Otology & Neurotology最新文献

{"title":"Randomized Controlled Trial Comparing Outcomes for Adult Cochlear Implant Recipients Using a Lateral Wall or Perimodiolar Electrode Array.","authors":"Robert J S Briggs, Timothy McLean, Alexandra Rousset, Sylvia Tari, Stephen J O'Leary, Richard C Dowell, Jaime Leigh, Robert Cowan","doi":"10.1097/MAO.0000000000004518","DOIUrl":"10.1097/MAO.0000000000004518","url":null,"abstract":"<p><strong>Objective: </strong>The primary aim of this study was to compare outcomes of adult cochlear implant recipients receiving either perimodiolar or lateral wall electrode arrays.</p><p><strong>Study design: </strong>A prospective randomized controlled study was conducted to investigate final electrode array position, speech perception, and vestibular symptoms.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Patients: </strong>One hundred forty-four adults were assessed for the study. Inclusion criteria were bilateral postlingual severe to profound sensorineural hearing loss, with 500-Hz threshold in the implant ear of 75 dB HL or greater.</p><p><strong>Interventions: </strong>Subjects were randomized to receive either perimodiolar or lateral wall electrode arrays.</p><p><strong>Main outcome measures: </strong>Postoperative electrode array position was assessed by cone-beam computed tomography. Speech perception was measured preoperatively in best-aided conditions, and 3 and 12 months postoperatively. Vestibular symptoms were assessed using two self-reported questionnaires and/or clinician reports.</p><p><strong>Results: </strong>Postoperative speech perception results for 124 implants in 123 adults showed significant improvement from preoperative scores and from 3 to 12 months postoperatively. Multiple regression analysis indicated no significant effect of electrode array position for any speech perception results at 3 and 12 months postoperatively. Auditory alone, monosyllabic word, and phoneme scores at 12 months were 48.4 and 71.4% for lateral wall electrode arrays and 49.8% and 72.0% for perimodiolar electrode arrays, respectively. No relationships between angle (depth) of electrode array insertion and speech perception outcomes were detected. There was no significant difference in incidence of vestibular symptoms between the groups.</p><p><strong>Conclusions: </strong>Correct scala tympani placement of either the perimodiolar or lateral wall electrode arrays used in this study provides excellent speech perception outcomes, with no significant difference demonstrated between groups.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"802-808"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009354","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":"Electrode Placement Factors and Their Impact on Spectral Resolution in Pediatric and Adult Cochlear Implant Users.","authors":"Andrea DeFreese, Katelyn Berg, Jack Noble, Linsey Sunderhaus, Mackenzie Lighterink, Linjie Shi, Stephen Camarata, René Gifford","doi":"10.1097/MAO.0000000000004605","DOIUrl":"10.1097/MAO.0000000000004605","url":null,"abstract":"<p><strong>Objective: </strong>To examine how electrode placement factors-such as mean modiolar distance, scalar location, and angular insertion depth-correlate with postoperative spectral resolution in experienced pediatric and adult CI users.</p><p><strong>Study design: </strong>Retrospective case review.</p><p><strong>Setting: </strong>Cochlear implant (CI) program at a tertiary medical center.</p><p><strong>Patients: </strong>47 pediatric CIs (across 47 pediatric patients) and 84 adult CIs (across 74 adult patients).</p><p><strong>Main outcome measures: </strong>Correlations were used to identify the strengths of the associations between electrode placement and CI-alone spectral resolution measured using a spectral modulation detection task with two modulation rates (0.5 and 1.0 cyc/oct). Linear mixed-effects models with stepwise removal were then used to identify the best predictors of spectral resolution thresholds.</p><p><strong>Results: </strong>For adult CI users, electrode placement was not significantly correlated with spectral resolution. For pediatric CI users, larger mean modiolar distance was significantly correlated with better spectral modulation detection at 0.5 cyc/oct.</p><p><strong>Conclusions: </strong>Electrode placement differentially affected spectral resolution for pediatric and adult CI users. Mean modiolar distance was most associated with spectral resolution, but only for children with CIs, for whom research has yielded mixed results regarding the relationship between spectral resolution and speech recognition.