Computed Tomography-Based Measurements of the Cochlear Duct: Implications for Cochlear Implant Pitch Tuning.

OBJECTIVES: To determine the sources of variability for cochlear duct length (CDL) measurements for the purposes of fine-tuning cochlear implants (CI) and to propose a set of standardized landmarks for computed tomography (CT) pitch mapping. DESIGN: This was a retrospective cohort study involving 21 CI users at a tertiary referral center. The intervention involved flat-panel CT image acquisition and secondary reconstructions of CIs in vivo. The main outcome measures were CDL measurements, CI electrode localization measurements, and frequency calculations. RESULTS: Direct CT-based measurements of CI and intracochlear landmarks are methodologically valid, with a percentage of error of 1.0% ± 0.9%. Round window (RW) position markers (anterior edge, center, or posterior edge) and bony canal wall localization markers (medial edge, duct center, or lateral edge) significantly impact CDL calculations [F(2, 78) = 9.9, p < 0.001 and F(2, 78) = 1806, p < 0.001, respectively]. These pitch distortions could be as large as 11 semitones. When using predefined anatomical landmarks, there was still a difference between researchers [F(2, 78) = 12.5; p < 0.001], but the average variability of electrode location was reduced to differences of 1.6 semitones (from 11 semitones. CONCLUSIONS: A lack of standardization regarding RW and bony canal wall landmarks results in great CDL measurement variability and distorted pitch map calculations. We propose using the posterior edge of the RW and lateral bony wall as standardized anatomical parameters for CDL calculations in CI users to improve pitch map calculations. More accurate and precise pitch maps may improve CI-associated pitch outcomes.

Worldwide differences in surgeon intraoperative practices for cochlear implantation.

OBJECTIVE: To characterize practice patterns of intraoperative imaging and/or functional confirmation of cochlear implant electrode location worldwide. METHODS: A cross-sectional survey of otolaryngologists performing cochlear implantation was conducted between March 1 and May 6, 2023. Participants were recruited worldwide using an international otologic society membership email list and at professional meetings. Ninety-seven of the 125 invited participants (78%) completed the survey. Participants were categorized by continent. RESULTS: North American surgeons use intraoperative X-rays more frequently than surgeons in Europe and Asia (p < 0.001). Otolaryngologists in Europe and Asia more frequently use no intraoperative imaging (p = 0.02). There is no regional difference between the intraoperative use of electrophysiologic instruments. European and Asian surgeons implant MED-EL devices (p = 0.012) more frequently than North American surgeons, who more frequently use Cochlear Corporation devices (p = 0.003). MED-EL use is related to less frequent intraoperative X-ray use (p = 0.02). Advanced Bionics use is related to more frequent intraoperative CT use (p = 0.03). No significant association existed between years of practice, number of cochlear implantation surgeries performed yearly, volume of pediatric CI practice, and use of intraoperative tools. CONCLUSION: Intraoperative practice for radiologic and functional verification of cochlear implant electrode positioning varies worldwide. Practice guidelines may help establish a standard of care for cochlear implantation.

A supervised machine learning model for identifying predictive factors for recommending head and neck cancer surgery.

BACKGROUND: New patient referrals are often processed by practice coordinators with little-to-no medical background. Treatment delays due to incorrect referral processing, however, have detrimental consequences. Identifying variables that are associated with a higher likelihood of surgical oncological resection may improve patient referral processing and expedite the time to treatment. The study objective is to develop a supervised machine learning (ML) platform that identifies relevant variables associated with head and neck surgical resection. METHODS: A retrospective cohort study was conducted on 64 222 patient datapoints from the SEER database. RESULTS: The random forest ML model correctly classified patients who were offered head and neck surgery with an 81% accuracy rate. The sensitivity and specificity rates were 86% and 71%. The positive and negative predictive values were 85% and 73%. CONCLUSIONS: ML modeling accurately predicts head and neck cancer surgery recommendations based on patient and cancer information from a large population-based dataset. ML adjuncts for referral processing may decrease the time to treatment for patients with cancer.

Music Perception in Bone-Anchored Hearing Implant Users.

