Association Between Hearing Difficulty and Mobility in Adults of All Ages: National Health Interview Survey.

OBJECTIVE: To investigate the relationship between hearing difficulty and measures of mobility for US adults. STUDY DESIGN: Cross-sectional study. SETTING: 2021 National Health Interview Survey. METHODS: The survey asked US adults about hearing difficulty and mobility measures, including difficulty walking 100 yards, difficulty climbing 12 steps, and injury from falling within the past 3 months. Multivariable logistic regressions examined the associations between hearing and mobility outcomes, controlling for visual difficulty, medical comorbidities, and various demographic characteristics (age [18-39, 40-64, 65+], race/ethnicity, sex, socioeconomic status). RESULTS: The 2021 NHIS surveyed 29,467 adults, representing 253 million people in weighted responses (52% female; mean age 48.3, standard deviation = 18.6). Controlling for covariates, hearing difficulty was associated with increased odds of difficulty walking 100 yards (odds ratio, OR = 1.47, P < .001), difficulty climbing stairs (OR = 1.62, P < .001), and injury from falling in the past 3 months (OR = 1.51, P < .001). There was a significant interaction between age and hearing difficulty for injurious falls; stratifying by age revealed that younger adults (ages 18-39) with hearing difficulty were more likely to report recent harmful falls than their normal hearing peers; this increased risk was greater in magnitude than that observed comparing older adults with and without hearing difficulty. CONCLUSION: The hearing difficulty is associated with worsened mobility for US adults and may be a stronger independent predictor of injury from falls for younger adults as compared to older adults. These findings can inform interventions to reduce the burden of declining mobility in adults with hearing difficulty.

Competency-based medical education in the United States: What the otolaryngologist needs to know.

Competency-based medical education (CBME) is an outcomes-focused approach to educating medical professionals that will be central to future efforts to improve resident training in otolaryngology. The transition to CBME for otolaryngology in the United States will require the development of specialty-specific assessments and benchmarks, the financial and administrative support for implementation, the professional development of faculty and learners, and the cooperation of all major stakeholders in graduate medical education. In this article, we describe the need for evidence-based innovation in surgical training, the history of CBME in the United States, and the progress towards defining "entrustable professional activities" as the building blocks of assessments for CBME. We explore what such a paradigm shift in surgical education could mean for academic otolaryngologists by examining innovative educational practices in other surgical specialties and discussing foreseeable challenges in implementation for the American healthcare system.

A paired curriculum for surgical faculty and residents on adult education.

A paired surgical educator curriculum on adult learning was designed for residents and faculty at a large otolaryngology residency program. In its first year of implementation, 12 core faculty and 20 residents attending the workshops, with positive feedback from all participants and measurable improvements in their understanding of basic terms in adult cognitive learning theory. The curriculum enabled faculty and residents to practice applying educational theories to their every day clinical teaching activities and is adaptable for use in other surgical training programs. Level of Evidence: IV.

The Impact of Hearing Loss on Health Care Access During the COVID-19 Pandemic.

Individuals with hearing loss are at increased risk of having poor access to health care compared with hearing peers. The impact of the COVID-19 pandemic on health care access for adults with hearing loss in the United States was investigated through weighted analyses of the 2021 National Health Interview Survey. The association of hearing loss and disruptions to health care use during the pandemic was examined using multivariable logistic regression controlling for demographic characteristics including sex, race/ethnicity, education, socioeconomic status, insurance status, and medical comorbidities. Adults with hearing loss had significantly higher odds of reporting receiving no medical care (odds ratio [OR] = 1.63, 95% confidence interval [CI]: 1.46-1.82, p < .001) or delayed medical care (OR = 1.57, 95% CI: 1.43-1.71, p < .001) due to the pandemic. Individuals with hearing loss did not have higher odds of COVID-19 diagnosis or vaccination. Strategies should be developed to support adults with hearing loss to improve their access to care during public health emergencies.

A Practical Introduction to Growth Mindsets in Surgical Training.

This Viewpoint summarizes the research behind psychological mindsets and their possible applications to surgical training and introduces some practical recommendations to harness growth mindsets for optimizing the learning of otolaryngology residents.

Predicting Resident Competence for Otolaryngology Key Indicator Procedures.