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789660","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":"Effect of Simvastatin on Irradiated Primary Vestibular Schwannoma Cells.","authors":"Matthew Wiefels, Olena Bracho, Mikhail Marasigan, Fred Telischi, Michael E Ivan, Scott Welford, Cristina Fernandez-Valle, Christine T Dinh","doi":"10.1097/MAO.0000000000004469","DOIUrl":"10.1097/MAO.0000000000004469","url":null,"abstract":"<p><strong>Hypothesis: </strong>Simvastatin enhances radiation cytotoxicity of primary vestibular schwannoma (VS) and NF2 -mutant human Schwann (HS01) cells.</p><p><strong>Background: </strong>Approximately 10% of VS progress after radiotherapy. Simvastatin is a lipid-lowering medication that promotes apoptosis, inhibits cell proliferation, and enhances radiation response in various cancers. In this study, we determine the effect of simvastatin on the viability of irradiated and nonirradiated primary VS and HS01 cells.</p><p><strong>Methods: </strong>Primary VS (N = 5) and HS01 cells were pretreated with simvastatin (0 or 1 μM) prior to irradiation (0 or 18 Gy). A cell-based assay was used to measure cell viability. Immunocytochemistry was performed for γH2AX (DNA damage marker) and RAD51 (DNA repair protein). Statistical analysis was conducted with parametric and nonparametric one-way analysis of variance tests.</p><p><strong>Results: </strong>Radiation initiated double-stranded breaks in DNA in both VS and HS01 cells. Two VS were radiation-resistant and the remaining three VS were radiation-sensitive. In response to radiation, radiation-resistant VS cells activated RAD51-mediated DNA repair. Simvastatin blocked RAD51 activation in radiation-resistant VS, increased levels of lethal DNA damage, and enhanced radiation-induced cell death. Simvastatin also enhanced radiation-induced cell death in radiation-sensitive VS cells through RAD51-independent mechanisms. However, simvastatin was not effective as a radiosensitizer in HS01 cells.</p><p><strong>Conclusion: </strong>Simvastatin improved radiation response of radiation-resistant primary VS cells by inhibiting RAD51-related DNA repair. Although through RAD51-independent mechanisms, simvastatin also improved radiation response in radiation-sensitive VS cells. Additional preclinical investigations are warranted to evaluate the mechanisms of action and efficacy of statin drugs as radiosensitizers for VS patients.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"842-847"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586535","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":"Botulinum Toxin Type A Injection Near the Stylomastoid Foramen: A Safe and Effective Therapeutic Modality for Tinnitus in Patients With Hemifacial Spasm.","authors":"Lingxi Zhu, Lizhen Pan, Xiaolong Zhang, Yougui Pan, Lingjing Jin, Fei Teng","doi":"10.1097/MAO.0000000000004542","DOIUrl":"10.1097/MAO.0000000000004542","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess the efficacy and safety of botulinum toxin type A (BTX-A) injection near the stylomastoid foramen for tinnitus in patients with hemifacial spasm (HFS).</p><p><strong>Study design: </strong>Retrospective study from 2011 to 2024.</p><p><strong>Setting: </strong>Tongji Hospital affiliated to Tongji University in Shanghai, China.</p><p><strong>Patients: </strong>Patients with HFS combined with tinnitus.</p><p><strong>Intervention: </strong>BTX-A injection near the stylomastoid foramen.</p><p><strong>Main outcome measures: </strong>The efficacy of BTX-A was assessed based on subjective improvement reported by patients after 1 month. Adverse events were also documented.</p><p><strong>Results: </strong>A total of 869 HFS patients were analyzed, including 122 with tinnitus. Among the 122 patients with tinnitus, 110 received BTX-A injections near the stylomastoid foramen, and complete follow-up data were available for 105 of them. The 3.75 U group showed a higher improvement rate (69.2 ± 14.3%) compared with the 2.5 U group (46.3 ± 25.0%, p < 0.05). The majority received a 5 U dose, with a significantly higher improvement rate (76.9 ± 15.1%) compared with the 2.5 U group ( p < 0.01). All reported adverse events were related to routine injection sites and were mild, requiring no special treatment. No adverse events related to BTX-A injection near the stylomastoid foramen were reported.</p><p><strong>Conclusion: </strong>In patients with HFS-associated tinnitus, additional injection of 5 U BTX-A near the stylomastoid foramen, targeting the stapedius muscle, proved to be an effective therapy with minimal adverse effects.