Otology & Neurotology最新文献

{"title":"Influence of Cochlear Microanatomy on Hearing Preservation in Cochlear Implant Recipients.","authors":"Elena Quinonez Del Cid, Ashley Micuda, Margaret T Dillon, Saangyoung E Lee, Hanif M Ladak, Sumit Agrawal, Kevin D Brown","doi":"10.1097/MAO.0000000000005042","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005042","url":null,"abstract":"<p><strong>Objective: </strong>Identify cochlear microanatomic variables that influence hearing preservation in adult cochlear implant (CI) recipients.</p><p><strong>Study design: </strong>Retrospective review.</p><p><strong>Setting: </strong>Tertiary academic referral center.</p><p><strong>Patients: </strong>Forty-two CI recipients with preoperative unaided thresholds ≤45 dB HL at 250 Hz.</p><p><strong>Interventions: </strong>Cochlear implantation with a 24, 28, or 31.5-mm straight electrode array.</p><p><strong>Main outcome measures: </strong>Preoperative and postoperative imaging were used to extract scala tympani (ST) volume, cochlear duct length (CDL), and cross-sectional measurements (height, width, area, and diameter), as well as angular insertion depth (AID) and cross-sectional measures at the most apical electrode (EA). Shift in low-frequency pure tone average (LFPTA; 125, 250, and 500 Hz) was computed at activation and at 6 months post activation.</p><p><strong>Results: </strong>A linear mixed-effects model analyzed the effects of cochlear microanatomy (ie, ST volume, CDL, and AID), cross-sectional measurements at EA (height, width, area, and diameter), as well as interval, age at surgery, and biological sex on the shift in LFPTA. Significant effects included biological sex (P = 0.01) and ST volume (P = 0.005). Age demonstrated a trend toward significance (P = 0.052). Interval (P = 0.26), CDL (P = 0.80), AID (P = 0.40), ST height (P = 0.71), ST width (P = 0.65), ST diameter (P = 0.56), and ST cross-sectional area (P = 0.14) did not significantly influence shift in LFPTA.</p><p><strong>Conclusions: </strong>ST volume and biological sex are significantly predictive of hearing preservation for adult CI recipients. Hearing preservation may be more affected by overall ST volume than by interactions of the electrode with the local environment. Indirect mechanisms of trauma, such as hydraulic pressure as the electrode is inserted, may predominate in damage to intracochlear structures. Future studies are needed to validate these findings with measurement of intraoperative fluid pressure transients in relation to ST volume during array insertion.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920554","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":"Diagnostic Value of Tubomanometry in Patulous Eustachian Tube.","authors":"Heidi Oehlandt, Saku T Sinkkonen","doi":"10.1097/MAO.0000000000005060","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005060","url":null,"abstract":"<p><strong>Background: </strong>A patulous Eustachian tube (PET) may be challenging to diagnose in cases where objective tympanic membrane movement is absent during physical examination.</p><p><strong>Objective: </strong>The primary aim was to assess the diagnostic usefulness of tubomanometry (TMM) in patients with PET. A secondary aim was to evaluate nasopharyngeal pressure curves as indicators of nasopharyngeal muscle function, given the proposed contribution of muscular dystrophy in PET pathophysiology.</p><p><strong>Methods: </strong>A retrospective study was conducted at a tertiary referral center on adult patients diagnosed with PET who had undergone TMM between August 2016 and May 2024. Ear-symptomatic patients without Eustachian tube dysfunction or sinonasal disease served as healthy controls. The PET group included 27 ears from 20 patients, and the control group included 91 ears from 49 subjects.</p><p><strong>Results: </strong>The nasopharyngeal pressure threshold at which middle ear pressure started to increase was markedly lower in the PET than the control group [7.0 mbar (3.0 to 23) vs. 21 mbar (10 to 25), respectively, P=0.014]. A threshold of ≤4.5 mbar showed 90% specificity for PET. No differences were observed in nasopharyngeal pressure curves between the groups, suggesting similar nasopharyngeal muscle dynamics.</p><p><strong>Conclusions: </strong>TMM showed diagnostic value for PET. No differences in nasopharyngeal muscle dynamics were observed.