Simultaneous versus Sequential Cochlear Implantation in Adults: Quantitative and Qualitative Outcomes.

OBJECTIVE: To compare speech recognition and quality of life outcomes between bilateral sequentially and simultaneously implanted adult cochlear implant (CI) recipients who initially qualify for a CI in both ears. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. METHODS: Retrospective chart review identified adults who underwent bilateral CI, either simultaneously or sequentially, at a high-volume center between 2012 and 2022. Sequentially implanted patients were only included if the second ear qualified for CI in quiet (defined as best-aided AzBio quiet testing <60%), at time of initial CI evaluation. RESULTS: Of 112 bilateral CI patients who qualified in both ears at initial evaluation, 95 underwent sequential implantation and 17 simultaneous. Age, duration, and etiology of hearing loss, and CI usage were similar between groups. Preoperatively, the sequential group had lower pure-tone average (PTA) in the 1st ear than the simultaneously implanted group (P = <.001) but, no difference in 2nd ear PTA (P = .657). Preoperative speech recognition scores were significantly higher for the sequential group; however, this was not true for postoperative scores. There was no difference in the proportion of patients showing significant CI-only or bilateral performance improvement between the groups. Both groups demonstrated similar benefit in quality of life measures. CONCLUSION: Our findings indicate both simultaneous and sequential cochlear implantation are effective in improving hearing performance and quality of life. Thus, bilateral versus simultaneous implantation should be discussed and tailored for each individual patient.

Predicting Early Cochlear Implant Performance: Can Cognitive Testing Help?

Introduction: There is significant variability in speech recognition outcomes in adults who receive cochlear implants (CIs). Little is known regarding cognitive influences on very early CI performance, during which significant neural plasticity occurs. Methods: Prospective study of 15 postlingually deafened adult CI candidates tested preoperatively with a battery of cognitive assessments. The mini-mental state exam (MMSE), forward digit span, Stroop measure of inhibition-concentration, and test of word reading efficiency were utilized to assess cognition. consonant-nucleus-consonant words, AZBio sentences in quiet, and AZBio sentences in noise (+10 dB SNR) were utilized to assess speech recognition at 1- and 3-months of CI use. Results: Performance in all speech measures at 1-month was moderately correlated with preoperative MMSE, but these correlations were not strongly correlated after correcting for multiple comparisons. There were large correlations of forward digit span with 1-month AzBio quiet (P ≤ 0.001, rho = 0.762) and AzBio noise (P ≤ 0.001, rho = 0.860), both of which were strong after correction. At 3 months, forward digit span was strongly predictive of AzBio noise (P ≤ 0.001, rho = 0.786), which was strongly correlated after correction. Changes in speech recognition scores were not correlated with preoperative cognitive test scores. Conclusions: Working memory capacity significantly predicted early CI sentence recognition performance in our small cohort, while other cognitive functions assessed did not. These results differ from prior studies predicting longer-term outcomes. Findings and further studies may lead to better preoperative counseling and help identify patients who require closer evaluation to ensure optimal CI performance.

Cochlear Implant Qualification in Noise Versus Quiet: Do Patients Demonstrate Similar Postoperative Benefits?

OBJECTIVE: To assess patient factors, audiometric performance, and patient-reported outcomes in cochlear implant (CI) patients who would not have qualified with in-quiet testing alone. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. METHODS: Adult CI recipients implanted between 2012 and 2022 were identified. Patients with preoperative AzBio Quiet > 60% in the implanted ear, requiring multitalker babble to qualify, comprised the in-noise qualifying (NQ) group. NQ postoperative performance was compared with the in-quiet qualifying (QQ) group using CNC, AzBio Quiet, and AzBio +5 dB signal-to-noise ratio. Speech, Spatial and Qualities of Hearing Scale (SSQ), Cochlear Implant Quality of Life scale (CIQOL-10), and daily device usage were also compared between the groups. RESULTS: The QQ group (n = 771) and NQ group (n = 67) were similar in age and hearing loss duration. NQ had higher average preoperative and postoperative speech recognition scores. A larger proportion of QQ saw significant improvement in CNC and AzBio Quiet scores in the CI-only listening condition (eg, CI-only AzBio Quiet: 88% QQ vs 51% NQ, P < .001). Improvement in CI-only AzBio +5 dB and in all open set testing in the best-aided binaural listening condition was similar between groups (eg, Binaural AzBio Quiet 73% QQ vs 59% NQ, P = .345). Postoperative SSQ ratings, CIQOL scores, and device usage were also equivalent between both groups. CONCLUSION: Patients who require in-noise testing to meet CI candidacy demonstrate similar improvements in best-aided speech perception and patient-reported outcomes as in-QQ, supporting the use of in-noise testing to determine CI qualification for borderline CI candidates.

