix (TIM) measurements can not only detect abnormal electrode positioning in patients with cochlear implants (CI) but also estimate the angular insertion depth (AID). This study aims to assess the feasibility of using TIM to measure cochlear morphology-specifically its dimensions and electrode position-and to identify electrode pairs best associated with these dimensions.

Study design: Retrospective cohort study.

Setting: University Medical Center, tertiary academic referral center.

Patients: Patients undergoing CI (CI622) surgery between January 2020 and April 2024.

Intervention: Cochlear size parameters, including diameter, width, height, and cochlear duct length (CDL), were obtained preoperatively from CT imaging using OTOPLAN. The maximal angular insertion depth (maxAID) was determined from x-ray imaging based on Stenvers' projection. Gradient phases between electrode pairs and heatmaps were extracted from TIM data. Pearson correlation analysis was conducted to examine the relationships between cochlear size parameters and TIM data.

Main outcome measures: Out of 41 patients, 39 were included in this study. A significant positive correlation was found between the maxAID and the gradient phase of electrode pairs E20-E10 (R = 0.798, P < 0.0001). Negative correlations between cochlear size and gradient phase were identified: (1) diameter: R = -0.59, P < 0.05 (E18-E11), (2) width: R = -0.609, P < 0.05 (E16-E4), (3) height: R = -0.634, P < 0.01 (E8-E22), (4) cochlear duct length (CDL) R = -0.634, P < 0.01 (E16-E12).

Conclusions: TIM measurements are useful for assessing cochlear dimensions.

Background: Asymmetric hearing loss (AHL)-defined as severe-to-profound hearing loss in one ear with better hearing in the other-can significantly impair communication and quality of life (QoL). Although cochlear implantation (CI) is an established treatment for sensorineural hearing loss, restrictive FDA and Medicare criteria often exclude AHL patients who could benefit. Emerging evidence suggests CI improves auditory function and QoL in this population.

Objectives: Perform a scoping review of the literature on CI in adults with AHL, focusing on audiometric and QoL outcomes.

Methods: A scoping review was conducted per PRISMA guidelines. Databases searched included Ovid MEDLINE, Embase, CENTRAL, CINAHL, and Web of Science. Eligible studies involved adult AHL patients undergoing CI reporting preoperative and postoperative audiometric or QoL data. Two reviewers independently screened and extracted data.

Results: Twenty-five studies met inclusion criteria, reporting 23 audiometric and 21 different QoL measures. The Consonant-Nucleus-Consonant (CNC) test was the most used, with average preoperative scores in the implanted ear ranging from 3.6% to 18.3% to 49.3% to 66.2% at 12 months. Sentence recognition in quiet (AzBio) increased from 13% to 25% preoperatively to as high as 84% bimodally. In noise (+5dB SNR), bimodal AzBio scores rose from 27% to 30% preoperatively to 49% to 68% at 6 months, with sustained 12-month benefit. QoL measures-including the Speech, Spatial and Qualities of Hearing Scale (SSQ) and Nijmegen Cochlear Implant Questionnaire (NCIQ)-showed significant improvements in 92% and 100% of studies, respectively.

Conclusions: CI provides substantial auditory and QoL benefits for adults with AHL, supporting reconsideration of candidacy criteria to expand access.

Objective: To examine the association of extent of otosclerotic plaque using high-resolution photon-counting computed tomography (PCCT) with hearing and surgical outcomes.

Study design: Historical cohort.

Setting: Large academic center.

Patients: Patients with otosclerosis who completed PCCT imaging at time of initial evaluation.

Interventions: Observation, surgery.

Main outcome measures: Audiometric data.

