Otology & Neurotology最新文献

Objective: To characterize adults with single-sided deafness (SSD) and cochlear implant (CI) utilization with associated clinical predictors.

Study design: Retrospective cohort study.

Setting: Tertiary care academic center.

Patients: Adults with SSD (pure tone average in contralateral ear ≤30 dB).

Interventions: Cochlear implantation in SSD ear.

Main outcome measures: Datalogging (hours/day of CI usage) and associated usage categories (full-time: ≥8 h/d; partial: 2 to 7.99 h/d; limited: 0.01 to 1.99 h/d; nonuse: 0 h/d).

Results: Ninety-six CI patients were identified, and 70 patients had longitudinal datalogging follow-up. At final follow-up, 33 were full-time users (47.1%), 27 were partial users (38.5%), 8 were limited users (11.4%), and 2 were nonusers (2.8%). Longitudinal datalogging showed that patients, as early as 1 month, display strong utilization patterns that reflect their final usage at 12 months. Traditional CI factors, including duration of hearing loss, speech performance in both quiet and in noise, and hearing loss etiology, had no association with final user status. Younger patients had a higher likelihood of becoming partial/limited users (-7.8 y; 95% CI -14.8 to -2.6; P =0.004). A subset of patients who transitioned from initial full-time users to partial/limited users also tended to be younger, but nonsignificant after Bonferroni correction (-8.0 y; 95%CI -17.5 to -0.7; P =0.034).

Conclusions: Receiving a CI remains a meaningful treatment option for patients with SSD. While utilization patterns vary, over 80% will use their device regularly (full-time or part-time). Speech perception performance does not appear to correlate with final device utilization, but device usage behavior as early as one month appears to be strongly associated with usage at the final 12-month follow-up.

Level of evidence: Level IV.

Objectives: To highlight our over 40 years of experience with subtotal petrosectomy (STP), we aim to present updated information on its technique, indications, and long-term outcomes.

Study design: A retrospective case series study was conducted in a private quaternary skull base center.

Materials and methods: The medical records of 900 cases of STP performed between 1983 and 2023 were thoroughly evaluated in this study. The assessment encompassed symptoms and signs, preoperative and postoperative audiological parameters, radiologic and surgical details, diagnoses, and complications.

Results: Six hundred eighty-seven (65.2%) patients had undergone multiple surgeries before a STP was performed. The most common indication for STP was middle ear cholesteatoma, with 344 (38.2%) patients. Challenging cases of cochlear implantation, meningoencephalic herniation, class B3 paragangliomas, and temporal bone fractures, with 281 (31.2%), 68 (7.6%), 52 (5.8%), and 37 (4.1%) cases, respectively. The mean follow-up time for our patients was 40.7 months, with a median follow-up of 24.6 months. The most common complications were recidivism and postauricular wound fistula, occurring in 12 and 9 patients, respectively. To the best of our knowledge, this series is the largest documented cohort in the literature to date.

Conclusions: STP should be regarded as the preferred approach for a range of challenging situations in otology, as it offers the potential for a definitive cure through radical clearance. In addition, this procedure can be safely combined with various other otologic and lateral skull base surgical procedures, including hearing implantation.

Background: Notched sound therapy (NST) is a mobile application that has been shown to provide tinnitus relief by reducing dysfunctional auditory cortex reorganization. This study aimed to evaluate the role of compliance with notched sound therapy (NST) on the effectiveness of reducing tinnitus symptoms.

Methods: A prospective randomized control trial was performed in patients older than or equal to 18 years at a tertiary referral center. Patients were randomized at enrollment to either the NST group and given a free subscription to the NST mobile application or the standard of care (SOC) group. Continued enrollment in the study, NST use, and tinnitus handicap index (THI) were evaluated at 6 weeks, 3 months, 6 months, and 12 months in the NST versus SOC group and in NST users versus non-users.