Comparison of Speech Recognition and Hearing Preservation Outcomes Between the Mid-Scala and Lateral Wall Electrode Arrays.

OBJECTIVE: To assess speech recognition and hearing preservation (HP) outcomes with the Advanced Bionics Mid-Scala and SlimJ electrodes. STUDY DESIGN: Retrospective cohort. SETTING: Tertiary referral center. PATIENTS: A total of 237 adult patients implanted between 2013 and 2020 (Mid-Scala, n = 136; SlimJ, n = 101). MAIN OUTCOME MEASURES: Consonant-nucleus-consonant (CNC) and AzBio (Arizona Biomedical) scores at 6 and 12 months; postoperative HP, defined as low-frequency pure-tone average ≤ 80 dB HL; scalar position. RESULTS: Mean CNC scores did not significantly differ between Mid-Scala and SlimJ recipients at 6 (45.8% versus 46.0%, p = 0.962) and 12 (51.9% versus 48.8%, p = 0.363) months. Similarly, mean AzBio in quiet scores were equivalent for both groups at 6 (55.1% versus 59.2%, p = 0.334) and 12 (60.6% versus 62.3%, p = 0.684) months. HP rates were significantly higher with the SlimJ (48.4%) than the Mid-Scala (30.8%; p = 0.033). Scalar translocations were 34.8 and 16.1% for the Mid-Scala and SlimJ groups, respectively ( p = 0.019). Ears with postoperative HP had significantly fewer scalar translocations (16.7% versus 37.2%, p = 0.048), and postoperative HP was associated with higher AzBio in noise scores at the most recent follow-up interval (38.7% versus 25.1%, p = 0.042). CNC, AzBio in quiet and noise, low-frequency pure-tone average shifts, and PTA at 6 and 12 months were not significantly different between patients with scala tympani insertions of the SlimJ versus the Mid-Scala ( p > 0.05). CONCLUSIONS: Compared with the Mid-Scala, the lateral wall electrode has superior HP rates and fewer scalar translocations, whereas speech recognition scores are equivalent between both electrode arrays. These findings can help providers with electrode selection and patient counseling.

Single Institution Experience With Sinonasal Glomangiopericytoma: A Case Series.

Introduction: Sinonasal glomangiopericytoma (GPC) is an uncommon neoplasm, accounting for less than 0.5% of all sinonasal tumors. It is characterized as having low malignant potential, with complete surgical excision representing optimal treatment. Presenting symptoms are typically due to mass effect and vascularity of this tumor, often including unilateral nasal obstruction or epistaxis. Accounts of this tumor in the literature remain sparse. Methods: Single institution retrospective review. Results: Six cases of sinonasal GPC were identified from a review of the electronic medical records spanning from 2009 through 2021. Age at diagnosis ranged from 48 to 67 years, with a gender distribution of 5 males and 1 female. Most subjects presented with unilateral sinonasal obstruction of variable duration. Each underwent endoscopic resection of the mass with negative margins, and no adjuvant therapy was pursued. Pathologic specimens demonstrated a vascular patterned tumor with spindled cells surrounding vessels and were positive for smooth muscle actin and negative for cytokeratin. Active post-surgical follow-up ranged from 11 months to 10 years. All patients were without endoscopic evidence of recurrence, and 2 had post-operative imaging which showed no evidence of disease. Conclusions: This review of 6 cases of sinonasal GPC represents the largest known series of this rare pathology in the literature to date. Based on our experience, and in agreement with the available literature, this disease is reliably managed with complete surgical excision. Adjuvant therapy can be avoided in otherwise uncomplicated cases. Although rare, GPC should be considered in the differential diagnosis of all vascular sinonasal tumors.

Slow-Growing Pediatric Neck Mass.

An 11-year-old girl with no significant medical history was referred to the pediatric otolaryngology department for a painless, left-sided neck mass that had been slowly enlarging for 8 months. What is your diagnosis?

Gender Prevalence and Trends in Otology and Neurotology Publications.