OBJECTIVE: Music is a highly complex acoustic stimulus in both spectral and temporal contents. Accurate representation and delivery of high-fidelity information are essential for music perception. However, it is unclear how well bone-anchored hearing implants (BAHIs) transmit music. The study objective is to establish music perception performance baselines for BAHI users and normal hearing (NH) listeners and compare outcomes between the cohorts. METHODS: A case-controlled, cross-sectional study was conducted among 18 BAHI users and 11 NH controls. Music perception was assessed via performance on seven major musical element tasks: pitch discrimination, melodic contour identification, rhythmic clocking, basic tempo discrimination, timbre identification, polyphonic pitch detection, and harmonic chord discrimination. RESULTS: BAHI users performed comparably well on all music perception tasks with their device compared with the unilateral condition with their better-hearing ear. BAHI performance was not statistically significantly different from NH listeners' performance. BAHI users performed just as well, if not better than NH listeners when using their control contralateral ear; there was no significant difference between the two groups except for the rhythmic timing (BAHI non-implanted ear 69% [95% CI: 62%-75%], NH 56% [95% CI: 49%-63%], p = 0.02), and basic tempo tasks (BAHI non-implanted ear 80% [95% CI: 65%-95%]; NH 75% [95% CI: 68%-82%, p = 0.03]). CONCLUSIONS: This study represents the first comprehensive study of basic music perception performance in BAHI users. Our results demonstrate that BAHI users perform as well with their implanted ear as with their contralateral better-hearing ear and NH controls in the major elements of music perception. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:1381-1387, 2024.

Inner ear therapeutics and the war on hearing loss: systemic barriers to success.

Despite over 20 years of effort in academic research centers, start-up companies, and established pharmaceutical companies, there are no FDA-approved inner ear therapeutics for treatment of sensorineural hearing loss. There are a number of systemic barriers to creation of this new field of inner ear therapeutics. These include insufficient understanding of the particularity of different causes of hearing loss at the cellular and molecular level, lack of diagnostics of adequate sensitivity and specificity to discern these differences in vivo, a tendency for start-up biotech/pharma companies to prioritize competition over collaboration, and a drug development ecosystem that is really in the "pre-competitive" phase and a lack of infrastructure to develop, validate, gain regulatory approval, and successfully market an inner ear therapeutic. These issues will be discussed in this perspective article and a proposed remedy in the form of an inner ear therapeutics "moon shot" will be offered.

The Impact of Vocal Boost Manipulations on Musical Sound Quality for Cochlear Implant Users.

OBJECTIVE: To evaluate the impact of vocal boost manipulations on cochlear implant (CI) musical sound quality appraisals. METHODS: An anonymous, online study was distributed to 33 CI users. Participants listened to auditory tokens and assessed the musical quality of acoustic stimuli with vocal boosting and attenuation using a validated sound quality rating scale. Four versions of real-world musical stimuli were created: a version with +9 dB vocal boost, a version with -9 dB vocal attenuation, a composite stimulus containing a 1,000 Hz low-pass filter and white noise ("anchor"), and an unaltered version ("hidden reference"). Subjects listened to all four versions and provided ratings based on a 100-point scale that reflected the perceived sound quality difference of the music clip relative to the reference excerpt. RESULTS: Vocal boost increased musical sound quality ratings relative to the reference clip (11.7; 95% CI, 1.62-21.8, p = 0.016) and vocal attenuation decreased musical sound quality ratings relative to the reference clip (28.5; 95% CI, 18.64-38.44, p < 0.001). When comparing the non-musical training group and musical training group, there was a significant difference in musical sound quality rating scores for the vocal boost condition (21.2; 95% CI: 1.76-40.7, p = 0.028). CONCLUSIONS: CI-mediated musical sound quality appraisals are impacted by vocal boost and attenuation. Musically trained CI users to report greater musical sound quality enhancement with a vocal boost with respect to CI users with no musical training background. Implementation of front-end vocal boost manipulations in music may improve sound quality and music appreciation among CI users. LEVEL OF EVIDENCE: 2 (Individual cohort study) Laryngoscope, 133:938-947, 2023.

Lyrical Trends: An Analysis of Music's (Mis) Use of Vertigo.

BACKGROUND: Popular culture and music have long served as windows into the common attitudes, trends, and issues of the time. The representation of vertigo in music has not been previously explored. The objective of this study was to analyze the portrayal of vertigo in music through content and sentiment analysis of song lyrics. METHODS: A large song lyric database was queried to identify English language song titles containing the word "vertigo." A sentiment and content analysis of the lyrics was performed to delineate the most frequently used words, the accuracy of vertigo depictions, and emotional valence (i.e., the ratio of positive to negative references to vertigo). RESULTS: Between 1969 and 2022, there were a total of 54 songs specifically titled "Vertigo." Most songs (73%) portrayed vertigo negatively, and the prevalence of negative sentiment within music increased with each decade. The three most common words being used in association with vertigo within music were "feel" (n = 97), "love" (n = 66), and "falling" (n = 57). In early decades, songs using the word vertigo misrepresented the condition and associated perceptions relative to common medical understanding. In more recent decades, vertigo was used in a way more representative of medical interpretations. CONCLUSION: The depiction of vertigo in songs has changed over time, and more recently, usage has reflected Bárány Society definitions. Interestingly, the negative sentiment has also increased with time. This work provides a lyrical analysis of vertigo that may improve physician understanding of the cultural usage of this challenging symptom.

