Otology & Neurotology最新文献

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.

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 measures: 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 < 0.01) and duration of high drill speed (>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.

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.

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.

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.

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.