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920552","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":"Labyrinthectomy and Cochlear Implantation in Patients With Meniere Disease: A Systematic Review.","authors":"Dimitrios Paouris, Konstantinos Papantoniou, Christos Tsilivigkos","doi":"10.1097/MAO.0000000000005066","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005066","url":null,"abstract":"<p><strong>Objective: </strong>Ménière disease (MD) may progress to disabling vertigo and severe hearing loss despite conservative management. In patients with nonserviceable hearing, labyrinthectomy can provide effective vertigo control, while cochlear implantation (CI) offers the potential for auditory rehabilitation. This systematic review aimed to evaluate audiological, vestibular, tinnitus-related, and postoperative outcomes following labyrinthectomy combined with CI in patients with MD.</p><p><strong>Databases reviewed: </strong>MEDLINE/PubMed, Scopus, and Embase.</p><p><strong>Methods: </strong>A systematic review with qualitative synthesis was conducted in accordance with the PRISMA guidelines. Primary outcomes included postoperative speech audiometry and pure-tone average (PTA). Secondary outcomes included vertigo and dizziness control, Dizziness Handicap Inventory (DHI), Tinnitus Handicap Inventory (THI), and postoperative complications.</p><p><strong>Results: </strong>Eight studies comprising 123 implanted ears met the inclusion criteria, including 3 cohort studies and 5 case series. Simultaneous labyrinthectomy and CI were reported in 7 studies, whereas 4 studies described sequential CI following prior labyrinthectomy. Audiological outcome reporting was heterogeneous and included PTA, Consonant-Nucleus-Consonant (CNC) or monosyllabic word recognition scores, AzBio sentence recognition, speech discrimination scores, and Bamford-Kowal-Bench (BKB)/City University of New York (CUNY) sentence tests. Most studies demonstrated measurable postoperative auditory benefit. DHI outcomes were reported in 3 studies and generally indicated low to mild residual dizziness-related handicap. THI outcomes, reported in 3 studies, suggested a low to mild residual tinnitus burden. Surgical complications were reported in 2 studies, while postoperative imbalance or recurrent vertigo was described in selected cohorts.</p><p><strong>Conclusion: </strong>The combination of labyrinthectomy and CI could provide effective vertigo control while enabling meaningful auditory rehabilitation in carefully selected patients with advanced or treatment-refractory MD.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920577","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 Rehabilitation for Vestibular Migraine: A Systematic Review and Meta-Analysis.","authors":"Lindsay Booth, Richard Mageto, Golpira E Assadzadeh, Justin Lui","doi":"10.1097/MAO.0000000000005063","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005063","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of vestibular rehabilitation (VR) on patient-reported outcome measures in adults with vestibular migraine (VM).</p><p><strong>Databases reviewed: </strong>Medline, Embase, and Scopus were reviewed from database inception to May 2025. Additional citation searches were performed.</p><p><strong>Methods: </strong>The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines were used. Primary studies assessing VR in adults with VM diagnosed using ICHD-3 or equivalent criteria were included. The primary outcome was the change in the Dizziness Handicap Inventory (DHI) and the Activity-Specific Balance Confidence Scale (ABC). Mixed-effects modeling was used for the meta-analysis.</p><p><strong>Results: </strong>Seven studies comprising 272 participants were included. All studies demonstrated improvement in DHI following VR, with individual study treatment effects ranging from -10.57 to -44.7 points reduction. Meta-analysis showed a clinically significant pooled DHI reduction of -23.97 (95% CI: -33.31 to -14.62; P<0.0001). Heterogeneity was high (I2=96%), potentially due to patient selection, duration of disease, duration of VR, adjunctive therapies, timing of outcomes assessment, and VR protocol differences. Funnel plot asymmetry suggested small-study effect. Improvements in the ABC were reported but did not meet clinically significant thresholds.</p><p><strong>Conclusion: </strong>On the basis of the included studies, VR is associated with clinically meaningful reductions in DHI among VM patients; however, effects on balance may not be clinically significant. Heterogeneity, limited data, as well as moderate and low quality of evidence for the available outcomes, highlight the importance of future large prospective studies with standardized VR protocols and outcomes.