Otology & Neurotology最新文献

{"title":"Congenital Cytomegalovirus Infection and Hearing Loss: It's Time to Screen.","authors":"Javier K Nishikawa, Pablo J Sánchez","doi":"10.1097/MAO.0000000000004323","DOIUrl":"10.1097/MAO.0000000000004323","url":null,"abstract":"<p><p>Congenital CMV infection is the leading nongenetic cause of sensorineural hearing loss worldwide, yet most parents have never heard of it. The majority of infected newborns have no clinical signs of infection, although a substantial proportion may have hearing loss at birth or develop it later in life. As antiviral treatment with ganciclovir or valganciclovir initiated in the first month of age improves audiologic outcomes, there is an urgent need for timely identification of infected neonates. A targeted approach that tests neonates who refer on the newborn hearing screen has been implemented in many states and hospital programs, but it fails to identify about 40% of children who experience CMV-related hearing loss. A universal screening approach is optimal given the prevalence of congenital CMV infection, its associated sequelae, the availability of a simple saliva screening tool, the available antiviral treatment, and the directed therapies for hearing impairment.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":"45 10","pages":"e702-e709"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605627","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":"How to Teach an \"Old Dog\" New Tricks: Improving Clinical Efficiency in a Well-Established Cochlear Implant Program.","authors":"Meredith A Holcomb, Molly R Smeal","doi":"10.1097/MAO.0000000000004300","DOIUrl":"10.1097/MAO.0000000000004300","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the implementation of a new streamlined service delivery model for cochlear implant (CI) patients at a mature academic CI program.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Patients: </strong>CI candidates and CI users.</p><p><strong>Interventions: </strong>Implementation of a new CI service delivery model.</p><p><strong>Main outcome measures: </strong>CI surgical numbers, conversion rate from CI evaluation to surgery, documentation time, number of visits for new versus established CI users, ratio of CI clinical full-time equivalency to CI surgical numbers, time from CI referral to CI evaluation, patient travel burden.</p><p><strong>Results: </strong>De-identified data from the electronic health record (EHR) were used to develop an efficiency improvement plan. With the old clinical model, audiologists' schedules were at capacity, wait for CI evaluation appointments was prolonged, and CI surgical numbers were declining. The new model implemented an interactive electronic medical record, a de-escalated postoperative programming schedule, inclusion of telehealth pre-CI surgery, and an evidence-based approach to CI programming. After a 4-year time period (2019-2022) of implementing clinical improvement strategies, the postoperative CI programming schedule in the first year after activation was reduced from 10 visits (unilateral CI user) and 16 visits (bilateral CI user) to 4 visits total. This saved the patient up to 16 hours of time at the clinic, reduced travel burden, and opened 19 weeks of appointment slots for new patients. Increased utilization of the EHR and telehealth increased the conversion rate from CI evaluation to CI surgery by 33% and decreased the no-show rate by 5%. Annual CI surgical numbers subsequently increased by 45% with the new model, which increased our program's CI utilization rate and reduced our role as a barrier to CI care.</p><p><strong>Conclusion: </strong>If CI programs wish to be instrumental in improving CI utilization rates, clinical care models need to be adapted now in preparation for the projected rise in the number of potential CI candidates. This streamlined clinical efficiency model serves as an example of patient-centered CI care that can be recreated at other institutions. Outcomes from our 4-year strategic initiative will add to the scarcity of literature in this area.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":"45 10","pages":"e735-e742"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605739","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":"Proceedings From the Dallas 2023 Cochlear Implants (CI) in Children and Adults Symposium.","authors":"Donna Sorkin, Kara Leyzac, Aaron C Moberly","doi":"10.1097/MAO.0000000000004360","DOIUrl":"10.1097/MAO.0000000000004360","url":null,"abstract":"","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":"45 10","pages":"e700-e701"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605763","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 Relationship Between eSRTs and Upper Stimulation Levels in a Large Cohort of Adult Cochlear Implant Recipients.","authors":"Jourdan T Holder, Jennifer Hoffman, Haley Williams, René H Gifford","doi":"10.1097/MAO.0000000000004329","DOIUrl":"10.1097/MAO.0000000000004329","url":null,"abstract":"<p><strong>Objective: </strong>To compare electrically evoked stapedial reflex thresholds (eSRTs) measured at 1 month post-activation to upper stimulation levels used for programming adult cochlear implant (CI) recipients over time in a large clinical population.</p><p><strong>Study design: </strong>Review of prospectively collected clinical database.</p><p><strong>Setting: </strong>Large CI program at an academic medical center.</p><p><strong>Patients: </strong>Postlingually deafened adult CI recipients (n = 439).</p><p><strong>Main outcome measures: </strong>eSRTs recorded in the medical record and upper stimulation levels derived from the programming software at 1 and 6 months post-activation.</p><p><strong>Results: </strong>The correlation between eSRTs and upper stimulation levels was strong for all three manufacturers (r = 0.80-0.86). On average, upper stimulation levels were set 15.4 clinical levels below eSRT for Cochlear using a pulse width of 25 microseconds, 13.4 clinical levels below eSRT for Cochlear using a pulse width of 37 microseconds, 11.3 clinical units below eSRT for Advanced Bionics, and 0.1 charge unit above eSRT for MED-EL. eSRTs were found to be elicited at similar levels for different electrodes/frequencies across the array. After upper stimulation levels were set based on eSRT at 1 month post-activation, there was no significant change in upper stimulation levels between 1 and 6 months post-activation.