Otology & Neurotology最新文献

{"title":"Electrocochleography-Guided Pull-Back Technique of Perimodiolar Electrode for Improved Hearing Preservation.","authors":"Amit Walia, Matthew A Shew, David S Lee, Amanda Ortmann, Jordan Varghese, Shannon Lefler, Nedim Durakovic, Cameron C Wick, Jacques A Herzog, Craig A Buchman","doi":"10.1097/MAO.0000000000004407","DOIUrl":"10.1097/MAO.0000000000004407","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether electrocochleography (ECochG)-guided pull-back of the perimodiolar electrode improves perimodiolar proximity, hearing preservation (HP), and cochlear implant performance.</p><p><strong>Study design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Patients: </strong>77 adult CI recipients with residual acoustic hearing (low-frequency pure-tone average of 125, 250, 500 Hz; LFPTA ≤80 dB HL).</p><p><strong>Intervention: </strong>Unilateral implantation, comparing conventional insertion (N = 31) with ECochG-guided electrode pull-back (N = 46). The guided method uses active ECochG from the apical electrode during adjustment and post-insertion electrode sweep to identify \"tonotopic response\" (defined as maximum response for 250 Hz at most apical electrode on electrode sweep).</p><p><strong>Main outcome measures: </strong>Perimodiolar proximity (wrapping factor on postoperative CT); speech-perception testing (CNC, AzBio in noise +10 dB SNR); and HP at 3 and 6 months post-activation (defined as LFPTA ≤80 dB HL).</p><p><strong>Results: </strong>Of the subjects undergoing ECochG-guided insertion, 36 required pull-back based on lack of tonotopic responses, whereas the remaining 10 exhibited \"optimal responses\" post-insertion, needing no adjustment. Improved perimodiolar proximity was achieved with the ECochG-guided method (mean wrapping factor difference, 6.4; 95% CI, 3.0-9.9). The LFPTA shift was smaller using ECochG-guided pull-back when compared with conventional insertion by 17.0 dB HL (95% CI, 8.3-25.7) and 14.8 dB HL (95% CI, 6.5-23.2) at 3 and 6 months, respectively. Forty percent achieved HP using ECochG-guided pull-back versus 27.5% without. There was no difference in CNC scores among both cohorts, but AzBio in noise scores at 6 months was improved in the ECochG-guided pull-back cohort (mean difference, 19.1%; 95% CI, 5.8-32.4).</p><p><strong>Conclusions: </strong>ECochG-guided pull-back increased perimodiolar proximity and HP rates. Although there was no difference in speech perception performance in quiet, a significant improvement was noted in noisy conditions, potentially attributable to HP and the utilization of hybrid stimulation.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"766-774"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448280","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":"Longitudinal Trends in Cochlear Implant Programming from a Single-Institution Review of Over 400 Adult Implant Recipients: Evidence to Support Selective De-Escalation of Device Programming.","authors":"James R Dornhoffer, Karl R Khandalavala, Aniket A Saoji, Christine M Lohse, Matthew L Carlson","doi":"10.1097/MAO.0000000000004459","DOIUrl":"10.1097/MAO.0000000000004459","url":null,"abstract":"<p><strong>Objective: </strong>To examine comfort (C) and threshold (T) levels in adult cochlear implant (CI) recipients over the first 18 months postactivation.</p><p><strong>Study design: </strong>Retrospective review of longitudinal CI programming data.</p><p><strong>Setting: </strong>Tertiary academic center.</p><p><strong>Patients: </strong>A total of 480 CIs among 428 adult CI recipients.</p><p><strong>Interventions: </strong>Cochlear implantation with Cochlear Ltd. devices with subsequent programming to behavioral standards using Custom Sound® fitting software.</p><p><strong>Main outcome measures: </strong>Charge levels needed to achieve C and T levels were measured longitudinally using Custom Sound®, from time of activation to a minimum of 6 and a maximum of 18 months postactivation. Charge (nC) levels were calculated as the product of pulse width (μs) and current amplitude (μA) to standardize among implant models. Changes in C and T charge levels over time were evaluated using repeated-measures analysis of variance.</p><p><strong>Results: </strong>When considering the entire electrode, the largest increases were seen at 1 month postactivation, and C and T charge levels did not increase significantly after 6 and 12 months, respectively. These findings were consistent across patient age at implantation and sex. When considering proximal electrodes only, C and T levels did not increase significantly after 6 months. In distal electrodes only, C levels did not increase significantly after 6 months, but T levels continued to demonstrate small, but statistically significant increases up to 18 months postactivation.