OBJECTIVE: To assess otology and neurotology authorship by gender, subject, and country of origin from 2000 to 2019. STUDY DESIGN: Retrospective review of otology and neurotology publications in 2000, 2005, 2010, 2015, and 2019 from 10 prominent journals within otolaryngology. MAIN OUTCOME MEASURES: Demographics for first through third and final authors, including gender, degree, coauthorship, as well as number of authors, subject matter, and region of origin for each publication. RESULTS: A total of 4,411 neurotology articles published in 2000, 2005, 2010, 2015, and 2019 were analyzed. During the study period, the proportion of female authors increased from 22.3% in 2000 to 33.9% in 2019 (p < 0.0001). However, authorship position analysis demonstrated no increase in final female authorship (22.5% in 2019, from 19.4% in 2000, p = 0.112). Geographic region analysis demonstrated a similar overall global trend toward an increase in female authors. When considering author gender by position, North America, the Middle East, and Africa failed to demonstrate significant increasing trends for female final authors. Female final authors were also significantly less likely to have medical degrees than final male authors, (37.4% versus 78.6%, respectfully, p =  < 0.0001). Finally, women published more often within the subjects of pediatrics and audiology (46.5% and 37.3% of final authors, p < 0.0001). CONCLUSIONS: Female authorship in otology and neurotology has increased globally. With the predominant number of articles originating from North America, and articles originating from North America failing to demonstrate an increase in female final authorship, overall, final female authorship did not change during the study period. PROFESSIONAL PRACTICE GAP AND EDUCATIONAL NEED: There is no comprehensive study exploring gender distribution within only the specialty of otology and neurotology. While it is known that more women are becoming otolaryngologists, it is unknown if this increase is reflected in otology and neurotology publications, domestically and internationally. LEARNING OBJECTIVE: To understand if gender biases and/or differences exist within otology and neurotology publications. DESIRED RESULT: Identify trends in otology and neurotology publications to address particular barriers to female publication within the field.

Lost to follow up: Exploring patients who initially fail cochlear implant evaluation.

Objective: To explore variables predicting which individuals return for repeat cochlear implantation (CI) evaluation after initially not qualifying. Study design: Retrospective chart review. Setting: University CI program. Patients: Adults undergoing CI evaluation between 2007-2017 who did not meet implantation criteria. Main outcome measures: Demographics, pure tone audiogram (PTA), speech perception testing, and evaluation hearing aids for patients who did and did not pursue subsequent evaluations after failing to qualify. Results: In total, 135 patients failed to qualify for CI, with 37 returning for additional evaluations. 72.9% of returning patients qualified. Repeat evaluations performed >6 months after initial evaluation were no more likely to result in qualification (P = 0.647). PTA and speech perception testing were no different for patients who did and did not return. With multivariate analysis, quantifying hearing impairment by speech perception scores, no variable predicted return. However, quantifying hearing impairment with WRS, evaluation with personal devices (P = 0.012) and recommendations to return within 6 months (P = 0.001) predicted increased rate of return. Conclusions: The majority who initially do not, will qualify with repeat CI testing. Patients given scheduled time for re-evaluation, and those properly fitted with personal devices return at higher rates. We recommend patients initially not qualifing for CI, return for repeat evaluation within a year.

Quantifying differences in femoral head and neck asphericity in CAM type femoroacetabular impingement and hip dysplasia versus controls using radial 3DCT imaging and volumetric segmentation.

OBJECTIVE: Femoroacetabular impingement (FAI) and hip dysplasia are the most common causes of groin pain originating from the hip joint. To date, there is controversy over cut-off values for the evaluation of abnormal femoral head-neck anatomy with significant overlap between the normal and abnormal hips. Our aim was to perform three-dimensional CT analysis of femoral head and bump anatomy to quantify common hip pathologies (FAI and hip dysplasia) vs controls. METHODS: Consecutive patients who underwent three-dimensional CT imaging for hip dysplasia or CAM type FAI were compared to asymptomatic controls. α angles on radial CT and 3D volumetric femoral head and bump segmentations were performed by two readers. Inter- and intrapatient comparisons were performed including interreader and receiver operating characteristic analyses. RESULTS: 25 FAI patients, 16 hip dysplasia patients and 38 controls were included. FAI and dysplasia patients exhibited higher α angles and higher bump-head volume ratios than the controls (p < 0.05). Larger bump volumes were found among FAI than dysplasia patients and contralateral hips of FAI patients were also different than the controls. α angle at 2 o'clock and bump to head ratio showed the highest area under the curve for patients vs controls. The interreader reliability was better for volumetric segmentation (intraclass correlation coefficient = 0.35-0.84) as compared to the α angles (intraclass correlation coefficient = 0.11-0.44). CONCLUSION: Patients with FAI and dysplasia exhibit different femoral head anatomy than asymptomatic controls. Volumetric segmentation of femoral head and bump is more reliable and better demonstrates the bilateral femoral head anatomy differences in hip patients vs controls. ADVANCES IN KNOWLEDGE: Utilizing information from 3D volumetric bump assessment in patients with FAI and dysplasia, the physicians may be able to more objectively and reliably evaluate the altered anatomy for better pre-surgical evaluation.

