Otology & Neurotology最新文献

{"title":"Predictors of Prolonged Hospital Stay After Microsurgery for Vestibular Schwannoma: Analysis of a Decade of Data.","authors":"Mohamed A Aboueisha, Regan Manayan, Kevin Tie, Peter P Issa, Mohamed A Al-Hamtary, Victoria Huang, James G Naples","doi":"10.1097/MAO.0000000000004320","DOIUrl":"10.1097/MAO.0000000000004320","url":null,"abstract":"<p><strong>Importance: </strong>Microsurgical resection is one of the treatments for vestibular schwannomas (VS). While several factors have been linked to increased length of stay (LOS) for VS patients undergoing microsurgery, a better understanding of these factors is important to provide prognostic information for patients.</p><p><strong>Objective: </strong>Determine predictors of increased LOS for VS patients undergoing microsurgical resection.</p><p><strong>Design: </strong>Retrospective analysis using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2010 to 2020.</p><p><strong>Setting: </strong>Database review.</p><p><strong>Participants: </strong>All patients who underwent microsurgery (CPT codes 61520, 61526/61596) for the management of vestibular schwannoma (ICD9 and ICD10 codes 225.1, D33.3) were included.</p><p><strong>Main outcomes and measures: </strong>Analyzing perioperative factors that can predict prolonged hospital stay.</p><p><strong>Results: </strong>A total of 2096 cases were identified and 1,188 (57%) of these patients were female. The mean age was 51.0 ± 14.0 years. Factors contributing to prolonged LOS included African American race (OR = 2.11, 95% CI: 1.32-3.36, p = 0.002), insulin-dependent diabetes mellitus (OR = 2.12, 95% CI: 1.09-4.4.11, p = 0.026), hypertension (OR = 1.26, 95% CI: 1-1.58, p = 0.046), functional dependency (OR = 5.22, 95% CI: 2.31-11.79, p = 0.001), prior steroid use (OR = 1.96, 95% CI: 1.18-3.15, p = 0.009), ASA class III (OR = 2.06, 95% CI: 1.18-3.6, p < 0.011), ASA class IV (OR = 6.34, 95% CI: 2.62-15.33, p < 0.001), and prolonged operative time (OR = 2.14, 95% CI: 1.76-2.61). Microsurgery by a translabyrinthine (TL) approach compared to a retrosigmoid (RSG) approach had lower odds of prolonged LOS (OR = 0.67, 95% CI: 0.54-0.82, p < 0.001). In a separate analysis regarding patients receiving reoperation, operative time was the only predictor of prolonged LOS (OR = 2.77, 95% CI: 1.39-5.53, p = 0.004.).</p><p><strong>Conclusions and relevance: </strong>Our analysis offers an analysis of the factors associated with a prolonged LOS for the surgical management of VS. By identifying healthcare disparities, targeting modifiable factors, and applying risk stratification based on demographics and comorbidities, we can work toward reducing disparities in LOS and enhancing patient outcomes.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cochlear Implantation for Single-Sided Deafness in Pediatric Patients: A Critical Assessment of Usage Rate.","authors":"Robert J Macielak, Celine Richard, Prashant S Malhotra, Oliver F Adunka, Ursula M Findlen","doi":"10.1097/MAO.0000000000004331","DOIUrl":"10.1097/MAO.0000000000004331","url":null,"abstract":"<p><strong>Objective: </strong>To assess the usage rate of pediatric patients undergoing cochlear implantation (CI) for single-sided deafness (SSD).</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary care pediatric referral center.</p><p><strong>Patients: </strong>Pediatric patients who underwent CI for SSD.</p><p><strong>Interventions: </strong>CI with requisite audiometric follow-up.</p><p><strong>Main outcome measures: </strong>Device use and audiometric testing.</p><p><strong>Results: </strong>Sixty-six patients were implanted for SSD between 8/2015 and 7/2023 at a median age of 4.7 years (interquartile range, 1.7-7.7 yr). The cause of hearing loss was unknown in the majority of cases (28 patients, 42%), with cytomegalovirus being the most common known cause (17 patients, 26%). Hearing loss was prelingual in 38 patients (58%). Post-implantation, 12 patients (18%) were identified as lost to follow-up. For the remaining 54 patients, the median length of audiometric follow-up was 1.4 years (interquartile range, 0.9-2.2 yr). At last evaluation, only 10 of these 54 patients (19%) were designated as users (≥6 h per day), and 13 patients (24%) were designated as limited users (>2 but <6 h per day). Of patients capable of performing speech-in-noise testing (n = 13), 11 patients (85%) showed improvement on BKB-SIN SNR-50 testing with their implant on versus off with a mean improvement of 3 dB. Notably, 4 of these 11 patients (36%) were categorized as nonusers despite this benefit.</p><p><strong>Conclusions: </strong>Despite audiometric benefit from CI in the pediatric SSD population, usage rates over time remain markedly lower than anticipated at a high-volume, well-resourced tertiary care pediatric center. No influencing factors were identified, warranting critical assessment to ensure appropriate resource allocation.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vestibular Dysfunction in Patients With Sickle Cell Disease: A Systematic Review.","authors":"Jonathan Laredo, Sofia Torres-Small, Lin Wu, Tomoko Makishima, Celine Richard","doi":"10.1097/MAO.0000000000004327","DOIUrl":"10.1097/MAO.0000000000004327","url":null,"abstract":"<p><strong>Introduction: </strong>Sickle cell disease (SCD) often leads to sensorineural hearing loss due to vaso-occlusive events in the cochlear vasculature. Although the vestibule and cochlea share a blood supply, information on vestibulopathy in SCD is limited. This systematic review aims to consolidate current knowledge on vestibular dysfunction in SCD patients.