Otology & Neurotology最新文献

Objective: Evaluate the sensitivity and financial costs of Trans-Impedance Matrix recordings, Spread of Excitation functions, and x-rays in detecting cochlear implant tip foldovers.

Setting: Tertiary academic medical center.

Patients: 113 ears of 108 patients.

Interventions: Following cochlear implantation and before concluding surgery, intraoperative Trans-Impedance Matrix recordings, Spread of Excitation functions, and x-rays were conducted to evaluate presence of tip foldover.

Main outcome measures: Presence of tip foldover; recording time necessary for and costs of Trans-Impedance Matrix, spread of excitation, and x-rays.

Results: There were six tip foldovers. Trans-Impedance Matrix showed 100% sensitivity, 100% specificity, 100% positive predictive value, and 100% negative predicative value in detecting tip foldovers. Spread of excitation showed 29% sensitivity, 99% specificity, 67% positive predictive value, and 95% negative predicative value. Trans-Impedance Matrix recordings were completed significantly faster than spread of excitation and x-rays. Elimination of x-rays from our intraoperative workflow results in a twofold cost reduction.

Conclusion: Trans-Impedance Matrix recordings have potential great clinical utility in evaluating proper CI placement intraoperatively and reducing costs of surgery while not compromising patient care. Given the low tip foldover rate, a multicenter study is in progress to evaluate the sensitivity, specificity, positive predictive value, and negative predicative value of Trans-Impedance Matrix in a larger dataset. This can provide better guidance to cochlear implant clinics interested in evaluating the impact of using Trans-Impedance Matrix on patient care as well as the economics of reducing use of intraoperative imaging.

Objective: Investigate whether nonopioid analgesics (NOA) provide adequate pain control after otologic surgery.

Study design: Retrospective multicenter cohort.

Setting: Two quaternary academic medical centers.

Patients: Patients over 12 years old who underwent otologic surgery involving the middle ear and/or mastoid at two centers over a 5-month period.

Interventions: Patients were prescribed acetaminophen and ibuprofen postoperatively and instructed to contact the surgical team if pain control was inadequate, in which case an opioid medication was prescribed. Level of pain and medication use were assessed with a standardized questionnaire, 1 week after surgery.

Main outcome measures: Postoperative pain levels during the first week after surgery (0-10); proportion of patients requiring opioid medication.

Results: Sixty-seven patients were included. Of these, 37% underwent tympanomastoidectomy, 27% cochlear implant, 19.5% postauricular tympanoplasty, 10.5% transcanal tympanoplasty, and 6% had a different surgery. The median of the average level of pain in the first 7 days was 5/10 (IQR 3-6). The median highest level of pain was 5 (IQR 4-8). The median current level of pain was 3 (IQR 1-5). Seven patients (10%) required breakthrough opioid pain medication. The remaining 90% utilized NOA only. One week after surgery, 60% were taking nonopioid analgesics only while the remaining 40% were not taking any pain medication at all. Although opioids were required infrequently, there were no significant differences in medication use between the two centers.

Conclusions: NOA provide adequate pain control for most patients after middle ear and mastoid otologic surgery. Opioid analgesics do not routinely need to be prescribed.

Hypothesis: If otolithiasis can be demonstrated to affect multiple species, it may be possible to identify an experimental animal for prospective study of this entity.

Background: Otolithiasis refers to dislodged otolithic matter within the confines of the membranous labyrinth that has the potential to cause clinical symptoms. The mechanism involves separation of free-floating otoconia that can affect the hearing and balance functions of the ear. While this process is known to occur in humans, it is uncertain if other species are affected.

Methods: The published images of 37 whole-mount specimens of mammalian labyrinths were identified for retrospective examination. These were evaluated stereographically for the presence of calcareous material in abnormal locations within the membranous labyrinth.

Results: Thirty normal labyrinth specimens were found, exemplified by that of the Cape sea lion. Seven pathologic specimens were found, including a human, a black ape, a yellow-faced baboon, a hocheur monkey, a collie dog, a common sheep, and a common hare. Abnormal accumulations of calcareous material were found at one or more sites, more frequently in the utricle and canal system and less frequently in the endolymphatic and cochlea ducts.

Conclusions: Otolithiasis appears to occur in other animal species besides the human. Abnormal calcareous material was found in various locations within the membranous labyrinth of affected animals. One or more of these might serve as an animal model to prospectively study the phenomenon of otolithiasis.

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.