Otology & Neurotology最新文献

{"title":"Prevalence of Elevated Intracranial Pressure in Lateral Spontaneous Cerebrospinal Fluid (CSF) Leaks.","authors":"Evan C Cumpston, William Zhang, Ritika S Bhadouriya, Douglas J Totten, Charles W Yates, Rick F Nelson","doi":"10.1097/MAO.0000000000004466","DOIUrl":"https://doi.org/10.1097/MAO.0000000000004466","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate postoperative opening pressures (OP) on lumbar puncture (LP) and polysomnogram (PSG) findings in patients who underwent middle cranial fossa (MCF) repair with lateral spontaneous cerebrospinal fluid (sCSF) leaks.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Interventions: </strong>MCF repair of sCSF leak, PSG, and postoperative LP.</p><p><strong>Main outcome measures: </strong>Prevalence of intracranial hypertension (IH; LP OP >25 cm H2O), and of obstructive sleep apnea (OSA) (apnea-hypopnea index [AHI] >5).</p><p><strong>Results: </strong>Seventy-two patients had an average (standard deviation) age of 56.7 (±11.7) years and BMI of 39.0 (±9.9) kg/m2. There were no unilateral recurrent CSF leaks. OP was completed by 39 patients at a mean 155.5 days (±172.3) postop with a mean OP 22.3 cm H2O (±8.3). Only 10 (32%) patients had an LP ≥25 cm H2O, of which 9 were female and 1 male. Papilledema was observed in 1 of 12 patients on retinal exam. Polysomnogram was completed by 35 patients and OSA was observed in 93% of patients with a mean AHI of 25.6 (±35.1). There was a positive correlation between AHI and elevated OP. All patients with an OP>25 cm H2O had an AHI > 15. In the three patients who developed a contralateral leak, the mean OP was 27.5 (±8.8), AHI 16.5 (±2.5), and mean BMI 37.2 (±12.6). In the four patients with a history of anterior and lateral sCSF leak, mean OP was significantly elevated at 28.75 (±2.9) (p = 0.03). In the six patients with a history of bilateral sCSF leaks, mean OP was also significantly elevated at 31.5 (±6.9) (p = 0.03).</p><p><strong>Conclusions: </strong>The prevalence of IH on postoperative LP was 32% in lateral sCSF leak patients and nearly all patients had OSA. There was a positive correlation between AHI and elevated OP. All patients should obtain a PSG and those with an AHI >15, multifocal sCSF leaks, or visual symptoms should also obtain a postoperative LP.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143616638","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":"Outcomes of Primary Acquired Cholesteatoma Managed with Endoscopic-Microscopic Approaches According to EAONO-JOS and SAMEO-ATO Classifications.","authors":"Tyler J Gathman, Huong Dang, Nell Adams, Tajanae Henderson, Manuela Fina","doi":"10.1097/MAO.0000000000004461","DOIUrl":"https://doi.org/10.1097/MAO.0000000000004461","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the utility of the European Academy of Otology and Neurotology-Japanese Otological Society (EAONO-JOS) and SAMEO-ATO tympanomastoid surgery classification systems in predicting recidivistic disease in patients with primary acquired cholesteatoma and to compare outcomes between endoscopic and combined approaches.</p><p><strong>Study design: </strong>Retrospective chart review.</p><p><strong>Setting: </strong>Academic teaching hospital.</p><p><strong>Methods: </strong>Eighty-one surgical ears from 77 patients were operated on between 2015 and 2022 by the senior author and fit the inclusion criteria. Surgeries were retrospectively classified according to SAMEO-ATO and EAONO-JOS classifications. Descriptive statistics for staging and demographics were reported. Multivariate analysis was completed to assess the correlation between EAONO-JOS and SAMEO-ATO classification and residual disease with covariates including age. The incidence of residual and recurrent disease was investigated using Kaplan-Meier survival analysis. Patients had a median follow-up of 36.7 months.</p><p><strong>Results: </strong>Based on EAONO-JOS staging, 13.6% of ears were stage I, 65.4% were stage II, 21.0% were stage III, and 0% were stage IV. Exclusive endoscopic approaches (A1Mx, A1M2a, and A1M2b) were performed in 50.6% of all ears, and combined approaches (A4M1a, A4M1b, A4M1a + M2a, and A4M2c) in the remaining 49.4% of ears. Overall residual disease rate was 41.9% (n = 34), while recurrence occurred in 7.4% (n = 6). In Kaplan-Meier analysis, SAMEO-ATO and EAONO staging did not predict residual or recurrent disease. In multivariate analysis, age was correlated with a lower risk of residual disease for each advancing year (HR 0.97, 95% CI = 0.95-0.99, p < 0.01). Compared to combined approaches during primary surgery, exclusive endoscopic approaches were correlated with lower conversion to CWU or CWD mastoidectomy for revision surgery (HR 0.19, 95% CI = 0.05-0.71, p = 0.014).</p><p><strong>Conclusion: </strong>In this cohort of patients with primary acquired cholesteatoma, predominantly EAONO-JOS stage II and III, half were managed with an exclusive transcanal endoscopic approach. Although EAONO-JOS and SAMEO-ATO did not predict recidivism, the classification is an important starting point for maintaining uniformity in collecting outcomes. The study was limited by a small sample size and limited follow-up duration.