Results: A total of 53 ears were eligible for study. The mean age at PCCT was 51 years (SD: 14). The mean extent of oval window otosclerotic plaque measured in radial degrees was 112 (SD: 65) and the mean otosclerotic depth was 1.6mm (SD: 0.6). The mean air-bone gap pure-tone average was 18 dB (SD: 12) and the mean Carhart degree was 9 dB (SD: 10). The radial degrees of oval window extent were not significantly associated with air-bone gap (correlation coefficient: 0.14; P =0.3) or Carhart degree (correlation coefficient: 0.04; P =0.8). Likewise, otosclerotic plaque depth was not significantly associated with air-bone gap (correlation coefficient: -0.19; P =0.2) or Carhart degree (correlation coefficient: -0.08; P =0.6). After PCCT, 22 ears underwent surgery. In this subset, oval window extent and plaque depth were not significantly associated with the postoperative changes in air-bone gap or high-frequency thresholds.

Conclusions: Despite enhanced visualization of subtle abnormalities with PCCT imaging, the extent of oval window otosclerotic plaque, measured in angular degrees and depth, was not associated with hearing loss at time of initial evaluation or postoperative audiologic changes in patients with otosclerosis.

Objective: To investigate the impact of perioperative coagulation continuation/interruption on cochlear implantation outcomes.

Study design: Retrospective case series.

Setting: Tertiary academic referral center.

Patients: All patients 18 years and older who underwent cochlear implantation between January 2014 and February 2025.

Main outcome measure: Postoperative complications (hematoma, wound breakdown, infection) as well as operative time and estimated intraoperative blood loss.

Results: 101 adult patients (median age: 72 y; 43.6% female) undergoing cochlear implant surgery were on anticoagulation medications, of which 45 (44.6%) continued anticoagulants in the perioperative period. The types of anticoagulants patients used included aspirin (58.4%), direct oral anticoagulants (12.9%), aspirin and clopidogrel (9.9%), clopidogrel only (5.9%), subcutaneous heparin (4%), warfarin (4%), aspirin and warfarin (2%), and other combinations of anticoagulative therapies (3%). There was no association between continuation of anticoagulation and increased operation time ( P =0.59) or increased estimated blood loss ( P =0.45). One patient who suspended anticoagulation before surgery developed wound breakdown, which responded to conservative management. No patients developed complications of wound infection or hematoma.

Conclusion: Our findings demonstrate that continued anticoagulation during the perioperative period was not associated with intraoperative complications or bleeding-related postoperative complications in adult patients. This reiterates the findings of prior work examining the safety of perioperative anticoagulation during cochlear implantation and is consistent with related studies examining the safety of anticoagulants during other head and neck surgery procedures. As such, individualized decision-making leading to perioperative continuation of anticoagulation may be indicated, particularly in medically complex patients.

Objective: As many centers around the world are shifting towards earlier cochlear implant (CI) activation, there have been no studies of patient preference on timing. This study aimed to determine patient timing preferences before and after standard 3-week activation and examine factors influencing preference changes.

Study design: Prospective survey-based study.

Setting: Tertiary care academic CI center.

Patients: Adults 18 years of age or older receiving their first CI.

Interventions: Participants completed questionnaires preoperatively, immediately postoperatively, 1-week postoperatively, and 1-week postactivation. Data included demographics, CI quality of life (CIQoL-10), and device characteristics. Patient-reported outcomes, activation preferences, and rationales for activation timing were assessed.

Main outcome measures: Change in patient-preferred activation timing from preoperative to 1-week postactivation.

Results: Fifty-two patients (46.2% male) participated. Mean age was 65.6±16.0 years. Preoperatively, most preferred same-day activation (25.5%), followed by the standard 3-week interval (23.5%) and equally at 1 and 2 weeks (17.6% each). The primary rationale was the desire for immediate hearing (38.3%). At 1-week postactivation, preferences shifted toward later activation: 32.6% preferred the standard 3-week timeline versus 8.7% for same-day. One week postoperatively, dizziness was significantly correlated with delayed activation preference ( P =0.033). Patients initially preferring "early" activation (<2 wk) had 2.5-fold increased odds of preferring "standard" activation (≥2 wk) postoperatively (95% CI: 0.97-6.44), though this did not reach significance.

Conclusions: Many CI patients prefer early device activation, yet many adjust their preference postoperatively, likely due to underestimation of surgical recovery. This study highlights the dynamic nature of activation preferences, underscoring the importance of adequate patient counseling and considering patient input before uniformly adopting earlier activation protocols.