</p><p><strong>Conclusions: </strong>Across the entire electrode, we observed the largest changes in C and T charge levels at 1 month postactivation. Small increases in C and T levels continued out to 6 and 12 months, respectively, but may be of limited clinical significance. The stability of programming levels over time may support selective de-escalation of CI follow-up after the initial postactivation period, but, given small yet persistent increases with time, most notably in the distal electrodes, alternatives for follow-up or remote programming may still be encouraged.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"796-801"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586557","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":"Unique Cell Type-Specific Signaling Patterns Define Cholesteatoma.","authors":"Christopher M Welch, Shuze Wang, Joerg Waldhaus","doi":"10.1097/MAO.0000000000004455","DOIUrl":"10.1097/MAO.0000000000004455","url":null,"abstract":"<p><strong>Objective: </strong>To identify cell types and signaling pathways that drive cholesteatoma.</p><p><strong>Methods: </strong>Single-cell RNA sequencing (scRNA-seq) was applied to identify differences between human cholesteatoma specimens and previously published scRNA-seq data for normal human tympanic membrane. The CellChat algorithm determined differential signaling pathways between both tissues. Cholesteatoma-specific markers were validated utilizing immunohistochemistry on human cholesteatoma specimens.</p><p><strong>Background: </strong>Cholesteatoma is a complex, expansile, and destructive cystic epithelial lesion that occurs within the temporal bone. It destroys surrounding tissue, leading to significant otologic complications. Currently, the only treatment option is surgical removal of the disease, and despite surgical treatment, rates of recurrent or residual cholesteatoma following surgery approach 40% to 50% a decade later. Extensive research has attempted to generate medical treatments by delineating signaling pathways that drive cholesteatoma behavior, with numerous pathways identified. However, progress in developing pharmacologic treatment of cholesteatoma has been hampered by the inherent cellular heterogeneity, with cell type-specific behaviors obscured by bulk analysis of tissue.</p><p><strong>Results: </strong>Cholesteatoma cellular composition differs notably from normal tympanic membrane, with increased numbers of immune cells in cholesteatoma. A number of cell signaling pathways are also differentially regulated between cholesteatoma and normal tissues, including several growth factors, Wnt, interleukin, cell adhesion, and tumor necrosis factor pathways, with unique cell type-specific patterns in cholesteatoma.</p><p><strong>Conclusions: </strong>scRNA-seq data define the cellular composition and cell type-specific signaling pathways in cholesteatoma, thereby identifying potential drug targets and informing future strategies to improve treatment of the disease.</p><p><strong>Professional practice gap and educational need: </strong>The molecular understanding of cholesteatoma remains poor, resulting in a lack of medical treatments for this relatively common and troublesome condition.</p><p><strong>Learning objective: </strong>To define the cellular profile and cell type-specific signaling pathways of cholesteatoma relative to normal tympanic membrane.</p><p><strong>Desired result: </strong>To define the unique cell type-specific signaling pathways within cholesteatoma that may warrant further evaluation as potential therapeutic targets for medical treatment of cholesteatoma.</p><p><strong>Level of evidence: </strong>Not applicable, in silico cellular study.</p><p><strong>Indicate irb or iacuc: </strong>IRB HUM00153531.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"e285-e292"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586487","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":"Evaluating Patient Motivation Behind Device Removal in Cochlear Implant Patients.","authors":"Robert J Macielak, Lisa Zhang, Diana Hallak, Desi P Schoo, Edward E Dodson, Oliver F Adunka, Yin Ren","doi":"10.1097/MAO.0000000000004513","DOIUrl":"10.1097/MAO.0000000000004513","url":null,"abstract":"<p><strong>Objective: </strong>To assess indications behind cochlear implant (CI) removal without subsequent re-implantation.</p><p><strong>Patients: </strong>Patients who underwent CI explantation between January 2013 and December 2022.</p><p><strong>Interventions: </strong>Explantation of CI device without ipsilateral re-implantation.