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912556","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":"Otoscopic and Audiometric Clues for Suspecting OMAAV in Elderly Patients With Refractory Otitis Media With Effusion.","authors":"Yutaro Oi, Koji Takii, Shinsuke Ito, Miki Junicho, Nao Koide, Akira Kimura, Arata Horii, Yuka Morita","doi":"10.1097/MAO.0000000000005059","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005059","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether tympanic membrane findings and audiometric parameters can distinguish otitis media with ANCA-associated vasculitis (OMAAV) from refractory otitis media with effusion (OME).</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Patients: </strong>Twenty-one patients with OME-type OMAAV limited to otologic symptoms and 9 with refractory OME requiring differentiation from OMAAV.</p><p><strong>Main outcome measures: </strong>Tympanic membrane findings were assessed using the scoring system of OMAAV tympanic membrane (SCOT). Pure-tone audiometry was performed using 3-frequency pure-tone averages and frequency-specific thresholds. Receiver operating characteristic (ROC) and logistic regression analyses evaluated diagnostic performance.</p><p><strong>Results: </strong>The total SCOT score was significantly higher in the OME-type OMAAV group than in the OME group (median, 2 vs. 0; P<0.01), particularly for vascular dilatation and posterior wall swelling. Although the 3-frequency pure-tone averages did not differ significantly, frequency-specific analysis revealed significantly elevated air conduction thresholds at 2000 and 8000 Hz and bone conduction thresholds at 250 and 500 Hz in the OMAAV group. The combination of the SCOT total score and the bone conduction threshold at 500 Hz showed promising diagnostic performance (area under the curve, 0.952), with a sensitivity of 100% and a specificity of 88.9%.</p><p><strong>Conclusion: </strong>The combined assessment of tympanic membrane findings using the SCOT score and the bone conduction threshold at 500 Hz may provide useful otologic clues that prompt further evaluation for OMAAV, including ANCA testing, in elderly patients with refractory OME.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912500","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 Changes in Cochlear Implant Datalogging and Quality of Life Measures.","authors":"Kara C Schvartz-Leyzac, Isabelle J Chau, Christian M Shannon, Theodore R McRackan, Kelly C Harris","doi":"10.1097/MAO.0000000000005055","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005055","url":null,"abstract":"<p><strong>Objective: </strong>To examine changes in datalogging statistics in adult cochlear implant (CI) users during their first post-CI year and evaluate their association with cochlear implant quality of life-35 (CIQOL-35) scores.</p><p><strong>Study design: </strong>Retrospective longitudinal cohort study.</p><p><strong>Setting: </strong>Tertiary medical center.</p><p><strong>Patients: </strong>104 adult CI users with bilateral hearing loss.</p><p><strong>Main outcome measures: </strong>Hours of device use per day (h/d), percentage of use in various listening environments (quiet, noise, speech, music), and pre-/post-CI CIQOL-35 Profile scores were recorded at 1-, 3-, 6-, and 12-months postactivation. Data were assessed using linear mixed-effects models.</p><p><strong>Results: </strong>Daily hours of CI use increased significantly from 1-month ( 11.2±3.3 h/d) to 3-months ( 11.8±3.2 h/d) postactivation, then plateaued from 3-months to 12-months ( 11.8±3.6 h/d) postactivation. Between 1 and 12 months, the percentage of time spent in Quiet increased (42% vs. 46%, P<0.001), while time spent in speech (31% vs. 28%, P=0.007) and Noise (20% vs. 18%, P=0.025) declined. Device use (h/d) was positively associated with CIQOL-35 scores (P<0.01). Increased percentage of time in noise was associated with poorer communication, emotional, environment, and social CIQOL-35 scores (P<0.01). Increased Music percentage was associated with higher Entertainment scores (P<0.05).</p><p><strong>Conclusions: </strong>Patients increasingly use their CI during the first 3 months postactivation and spend less time listening to speech and noise over the first 12 months. Associations between listening environments and certain CIQOL domains demonstrate that listening patterns and functional abilities might influence each other. Determining causality in future studies may enable more individualized counseling on device use for an improved early CI experience.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912426","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":"Policy Expansion and Cochlear Implant Utilization: A National Medicare Analysis (2012-2024).","authors":"Akshay Warrier, Daniel Bu, Ryan Bartholomew, Daniel J Lee","doi":"10.1097/MAO.0000000000005053","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005053","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate trends in cochlear implant (CI) utilization, provider participation, billing distribution, and inflation-adjusted Medicare part B professional payment following the 2019 FDA and 2022 Medicare eligibility expansions.