The Impact of Musical Rehabilitation on Complex Sound Perception in Cochlear Implant Users: A Systematic Review.

OBJECTIVE: Musical rehabilitation has been used in clinical and nonclinical contexts to improve postimplantation auditory processing in implanted individuals. This systematic review aimed to evaluate the efficacy of music rehabilitation in controlled experimental and quasi-experimental studies on cochlear implant (CI) user speech and music perception. DATABASES REVIEWED: PubMed/MEDLINE, EMBASE, Web of Science, PsycARTICLES, and PsycINFO databases through July 2022. METHODS: Controlled experimental trials and prospective studies were included if they compared pretest and posttest data and excluded hearing aid-only users. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were then used to extract data from 11 included studies with a total of 206 pediatric and adult participants. Interventions included group music therapy, melodic contour identification training, auditory-motor instruction, or structured digital music training. Studies used heterogeneous outcome measures evaluating speech and music perception. Risk of bias was assessed using the National Heart, Lung, and Blood Institute Quality Assessment Tool. RESULTS: A total of 735 studies were screened, and 11 met the inclusion criteria. Six trials reported both speech and music outcomes, whereas five reported only music perception outcomes after the intervention relative to control. For music perception outcomes, significant findings included improvements in melodic contour identification (five studies, p < 0.05), timbre recognition (three studies, p < 0.05), and song appraisal (three studies, p < 0.05) in their respective trials. For speech prosody outcomes, only vocal emotion identification demonstrated significant improvements (two studies, p < 0.05). CONCLUSION: Music rehabilitation improves performance on multiple measures of music perception, as well as tone-based characteristics of speech (i.e., emotional prosody). This suggests that rehabilitation may facilitate improvements in the discrimination of spectrally complex signals.

Hearing and sociality: the implications of hearing loss on social life.

Hearing is essential to the formation of social relationships and is the principal afferent of social life. Yet hearing loss, which is one of the most prevalent forms of sensory disability worldwide and is critical for social development, has received little attention from the social interventionalist perspective. The purpose of this mini-review is to describe the basic neurobiological principles of hearing and to explore the reciprocal relationships between social support, hearing loss, and its psychosocial comorbidities. We also discuss the role of social enrichment in sensorineural recovery and identify open questions within the fields of hearing physiology and social networks.

Electrical Determinants of Tinnitus Extinction in a Cochlear Implant Patient.

HYPOTHESIS: Electrical tinnitus suppression by cochlear implants requires stimulation of a subset of neural elements in the cochlea. BACKGROUND: Tinnitus is the phantom perception of sound in the ears and is a known correlate of hearing loss. Cochlear implants restore hearing and are known to lessen or extinguish tinnitus. The amount of electrical charge required and the number and location of electrodes required to extinguish tinnitus with a cochlear implant are factors that remain poorly understood. METHODS: In a subject with single-sided deafness, with tinnitus in the deaf ear, we enabled single electrodes and groups of electrodes along the cochlea and increased the current until tinnitus was diminished or extinguished. We recorded the subject's perception of these changes using loudness scaling of both the electrical stimuli and the tinnitus. RESULTS: Tinnitus could be extinguished with individual electrodes and more effectively extinguished by activating a greater number of electrodes. Tinnitus suppression and loudness growth of the electrical stimuli were imperfectly correlated. CONCLUSION: Tinnitus suppression in this cochlear implant patient was achieved by electrically stimulating multiple distinct portions of the cochlea, and the cochlear neural substrate for tinnitus suppression may be distinct from that for auditory perception.

Is the clinical head impulse test helpful in cochlear implantation candidacy evaluation?