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586563","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":"Long-Term Results of Cochlear Implantation in Single-Sided Deaf Patients: Influence of Duration of Deafness and Age at Onset of Deafness.","authors":"Clemens Honeder, Anselm J Gadenstaetter, Rudolfs Liepins, Alice B Auinger, Dominik Riss, Christoph Arnoldner, Valerie Dahm","doi":"10.1097/MAO.0000000000004419","DOIUrl":"10.1097/MAO.0000000000004419","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the current study was to investigate the influence of duration, time point, and etiology of deafness on cochlear implant user rates, and to investigate the long-term hearing performance in single-sided deaf patients.</p><p><strong>Study design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Tertiary care hospital.</p><p><strong>Patients: </strong>77 subjects with single-sided deafness.</p><p><strong>Intervention: </strong>Unilateral cochlear implantation between 2009 and 2022.</p><p><strong>Main outcome measures: </strong>Patients were categorized into users and nonusers. Duration of deafness, onset of deafness, etiology, and further demographic data were collected. Pure tone audiometry, Freiburg numbers, and monosyllables test were carried out at activation, as well as 1 year, 2 to 3 years, and 5 years after cochlear implant activation.</p><p><strong>Results: </strong>Most patients who lost their hearing after the age of 10 years were cochlear implant users, while patients who lost their hearing earlier and were implanted with a significant delay were likely nonusers. Even patients implanted more than 10 years after the hearing loss regularly used the cochlear implant, if deafness occurred at the age of 10 years or later. Implanted patients showed an improvement of hearing from activation to 1 year postoperatively as well as stable hearing thresholds for 5 years.</p><p><strong>Conclusions: </strong>The timing of hearing loss influences cochlear implant user rates. Patients who acquired single-sided deafness above the age of 10 years use the device regularly even if the duration of deafness was more than 10 years. This challenges the 10-year cutoff for cochlear implant indication. Furthermore, results show good long-term hearing thresholds and speech understanding for cochlear implant patients who use their device regularly.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":"46 3","pages":"279-286"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416962","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":"Treatment Response Evaluation in Necrotizing Otitis Externa Using 18 F-FDG-PET Imaging.","authors":"Robin W Jansen, Pieter Kemp, Sanne E Wiegers, Pim de Graaf, Annelies van Schie, Roland M Martens, Ronald Boellaard, Gerben J C Zwezerijnen, Thadé Goderie","doi":"10.1097/MAO.0000000000004402","DOIUrl":"10.1097/MAO.0000000000004402","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to identify 18 F-FDG-PET imaging features for improving treatment response evaluation in patients with necrotizing otitis externa (NOE), aiding in the difficult differentiation between sterile inflammation and active infection.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary hospital.</p><p><strong>Patients: </strong>Patients diagnosed with NOE between 2011 and 2022. NOE criteria included otalgia, otorrhea, granulation, and radiological features consistent with osteomyelitis.</p><p><strong>Intervention: </strong>18 F-FDG-PET/computed tomography (CT) parameters were derived from manually delineated regions of interest and were evaluated on both pretreatment and end-of-treatment scans.</p><p><strong>Main outcome measures: </strong>Recurrent disease of NOE after end-of-treatment 18 F-FDG-PET scans.</p><p><strong>Results: </strong>This study comprised 20 NOE patients, including 5 (25%) experiencing recurrent disease after the end-of-treatment scan. The end-of-treatment 18 F-FDG-PET parameters of maximal and peak standardized uptake value (SUVmax and SUVpeak) were significantly higher in recurrent cases ( p = 0.025 and p = 0.025, respectively). Both parameters demonstrated good discrimination ability in predicting recurrence, with optimal cutoffs yielding 100% sensitivity and 67% specificity. Other parameters, including mean SUV and total lesion glycolysis (TLG), did not yield significant results, neither did the calculated difference in uptake between end-of-treatment and pretreatment scans.</p><p><strong>Conclusions: </strong>SUVpeak on 18 F-FDG-PET was the preferred parameter for treatment response evaluation of NOE at the end-of-treatment scan. A high residual SUVpeak may adequately detect patients at risk for recurrent disease, which may necessitate prolonged treatment, while low SUVpeak is found in patients with low risk for recurrent disease permitting safe treatment cessation.