Objective: Electrode array design may influence auditory and language performance in pediatric cochlear implant (CI) recipients. Slim perimodiolar arrays, positioned closer to the modiolus, are hypothesized to provide more focused stimulation and lower current requirements. This study compares outcomes of slim perimodiolar (PM) and straight (ST) electrode arrays in children.

Study design: Retrospective cohort review.

Setting: Tertiary pediatric otolaryngology referral center.

Patients: Eighty-eight children underwent 122 implantations with slim PM (CI632/532, n = 65) or slim ST (CI422/522/622, n = 57) arrays between 2016 and 2023. For speech and language outcomes, 72 children were assessed globally at the patient level, including 68 sequential cases (first implanted side) and 4 simultaneous bilateral cases.

Main outcome measures: Auditory thresholds, impedances, T/C levels, and neural response telemetry (NRT) were analyzed postoperatively, at 6 and 12 months, speech and language performance (CAP and APCEI profile at 2 y). Angular depth of insertion (aDOI), basal insertion depth (BID), and modified intracochlear position index (mICPI) were derived from preoperative CT and postoperative radiographs.

Results: PM arrays achieved significantly closer modiolar positioning (mICPI: 0.72 ± 0.07 vs 0.98 ± 0.06, P < 0.0001) with no difference in aDOI and BID, lower impedances at 1 and 12 months (P < 0.0001), lower NRT levels at 6 months (P = 0.001), and reduced energy requirements. In patient-level analyses, children implanted ≤3 years with PM arrays had higher APCEI (P = 0.006) and CAP scores (P < 0.03) compared with ST arrays. In children implanted >3 years, electrode type was not associated with outcomes, while age at implantation was the main determinant of language scores.

Conclusions: Slim PM arrays provide closer modiolar proximity, lower impedances, reduced energy consumption, with more consistent early hearing outcomes and better speech/language scores if implanted before 3 years of age. These findings support early implantation with slim perimodiolar arrays to optimize pediatric auditory and language performance.

Objective: To evaluate the impact of cochlear implantation (CI) and simultaneous endolymphatic sac decompression (ELSD) on vestibular and audiometric outcomes in patients with advanced Ménière disease (MD).

Study design: Historical cohort.

Setting: Tertiary academic medical center.

Patients: Patients with medically refractory MD who underwent CI with or without simultaneous ELSD from 2000 through 2024.

Interventions: CI with or without ELSD.

Main outcome measures: Post-CI patient-reported changes in vertigo severity and frequency, Consonant-Nucleus-Consonant word (CNCw) scores, and AzBio sentences in quiet scores.

Results: Ninety-nine patients with preoperative vertigo secondary to MD were eligible for study, including 17 (17%) who underwent simultaneous ELSD. In total, 15 (88%) and 2 (12%) of the 17 patients with simultaneous ELSD reported improvement and stability in vertigo severity, respectively; in comparison, 26 (32%), 40 (49%), and 16 (20%) of the 82 patients with CI alone reported improvement, stability, and worsening in vertigo severity, respectively ( P <0.001). Likewise, 15 (88%) and 2 (12%) of the patients with simultaneous ELSD reported improvement and stability in vertigo frequency, respectively, whereas 21 (26%), 43 (52%), and 18 (22%) of patients with CI alone reported improvement, stability, and worsening in vertigo frequency, respectively ( P <0.001). Post-CI speech recognition scores were not significantly different between the simultaneous ELSD and CI alone groups [median (IQR) CNCw 70 (38 to 82) vs. 72 (58 to 82) and median (IQR) AzBio quiet 87 (67 to 96) vs. 87 (73 to 94), respectively].

Conclusions: In patients with MD, CI with simultaneous ELSD provides improvement in vertigo symptoms and similar audiometric outcomes when compared with CI alone. In appropriately selected patients with both refractory vestibular symptoms and sensorineural hearing loss meeting criteria for implantation, CI with simultaneous ELSD offers improvement in severity and frequency of vertigo as well as successful auditory rehabilitation.