Objective: Vestibular dysfunction is a known risk of cochlear implantation (CI). However, the utility of the physical exam to screen CI candidates for vestibular dysfunction is not well-studied. The objective of this study is to evaluate the preoperative role of the clinical head impulse test (cHIT) in subjects undergoing CI surgery evaluation. Study Design Setting and Subjects: We conducted a retrospective review of 64 adult CI candidacy cases between 2017 and 2020 at a tertiary health care center. Methods: All patients underwent audiometric testing and evaluation by the senior author. Patients with an abnormal catch-up saccade contralateral to their worse hearing ear during cHIT were referred for formal vestibular testing. Outcomes included clinical and formal vestibular results, operated ear with regard to audiometric and vestibular results, and postoperative vertigo. Results: Among all CI candidates, 44% (n = 28) reported preoperative disequilibrium symptoms. Overall, 62% (n = 40) of the cHITs were normal, 33% (n = 21) were abnormal, and 5% (n = 3) were inconclusive. There was one patient who presented with a false positive cHIT. Among the patients who endorsed disequilibrium, 43% had a positive preoperative cHIT. Fourteen percent of the subjects (n = 9) without disequilibrium had an abnormal cHIT. In this cohort, bilateral vestibular impairment (71%) was more common than unilateral vestibular impairment (29%). In 3% of the cases (n = 2), surgical management was revisited or altered due to cHIT findings. Conclusion: There is a high prevalence of vestibular hypofunction in the CI candidate population. Self-reported assessments of vestibular function are often not congruent with cHIT results. Clinicians should consider incorporating cHITs as part of the preoperative physical exam to potentially avoid bilateral vestibular dysfunction in a minority of patients.

Formal Closure of Endoscopic Endonasal Skull Base Defects With a "Bow Tie" Tri-Layer Graft.

OBJECTIVE: Risk factors for a postoperative cerebrospinal fluid leak (CSF) after surgery include an intraoperative high flow of CSF, elevated body mass index, defect size, and defect site. In our prior series, a high postoperative CSF leak rate for tumors of the central skull base (planum, sella, and clivus) appeared to be due to graft migration. We changed our closure technique from a single layer of collagen +/- fat graft to a novel graft, termed a "Bow tie" (a tri-layer fat graft with two pieces of collagen matrix), and report our results in this study. METHODS: Retrospective temporal epoch study of a single otolaryngologist's experience of closing skull base defects in our skull base center from 2005 to 2017. RESULTS: One hundred and forty-nine patients met inclusion criteria in two time periods, pre- and post-introduction of the Bow tie technique. In epoch I, from 2005 to 2013, 79 patients had reconstruction with a single layer of dural graft (25 had additional free fat graft). In epoch II, from 2014 to 2017, 70 patients had reconstruction with the Bow tie. RESULTS: CSF leak rates were 8.7% overall: 15.2% in epoch I and 1.4% in epoch II (p = 0.01). After controlling the procedure, defects with a size greater than 2 cm had a 5.7 greater likelihood of failure. Epoch II had a lower incidence of major complications. CONCLUSION: Using a single surgeon's experience, the multilayer Bow tie has a significant reduction in postoperative CSF leak and associated major complications for defects of the central skull base. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:1568-1575, 2023.

Differences in Hearing, Balance, and Quality-of-Life Outcomes in Petroclival Versus Nonpetroclival Posterior Fossa Meningiomas.

OBJECTIVE: To compare hearing, tinnitus, balance, and quality-of-life treatment outcomes of petroclival meningioma and nonpetroclival cerebellopontine angle meningioma cohorts. STUDY DESIGN: A retrospective cohort study of 60 patients with posterior fossa meningiomas, 25 petroclival and 35 nonpetroclival, who were treated at a single tertiary care center between 2000 and 2020. INTERVENTION: A survey battery that included the Hearing Effort of the Tumor Ear, Speech and Spatial Qualities of Hearing, Tinnitus Functional Index, Dizziness Handicap Inventory (DHI), and Short Form Health Survey. Petroclival and nonpetroclival cohorts were matched for tumor size and demographic features. MAIN OUTCOME MEASURES: Differences between groups in hearing, balance outcomes, and quality of life and patient factors that influence posttreatment quality of life. RESULTS: Petroclival meningioma patients reported poorer audiovestibular outcomes with a higher rate of deafness in the tumor ear (36.0% versus 8.6%, p = 0.032) and lower functional hearing by the Hearing Effort of the Tumor Ear, Speech and Spatial Qualities of Hearing (76.6 [6.1] versus 82.0 [4.4], p < 0.001). Current dizziness rate was higher (48.0% versus 23.5%, p = 0.05), with more severe dizziness by DHI (18.4 [4.8] versus 5.7 [2.2], p < 0.001). Both cohorts had similar high quality of life and low tinnitus severity indices. Quality-of-life Short Form Health Survey predictors were tumor size ( p = 0.012) and DHI ( p = 0.005) in multivariable analysis. CONCLUSIONS: Hearing and dizziness treatment outcomes of petroclival meningioma are poorer relative to other posterior fossa meningiomas. Despite audiovestibular outcome distinctions, the overall posttreatment quality of life was high for both petroclival and nonpetroclival meningioma.