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"295-302"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142966399","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":"Effects of Insertion Depth and Modiolar Proximity on Cochlear Implant Speech Recognition Outcomes With a Precurved Electrode Array.","authors":"Michael W Canfarotta, Margaret T Dillon, Nicholas J Thompson, A Morgan Selleck, Matthew M Dedmon, Kevin D Brown","doi":"10.1097/MAO.0000000000004405","DOIUrl":"10.1097/MAO.0000000000004405","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the relationship between angular insertion depth (AID), modiolar proximity, and speech recognition outcomes for cochlear implant (CI) recipients of a precurved electrode array.</p><p><strong>Study design: </strong>Retrospective review.</p><p><strong>Setting: </strong>Tertiary academic referral center.</p><p><strong>Patients: </strong>Thirty-five adult CI recipients (n = 40 ears) of precurved electrode arrays listening with a CI-alone device.</p><p><strong>Interventions: </strong>Cochlear implantation with postoperative computed tomography.</p><p><strong>Main outcome measures: </strong>Consonant-nucleus-consonant (CNC) word recognition at 6 months post-activation.</p><p><strong>Results: </strong>A multivariate regression model demonstrated that both deeper apical AID and closer modiolar proximity in the basal turn were independently associated with better CNC word scores at 6 months (F2,37 = 7.264, p = 0.002). A deeper basal insertion depth was positively correlated with apical AID (r = 0.754, p < 0.001) but negatively correlated with modiolar proximity in the basal turn (r = -0.766, p < 0.001).</p><p><strong>Conclusions: </strong>These data suggest that both apical cochlear coverage and modiolar proximity independently confer speech recognition benefit with a precurved array. However, these benefits are mutually exclusive for current precurved array designs as a deeper basal insertion depth results in greater apical coverage but lateralization of electrodes away from the modiolus in the basal turn. Future work is needed to elucidate mechanisms behind these findings that may motivate electrode array design modifications to further optimize outcomes for CI users.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":"46 3","pages":"272-278"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416958","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":"Hearing Preservation Outcomes in 230 Consecutive Patients with Small Vestibular Schwannomas Treated with Microsurgery.","authors":"Pawina Jiramongkolchai, Alexandra Vacaru, Tamara Wahlin, Marc S Schwartz, Rick A Friedman","doi":"10.1097/MAO.0000000000004404","DOIUrl":"10.1097/MAO.0000000000004404","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate hearing preservation (HP) outcomes for patients with small sporadic vestibular schwannomas (VS) who elect to undergo microsurgical resection.</p><p><strong>Study design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Tertiary single-academic institution.</p><p><strong>Patients: </strong>Individuals 18 years or older with small sporadic VS (≤15 mm) who underwent microsurgical resection from 2018 to 2023.</p><p><strong>Interventions: </strong>Microsurgical resection via a middle cranial fossa (MCF) or retrosigmoid (RS) approach.</p><p><strong>Main outcome measures: </strong>Postoperative HP (word recognition score ≥ 50%) and facial nerve function.</p><p><strong>Results: </strong>Of the 230 consecutive patients with small sporadic VS who elected to undergo microsurgical resection, hearing was preserved in 61% of patients. When stratified by tumor size, patients with tumors ≤10 mm had a 72% hearing preservation rate. On multivariate analysis, the most important prognostic factors for hearing preservation were the presence of preoperative vertigo (OR, 0.33; 95% CI, 0.17-0.52) and tumor size. Patients with tumors between 0 to 5 mm and 5.1 to 10 mm had 3.62 higher odds (95% CI, 1.39-9.4) and 2.52 higher odds (95% CI, 1.30-4.9) of hearing preservation, respectively, when compared to patients with tumors that were larger than 10 mm. At the time of last follow-up, a House-Brackmann (HB) 1 or 2 was maintained in 95% (n = 218) patients.</p><p><strong>Conclusions: </strong>Microsurgical resection for patients with small VS is associated with good hearing preservation and excellent facial nerve outcomes. Because larger tumor size portends poorer hearing outcomes, for patients who elect to undergo microsurgical resection for hearing preservation, proactive surgical intervention when tumors are ≤10 mm should be considered to increase the likelihood of hearing preservation.