Otology & neurotology open最新文献

Objective: Cochlear implants (CIs) enable adults with hearing loss to regain access to sound. However, many CI users continue to face difficulties in everyday communication, potentially resulting in fewer social interactions. This study aimed to identify CI users' self-reported hearing difficulties in everyday listening environments.

Study design: Cross-sectional survey-based study.

Setting: Tertiary care academic medical center; surveys were completed during visit.

Patients: Thirty-seven postlingually deafened adult CI users and 19 age-matched adults with normal hearing (NH) participated.

Interventions: Participants completed the Personal Assessment of Communication Abilities survey, rating their communication difficulty in 12 everyday listening environments on a 5-point scale (1 = no difficulty, 5 = very much difficulty).

Main outcome measures: Self-reported communication difficulty levels in the 12 listening environments with comparisons between CI users and NH peers, and across different environments within each group.

Results: CI users reported significantly more difficulty than NH peers in all 12 environments (P < 0.001). Listening context significantly affected difficulty ratings (P = 0.003), with a significant group-by-environment interaction (P = 0.006). CI users perceived large groups, concerts/movie theaters, and restaurants/cafés most challenging, while one-to-one conversations, outdoors, and conversations in small groups were the least difficult. Outdoor settings and landline phone use showed the greatest differences between groups.

Conclusions: Adult CI users face variable communication challenges in everyday environments. Identifying the everyday listening challenges of adult CI users will help shed light on real-world CI benefits and provide specific targets for rehabilitation.

Objective: To understand current patient navigator (PN) use in cochlear implant (CI) programs and assess the perceived value of PNs in this context.

Design: A cross-sectional online survey was administered via Qualtrics-XM between February'24 and January'25.

Setting: Survey was distributed to CI professionals via the American Cochlear Implant Alliance's email list and social media.

Main outcome measures: Demographics and PN use were summarized using descriptive statistics, and perceived PN value using a Likert scale from 1-not useful at all to 5-extremely useful. Barriers to care were categorized using an ecological framework.

Results: In total, 84 respondents completed the survey anonymously. Most were CI audiologists (n = 58, 69%), from urban (n = 57, 67.9%) and academic clinical settings (n = 41, 48.8%). Most reported not having someone fulfilling a PN role (n = 59, 70.2%). Only 9.5% (8) had a full-time PN, and 20.2% (17) had part-time PNs. Common PN duties included: navigating financial barriers, coordinating multi-specialty visits, addressing logistical issues (eg, transportation and childcare), and patient-tracking. Four PN responsibilities were rated "extremely useful": addressing emotional barriers, resolving logistical challenges, tracking patients, and coordinating multi-specialty visits. Totally, 251 open-ended responses spotlighted organizational barriers to care.

Conclusions: PNs are uncommon in CI programs but are seen as highly valuable for addressing emotional, logistical, and systemic barriers. We offer a definition for the PN role to facilitate models of integration. As CI programs embrace both the existing disparities to care and the overall underutilization of CIs, integrating PNs into CI teams merits thoughtful consideration.

Objective: Semicircular canal dehiscence (SCD) and vestibular aqueduct (VA) hypoplasia are developmental anomalies associated with distinct inner ear syndromes-SCD syndrome and Meniere's disease (MD). Our previous work found frequent SCD in MD patients with VA hypoplasia, suggesting a shared developmental origin. To further explore this association, we adopted a reciprocal approach by assessing VA hypoplasia prevalence in patients diagnosed with SCD.

Study design: Retrospective cohort study.

Setting: Tertiary referral center.

Patients: A total of 219 ears from 173 patients (mean age 53.5 years, standard deviation 16.6 years; 54.3% females) were evaluated for suspected SCD, confirmed by temporal bone computed tomography (CT).

Interventions: Radiological analysis of temporal bone CT scans using the angular trajectory of the vestibular aqueduct (ATVA) marker; review of clinical records for diagnosis of MD.

Main outcome measures: Prevalence of VA hypoplasia among SCD patients; association of radiological findings with clinical diagnosis of MD.

Results: VA hypoplasia was identified in 4 of 173 patients (2.3%), representing a 46-fold increase compared with the estimated 0.05% prevalence of MD patients with VA hypoplasia in the general population. These cases showed an atypical SCD localization in the posterior limb of the superior semicircular canal. All 4 patients were diagnosed with MD ipsilateral to the SCD/VA hypoplasia.

Conclusions: SCD and VA hypoplasia are associated in a distinct patient group, suggesting a shared developmental etiology. These patients may be predisposed to an early overlap of SCD syndrome and MD, with their clinical course eventually dominated by the progressive nature of MD.

Objective: This study investigated the impact of a contralateral routing of signal (CROS) device on subjective and objective listening effort and speech recognition in unilateral cochlear implant (CI) recipients.

Study design: A single-group, prospective, repeated measures design in 2 technology conditions (with CROS and without CROS), 3 talker locations (0°, 90°, and 270°), and 3 signal-to-noise ratio conditions (quiet, easy, and hard).