</p><p><strong>Main outcome measures: </strong>Indications for and audiometric testing before CI explantation.</p><p><strong>Results: </strong>Within a cohort of 743 CI patients, 35 patients (5%) underwent implant revision. A total of 16 patients (2%) underwent explantation without ipsilateral re-implantation (mean age of 51 yr [SD, 23]), and 19 (3%) underwent explantation followed by re-implantation (mean age of 51 yr [SD, 18]). The average time between CI insertion and removal was 56 months (SD, 72). Six explantations (6 of 16 [37.5%]) were due to infectious complications: 2 (13%) did not undergo re-implantation given severe life-threatening comorbidities, 1 (6%) underwent simultaneous contralateral implantation, 1 (6%) experienced insurance barriers preventing re-implantation, and 2 (13%) were lost to follow-up. Ten patients (10 of 16 [62.5%]) underwent device removal for noninfectious indications, including 6 (38%) with non-audiologic symptoms attributed to CI, 3 (19%) who required repeated MRIs and desired avoidance of peri-imaging procedures, and 1 (6%) who had poor audiometric outcomes due to cochlear ossification. Patients who were not re-implanted performed worse on AzBio (35% versus 59%; p = 0.10) and CNC testing (27% versus. 70%; p = 0.02) after initial successful implantation compared with those who did undergo re-implantation.</p><p><strong>Conclusions: </strong>Patients undergo explantation for a variety of reasons, with ill-defined symptoms being the motive in over half of the cases. These desires are compounded by poor postoperative audiometric performance, which likely hinders the patient's desire to undergo re-implantation.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"e230-e233"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023151","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 of Slim Precurved Arrays Using Automatic Preoperative Insertion Plans.","authors":"Kareem O Tawfik, Mohammad M R Khan, Ankita Patro, Miriam R Smetak, David Haynes, Robert F Labadie, René H Gifford, Jack H Noble","doi":"10.1097/MAO.0000000000004525","DOIUrl":"10.1097/MAO.0000000000004525","url":null,"abstract":"<p><strong>Hypothesis: </strong>Preoperative cochlear implant (CI) electrode array (EL) insertion plans created by automated image analysis methods can improve positioning of slim precurved EL.</p><p><strong>Background: </strong>This study represents the first evaluation of a system for patient-customized EL insertion planning for a slim precurved EL.</p><p><strong>Methods: </strong>Twenty-one temporal bone specimens were divided into experimental and control groups and underwent cochlear implantation. For the control group, the surgeon performed a traditional insertion without an insertion plan. For the experimental group, customized insertion plans guided entry site, trajectory, curl direction, and base insertion depth. An additional 35 clinical insertions from the same surgeon were analyzed, 7 of which were conducted using the insertion plans. EL positioning was analyzed using postoperative imaging auto-segmentation techniques, allowing measurement of angular insertion depth (AID), mean modiolar distance (MMD), and scalar position.</p><p><strong>Results: </strong>In the cadaveric temporal bones, three scalar translocations, including two foldovers, occurred in 14 control group insertions. In the clinical insertions, translocations occurred in 2 of 28 control cases. No translocations or folds occurred in the seven experimental temporal bone and the seven experimental clinical insertions. Among the nontranslocated cases, overall AID and MMD were 401 ± 41 degrees and 0.34 ± 0.13 mm for the control insertions. AID and MMD for the experimental insertions were 424 ± 43 degrees and 0.34 ± 0.09 mm overall and were 432 ± 19 degrees and 0.30 ± 0.07 mm for cases where the planned insertion depth was achieved.</p><p><strong>Conclusions: </strong>Trends toward improved EL positioning within scala tympani were observed when EL insertion plans are used. Variability in MMD was significantly reduced (0.07 versus 0.13 mm, p = 0.039) when the planned depth was achieved.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"862-870"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974912","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":"Contemporary Tympanostomy Tube Complications in Children: A Population-Based Longitudinal Study.","authors":"Nofar Ben-Mordechai Sharon, Sharon Ovnat Tamir, Marina Gitin, Yehuda Schwarz, Tal Marom","doi":"10.1097/MAO.0000000000004536","DOIUrl":"10.1097/MAO.0000000000004536","url":null,"abstract":"<p><strong>Objective: </strong>To describe the current tympanostomy tube insertion (TTI) complication rates occurring within 3 years of surgery in the post-intervention era. Current TTI complication rates in children are based on reports from a meta-analysis that was published in 2001, reporting on 16 to 26% otorrhea rates, cholesteatoma development of 0.7%, and tympanic membrane perforation (TMP) of 2.2 to 16%. Since then, interventions aimed at reducing pediatric otitis media burden have been largely implemented worldwide, and indications for TTI have been published.