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"303-307"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142966398","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":"Automated Technical Skill and Performance Assessment in Otology and Neurotology: A Scoping Review.","authors":"Obinna I Nwosu, Mitsuki Ota, Deborah Goss, Matthew G Crowson","doi":"10.1097/MAO.0000000000004427","DOIUrl":"10.1097/MAO.0000000000004427","url":null,"abstract":"<p><strong>Objectives/hypothesis: </strong>This scoping review aims to provide an overview of existing semi-automated and fully automated methods for technical skill and performance assessment in otologic and neurotologic procedures.</p><p><strong>Study design: </strong>Scoping review.</p><p><strong>Databases reviewed: </strong>Ovid MEDLINE (PubMed), Ovid EMBASE, Web of Science Core Collection, and IEEE Xplor Digital Library.</p><p><strong>Methods: </strong>A literature search was conducted according to PRISMA-ScR. Included studies were full-text articles that detailed an automated method of technical skill and performance assessment in otologic/neurotologic procedures. Extracted elements included general study characteristics (publication year, study objective, validity type, surgical procedure, and setting) and assessment approach characteristics (method of analysis, metrics assessed, source of metric data, degree of automation, and use of artificial intelligence [AI]).</p><p><strong>Results: </strong>A total of 1,141 studies were identified from the literature search. After deduplication, title/abstract screening, and full-text review, 21 studies met the inclusion criteria. All but one of the included studies focused on mastoidectomy. Most studies assessed performance exclusively in VR-simulated mastoidectomy (n = 12) as opposed to cadaveric, 3D-printed, or live dissections. The majority of studies concentrated on establishing internal validity of their assessment methods (n = 13). Performance metrics were primarily obtained through motion analysis and final product analysis. Only a minority of studies used AI, which typically involved machine learning regression or classification to predict skill levels based on automatically extracted metrics.</p><p><strong>Conclusion: </strong>This scoping review explores the developing landscape of automated technical skill and performance assessment in otology and neurotology. Though progress has been made in automating assessment in the field, most investigations are narrowly focused on performance in VR-simulated mastoidectomy and lack external validity evidence. AI and computer vision (CV), which have advanced automated assessment in other surgical fields, have been underutilized in assessing performance in otology and neurotology. Future work must explore the development and validation of automated assessment approaches across a wider range of otologic and neurotologic procedures. Incorporation of novel AI/CV techniques may facilitate real-time integration of automated assessment in a broader range of simulated procedures and live surgical settings.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":"46 3","pages":"248-255"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416956","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":"The Possible Role of Biofilm Formation in Recidivism of Cholesteatomatous and Noncholesteatomatous Chronic Suppurative Otitis Media.","authors":"Zuhal Zeybek Sivas, Nadir Yıldırım","doi":"10.1097/MAO.0000000000004424","DOIUrl":"10.1097/MAO.0000000000004424","url":null,"abstract":"<p><strong>Objective: </strong>Chronic suppurative otitis media (CSOM) is typically classified into two distinct types: CSOM (without cholestetoma) and CSOM with cholesteatoma (CCSOM). The main microbial agents in both types are Pseudomonas aeruginosa, Staphylococcus aureus, and Klebsiella pneumoniae. It is believed that the virulence of the infecting microorganisms and their biofilm production capacity play a role in the chronicity and persistence of the disease. The aim of this study was to investigate the pathogen microorganisms with their biofilm formation in CSOM, CCSOM, and their recidivism.</p><p><strong>Materials and methods: </strong>A cohort of 57 patients was separated into four subgroups as primary CSOM (CSOM, CCSOM) and postoperatively recurring/residual CSOM [(R)CSOM, (R)CCSOM] groups. A control group was formed of 10 patients who underwent tympanotomy for conductive hearing loss without any known past/present ear inflammation. In all 67 patients, ear swabs for culture and the tissue samples for biofilm studies were obtained pre- or intraoperatively.</p><p><strong>Results: </strong>The most common bacteria grown in the culture mediums were Pseudomonas spp., S. aureus, coagulase-negative Staphylococcus, and coliform bacteria. In the SEM study, biofilms were detected in 9 of 15 CCSOM and 6 of 14 CSOM, and in 13 of 14 (R)CCSOM and 11 of 14 (R)CSOM ears. Statistical analysis showed significantly higher rates of biofilm formation in both recidivist cholesteatomatous and noncholesteatomatous CSOM groups than their primary counterpart groups.</p><p><strong>Conclusion: </strong>The findings that biofilm is more prevalent in the recidivist cases substantiated that biofilm formation is correlated with the persistence and additionally aggressiveness of the disease in both CSOM types. S. aureus appeared as the leading biofilm-producing bacterium.