Setting: Nonprofit audiology and speech language therapy (listening and spoken language) program.

Participants: Unilateral adult CI recipients with limited functional hearing in their poorer performing ear or bilateral CI listeners willing to participate with their better hearing or preferred implanted ear for the duration of the testing (N = 15).

Intervention: Participants were fitted with a CROS device on their poorer hearing ear.

Main outcome measures: Objective listening effort measured via verbal response time, subjective listening effort and motivation measured via questionnaires, and speech recognition.

Results: The CROS device reduced objective and subjective listening effort and improved speech recognition, particularly when speech was presented to the non-CI ear.

Conclusions: The CROS device can reduce subjective and objective listening effort and improve speech recognition and motivation in certain situations.

Objective: This study aimed to investigate the utility of wideband tympanometry (WBT) in diagnosing patulous Eustachian tube (PET) by examining differences in middle ear absorbance and resonant frequency between PET patients and controls.

Study design: This is a retrospective observational study.

Setting: This study was conducted at Iwate Medical University Hospital.

Subjects and methods: A review of medical records identified 25 ears of 19 PET patients and 18 ears of 9 patients with sensorineural hearing loss or vertigo as a control group. Diagnosis of PET was based on Japan Otological Society criteria. WBT was conducted across frequencies of 226-8000 Hz, measuring ambient pressure absorbance ratios and peak pressure absorbance ratios, as well as resonant frequency (RF) values.

Results: The PET group demonstrated significantly lower absorbance at 1000 Hz (P = 0.006) compared with the control group, with no significant differences observed at other frequencies. The RF was significantly reduced in the PET group compared with controls (P < 0.001), indicating alterations in middle ear mechanics associated with PET. The Valsalva maneuver had no significant effect on absorbance values across frequencies.

Conclusion: WBT is a valuable diagnostic tool for PET, with significant reductions in 1000 Hz absorbance and resonant frequency in PET patients. These parameters may serve as markers for PET, aiding in its differentiation from other middle ear conditions.

Objective: To evaluate the impact of cochlear implantation (CI) on vestibular symptoms in patients with Meniere disease (MD).

Study design: Retrospective chart review.

Setting: Single tertiary referral center.

Patients: Patients with MD, who underwent CI between 2011 and 2024 and had documentation of preoperative and postoperative vestibular symptoms.

Intervention: Placement of a cochlear implant for hearing rehabilitation.

Main outcome measure: Preoperative and postoperative subjective vestibular symptom severity.

Results: Of 39 patients meeting inclusion criteria, 51% had moderate or severe vestibular symptoms preoperatively and 41% had mild symptoms. After CI, 28.2% had symptom improvement, 64.1% had stable symptoms, and 7.7% had symptom worsening. If preoperative symptom severity was mild or absent, compared with moderate or severe, patients were more likely to have stable symptoms (78.9% versus 50.0%, respectively) and less likely to experience symptom improvement (10.5% versus 45.0%, respectively), P = 0.038. Significantly more patients with moderate or severe preoperative symptoms had migraines compared with those with mild or absent symptoms (35.0% versus 5.3%, respectively, P = 0.044). Among patients with moderate or severe symptoms, those without comorbid migraines were more likely to experience symptom improvement compared with those with migraines (P = 0.0031).

Conclusions: Over 90% of MD patients who underwent CI in the MD-affected ear experienced vestibular symptom stability or improvement postoperatively. Patients with more severe preoperative symptoms were more likely to experience symptom improvement if they did not have comorbid migraines. These findings may have important implications for preoperative patient counseling and require validation in a larger patient cohort with objective vestibular symptom metrics.

Objective: This study aimed to evaluate the effect of integrating osteopathic manipulative treatment (OMT) in the acute postsurgical care of patients after vestibular schwannoma resection.

Methods: This retrospective observational cohort study took place at a single tertiary care academic health center with a high-volume vestibular schwannoma program. Adults 18 years or older who underwent primary microsurgical resection of a vestibular schwannoma between November 2017 and October 2021 were included in the study. Patients were grouped by exposure to postoperative OMT, defined as receiving at least 1 OMT session during the postresection admission. The primary outcome measure was total inpatient length of stay (days), and the secondary outcome measures were daily and total opioid use (morphine milligram equivalents).

Results: There were 502 patients included in this study, 284 (57%) received OMT during their postresection hospitalization. The 2 groups were similar in demographics (except race, P = 0.03), health history, tumor size, surgical approaches, and postoperative course. Patients who received postoperative OMT had a significantly shorter hospital length of stay compared to patients who did not receive OMT (OMT: 3.42 ± 1.41 days, 95% confidence interval [CI]: 3.26-3.59; no OMT: 3.96 ± 2.35 days, 95% CI: 3.65-4.28; F_(1,501) = 10.29, P = 0.001). The OMT group had a significantly lower daily opioid consumption over time (F_(1,1382) = 31.00, P < 0.001).

Conclusions: Receiving OMT after vestibular schwannoma resection is associated with a shorter length of stay and less daily opioid use.