Anterior Inferior Cerebellar Artery Aneurysm Mimicking a Vestibular Schwannoma.

Anterior inferior cerebellar artery (AICA) aneurysms are rare pathologies that may present with hearing loss, facial paralysis, vertigo, and tinnitus. Otologic symptoms at the time of presentation may prompt physicians to order an MRI, which can lead to the misdiagnosis of AICA aneurysms as vestibular schwannomas. We discuss the case of a 27-year-old female who presented with sudden-onset vertigo and right-sided hearing loss. She was found to have a right homogeneously enhancing internal auditory canal (IAC) mass abutting the vestibular nerve on post-gadolinium T1 MRI two hours after the presentation, which was initially diagnosed as a vestibular schwannoma. Serial T1 MRI highlighted the evolution of blood products within this mass by presenting as bright at two days and dark at two months after presentation. Profound ipsilateral sensorineural hearing loss and absent vestibulocochlear function were confirmed on audiometry and vestibular testing, respectively. The diagnostic cerebral angiogram was complicated by an iatrogenic right mid-cervical vertebral artery dissection, and the patient ultimately underwent successful embolization two months after presentation with the resolution of all presenting symptoms except right-sided hearing loss. Early recognition and treatment of an AICA aneurysm may help prevent associated vascular complications, and they should be considered as part of the differential diagnosis for IAC lesions despite their rarity.

Effect of Frequency Response Manipulations on Musical Sound Quality for Cochlear Implant Users.

Cochlear implant (CI) users commonly report degraded musical sound quality. To improve CI-mediated music perception and enjoyment, we must understand factors that affect sound quality. In the present study, we utilize frequency response manipulation (FRM), a process that adjusts the energies of frequency bands within an audio signal, to determine its impact on CI-user sound quality assessments of musical stimuli. Thirty-three adult CI users completed an online study and listened to FRM-altered clips derived from the top songs in Billboard magazine. Participants assessed sound quality using the MUltiple Stimulus with Hidden Reference and Anchor for CI users (CI-MUSHRA) rating scale. FRM affected sound quality ratings (SQR). Specifically, increasing the gain for low and mid-range frequencies led to higher quality ratings than reducing them. In contrast, manipulating the gain for high frequencies (those above 2 kHz) had no impact. Participants with musical training were more sensitive to FRM than non-musically trained participants and demonstrated preference for gain increases over reductions. These findings suggest that, even among CI users, past musical training provides listeners with subtleties in musical appraisal, even though their hearing is now mediated electrically and bears little resemblance to their musical experience prior to implantation. Increased gain below 2 kHz may lead to higher sound quality than for equivalent reductions, perhaps because it offers greater access to lyrics in songs or because it provides more salient beat sensations.

Treated large posterior fossa vestibular schwannoma and meningioma: Hearing outcome and willingness-to-accept brain implant for unilateral deafness.

Background/Objective: To compare functional hearing and tinnitus outcomes in treated large (~ 3 cm) vestibular schwannoma (VS) and posterior fossa meningioma cohorts, and construct willingness-to-accept profiles for an experimental brain implant to treat unilateral hearing loss. Methods: A two-way MANOVA model with two independent variables (tumor type; time from treatment) and three dependent variables (hearing effort of tumor ear; abbreviated Speech, Spatial, and Qualities of Hearing scale (SSQ12); Tinnitus Functional Index (TFI)) was used to analyze data from VS (N = 32) and meningioma (N = 50) patients who were treated at a tertiary care center between 2010 and 2020. A query to probe acceptance of experimental treatment for hearing loss relative to expected benefit was used to construct willingness-to-accept profiles. Results: Tumor type was statistically significant on the combined dependent variables analysis (F[3, 76] = 19.172, p < .0005, Wilks' Λ = 0.569). Meningioma showed better outcome for hearing effort (F[1, 76] = 14.632, p < .0005) and SSQ12 (F[1, 76] = 16.164, p < .0005), but not for TFI (F[1, 76] = 1.247, p = .268) on univariate two-way ANOVA analyses. Superior hearing effort and SSQ12 indices in the short-term (< 2 years) persisted in the long-term (> 2 years) (p ≤ .017). At the 60% speech understanding level, 77% of respondents would accept an experimental brain implant. Conclusion: Hearing outcome is better for posterior fossa meningioma compared to VS. Most patients with hearing loss in the tumor ear would consider a brain implant if the benefit level would be comparable to a cochlear implant. Level of Evidence: 2.