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":"46 3","pages":"e74-e80"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416970","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":"Amplitude and Phase Changes in Electrocochleographic Real-Time Recordings During Cochlear Implantation and Its Relation to Pre- and Postoperative Hearing.","authors":"Adrian Dalbert, Christofer Bester, Aaron Collins, Tayla Razmovski, Jean-Marc Gerard, Stephen O'Leary","doi":"10.1097/MAO.0000000000004420","DOIUrl":"10.1097/MAO.0000000000004420","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to relate response patterns of electrocochleography (ECochG) recordings during cochlear implantation to pre- and postoperative hearing.</p><p><strong>Methods: </strong>Thirty subjects with either flat (FA, n = 9) or sloping (SA, n = 21) audiograms before cochlear implantation were prospectively included. Real-time ECochG recordings were conducted via the cochlear implant. The difference curve (DIF) signal of the ECochG recordings was analyzed regarding alteration of the waveform, amplitude changes, and relative phase shifts during insertion.</p><p><strong>Results: </strong>Five subjects (56%) with FA and 13 (62%) with SA exhibited DIF signal drops in the early phase of the insertion. In subjects with FA, alterations of the DIF signal waveform in the early phase of the insertion occurred in 8 subjects (90%), whereas such changes were detectable in only 2 out of 21 subjects (10%) with SA ( p < 0.001). DIF signal drops with relative phase shifts of >0.7 radians but without alterations of the waveform occurred in 5 subjects (56%) with FA and 11 (52%) with SA. Such drops were associated with larger postoperative hearing losses than DIF signal drops without phase changes in both groups (FA: 43 versus 20 dB, p = 0.045; SA: 30 versus 14 dB, p = 0.001).</p><p><strong>Conclusion: </strong>Residual cochlear function in basal regions leads to alteration of the DIF signal waveform during insertion, probably not associated with cochlear injury. A decrease of the DIF signal amplitude with a simultaneous relative phase shift but no alteration of the waveform is associated with greater loss of residual hearing independent from the preoperative hearing.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"e65-e73"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142966395","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":"Access to Ear and Hearing Care Globally: A Survey of Stakeholder Perceptions from the Lancet Commission on Global Hearing Loss.","authors":"Rolvix H Patterson, Catherine McMahon, Chris Waterworth, Sarah Morton, Alyssa Platt, Shelly Chadha, Mary Jue Xu, Carolina Der, Doreen Nakku, Amina Seguya, Robert Frost, Ali Jaffer, Samantha Kleindienst Robler, Susan D Emmett","doi":"10.1097/MAO.0000000000004401","DOIUrl":"10.1097/MAO.0000000000004401","url":null,"abstract":"<p><strong>Objective: </strong>Characterize global access to ear and hearing care (EHC) to inform future policy recommendations.</p><p><strong>Study design: </strong>Survey using convenience sampling.</p><p><strong>Setting: </strong>Subjects were surveyed via contact lists of the World Health Organization, Global Otolaryngology-Head and Neck Surgery Initiative, and Global HEAR Collaborative.</p><p><strong>Participants: </strong>Otolaryngologists, audiologists, other health care professionals, adults with hearing loss, parents/caregivers of children with hearing loss, and policymakers.</p><p><strong>Intervention: </strong>None.</p><p><strong>Main outcome and measures: </strong>Responses to questions regarding EHC screening programs, workforce, supports, access to care, and government priority by World Bank income group.</p><p><strong>Results: </strong>There were 125 included survey responses from EHC stakeholders representing 59 countries: 71% from low- and middle-income countries (LMICs) and 29% from high-income countries (HICs). Compared with respondents from LMICs, those from HICs more frequently indicated that their country had adequate numbers of ENTs, audiologists, SLPs, and EHC community health workers. This trend was consistent across questions regarding number of training programs for EHC workforce, presence of hearing screening programs, cost of hearing aids and cochlear implants, availability of EHC supports and services, affordability of EHC, government funding or investment, and inclusion of EHC in national health strategy.</p><p><strong>Conclusion: </strong>Globally, EHC is limited by systems-level barriers that disproportionately affect LMICs. Urgent policy development and intervention is needed to eliminate these barriers and improve EHC around the world.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":"46 3","pages":"256-264"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416947","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}