</p><p><strong>Study design: </strong>Population-based longitudinal study. Data were anonymously retrieved from a big stable healthcare database between 2005 and 2021.</p><p><strong>Setting: </strong>Hospitals and ambulatory surgical centers, nationwide.</p><p><strong>Patients: </strong>Children who underwent TTI and completed 3 postoperative follow-up years within the health insurance. We excluded children with previous otological surgery and congenital craniofacial anomalies. Children were categorized into the younger (0-<7 yr) and older (7-18 yr) age groups.</p><p><strong>Intervention: </strong>TTI (therapeutic).</p><p><strong>Main outcome measures: </strong>Number of TTI performed per 100,000 children per study year, and cumulative incidence of these postoperative complications: TT removal, otorrhea, TMP, cholesteatoma development, and need for mastoidectomy.</p><p><strong>Results: </strong>Of the 19,920 unique children identified, 86.6% were in the younger age group with a mean age of 3.57 ± 1.59 years, and 61% were boys. At the end of follow-up, older children had statistically significantly higher TMP (6.9% versus 3.3%, p < 0.001), TT removal (5.1% versus 3.8%, p < 0.001), cholesteatoma (2.2% versus 0.8%, p < 0.001), and mastoidectomy (0.8% versus 0.3%, p < 0.001) rates when compared with younger children, respectively. Younger children experienced higher otorrhea rates when compared with older children (11% versus 6.4%, p < 0.001) but for a shorter period (324 ± 290 versus 404 ± 303 days, p < 0.001).</p><p><strong>Conclusions: </strong>Post-TTI complication rates are lower in the post-intervention era, except for cholesteatoma. This current quantitative appreciation of TTI complications can help both patients and caregivers define realistic postoperative expectations.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"829-835"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151387","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":"Impact of Implantable Hearing Devices on Delirium Risk in Patients with Hearing Loss: A National Database Study.","authors":"Bryce Hambach, Jena Patel, Kathryn Nunes, Elliott M Sina, Pablo Llerena, Alexander Knops, Rebecca C Chiffer, Jacob B Hunter","doi":"10.1097/MAO.0000000000004416","DOIUrl":"10.1097/MAO.0000000000004416","url":null,"abstract":"<p><strong>Objective: </strong>Exploring whether the utilization of implantable hearing rehabilitation devices is associated with a reduced likelihood of developing delirium in patients with hearing loss.</p><p><strong>Study design: </strong>A retrospective cohort database study with propensity score matching (PSM) utilizing TriNetX clinical database.</p><p><strong>Setting: </strong>The US Collaborative Network within the TriNetX database (100 million people).</p><p><strong>Patients: </strong>Patients over 55 years old were selected based on three categories: a non-hearing loss study control (ICD-10: H90-91), a hearing loss (HL without implantable device), and an implantable device cohort (ICD-10: Z96.21, Z96.29, 09HD, 09HE; CPT: 69714, 69930). Patients with prior dementia or memory loss diagnosis were excluded (F01-03, 27-29).</p><p><strong>Interventions: </strong>Observational.</p><p><strong>Main outcome measures: </strong>Odds ratios with 95% confidence intervals for delirium diagnosis code (F0.5).</p><p><strong>Results: </strong>The control cohort (n = 36.5 million) was 1:1 PSM for age and sex with the HL cohort (n = 1.77 million) in which 0.28% of patients developed delirium compared to 0.74% in the HL cohort (OR 2.66, 95% CI = 2.58-2.75). When looking at the same PSM between HL and implantable device cohorts (n = 20,847), 0.81% developed a delirium diagnosis compared to 0.45% in the implantable device cohort (OR = 1.79, 95% CI = 1.39-2.31). Further analysis accounting for 16 PSM covariates showed that 0.74% of the HL cohort developed delirium compared to 0.45% of the implantable device cohort (OR = 1.64, 95% CI = 1.27-2.13).</p><p><strong>Conclusions: </strong>The present study shows that patients with hearing loss were more likely to develop delirium than those with normal hearing. Importantly, patients with implantable hearing devices were significantly less likely to develop delirium compared to hearing loss patients without an implantable device. Our research highlights the importance of treating hearing loss to prevent delirium.Level of Evidence: III.