</p><p><strong>Study design: </strong>Retrospective interrupted time-series analysis using national Medicare fee-for-service claims.</p><p><strong>Setting: </strong>US Medicare part B fee-for-service claims.</p><p><strong>Patients: </strong>Medicare fee-for-service beneficiaries receiving CI services identified by CPT 69930 from 2012 to 2024; provider and state identifiers were used for distributional analyses.</p><p><strong>Interventions: </strong>None; policy exposure analysis only.</p><p><strong>Main outcome measures: </strong>Inflation-adjusted Medicare part B professional payment per service, total part B professional payments, procedure volume, provider counts, mean provider volume, billing-state service distribution, reimbursement ratios, and descriptive comparator trends for hypoglossal nerve stimulation (HGNS).</p><p><strong>Results: </strong>Inflation-adjusted Medicare part B professional payment per CI service did not increase significantly after 2019; segmented regression showed a nonsignificant trend toward slope decline (-$172.2/year; P=0.08), while reimbursement ratios remained largely stable. Procedure volume increased to 5918 services in 2024, with total Medicare payments rising to approximately $21 to 22 million without a proportional per service increase. Billing-state mapping demonstrated broader post-2019 service distribution, with more states recording CI services, while mean provider volume remained relatively stable despite growth in the number of unique providers. HGNS, presented descriptively, showed contemporaneous increases in reimbursement and utilization.</p><p><strong>Conclusions: </strong>Regulatory and coverage expansions were associated with broader billing distribution and increased utilization without sustained growth in inflation-adjusted payment per service. These findings suggest that eligibility expansion alone may not address the broader institutional, geographic, and reimbursement factors that shape scalable CI delivery.</p><p><strong>Level of evidence: </strong>Retrospective observational claims analysis; not classifiable within traditional clinical evidence hierarchies.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Tool to Create Digital Twin Temporal Bone Models for Virtual and 3D-Printing: Proof-of-Concept and Evaluation.","authors":"Peter Trier Mikkelsen, Adam Omari, Andreas Frithioff, Thomas Winther Frederiksen, Martin Reznitsky, Mads Sølvsten Sørensen, Steven Arild Wuyts Andersen","doi":"10.1097/MAO.0000000000005062","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005062","url":null,"abstract":"<p><strong>Objective: </strong>To develop a haptic software tool for creating digital twin models for virtual or physical interaction based on cone beam (CB) computed tomography (CT) temporal bone imaging and to evaluate the quality of resulting 3D-printed models.</p><p><strong>Background: </strong>Temporal bone surgery involves drilling near critical structures with anatomic variation. Patient-specific models for rehearsal and surgical planning might be clinically valuable but require processing of clinical imaging data into accurate \"digital twins\". This processing remains a major obstacle to widespread clinical adoption.</p><p><strong>Methods: </strong>This technical proof-of-concept study utilized clinical CBCT of a cadaver head. The imaging data were processed using the VES-tool, a custom-developed visualization engine that uses haptic interaction for guided processing with tools for segmentation of anatomical structures, hole patching, and cleaning. Resulting digital twins were 3D-printed for mastoidectomy by 2 surgeons. The models were evaluated with the Mowry questionnaire by primary surgeons and, using video-based assessment, by 5 additional experts.</p><p><strong>Results: </strong>The VES-tool was iteratively developed to guide processing into digital twin models with features supporting interactive segmentation. The resulting 3D-printed models were rated at 48 and 50 points by the 2 primary surgeons, respectively, exceeding the established 40-point cutoff for educational benefit. Video-based panelists rated models lower (average 31.8 points), although 3 of 5 scored the models above the modified 30-point cutoff for video-based rating.</p><p><strong>Conclusions: </strong>VES-tool effectively converts clinical imaging into high-quality digital twins rated as highly useful for surgical practice. This pipeline facilitates patient-specific surgical rehearsal and the creation of diverse anatomic libraries for otosurgical training.