To compare hearing outcomes between traditional microsurgical transmastoid repairs and underwater, endoscopic transmastoid repairs of superior semicircular canal dehiscence syndrome (SCDS).
A ...retrospective review of 14 patients undergoing transmastoid repair of SCDS between 2013 and 2017. Preoperative, immediate (7-10 d) postoperative, and long-term (>6 wk) postoperative speech discrimination scores, pure-tone averages, as well as pure-tone air conduction and bone conduction thresholds were obtained at 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz, and 8000 Hz. Hearing threshold changes were all calculated as preoperative thresholds subtracted from postoperative threshold at each frequency. Wilcoxon rank-sum tests were conducted to assess changes in postoperative hearing thresholds at both the immediate and long-term postoperative period between those undergoing the traditional transmastoid technique and the underwater, endoscopic transmastoid technique.
Our results demonstrate patients who underwent underwater transmastoid repairs had significantly less increase in their high-frequency bone conduction thresholds at both time periods, indicating less sensorineural hearing loss, compared to the traditional microscopic repair (p = 0.02 effect size, r = 0.4, p = 0.006 r = 0.6). At long-term follow-up, there was also significantly improved pure-tone averages in the patients in the underwater repair cohort compared to the traditional group (p = 0.004 r = 0.6). There were no differences in air-bone gaps at any frequency or any time period between the two cohorts.
Preliminary findings show that the underwater endoscopic technique may prevent sensorineural hearing loss during transmastoid repair of SCDS.
Cochlear implant electrode arrays are categorized based on their design as lateral wall (LW) and perimodiolar (PM) electrode arrays. The objective of this study was to investigate the effect of LW ...versus PM designs on postoperative speech perception across multiple manufacturers and over long follow-up durations.
Retrospective cohort study.
Single academic medical center.
A total of 478 adult cochlear implant recipients, implanted between the years 1992 and 2017.
PM versus LW cochlear implants.
Postoperative Consonant-Nucleus-Consonant Word (CNC-w) and Hearing in Noise Test (HINT) scores between 6 months and 5 years.
Across 478 patients, approximately one-third received LW (n = 176, 36.8%), whereas 302 patients received a PM array (63.2%). The PM group had higher CNC-w scores from 6 months to 2 years (52 interquartile range, 38-68 versus 48 31-62, p = 0.036) and from 2 to 5 years (58 43-72 versus 48 33-66, p < 0.001). Multivariable analysis of patient-averaged scores indicated that the PM group had greater improvement from preoperative scores at all time points after the initial 6 months for both CNC-w ( β = 4.4 95% confidence interval, 0.6-8.3, p = 0.023) and HINT testing ( β = 4.5 95% confidence interval, 0.3-8.7, p = 0.038).
This study indicates that PM electrode arrays are associated with small increases in postoperative speech perception scores, relative to LW arrays, when assessed across manufacturers, over long time durations, and using multiple outcome instruments. These findings may help guide surgeon selection and patient counseling of cochlear implant arrays.
Objective
Cochlear implants (CIs) are a well‐established treatment modality for hearing loss due to neurofibromatosis type 2 (NF2). Our aim is to investigate variables that affect longitudinal ...performance of CIs among patients with NF2.
Study Design
Retrospective review at a single academic institution consisting of patients who have received cochlear implants following hearing loss due to NF2.
Methods
The primary outcome examined was CI disuse or explantation. Associated clinical and surgical variables were analyzed using descriptive statistics. These included postoperative pure tone average (PTA) at 500, 1000, and 2000 Hz, tumor size, previous surgery, and comorbid depression.
Results
A total of 12 patients and 14 cochlear implants received at our institution from 2001 to 2022 were included. Notably, 35.7% of CIs (5 out of 14 cases) resulted in disuse or explantation. The average interval until explant was 9.4 years (range 3–14 years). In explanted CI cases, 20% had previous surgery and 80% had a diagnosis of comorbid depression as compared to 22.2% and 22.2%, respectively, in intact CI cases. Maximum tumor diameter was the only variable found to impact CI usage outcome (p = 0.028). Long‐term data showed that on average, patients benefit from 13.85 years of CI utility and a maximum PTA improvement of 45.0 ± 29.0 dB.
Conclusion
Despite the recurrent nature of NF2, patients continue to receive audiological benefit from cochlear implants. We found that larger tumor size may be associated with longitudinal CI failure.