Posterior petrous face meningiomas presenting with Ménière's-like syndrome: a case series and review of the literature.

OBJECTIVE: Ménière's disease is an inner ear disorder classically characterized by fluctuating hearing loss, tinnitus, and aural fullness accompanied by episodic vertigo. While the pathogenesis of Ménière's remains under debate, histopathological analyses implicate endolymphatic sac dysfunction with inner ear fluid homeostatic dysregulation. Little is known about whether external impingement of the endolymphatic sac by tumors may present with Ménière's-like symptoms. The authors present a case series of 7 patients with posterior fossa meningiomas that involved the endolymphatic sac and new onset of Ménière's-like symptoms and review the literature on this rare clinical entity. METHODS: A retrospective review of patients undergoing resection of a posterior petrous meningioma was performed at the authors' institution. Inclusion criteria were age older than 18 years; patients presenting with Ménière's-like symptoms, including episodic vertigo, aural fullness, tinnitus, and/or hearing loss; and tumor location overlying the endolymphatic sac. RESULTS: There were 7 cases of posterior petrous face meningiomas involving the vestibular aperture presenting with Ménière's-like symptoms. Imaging and intraoperative examination confirmed no cranial nerve VIII compression or labyrinthine artery involvement accounting for audiovestibular symptoms. Of the 7 patients in the series, 6 experienced significant improvement or resolution of their vertigo, and all 7 had improvement or resolution of their tinnitus after resection. Of the 5 patients who had preoperative hearing loss, 2 experienced improvement or resolution of their ipsilateral preoperative hearing deficit, whereas the other 3 had unchanged hearing loss compared to preoperative evaluation. CONCLUSIONS: Petrous face meningiomas overlying the endolymphatic sac can present with a Ménière's syndrome. Early recognition and microsurgical excision of these tumors is critical for resolution of most symptoms and stabilization of hearing loss.

Interference with reelin signaling in the lateral entorhinal cortex impairs spatial memory.

Entorhinal neurons receive extensive intracortical projections, and form the primary input to the hippocampus via the perforant pathway. The glutamatergic cells of origin for the perforant pathway are distinguished by their expression of reelin, a glycoprotein involved in learning and synaptic plasticity. The functional significance of reelin signaling within the entorhinal cortex, however, remains unexplored. To determine whether interrupting entorhinal reelin signaling might have consequences for learning and memory, we administered recombinant receptor-associated protein (RAP) into the lateral entorhinal cortex (LEC) of young Long-Evans rats. RAP prevents reelin from binding to its receptors, and we verified the knockdown of reelin signaling by quantifying the phosphorylation state of reelin's intracellular signaling target, disabled-1 (DAB1). Effective knockdown of reelin signaling was associated with impaired performance in the hippocampus-dependent version of the water maze. Moreover, inhibition of reelin signaling induced a localized loss of synaptic marker expression in the LEC. These observations support a role for entorhinal reelin signaling in spatial learning, and suggest that an intact reelin signaling pathway is essential for synaptic integrity in the adult entorhinal cortex.

Preserved Cochlear Implant Function After Multiple Electroconvulsive Therapy Treatments.

This case report presents the successful use of multiple treatments of electroconvulsive therapy (ECT) in a patient with a cochlear implant (CI). A 60-year-old man with a left-sided CI and bipolar disorder presented with severe depression. A total of 9 separate sessions of unilateral ECT was administered to the contralateral side of the existing CI. We collected subjective, clinical, and audiological assessment of the patient and the CI prior, during, and after ECT therapy. The patient tolerated ECT well and there were no complications. Unilateral ECT was performed contralateral to the CI without any harm to the patient or implant. Laryngoscope, 131:E1695-E1698, 2021.

Nonvestibular Dizziness.

Dizziness is a common chief complaint with an extensive differential diagnosis that ranges from peripheral, central, to nonvestibular conditions. An understanding of nonvestibular conditions will aid accurate diagnosis and initiation of appropriate management. Thus, the objective of this article is to present an overview of nonvestibular etiologies that may plague a dizzy patient and the recommended treatment options.