</p><p><strong>Conclusions: </strong>eSRTs and upper stimulation levels are highly correlated. Average differences between eSRTs and upper stimulation levels reported herein can be used to guide programming in the clinic. Further, when eSRTs are used to program upper stimulation levels, upper stimulation levels should be relatively similar across channels and stable over time.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":"45 10","pages":"e756-e762"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11566993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","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":" ","pages":"1122-1127"},"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":" ","pages":"1098-1107"},"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":"Sensitivity and Costs of Intraoperative Trans-Impedance Matrix Recordings, Spread of Excitation Functions, and X-ray Imaging in Detecting Cochlear Implant Tip Foldovers.","authors":"Viral Tejani, Robin Piper, Gail Murray, Nauman F Manzoor, Sarah Mowry, Maroun Semaan, Alejandro Rivas","doi":"10.1097/MAO.0000000000004361","DOIUrl":"10.1097/MAO.0000000000004361","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate the sensitivity and financial costs of Trans-Impedance Matrix recordings, Spread of Excitation functions, and x-rays in detecting cochlear implant tip foldovers.</p><p><strong>Setting: </strong>Tertiary academic medical center.</p><p><strong>Patients: </strong>113 ears of 108 patients.</p><p><strong>Interventions: </strong>Following cochlear implantation and before concluding surgery, intraoperative Trans-Impedance Matrix recordings, Spread of Excitation functions, and x-rays were conducted to evaluate presence of tip foldover.</p><p><strong>Main outcome measures: </strong>Presence of tip foldover; recording time necessary for and costs of Trans-Impedance Matrix, spread of excitation, and x-rays.</p><p><strong>Results: </strong>There were six tip foldovers. Trans-Impedance Matrix showed 100% sensitivity, 100% specificity, 100% positive predictive value, and 100% negative predicative value in detecting tip foldovers. Spread of excitation showed 29% sensitivity, 99% specificity, 67% positive predictive value, and 95% negative predicative value. Trans-Impedance Matrix recordings were completed significantly faster than spread of excitation and x-rays. Elimination of x-rays from our intraoperative workflow results in a twofold cost reduction.</p><p><strong>Conclusion: </strong>Trans-Impedance Matrix recordings have potential great clinical utility in evaluating proper CI placement intraoperatively and reducing costs of surgery while not compromising patient care. Given the low tip foldover rate, a multicenter study is in progress to evaluate the sensitivity, specificity, positive predictive value, and negative predicative value of Trans-Impedance Matrix in a larger dataset. This can provide better guidance to cochlear implant clinics interested in evaluating the impact of using Trans-Impedance Matrix on patient care as well as the economics of reducing use of intraoperative imaging.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":"45 10","pages":"e763-e771"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605773","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":"Pain Control after Otologic Surgery: Do Nonopioid Analgesics Suffice?","authors":"Mustafa G Bulbul, Zulkifl Jafary, Brian M Kellermeyer, Scott B Shapiro","doi":"10.1097/MAO.0000000000004344","DOIUrl":"10.1097/MAO.0000000000004344","url":null,"abstract":"<p><strong>Objective: </strong>Investigate whether nonopioid analgesics (NOA) provide adequate pain control after otologic surgery.</p><p><strong>Study design: </strong>Retrospective multicenter cohort.</p><p><strong>Setting: </strong>Two quaternary academic medical centers.</p><p><strong>Patients: </strong>Patients over 12 years old who underwent otologic surgery involving the middle ear and/or mastoid at two centers over a 5-month period.</p><p><strong>Interventions: </strong>Patients were prescribed acetaminophen and ibuprofen postoperatively and instructed to contact the surgical team if pain control was inadequate, in which case an opioid medication was prescribed. Level of pain and medication use were assessed with a standardized questionnaire, 1 week after surgery.</p><p><strong>Main outcome measures: </strong>Postoperative pain levels during the first week after surgery (0-10); proportion of patients requiring opioid medication.</p><p><strong>Results: </strong>Sixty-seven patients were included. Of these, 37% underwent tympanomastoidectomy, 27% cochlear implant, 19.5% postauricular tympanoplasty, 10.5% transcanal tympanoplasty, and 6% had a different surgery. The median of the average level of pain in the first 7 days was 5/10 (IQR 3-6). The median highest level of pain was 5 (IQR 4-8). The median current level of pain was 3 (IQR 1-5). Seven patients (10%) required breakthrough opioid pain medication. The remaining 90% utilized NOA only. One week after surgery, 60% were taking nonopioid analgesics only while the remaining 40% were not taking any pain medication at all. Although opioids were required infrequently, there were no significant differences in medication use between the two centers.</p><p><strong>Conclusions: </strong>NOA provide adequate pain control for most patients after middle ear and mastoid otologic surgery. Opioid analgesics do not routinely need to be prescribed.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":"45 10","pages":"1143-1147"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605758","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":"Book Review: Cochlear Implants-Basic Textbook, Sandro Burdo, Arestampa Srl, Varese Italy, 2023.","authors":"Moises Arriaga","doi":"10.1097/MAO.0000000000004348","DOIUrl":"https://doi.org/10.1097/MAO.0000000000004348","url":null,"abstract":"","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":"45 10","pages":"1097"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751425","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":" ","pages":"1224"},"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}