Level of Evidence
4 Laryngoscope, 134:1847–1853, 2024
This paper is the first to describe the long‐term outcomes of cochlear implants in patients with Neurofibromatosis type 2. We found that larger lifetime VS tumor size is significantly correlated with the odds of becoming a non‐user of CI (p = 0.028). While failure of CI function and profound hearing loss are frequent in the course of NF2, patients may still experience long‐term benefits from cochlear implants.
Objective
To provide a comprehensive overview on the applications of artificial intelligence (AI) in rhinology, highlight its limitations, and propose strategies for its integration into surgical ...practice.
Data Sources
Medline, Embase, CENTRAL, Ei Compendex, IEEE, and Web of Science.
Review Methods
English studies from inception until January 2022 and those focusing on any application of AI in rhinology were included. Study selection was independently performed by 2 authors; discrepancies were resolved by the senior author. Studies were categorized by rhinology theme, and data collection comprised type of AI utilized, sample size, and outcomes, including accuracy and precision among others.
Conclusions
An overall 5435 articles were identified. Following abstract and title screening, 130 articles underwent full-text review, and 59 articles were selected for analysis. Eleven studies were from the gray literature. Articles were stratified into image processing, segmentation, and diagnostics (n = 27); rhinosinusitis classification (n = 14); treatment and disease outcome prediction (n = 8); optimizing surgical navigation and phase assessment (n = 3); robotic surgery (n = 2); olfactory dysfunction (n = 2); and diagnosis of allergic rhinitis (n = 3). Most AI studies were published from 2016 onward (n = 45).
Implications for Practice
This state of the art review aimed to highlight the increasing applications of AI in rhinology. Next steps will entail multidisciplinary collaboration to ensure data integrity, ongoing validation of AI algorithms, and integration into clinical practice. Future research should be tailored at the interplay of AI with robotics and surgical education.
An augmented reality (AR) platform using a head mounted display (HMD) can successfully display and register virtual computerized tomography (CT) data to corresponding real world anatomy using ...fiducial markers.
AR is a growing field in surgical planning, and has been used by this group to aide in orthopedic surgery applications. Intraoperative AR registration of preoperative CT images could improve identification of critical anatomical structures during lateral skull base surgery.
An AR based HMD platform was created to allow for virtual display and real time manipulation of a temporal bone phantom model. Four fiducial markers were incorporated into this model and used to allow manual alignment of surface markers in real-time. To test the accuracy of this platform virtual lines were created in the AR environment running through the visualized real-world fiducial marker points. Target registration error (TRE) was calculated by measuring the orthogonal distance between these virtual lines and the corresponding virtual fiducial marker for each of the four markers from varying angles. Ten consecutive experiments were performed.
The AR based platform successfully displayed CT renderings in the AR environment and allowed real time translation and rotation for manual alignment. A TRE of 10.62 ± 5.90 mm was found.
Our results suggest that AR visualization of CT imaging can be registered to patient surface landmarks, but current limitations of AR hardware resulted in TREs too large to be used in the lateral skull base. Future advancements in AR technology will hopefully allow for reduction of registration error.
Stereo depth estimation relies on optimal correspondence matching between pixels on epipolar lines in the left and right images to infer depth. In this work, we revisit the problem from a ...sequence-to-sequence correspondence perspective to replace cost volume construction with dense pixel matching using position information and attention. This approach, named STereo TRansformer (STTR), has several advantages: It 1) relaxes the limitation of a fixed disparity range, 2) identifies occluded regions and provides confidence estimates, and 3) imposes uniqueness constraints during the matching process. We report promising results on both synthetic and real-world datasets and demonstrate that STTR generalizes across different domains, even without fine-tuning.
To present a protocol for audiologic monitoring in the setting of teprotumumab treatment of thyroid eye disease, motivated by 4 cases of significant hearing loss, and review the relevant literature.
...Cases of hearing loss in the setting of teprotumumab were retrospectively elicited as part of a multi-institutional focus group, including oculoplastic surgeons, a neurotologist and an endocrinologist. A literature review was performed.
An aggregate of 4 cases of teprotumumab-associated hearing loss documented by formal audiologic testing were identified among 3 clinicians who had treated 28 patients.