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"775-780"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586540","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 of Slim Modiolar and Slim Straight Electrodes: A Systematic Review and Meta-Analysis.","authors":"Shuang Geng, Sudanthi Wijewickrema, Bridget Copson, Jean-Marc Gerard, Stephen O'Leary","doi":"10.1097/MAO.0000000000004540","DOIUrl":"10.1097/MAO.0000000000004540","url":null,"abstract":"<p><strong>Purpose: </strong>This meta-analysis aims to investigate the hearing preservation (HP) rates of slim straight electrodes (SSE) and slim modiolar electrodes (SME) after cochlear implantation, in the short- and long-term (≤4 months and 4-12 months, respectively).</p><p><strong>Methods: </strong>A systematic search was conducted in PubMed, Embase, Cochrane Library, and ClinicalTrials databases for studies published between 1 January, 2014, and 1 January, 2024. Cohort studies, case series, and randomized controlled trials written in English, reporting HP rates using the HEARRING classification system, were included.</p><p><strong>Results: </strong>Sixteen studies were included, comprising 15 observational studies and 1 randomized controlled trial. The overall short-term HP rate for SSE was 68.70% (95% CI: 52.27-85.12%), which decreased to 56.38% (95% CI: 42.87-69.90%) in the long-term. In contrast, SME maintained stable HP rates of 59.07% (95% CI: 50.03-68.10%) in the short-term, and 59.09% (95% CI: 46.48-71.70%) in the long-term.</p><p><strong>Conclusion: </strong>The meta-analysis revealed that SME and SSE have a similar HP ability in both the short- and long-terms. Notably, a prominent decline in HP rate over time was observed in the SSE compared with SME.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"733-742"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009119","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":"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":"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 H 2 O), 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/m 2 . 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 H 2 O (±8.3). Only 10 (32%) patients had an LP ≥25 cm H 2 O, 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 H 2 O 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":"816-820"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","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":"Rationale for the Development of a Universal Hearing Metric for Public Consumption: Initiative 1 of the Hearing Health Collaborative.","authors":"Nicholas S Reed, Sahar Assi, Matthew Bush, Matthew L Carlson, Maura Cosetti, Liza Creel, Samuel Gubbels, Richard Gurgel, Meredith Holcomb, Anna M Jilla, Frank R Lin, John P Marinelli, Clarice Myers, Douglas P Sladen, Christopher Spankovich, Sarah Sydlowski, Bevan Yueh, Ashley M Nassiri","doi":"10.1097/MAO.0000000000004523","DOIUrl":"10.1097/MAO.0000000000004523","url":null,"abstract":"<p><strong>Objective: </strong>Present the rationale for the development of a new, patient-facing vital sign for adult hearing.</p><p><strong>Study design: </strong>Structured A3 process.</p><p><strong>Setting: </strong>Fourteen virtual meetings and two in-person meetings held between May 2021 and June 2022.</p><p><strong>Main outcome measures: </strong>Identification and refinement of a countermeasure to develop and imbed a hearing health vital sign for adult hearing.</p><p><strong>Results: </strong>Through a rigorous, structured A3 process, the Hearing Health Collaborative identified and refined the rationale for and the qualities associated with a public-facing vital sign for adult hearing loss. Specifically, such a vital sign must embody five qualities: simple, accessible, stable, inclusive, and meaningful. These qualities together would ensure that a hearing health vital sign would be useful not only as a screening tool but also as an instrument to guide next steps in workup and potentially treatment.</p><p><strong>Conclusions: </strong>Successful identification and implementation of a hearing metric or \"vital sign\" for the presence of adult hearing loss, using precedent convention of other medical diseases, may help reframe public perceptions surrounding hearing loss, improve awareness and literacy regarding the presence of the disease, and prompt action to seek diagnostic assessment.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"743-747"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008407","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}