OBJECTIVE: Competency-based surgical education requires practical assessments and meaningful benchmarks. In otolaryngology, key indicator procedure (KIP) minima are indicators of surgical exposure during training, yet it remains unknown how many times trainees must be evaluated on KIPs to ensure operative competence. Herein, we used Bayesian mixed effects models to compute predicted performance expectations for KIPs. METHODS: From November 2017 to September 2021, a smartphone application (SIMPL OR) was used by attendings at five otolaryngology training programs to rate resident operative performance after each case on a five-level scale. Bayesian mixed effects models were used to estimate the probability that postgraduate year (PGY) 3, 4, or 5 trainees would earn a "practice-ready" (PR) rating on a subsequent evaluation based on their previously earned PR ratings for each KIP. Probabilities of earning a subsequent PR rating were examined for interpretability, and cross-validation was used to assess predictive validity. RESULTS: A total of 842 assessments of KIPs were submitted by 72 attendings for 92 residents PGY 2-5. The predictive model had an average Area Under the Receiver Operating Curve of 0.77. The number of prior PR ratings that senior residents needed to attain a 95% probability of earning a PR rating on a subsequent evaluation was estimated for each KIP. For example, for mastoidectomies, PGY4 residents needed to earn 10 PR ratings whereas PGY5 residents needed 4 PR ratings on average to have a 95% probability of attaining a PR rating on a subsequent evaluation. CONCLUSION: Predictive modeling can inform assessment benchmarks for competency-based surgical education. LEVEL OF EVIDENCE: NA Laryngoscope, 133:3341-3345, 2023.

Bullying victimization in adolescents with hearing impairment.

OBJECTIVE: Children with disabilities may face increased social challenges among peers. The purpose of this study was to investigate the association between hearing loss and reports of bullying victimization among adolescents in the United States. METHODS: The 2021 National Health Interview Survey was a nationally representative cross-sectional survey administered to parents/caregivers of adolescent children ages 12 to 17. The effects of hearing loss on reports of bully victimization were assessed using multivariable logistic regression models, controlling for demographic characteristics including socioeconomic status and health status. RESULTS: Caregivers of 3207 adolescents completed the survey and their responses represented over 25 million children in weighted analyses. Among all respondents, 21% (95% confidence interval, CI 19%-23%) of caregivers reported that their child had been bullied at least once in the past 12 months. Among children with hearing loss, 34.4% (95% CI 21.1%-47.7%) were bullied. Hearing impairment was associated with increased odds of reporting bullying victimization (odds ratio, OR = 2.04, 95% CI 1.03-4.07, p = 0.04) and children with hearing loss who do not use hearing aids had even greater odds of being bullied (OR = 2.40, 95% CI 1.18-4.86, p = 0.015). CONCLUSION: In a nationally representative survey of caregivers for U.S. adolescents, hearing impairment among adolescents was associated with increased reported rates of bullying victimization. Further research is needed to investigate how anti-bully interventions can support this at-risk group.

Augmented Reality in Otology/Neurotology: A Scoping Review with Implications for Practice and Education.

OBJECTIVE: To determine how augmented reality (AR) has been applied to the field of otology/neurotology, examine trends and gaps in research, and provide an assessment of the future potential of this technology within surgical practice and education. DATA SOURCES: PubMed, EMBASE, and Cochrane Library were assessed from their inceptions through October 2022. A manual bibliography search was also conducted. REVIEW METHODS: A scoping review was conducted and reported according to PRISMA-ScR guidelines. Data from studies describing the application of AR to the field of otology/neurotology were evaluated, according to a priori inclusion/exclusion criteria. Exclusion criteria included non-English language articles, abstracts, letters/commentaries, conference papers, and review articles. RESULTS: Eighteen articles covering a diverse range of AR platforms were included. Publication dates spanned from 2007 to 2022 and the rate of publication increased over this time. Six of 18 studies were case series in human patients although the remaining were proof of concepts in cadaveric/artificial/animal models. The most common application of AR was for surgical navigation (14 of 18 studies). Computed tomography was the most common source of input data. Few studies noted potential applications to surgical training. CONCLUSION: Interest in the application of AR to otology/neurotology is growing based on the number of recent publications that use a broad range of hardware, software, and AR platforms. Large gaps in research such as the need for submillimeter registration error must be addressed prior to adoption in the operating room and for educational purposes. LEVEL OF EVIDENCE: N/A Laryngoscope, 133:1786-1795, 2023.

Screening Mammography Utilization Among Women With Visual or Hearing Impairment: Results From the 2019 NHIS.