Teprotumumab may cause a spectrum of potentially irreversible hearing loss ranging from mild to severe, likely resulting from the inhibition of the insulin-like growth factor-1 and the insulin-like growth factor-1 receptor pathway. Due to the novelty of teprotumumab and the lack of a comprehensive understanding of its effect on hearing, the authors endorse prospective investigations of hearing loss in the setting of teprotumumab treatment. Until the results of such studies are available, the authors think it prudent to adopt a surveillance protocol to include an audiogram and tympanometry before, during and after infusion, and when prompted by new symptoms of hearing dysfunction.
Objectives/Hypothesis
To determine whether septoplasty when combined with ambulatory oropharyngeal surgery increases postoperative complications.
Study Design
Cross‐sectional analysis of multistate ...ambulatory surgery and hospital databases.
Methods
Ambulatory adult septoplasty and oropharyngeal surgical procedures (tonsillectomy and uvulopalatoplasty UPPP) were extracted from the state ambulatory surgery databases for New York, Florida, Iowa, and California for 2010–2011. Cases with concurrent sinus surgery were excluded. Cases were linked to the state emergency department databases and the state inpatient databases to identify revisits within 14 days. The rates of unplanned revisits and postoperative bleeding were determined and compared among groups undergoing solely oropharyngeal surgery versus groups undergoing oropharyngeal surgery combined with septoplasty.
Results
Among 26,280 tonsillectomies alone versus 1,002 tonsillectomies + septoplasty, rates for unplanned revisits and hemorrhage were 13.2% and 12.8% (P = .66) and 4.9% and 7.0% (P = .003), respectively. Among 2,598 UPPPs alone versus 1,343 UPPPs + septoplasty, rates for revisits and hemorrhage were 11.4% versus 10.1% (P = .242) and 3.5% versus 3.8% (P = 0.683), respectively. Among 389 UPPP/tonsillectomies versus 164 UPPP/tonsillectomies + septoplasty, rates for revisits and hemorrhage were 11.8% versus 8.5% (P = .256) and 3.9% versus 6.1% (P = .247), respectively. Among all cases and groups, there were mortalities only in the UPPP alone group.
Conclusions
The addition of septoplasty to oropharyngeal ambulatory surgical procedures does not significantly increase the rate of unplanned revisits or postoperative hemorrhage except in the case of septoplasty added to tonsillectomy, with a small percentage increase in hemorrhage rate. Combining septoplasty with ambulatory oropharyngeal surgery is clinically reasonable in adults.
Level of Evidence
2b Laryngoscope, 125:2828–2831, 2015
To validate an intracochlear piezoelectric sensor for its ability to detect intracochlear pressure and function as a microphone for a fully implantable cochlear implant.
A polyvinylidene fluoride ...(PVDF) piezoelectric pressure sensor was inserted into a human fresh cadaveric round window at varying depths. An external sound pressure stimulus was applied to the external auditory canal (EAC). EAC pressure, stapes velocity, and piezoelectric sensor voltage output were recorded.
The PVDF sensor was able to detect the intracochlear sound pressure response to an acoustic input to the EAC. The frequency response of the pressure measured with the intracochlear sensor was similar to that of the pressure at the EAC, with the expected phase delay of the middle ear transmission. The magnitude of the response increased and smoothened with respect to frequency as the sensor was inserted more deeply into the scala tympani. Artifact measurements, made with the sensor in air near the round window, showed flat frequency response in both magnitude and phase, which were distinct from those measured when the sensor was inserted in the round window.
This study describes a novel method of measuring intracochlear pressure for an otologic microphone composed of a piezoelectric polymer, and demonstrates feasibility. Our next goal is to improve device sensitivity and bandwidth. Our long-term objective is to imbed the piezoelectric sensor within a conventional cochlear implant electrode, to enable a device to both measure intracochlear sound pressure and deliver electrical stimulus to the cochlea, for a fully implantable cochlear implant.
We report the fabrication and characterization of a prototype polyvinylidene fluoride polymer-based implantable microphone for detecting sound inside gerbil and human cochleae. With the current ...configuration and amplification, the signal-to-noise ratios were sufficiently high for normally occurring sound pressures and frequencies (ear canal pressures >50–60 dB SPL and 0.1–10 kHz), though 10 to 20 dB poorer than for some hearing aid microphones. These results demonstrate the feasibility of the prototype devices as implantable microphones for the development of totally implantable cochlear implants. For patients, this will improve sound reception by utilizing the outer ear and will improve the use of cochlear implants.
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