Use of Google Trends to evaluate for environmental variations in search terms for benign paroxysmal positional vertigo.

OBJECTIVES: Climate variables are implied in the pathogenesis of certain otologic diseases, including benign paroxysmal positional vertigo (BPPV). Using internet search data obtained through Google Trends (GT), we explored the relationship between climate patterns and symptom search frequencies for BPPV. We hypothesized that increased latitude, as a proxy for decreased sunlight exposure, would lead to increase in BPPV symptom searches. METHODS: GT searches for symptoms related to BPPV were obtained for five U.S. cities of different latitudes via the Google Trends online interface. Comparisons were made using SPSS via ANOVA analysis. Figures were made using Microsoft Excel. RESULTS: Searches for BPPV-related symptoms increased with increasing latitude. BPPV-related symptoms did show seasonal variations, but not in predictable manners. CONCLUSIONS: GT may be a viable research tool when comparing geographical differences in searches, but may be less sensitive in detecting time dependent changes. We offer suggestions as to how big data tools may be altered for research purposes. LEVEL OF EVIDENCE: NA.

Bilateral Sensorineural Hearing Loss Associated With Nivolumab Therapy for Stage IV Malignant Melanoma.

OBJECTIVES: Present the case of a 67-year-old male with stage IV malignant melanoma who presented with uveitis and sensorineural hearing loss (SNHL) while on nivolumab and review the literature for likely etiologies. METHODS: A retrospective case review was conducted. The current literature was accessed to inquire about possible pathologic mechanisms and treatment options. RESULTS: A 67-year-old male with stage IV malignant melanoma was treated with nivolumab. During therapy, the patient presented with bilateral uveitis, vertigo, and bilateral moderate sloping to moderate-severe SNHL. After 4 cycles of nivolumab, restaging scans showed no evidence of disease. Nivolumab was discontinued. The patient was placed on a 3-week course of systemic high dose steroids and topical steroid eye drops. Both his uveitis and SNHL resolved after treatment. Nivolumab enhances the antitumor activity of T cells by inhibiting the programed death-1 receptor. While nivolumab has shown great promise in the treatment of many types of cancers, it has also been associated with many autoimmune side effects. We propose the etiology of this 67-year-old male's SNHL and uveitis are the result of an autoimmune process secondary to an augmented T cell response induced by nivolumab. CONCLUSION: While immunotherapeutic agents such as nivolumab have shown great promise in the treatment of cancer, one should maintain an awareness and caution of autoimmune side effects such as uveitis and SNHL.

Noninvasive Control of Bacterial Biofilms by Wireless Electrostimulation.

Bacteria are well-known to form biofilms on biomaterials and implanted medical devices and cause serious infections that are incurable by conventional antibiotics. Consequently, such infections can lead to explantation and, in severe cases, amputation or even death. To address this unmet challenge, we developed a new method for noninvasive treatment of device-associated biofilm infections. We demonstrate that antibiotic tolerant biofilm cells of Pseudomonas aeruginosa and Staphylococcus aureus can be effectively killed by electromagnetically induced direct current generated wirelessly using a remote power source, which was further enhanced through synergy with conventional antibiotics. Electrochemical analyses attributed the cidal effects to DC-generated reactive oxygen species. The treatment conditions were found safe to the epithelial and fibroblast cell lines. On the basis of these findings, a prototype device was engineered and demonstrated for effective killing of biofilm cells using both ex vivo and in vivo models. With the capability to kill bacteria without using a directly connected power source, this platform technology has possible applications in noninvasive treatment of biofilm infections associated with cochlear, orthopedic, and other implanted medical devices.

Trends in sociodemographic disparities of pediatric cochlear implantation over a 15-year period.

OBJECTIVE: Sociodemographic disparities of cochlear implantation in children have been reported. This study sought to determine if disparities in children receiving cochlear implants have narrowed, widened or remained constant. METHODS: Children 18 years or younger who underwent cochlear implantation from 1997 to 2012 were selected using the Kids' Inpatient Database. Demographic data included primary insurance payer, income quartile and race. The Cochran-Armitage test was used to determine if trends were significant. Prevalence rates of cochlear implantation by race were generated. A Poisson regression model was used to evaluate the rates of cochlear implantation within each racial group. RESULTS: The proportion of children receiving cochlear implants with private insurance decreased from 79.3% to 42.6% (p < .0001), whereas children with Medicaid increased from 17.4% to 35.2% (p < .0001). Proportion of implanted children from the lowest two income quartiles increased from 15.5% to 24.4% (p < .0001) and 10.3%-21.8% (p < .0035), respectively. Rates of implantation among children from income quartile four decreased from 50.9% to 35.3% (p < .0001). White children were implanted twice as often as Black or Hispanic children (p = .007 and p = .0012 respectively). Asian children were implanted more than twice as often as Black or Hispanic Children (p = .0154 and p = .0098 respectively). CONCLUSIONS: Income and insurance disparities have narrowed within the inpatient pediatric cochlear implantation cohort. Racial disparities still exist. White and Asian children are implanted at higher rates than Black or Hispanic children.

Thermal Variations of Operative Microscopes in Otology.

Objectives (1) Measure temperature variations achieved by common otomicroscopes. (2) Raise awareness about possible thermal injury during otologic procedures with the advent of newer, high-powered otomicroscopes. (3) Describe optical technology that aims to reduce the potential for thermal injury. Methods A variety of otomicroscopes, with different light sources (ranging from 100W halogen to 300W xenon), were studied. Temperatures were recorded from human auricular skin with a noncontact infrared thermometer at various microscope light intensities and with use of irrigation. Multiple recordings were done at 5-minute intervals, and a working distance of 225 mm was maintained. Results Maximum skin temperatures were found to plateau relatively quickly, with higher-wattage xenon light sources reaching greater temperatures. One-way analysis of variance revealed significant differences in temperatures with decreased light intensities. High-wattage xenon light sources reached significantly higher temperatures when compared with halogen models. Discussion There is substantial variation in maximal skin temperatures reached by otomicroscopes. Temperatures can be decreased to safe levels by reducing light intensity and with use of irrigation. The maximum temperature obtained in our study was 41.4°C. Second-degree skin burns have been described with prolonged exposures to temperatures >44°C. Implications for Practice Given the described potential for burns, surgeons performing procedures on the ear and temporal bone should take precautions to diminish temperature in the operative field.

The Utility of the MAUDE Database for Osseointegrated Auditory Implants.

OBJECTIVE: To determine the utility of Manufacturer and User Friendly Device Experience (MAUDE) database in studying osseointegrated auditory implant (OAI)-related complications. METHODS: The MAUDE database was searched for all reports involving OAIs (ie, Baha, Ponto, Sophono). Complications were classified into 1 or more of 6 categories-implant, abutment, processor, skin, surgery, and other. Subcategories were generated to prevent overgeneralization. Other variables recorded included date of report, number of complications per report, manufacturer, and time from complication to report. RESULTS: Over the study period, there were 269 complications listed from 238 reports divided into the following categories: implant related (n = 145), abutment related (n = 16), processor related (n = 13), skin and soft tissue related (n = 79), surgery related (n = 11), and other (n = 5). No demographic data were available. There were no discernible trends from the data, and when compared to published literature, MAUDE data appear to under- or misrepresent complications. CONCLUSION: The MAUDE database is limited in its design and given fairly disparate reporting quality may not be ideally suited for quantifying risks of OAIs. These findings suggest the necessity for a substantially improved central registry for otologic implants and highlight the need for further research to investigate the root causes of their associated complication.