</p><p><strong>Methods: </strong>This study, registered on PROSPERO, involved a thorough electronic search using MEDLINE-Ovid, Embase, Google Scholar, The Cochrane Library, and Scopus databases from inception to December 2023. Data extraction adhered to PRISMA guidelines. Authors independently assessed bias and evidence quality using NIH Study Quality Assessment tools. Inclusion criteria covered articles mentioning vestibular symptoms in SCD patients, whereas exclusion criteria comprised non-English articles and vestibular symptoms limited to treatment side effects.</p><p><strong>Results: </strong>Out of 2,495 studies, only 12 met the criteria. Among SCD patients undergoing head imaging, 19% reported inner ear complaints, and 70% experienced dizziness/imbalance. In a group of SCD children, there was a significant relationship between endothelial dysfunction and vertigo duration. The recommended imaging sequence was T1-weighted thin-section temporal bone MRIs, which revealed abnormal findings even without clinical symptoms. Imaging showed labyrinthine hemorrhage and labyrinthitis ossificans, mostly unilateral. Vestibular symptoms emerged with older age, suggesting cortical compensation kept most subjects asymptomatic. In asymptomatic adult SCD patients, there was no significant difference compared with controls in tracking test batteries and positional tests; however, saccadic latency was longer in SCD patients.</p><p><strong>Conclusion: </strong>The existing data on vestibulopathy in SCD were limited and often of poor quality. Although a connection between SCD and vestibular symptoms was noted, information on treatment approaches was scant. Further research in this area could contribute to the early diagnosis of vestibular dysfunction, potentially enhancing outcomes for SCD patients.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: \"Intratympanic Lidocaine as a Potent Remedy for Tinnitus in Sudden Sensorineural Hearing Loss: A Double-Blind, Randomized Clinical Trial\".","authors":"Yali Liu, Guowei Ma, Yuanyuan Wu","doi":"10.1097/MAO.0000000000004355","DOIUrl":"10.1097/MAO.0000000000004355","url":null,"abstract":"","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Otolithiasis in the Animal Kingdom: A Retrospective Analysis.","authors":"Daniel J Pender","doi":"10.1097/MAO.0000000000004342","DOIUrl":"10.1097/MAO.0000000000004342","url":null,"abstract":"<p><strong>Hypothesis: </strong>If otolithiasis can be demonstrated to affect multiple species, it may be possible to identify an experimental animal for prospective study of this entity.</p><p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence Tracking of Otologic Instruments in Mastoidectomy Videos.","authors":"George S Liu, Sharad Parulekar, Melissa C Lee, Trishia El Chemaly, Mohamed Diop, Roy Park, Nikolas H Blevins","doi":"10.1097/MAO.0000000000004330","DOIUrl":"10.1097/MAO.0000000000004330","url":null,"abstract":"<p><strong>Objective: </strong>Develop an artificial intelligence (AI) model to track otologic instruments in mastoidectomy videos.</p><p><strong>Study design: </strong>Retrospective case series.</p><p><strong>Setting: </strong>Tertiary care center.</p><p><strong>Subjects: </strong>Six otolaryngology residents (PGY 3-5) and one senior neurotology attending.</p><p><strong>Interventions: </strong>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.</p><p><strong>Main outcome measures: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Selection Protocol to Identify Therapeutics to Target NLRP3-Associated Sensory Hearing Loss.","authors":"Viktoria Schiel, Kourosh Eftekharian, Anping Xia, Laurent A Bekale, Ritwija Bhattacharya, Peter L Santa Maria","doi":"10.1097/MAO.0000000000004321","DOIUrl":"10.1097/MAO.0000000000004321","url":null,"abstract":"<p><strong>Objective: </strong>We propose a selection process to identify a small molecule inhibitor to treat NLRP3-associated sensory hearing loss.</p><p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>Our selection process and preliminary results provide a promising concept to develop small molecule NLRP3 inhibitors to treat sensory hearing loss.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blast Exposure, Tinnitus, Hearing Loss, and Postdeployment Quality of Life in U.S. Veterans: A Longitudinal Analysis.","authors":"Hoda A O Mohammed, Kelly M Reavis, Samrita Thapa, Emily J Thielman, Wendy J Helt, Kathleen F Carlson, Charlotte K Hughes","doi":"10.1097/MAO.0000000000004332","DOIUrl":"10.1097/MAO.0000000000004332","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Study design: </strong>Prospective cohort.</p><p><strong>Setting: </strong>Multi-institutional tertiary referral centers.</p><p><strong>Patients: </strong>540 veterans.</p><p><strong>Exposure: </strong>Self-reported military blast exposure with and without tinnitus; high-frequency hearing loss (yes/no).</p><p><strong>Main outcome measure: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>Blast exposure negatively affects the quality of life of veterans, especially when compounded with tinnitus and hearing loss.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-Dimensional Reconstruction of a Malleus Handle Fracture Using Photon-Counting CT.","authors":"Julia J Shi, Rance J T Fujiwara, Marco C Pinho, Brandon Isaacson","doi":"10.1097/MAO.0000000000004343","DOIUrl":"10.1097/MAO.0000000000004343","url":null,"abstract":"","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply on: \"Comment on Intratympanic Lidocaine as a Potent Remedy for Tinnitus in Sudden Sensorineural Hearing Loss: A Double-Blind, Randomized Clinical Trial\".","authors":"Di Zhang, Daibo Li, Ting Chen, Xuefei Feng, Juan Zhang","doi":"10.1097/MAO.0000000000004356","DOIUrl":"10.1097/MAO.0000000000004356","url":null,"abstract":"","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}