Experience with Telemedicine in a Tertiary Academic Otologic Clinic During the COVID-19 Pandemic.

OBJECTIVE: To examine the utility of telemedicine in a tertiary otologic practice. STUDY DESIGN: Retrospective case series. SETTING: Tertiary neurotology clinic. PATIENTS: Consecutive adult patients presenting via video visit between January 2020 and January 2021. INTERVENTIONS: Televideo modality to conduct visits with patients seeking evaluation for new concerns, second opinions, or routine follow-up for established conditions. MAIN OUTCOME MEASURES: Success of the televideo visit defined by the televideo visit being sufficient for determining a definitive plan and not requiring deferment of recommendations for a subsequent in-person visit. RESULTS: A total of 102 televideo visits were performed among 100 unique patients. Of those, 92 (90.2%) visits were for second opinions or evaluation of new concerns, most commonly for vestibular schwannoma (n = 32, 31.4%), followed by sensorineural hearing loss (n = 20, 19.6%). Other visits were conducted for early postoperative follow-up and established general follow-up. In 91.2% of cases (n = 93), patients were successfully evaluated and provided recommendations from the initial video visit. All visits with patients having a diagnosis of meningioma (n = 7), and nearly all with vestibular Schwannoma (97%, n = 31) and sensorineural hearing loss (95%, n = 19) were successful. Of the 79 patients offered surgery as one potential treatment option, 31 patients underwent surgery at our institution by time of review. Patients with unsuccessful visits (n = 9, 8.8%) were advised to schedule additional in-person diagnostic imaging, vestibular testing, or cochlear implant candidacy evaluation to establish a more definitive care plan. CONCLUSION: Virtual televideo visits were successful for a high percentage of selected patients seen at a tertiary neurotology practice, particularly those seeking evaluation of vestibular schwannoma or sensorineural hearing loss.

Same-Day Patient Consultation and Cochlear Implantation: Patient Experiences and Barriers to Implementation.

OBJECTIVE: This study aimed to assess the efficacy of same-day cochlear implant (SDCI) evaluation and surgery in improving patient experience. PATIENTS: Adult CI candidates participated in this study. INTERVENTIONS: Education materials and communication with providers were offered via telephone, e-mail, and/or telemedicine. Patients then arrived for in-person consultation, imaging studies, and outpatient CI surgery in one visit and received a 3-month postoperative survey. MAIN OUTCOME MEASURES: Preoperative hearing, referral-to-surgery time, travel burden, and patient satisfaction were included as outcome measures. RESULTS: Of 35 patients who qualified, 14 were successfully contacted regarding the same-day program: 9 underwent CI, 1 enrolled but did not ultimately meet candidacy criteria, and 4 declined because of coronavirus and/or active medical conditions and did not pursue a CI. For the nine patients who underwent SDCI, mean age was 78 years, and mean preoperative consonant-nucleus-consonant score was 16% in the implanted ear. Mean referral-to-surgery time was 103 days and, after accounting for cancellations because of coronavirus, was 52 days. Mean travel distance to institution was 234 miles. Of the seven patients who completed the follow-up survey, none felt rushed for surgery, and mean program experience was rated 8.6 out of 10. Net promoter score was positive (+72), supporting high experience favorability among patients. Barriers to program expansion included patient recruitment and education, surgery scheduling, and the coronavirus pandemic. CONCLUSIONS: No patients declined the SDCI program to pursue traditional CI evaluation, and all patients were satisfied with their experience. The SDCI program is a feasible and successful model that overcomes barriers to implantation, including travel burden, and improves access to care.

Primary presentation of sarcoidosis with profound bilateral sensorineural hearing loss.

We present a case of a 7-year-old Afro-Caribbean girl presenting with rapidly progressive bilateral sensorineural hearing loss. She was found to have an elevated Angiotensin converting enzyme (ACE) and mediastinal lymphadenopathy containing non-caseating granulomas with multinucleate giant cells, in keeping with sarcoidosis. Cranial imaging demonstrated labyrinthitis. She underwent urgent bilateral cochlear implantation with rehabilitation of hearing sufficient to restart education within 1 month.

Radiological measurement of cochlear dimensions in cochlear hypoplasia and its effect on cochlear implant selection.

OBJECTIVE: To determine the effect of cochlear dimensions on cochlear implant selection in cochlear hypoplasia patients. METHODS: Temporal bone computed tomography images of 36 patients diagnosed with cochlear hypoplasia between 2010 and 2016 were retrospectively reviewed and compared with those of 40 controls without sensorineural hearing loss. RESULTS: Basal turn length and mid-modiolar height were significantly lower in the cochlear hypoplasia patients with subtypes I, II and III than in the control group (p < 0.001). Mid-scalar length was significantly shorter in subtype I-III patients as compared with the control group (p < 0.001). In addition, cochlear canal length (measured along the lateral wall) was significantly shorter in subtype I-IV patients than in the control group (subtypes I-III, p < 0.001; subtype IV, p = 0.002). CONCLUSION: Cochlear hypoplasia should be considered if basal turn length is less than 7.5 mm and mid-modiolar height is less than 3.42 mm. The cochlear implant should be selected according to cochlear hypoplasia subgroup. It is critically important to differentiate subtype II from incomplete partition type I and subtype III from a normal cochlea, to ensure the most appropriate implant electrode selection so as to optimise cochlear implantation outcomes.