Objective: To evaluate the efficacy and safety of remote cochlear implant (CI) programming. The primary efficacy objective was to demonstrate that speech recognition in quiet after remote fitting is no worse than speech recognition in quiet after in-person office fitting. The primary safety endpoint was the absence of unanticipated adverse device effects related to remote programming.

Study design and setting: Prospective within-subjects interventional study at 5 US centers.

Participants: 17 CI recipients (12 electric-only [EO] hearing; 5 with aidable residual hearing) with a minimum of 6 months of CI experience.

Intervention: Programming conducted in person and remotely via a smartphone application.

Main outcome measures: Speech recognition, fitting duration, and subjective questionnaires.

Results: In the EO cohort, mean AzBio speech recognition for in-person created programs was 89.28% (SE = 3.48), compared with 91.94% (SE = 2.76) for programs created remotely. The combined EO and aidable residual hearing cohort's mean speech recognition for programs created in person was 89.04% (SE = 2.66) versus 90.99% (SE = 2.09) for remotely created programs. The observed P value for EO and pooled cohorts was <0.001, indicating that speech recognition in quiet after remote fitting is no worse than that after in-person fitting. Absolute differences in fitting durations between programming methods ranged from 3 to 11 minutes. The total time spent for a typical CI office visit ranged from 1 to more than 4 hours for 88.3% of study participants.

Conclusions: Remote programming provides noninferior outcomes to in-person programming and represents an important step toward improving the accessibility and affordability of obtaining audiology services by eliminating the need to travel. Participants and audiologists rated remote programming positively.

Background: Pulsatile tinnitus (PT) is a common symptom in idiopathic intracranial hypertension (IIH). Previously published work suggests that the severity of individual MRI findings associated with IIH does not correlate with the presence of PT. However, recent studies suggest that other symptoms of IIH may be related to the number (rather than severity) of abnormal MRI findings. The purpose of this study is to determine if there is a difference in the number of abnormal MRI findings in those with and without PT.

Methods: We performed a retrospective, age-matched cohort study of patients with documented IIH and MRI head, assessing for the total number of abnormal MRI findings out of 16 variables associated with IIH. The groups were then stratified in numerous ways. Analysis was performed on each of these grouping strategies to assess the difference between PT+ and PT- cohorts and between low-, medium-, and high-number abnormal findings groups.

Results: A total of 80 age-matched patients met the inclusion criteria (40 PT+, 40 PT-). There was no statistically significant difference in the number of positive MRI findings between PT+ and PT- cohorts, 6.13 ± 2.77 and 6.68 ± 3.47, respectively (P = 0.572). Grouping patients into cohorts based on the number of findings revealed no significant differences. Furthermore, separating patients into groups above (P = 0.309) and below (P = 0.471), 7 total MRI findings did not demonstrate significant differences between PT+ and PT- cohorts.

Conclusions: The presence of PT does not correlate with the total number of MRI abnormalities. This reinforced current evidence that PT in patients with IIH is likely not related to the severity or chronicity of IIH.

Objective: Otologic surgery has specific anesthetic requirements such as avoiding nitrous oxide and allowing facial nerve monitoring, but lacks clear criteria for an optimal anesthetic regimen, often relying on anesthesiologist preference.

Study design: This study is a retrospective review of 600 primary cochlear implant surgeries and anesthetic variables.

Setting: This study was conducted in a tertiary academic medical center.

Methods: Univariate, multivariate, and cluster analyses of anesthetic regimen association with clinical metrics of postoperative recovery.

Results: Among 600 cochlear implant surgeries, anesthesia regimens included balanced (combination of gas and intravenous agents) (84.3%), gas alone (13.5%), and total intravenous anesthesia (TIVA) (2.2%). By univariate analysis, emergence from anesthesia was shortest with TIVA (11.9 ± 4.6 minutes) and longest with gas (14.2 ± 5.3 minutes), although not reaching statistical significance. Univariate analyses also failed to show a significant correlation between anesthesia regimen and phase I recovery or phase II duration. Multivariate regression indicated significantly shorter emergence times with TIVA compared with gas alone (coeff: -5.29, P = 0.0027). Cluster analysis identified 3 groups based on relative remifentanil and gas usage. Patients in cluster 1 (low gas and high remifentanil) had significantly longer emergence times than those in clusters 2 (low gas, low remifentanil: 16.26 ± 5.96 vs 13.39 ± 5.30 minutes; P = 0.001) and 3 (high gas, low remifentanil: 16.26 ± 5.96 vs 13.47 ± 5.48 minutes; P = 0.0069). Cluster 1 also had longer phase 1 recovery times compared with clusters 2 (65.33 ± 28.87 vs 54.33 ± 25.36 minutes; P = 0.0085) and 3 (65.33 ± 28.87 vs 56.38 ± 20.81 minutes; P = 0.0365).

Conclusion: TIVA anesthetic regimen is associated with shorter emergence time than gas alone, although the difference in time is small. Balanced regimens are most used among anesthesiologists, and limiting remifentanil dosage may shorten emergence and recovery times.