Results: Patients in the NST group were 2.2 times more likely to use NST at 6-week follow-up compared with the SOC group (70% vs. 32%, P =0.020). Initial THI score, age, and tinnitus frequency and loudness did not significantly impact follow-up rates or NST use. Assignment to the NST treatment group was associated with a significantly increased reduction in THI compared with the SOC group (β: -10.02, 95% CI: -18.20, -1.83, P =0.017). However, NST use was not associated with any significant changes in THI compared with NST non-users.

Conclusions: Overall, reduced cost of NST treatment was associated with greater tinnitus relief; however, compliance with treatment was not significantly associated with THI changes. Therefore, these changes may be explained by psychological factors reinforcing patient empowerment, perceived support, and accountability.

Objective: The Complete Cochlear Implant Care (CCIC) model is a highly coordinated care delivery model reducing and condensing in-person visits for cochlear implant (CI) patients, leveraging telehealth and remote programming. Clinical, quality-of-life, implementation, patient experience, and financial outcomes of the clinical trial are reported.

Study design: Prospective, nonrandomized, 2-arm clinical trial.

Setting: Tertiary referral CI center.

Patients: Adult CI candidates.

Interventions: Cochlear implantation.

Main outcome measures: Speech perception, quality of life, implementation, patient experience, and financial outcomes for both CCIC and traditional care delivery models.

Results: Patients participating in the traditional and CCIC delivery models demonstrated 12-month postoperative speech perception scores comparable to nationally reported outcomes (CNC 61% and 72% and AzBio in quiet 75% and 87% for traditional and CCIC cohorts, respectively). Quality-of-life evaluation using the CIQOL-10 demonstrated similar 12-month postoperative scores between groups (52 and 54 for traditional and CCIC cohorts, respectively). The CI Patient Experience Survey demonstrated high satisfaction outcomes in ease of communication, preparedness for surgery, and overall care in both cohorts. Implementation analysis of the CCIC model revealed perceived benefits from staff and clinicians; however, support for expansion of the program was contingent upon the availability of app-based or web-based remote programming technology. Finally, financial analysis revealed decreased out-of-pocket costs for CCIC patients.

Conclusion: The CCIC model has the potential to dramatically streamline hearing health care delivery and reduce out-of-pocket costs for CI recipients. Clinical outcomes between cohorts were comparable in this feasibility study; however, a sufficiently powered trial is required to definitively comment on clinical outcomes with the new care delivery model.

Objective: To evaluate safety and performance of a new active transcutaneous system, 3 and 6 months postoperatively.

Study design: An open, prospective, multicenter clinical investigation with 24-month follow-up.

Setting: Six European tertiary referral centers from the Netherlands, Germany, and United Kingdom.

Patients: Fifty-one adult patients with conductive hearing loss, mixed hearing loss, or single-sided deafness requiring surgical intervention for bone conduction hearing.

Intervention: Implantation and fitting of an active transcutaneous device, the Sentio System.

Main outcome measure: Performance outcomes included variables related to surgery (eg, surgery time and postoperative wound healing), audiology (eg, sound field thresholds, speech recognition in quiet and noise), and patient-reported outcomes (eg, quality of life, intervention benefit, and patient satisfaction). Moreover, safety was assessed by continuous reporting of adverse events and serious adverse events.

Results: Smooth implant installation with no or limited preoperative imaging, and without major events in the postoperative phase was demonstrated. Audiological assessments showed significant improvements in sound field thresholds, with a mean functional gain of 32.8 dB (PTA4) and a mean effective gain of 9.0 dB. Mean aided speech recognition in quiet was 97.9%, and the improvement in speech-noise-ratio compared with a sound processor on softband was -2.98 dB. The patients reported a high perceived quality of life, with 96.1% reporting improvements post-intervention. Safety was confirmed by a limited amount and mild nature of adverse events.

Discussion: The Sentio system provides a safe and effective treatment option, showing significant improvements in hearing outcomes, patient benefits, and quality of life for patients.

Objective: Validation of the accuracy of a preoperative planning tool in predicting electrode position for individualized partial cochlear implant (CI) insertions.