Regional muscle changes in adult dysfunctional hip conditions of femoroacetabular impingement and hip dysplasia.

OBJECTIVE: To analyze regional muscle CT density and bulk in femoroacetabular impingement (FAI) and hip dysplasia (HD) versus controls. MATERIALS AND METHODS: Patients who obtained perioperative CT imaging for FAI and HD before surgery were retrospectively studied. Asymptomatic controls included for comparison. Two readers independently evaluated regional hip muscle [iliopsoas (IP), rectus femoris (RF), gluteus minimus (Gm), and medius (GM)] density, muscle area, and muscle circumference. Inter-observer reliability calculated using intra-class correlation coefficient (ICC). RESULTS: A consecutive series of 25 FAI patients, 16 HD patients, and 38 controls were recruited in the study. FAI patients had significantly greater Gm and GM circumferences as well as greater RF and IP areas on the normal side compared to the asymptomatic control group (p values 0.004, 0.032, 0.033, and 0.028, respectively). In addition, Gm and RF circumferences and RF area were significantly larger (p values 0.029, 0.036, and 0.014, respectively) in FAI patients on the affected side compared to the control group. HD patients had significantly smaller Gm and GM circumferences on the affected side than normal side measurements in FAI group (p values 0.043 and 0.003, respectively). Normal side GM circumference was also smaller in HD patients than normal side FAI hips (p value 0.02). There was no significant difference between the measurements on normal and abnormal sides in each disease group. No significant difference was found between measurements of HD compared to controls (p > 0.05). No muscle density differences were seen among different groups. There was moderate to excellent inter-reader reliability for all measurements except Gm muscle density. CONCLUSIONS: Muscle analysis was able to quantify differences among patients with FAI, HD, and asymptomatic controls. These changes could indicate either a muscle imbalance contributing to the pathology or disuse atrophy, which may have implications for specific muscle-strengthening therapies and rehabilitation procedures in such patients.

Identifying Disadvantaged Groups for Cochlear Implantation: Demographics from a Large Cochlear Implant Program.

OBJECTIVE: To identify demographic predictors of patients undergoing cochlear implantation evaluation and surgery. METHODS: Consecutive adult patients between 2009 and 2018 who underwent cochlear implantation evaluation at a university cochlear implantation program were retrospectively identified to determine (1) cochlear implantation qualification rate and (2) pursuit of surgery rate with respect to age, gender, race, primary spoken language, marital status, insurance type, and distance to the cochlear implantation center. RESULTS: A total of 823 cochlear implantation evaluations were analyzed. Overall, 76.3% of patients qualified for cochlear implantation and 61.5% of these patients pursued surgery. Age was the only independent predictor for cochlear implantation qualification, such that, for each year younger, the odds of qualifying for cochlear implantation increased by 2.5% (OR 0.98; 95% CI: 0.96-0.99). Age, race, marital status, and insurance type were each independent predictors of the decision to pursue surgery. The odds of pursuing surgery increased by 2.8% for each year younger (OR 1.03; 95% CI: 1.01-1.05). Compared to White patients, non-Whites were half as likely to pursue surgery (OR 0.47; 95% CI: 0.25-0.88). Single (OR 0.49; 95% CI: 0.26-0.94) and widowed patients (OR 0.46; 95% CI: 0.23-0.95) were about half as likely to pursue surgery as compared to married patients. Patients with military insurance were 13 times more likely to pursue surgery as compared to patients with Medicare (OR 13.0; 95% CI: 1.67-101.4). CONCLUSION: Younger age is an independent predictor for a higher cochlear implantation qualification rate, suggesting the possibility for delayed candidacy referral. Rate of surgical pursuit in qualified cochlear implantation candidates is lower for racial minorities, single and widowed patients, and older patients.