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892275","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":"Pathophysiology of Acquired Cholesteatoma Associated With Habitual Sniffing: An Analysis Based on Mastoid Cell Development and Contralateral Ear Status.","authors":"Yuta Shimizu, Yutaka Yamamoto, Takara Nakazawa, Motoki Hirabayashi, Sho Kurihara, Masahiro Takahashi, Kazuhisa Yamamoto, Hiromi Kojima","doi":"10.1097/MAO.0000000000005064","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005064","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association of habitual sniffing with mastoid cell development and contralateral ear abnormalities in acquired pars flaccida cholesteatoma.</p><p><strong>Study design: </strong>Retrospective comparative study.</p><p><strong>Setting: </strong>Two tertiary referral hospitals.</p><p><strong>Patients: </strong>A total of 124 adults (133 ears) underwent primary surgery for acquired pars flaccida cholesteatoma between 2012 and 2026.</p><p><strong>Interventions: </strong>Primary cholesteatoma surgery.</p><p><strong>Main outcome measures: </strong>Mastoid cell development score classified according to the Japan Otological Society criteria and abnormal contralateral ear findings.</p><p><strong>Results: </strong>Habitual sniffing was identified in 67 of 133 ears (50.4%). The sniffing group had higher MC scores than the non-sniffing group, indicating better mastoid cell development (1.48±0.68 vs. 1.17±0.67; effect size r=0.222; P=0.010). Ordinal logistic regression showed that habitual sniffing was independently associated with better mastoid cell development [odds ratio (OR)=2.35; 95% confidence interval (CI), 1.15-4.87; P=0.020]. Among 110 ears with evaluable contralateral endoscopic findings, contralateral abnormalities were more frequent in the sniffing group than in the nonsniffing group (71.4% vs. 35.2%; OR=4.536; P=0.0002). Binary logistic regression showed that habitual sniffing was independently associated with abnormal contralateral ear findings (OR=4.57; 95% CI, 1.94-11.34; P=0.0007).</p><p><strong>Conclusions: </strong>Habitual sniffing was associated with better mastoid cell development and frequent contralateral ear abnormalities in acquired pars flaccida cholesteatoma, suggesting a distinct pathophysiologic subgroup related to dynamic negative pressure loading.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892328","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":"Time-Adjusted Risk of Bone-Anchored Hearing Device Explantation Following Early and Recurrent Wound Complications.","authors":"Tyler J Gathman, Julio Roque, Lulia Kana, Anagha Srivatsa, Izza Ali, Masanari Kato, Hyunseo Jung, Rachel Goffeney, Sandra Porps, Seilesh Babu","doi":"10.1097/MAO.0000000000005046","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005046","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to examine the time-adjusted risk of explantation of bone-anchored hearing devices following wound complications after primary implantation.</p><p><strong>Study design: </strong>Retrospective cohort study at a tertiary care neurotology center.</p><p><strong>Patients: </strong>Adults 18 years or older with primary bone-anchored hearing implants from 2003 to 2025, with available audiogram and medical history. Excluded were patients with incomplete data, prior implantations, or immediate postoperative loss to follow-up.</p><p><strong>Outcomes: </strong>The primary outcome was the incidence of device explantation following early (<60 days) or recurrent (>3 episodes) wound complications. The Cox proportional hazards framework with time-dependent modeling was applied for analysis.</p><p><strong>Results: </strong>A total of 1090 surgical ears (666 female, 61.1%; 8 bilateral) underwent primary device implantation, with 127 (11.7%) undergoing explantation; median follow-up was 4.40 years (IQR: 1.66-7.98 y). Patients who underwent explantation were more likely to experience early (HR: 2.30; 95% CI: 1.53-3.45; P<0.001) and frequent (HR: 5.29; 95% CI: 3.62-7.72; P<0.001) wound complications. The cumulative incidence of device explantation at 10 years among patients with frequent wound complications was 60.6% (95% CI: 45.5%-71.5%), compared with 15.6% (95% CI: 11.9%-19.9%) among patients without such complications. After adjustment, frequent wound complications remained significantly associated with the device removal (aHR: 4.60; 95% CI: 2.82-7.51; P<0.001).</p><p><strong>Conclusions: </strong>Recurrent wound complications are associated with nearly a fivefold increase in hazard for device explantation, supporting the need for risk stratification, monitoring, and earlier intervention.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888072","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}