Methods: This retrospective study was conducted at a tertiary university hospital and included ten patients who underwent cochlear implantation with MED-EL FLEX electrode arrays. Insertion depths were individually planned using a previously proposed virtual implantation tool, employing preoperative cone-beam CT imaging and audiological data. A target insertion angle was derived from each patient's audiogram using the audiogram and CBCT data, and the corresponding insertion depth was calculated. Postoperative imaging was used to reconstruct the actual electrode position, which was compared with the preoperative prediction. Anatomic parameters and surgical access metrics, including round window angle (RWA) and visual angle (VA), were assessed to investigate potential influences on prediction accuracy.

Results: Predicted and actual electrode positions showed high concordance, with a median insertion depth of 20.01 mm (planned) versus 19.08 mm (actual) and a median insertion angle of 344.96 degrees (planned) versus 354.60 degrees (actual). Bland-Altman analysis demonstrated small systematic deviations and good overall agreement. RWA and VA did not significantly impact prediction accuracy.

Conclusions: The used virtual planning tool, initially developed for full insertions, can reliably guide individualized partial electrode insertions. These findings support their clinical applicability for hearing-preservation CI strategies and highlight the need for precise anatomical assessments and high-quality imaging in surgical planning.

Objectives: Bone conduction devices (BCD) have been commercially available since the 1980s for patients with conductive hearing loss (CHL), mixed hearing loss (MHL), or single-sided deafness (SSD). BCDs significantly improve the hearing capacity of patients regardless of age, which has a positive impact on their quality of life, mental health, education, and work performance. BCDs are categorized as percutaneous or transcutaneous solutions based on the attachment method. Selecting the optimal solution for patients requires consideration of audiological outcomes, guidelines, safety, patient preferences, and costs. This study evaluated the cost-effectiveness of an active transcutaneous solution (Osia System, Cochlear Ltd.) compared with percutaneous solutions to treat adult patients in Sweden.

Materials and methods: A Markov model was developed to simulate a cohort of adult patients aged 59 years or older receiving Osia or percutaneous BCDs. The model considered 3 health states: patients who have received a BCD, patients without a device due to explantation (without reimplantation) or elective device non-use, and an absorbing state (death). The final state was based on age-dependent mortality, assuming hearing loss does not impact mortality. Probabilities were determined for transition between the health states with 6-month cycles and a lifetime horizon. Utility scores for each health state were derived from published literature using the Health Utilities Index Mark III (HUI3). Complication rates were also sourced from the literature, and the cost of complications and implantation from the National Board of Health and Welfare in Sweden, Socialstyrelsen. The perspective of the model was the Swedish health care system, and the main outcome was incremental cost per quality-adjusted life year (QALY) gained. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the results.

Results: Osia was associated with an increase in cost of 79,293 SEK and an increase in QALYs of 0.73 compared with percutaneous devices, resulting in an incremental cost-effectiveness ratio of 108,318 SEK per QALY gained. The main drivers of cost-effectiveness were baseline age, the cost of surgery, and the difference in utility scores between the two interventions. The differences in HUI3 scores may be linked to the reduced risk of complications, improved cosmetic appearance, and improved hearing with Osia.

Conclusions: Osia is cost-effective compared with percutaneous devices over a lifetime horizon, when applying low to moderate cost per QALY willingness-to-pay thresholds indicated by the Swedish Agency for Health Technology Assessment and Assessment of Social Services. This analysis provides information on the economic impact of different hearing solutions to support decisions on which BCD best meets the needs of patients and health care budgets.

Objective: To evaluate the ethical implications, clinical benefits, and challenges associated with centralizing the surgical care of vestibular schwannoma (VS) care.

Databases reviewed: PubMed, Embase, CINAHL, Web of Science, Cochrane, Scopus.

Methods: A scoping review was conducted per the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A comprehensive search of 6 electronic databases yielded 1,231 articles using keywords related to vestibular schwannoma, centralization of care, centers of excellence, and ethical considerations. After removing duplicates (n=344) and screening titles and abstracts (n=887), 17 full-text articles were reviewed. Two additional articles were identified through manual screening. A total of 15 studies were included in the final analysis.