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"855-861"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040878","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":"Intraoperative Auditory Brainstem Response (ABR) Measurement During Vibroplasty in Congenital Aural Malformation.","authors":"Bjoern Spahn, Kristen Rak, David P Herrmann, Mario Cebulla, Jonas Engert, Anja Kurz, Johannes Voelker, Stephan Hackenberg, Franz-Tassilo Müller-Graff","doi":"10.1097/MAO.0000000000004529","DOIUrl":"10.1097/MAO.0000000000004529","url":null,"abstract":"<p><strong>Objective: </strong>To determine the optimal coupling efficiency by auditory brainstem response (ABR) in patients with aural atresia undergoing vibroplasty to ensure optimal sound transmission and minimize the need for revision surgery.</p><p><strong>Study design: </strong>Retrospective data analysis.</p><p><strong>Setting: </strong>Tertiary referral center with an established active middle ear implant program.</p><p><strong>Patients: </strong>14 ears of 13 patients with congenital aural malformation receiving active middle ear implant surgery.</p><p><strong>Interventions: </strong>Therapeutic surgical treatment for hearing rehabilitation in human subjects.</p><p><strong>Main outcome measures: </strong>Intraoperative coupling efficiency as determined by ABR and postoperative audiologic outcomes (sound-field thresholds, speech perception) after active middle ear implantation in patients with congenital aural malformations.</p><p><strong>Results: </strong>Intraoperative ABR was performed in all patients and revealed thresholds that were not significantly different from preoperative PTA4 bone-conduction thresholds ( p = 0.67). Pearson correlation coefficient r was 0.57. Speech perception improved by 65.0% at 65 dB SPL and by 60.9% at 80 dB SPL. PTA4 Vibrogram thresholds showed stable long-term coupling outcomes (mean, 28.7 ± 8.3 dB HL eq ).</p><p><strong>Conclusion: </strong>ABR measurement during vibroplasty is applicable in patients with congenital aural malformation. There are often fewer options for coupling the vibratory element of the VSB (floating mass transducer [FMT]) to the ossicular chain or directly to the cochlea in this patients' collective. Confirmation of a stable and valid coupling efficacy during FMT positioning can be of great benefit in malformed middle ears for efficient hearing restoration and to reduce the risk of revision surgery.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"821-828"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226144","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":"Influence of CT Radiation Dose and Field-of-View on Automatic Morphometry for Cochlear Implant Planning.","authors":"Henner Huflage, Tobias Wech, Kristen Rak, Magnus Schindehuette, Jonas Engert, Stephan Hackenberg, Mirko Pham, Thorsten Alexander Bley, Jan-Peter Grunz, Bjoern Spahn","doi":"10.1097/MAO.0000000000004534","DOIUrl":"10.1097/MAO.0000000000004534","url":null,"abstract":"<p><strong>Introduction: </strong>In cochlear implantation (CI), precise preoperative cochlear duct length (CDL) and angular insertion depth (AID) measurements are pivotal for individualized electrode carrier selection, since recipients benefit from sufficient cochlear coverage of the electrode carrier, enabling electric stimulation of all crucial frequency bands. Since the quality of temporal bone CT largely depends on acquisition and reconstruction settings and is limited by the technical capabilities of the CT scanner, this study aims to assess how radiation dose and reconstruction field-of-view (FOV) affect automatic cochlear morphometry and electrode contact determination in conventional multislice CT.</p><p><strong>Methods: </strong>Twenty fresh-frozen human petrous bone specimens were examined at three radiation dose levels (40, 20, and 10 mGy) using a multislice CT scanner. Each dataset was reconstructed with three different FOV settings (250, 125, and 50 mm). Preoperative CDL and AID measurements were performed with dedicated otological planning software. Maxed-out dose images (250 mGy) served as standard of reference for comparing the morphometric results.</p><p><strong>Results: </strong>Regardless of the selected combination of dose level and FOV, significant CDL or AID measurement differences were neither ascertained among the individual groups, nor in comparison to the reference scans (all p ≥ 0.05). Likewise, the simulation of all stimulable frequency bandwidths showed no dependency on radiation dose or FOV settings (all p ≥ 0.05).</p><p><strong>Conclusion: </strong>The assessment of cochlear morphometry with conventional multislice CT imaging before CI surgery allowed a radiation dose reduction up to 75% without compromising the accuracy of software-based cochlear analysis. Notably, automatic CDL and AID measurements for surgical planning did not benefit from a smaller reconstruction FOV.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"e250-e256"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024545","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":"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}