Results: Hospitals were categorized by surgical case volume (high, medium, low) to compare patient demographics and clinical outcomes. Patients seen at low-volume hospitals (LVHs) were generally older and more racially diverse, and more likely to have public insurance (Medicare or Medicaid), whereas high-volume hospitals (HVHs) served a younger, predominantly White, and privately insured population. Of the 14 studies evaluating outcomes, 12 demonstrated a positive association between higher surgical volume and improved outcomes, including reduced complications, lower mortality, shorter length of stay, and decreased hospitalization costs. High-volume hospitals also had significantly higher rates of routine discharge.

Conclusion: Centralization of vestibular schwannoma care to high-volume centers is associated with improved clinical outcomes and reduced health care costs. However, these benefits must be carefully weighed against potential ethical concerns, including disparities in access related to socioeconomic status, insurance coverage, and geographic location.

Objective: According to the joint consensus of the European Academy of Otology and Neurotology and the Japan Otological Society on middle ear cholesteatoma, stage II encompasses a broad range of disease extensions, leading to variability in treatment outcomes among individuals with this disease stage. Herein, we aimed to investigate the risk factors for recidivism in stage II pars flaccida (PF) cholesteatoma.

Study design: Retrospective cohort study.

Setting: University hospital.

Patients: In total, 228 consecutive ears with stage II PF cholesteatoma were treated surgically and followed up for >12 months.

Interventions: Patients underwent transcanal atticotomy, canal wall up tympanoplasty, or canal wall down (CWD) tympanoplasty with or without mastoid obliteration (MO).

Main outcome measures: Recidivism rates, assessed using the Kaplan-Meier method, correlated with potential risk factors, including age, number of sites involved, difficult access sites (S1: supratubal recess, S2: tympanic sinus), and surgical procedures.

Results: The recidivism rate was significantly higher in pediatric patients (42.8%) than in adults (6.1%). Furthermore, recidivism rates were greater in patients with 3 or more involved sites (16.5%), S1 involvement (27.9%), and procedures other than CWD+MO (24.5%) than those with 2 involved sites (3.0%), no S1 involvement (5.1%), and underwent CWD+MO (5.4%), respectively. Multivariate analysis identified the involvement of 3 or more sites (hazard ratio: 5.12) and procedures other than CWD+MO (hazard ratio: 6.49) as independent risk factors for recidivism.

Conclusion: In stage II PF cholesteatoma, involvement of 3 or more sites was identified as a risk factor for recidivism. CWD+MO intervention may reduce the recidivism rate.

Objective: Emotional responses to music are a crucial facet of music listening, but remain inadequately characterized among cochlear implant (CI) users. We aimed to evaluate musical emotion in implantees with single-sided deafness (SSD).

Study design: Cross-sectional.

Setting: Tertiary academic center, community hearing loss groups.

Patients: CI users with SSD (N=18); adult normal hearing (NH) controls (N=21).

Exposures: Participants listened to 10 musical clips and rated valence (happiness vs. sadness) and arousal (excitement vs. calm).

Main outcome measures: Range-difference between a participant's maximum and minimum rating-and discrepancy-difference from a participant's NH ear ratings for each stimulus-of both valence and arousal.

Results: Compared with SSD participants' NH ears, CI-alone listening demonstrated diminished range of valence (4.43 vs. 5.82, P =0.035) and arousal (5.80 vs. 6.41, P =0.033), although binaural listening was not significantly different from the NH ear. Nine of 20 ratings exhibited significant discrepancy between NH and CI ears, compared with only one between NH and binaural conditions; average discrepancy was higher for both valence and arousal in the NH versus CI comparison than NH versus binaural. Binaural listening for SSD individuals did not differ significantly from NH individuals for individual stimulus ratings or for valence and arousal range.

Conclusions: CIs dampen musical emotion, but do not substantially influence the binaural music listening experience for individuals with SSD. Our findings using within-subject controls demonstrate deficits in CI-mediated musical emotion, but the compensation by the NH ear in binaural listening offers encouragement for music lovers with SSD considering implantation.

Level of evidence: Level III.