To evaluate for differences in breast cancer screening among women with visual or hearing impairment, the 2019 National Health Interview Survey was analyzed for mammography use in the past 2 years among women age 50-74, adjusting for demographic characteristics, health care access, and comorbidities. Visual impairment was independently associated with decreased likelihood of recent mammography (odds ratio [OR], 0.71; 95% CI, 0.59-0.85; p < .001). Hearing impairment was not independently associated with mammography use (OR, 0.91; 95% CI, 0.75-1.11; p = .37).

A Needs Assessment for the Future of Otolaryngology Education.

The field of otolaryngology-head and neck surgery is rapidly changing, and surgical education must keep pace. In the face of recent advances in medical knowledge, surgical technique, and novel technology, educators may find it increasingly difficult to identify the evolving educational needs of otolaryngology residents. To better align training activities with modern practice patterns, we propose conducting a longitudinal needs assessment by designing a standardized specialty-specific survey for practicing otolaryngologists. This recurring survey could be implemented alongside accreditation or other continuing medical education activities. The outcomes would report what contemporary otolaryngologists see and do in everyday practice to guide educational reforms to better prepare trainees for future practice.

Voluntary Field Recall of Advanced Bionics HiRes Cochlear Implants: A Single-Institution Experience.

OBJECTIVES: In 2020, Advanced Bionics (AB) announced a recall of two cochlear implant (CI) models, the "HiRes Ultra" and "HiRes Ultra 3D", because of reports of hearing degradation. The present study examines clinical parameters and patient features in cases of device failure and evaluates outcomes after reimplantation. MATERIALS AND METHODS: A series of 52 patients implanted with the recalled devices experienced suspected device failure and subsequently underwent revision CI placement at a tertiary academic medical center between December 2019 and November 2021. RESULTS: Consonant-nucleus-consonant scores and individual phonemes increased significantly between patients' preoperative evaluation and primary cochlear implantation. Performance declined significantly before revision and recovered after revision CI placement. Similarly, pure-tone average thresholds improved between preoperative and primary CI, fell before revision surgery, and were corrected with revision implantation. As a group, patients reached their peak hearing performance significantly faster after revision CI (mean ± standard deviation, 53.4 ± 51.8 d) compared with their primary CI (mean ± standard deviation, 260.6 ± 245.9 d). Electrical field imaging performed by AB and device impedance measurements were found to be abnormal in the basally positioned electrodes (electrodes 9-16). CONCLUSION: Hearing performance degradation is significant in AB Ultra device failures and seems to be linked to the basal-most electrodes in the array. Revision outcomes have been robust, necessitating continued monitoring of affected patients and support for reimplantation procedures. LEVEL OF EVIDENCE: IV.

Otopathologic and Computed Tomography Correlation of Internal Auditory Canal Diverticula in Otosclerosis.

INTRODUCTION: Internal auditory canal (IAC) diverticula, also known as IAC cavitary lesions or anterior cupping of the IAC, observed in otopathologic specimens and high-resolution computed tomography (CT) scans of the temporal bone are thought to be related to otosclerosis. Herein, we examined the usefulness of CT scans in identifying diverticula and determined whether IAC diverticula are associated with otosclerosis on otopathology. METHODS: One hundred five consecutive specimens were identified from the National Temporal Bone Hearing and Balance Pathology Resource Registry. Inclusion criteria included the availability of histologic slides and postmortem specimen CT scans. Exclusion criteria included cases with severe postmortem changes or lesions causing bony destruction of the IAC. RESULTS: Ninety-seven specimens met criteria for study. Of these, 42% of the specimens were from male patients, and the average age of death was 77 years (SD = 18 yr). IAC diverticula were found in 48 specimens, of which 46% were identified in the CT scans. The mean area of the IAC diverticula was 0.34 mm 2 . The sensitivity and specificity of detecting IAC diverticula based on CT were 77% and 63%, respectively. Overall, 27% of specimens had otosclerosis. Histologic IAC diverticula were more common in specimens with otosclerosis than those without (37.5% versus 16%; p = 0.019). Cases with otosclerosis had a greater mean histologic diverticula area compared with nonotosclerosis cases (0.69 mm 2 versus 0.14 mm 2 ; p = 0.001). CONCLUSION: IAC diverticula are commonly found in otopathologic specimens with varied etiologies, but larger diverticula are more likely to be associated with otosclerosis. The sensitivity and specificity of CT scans to detect IAC diverticula are limited.

Association of Outpatient Oral Macrolide Use With Sensorineural Hearing Loss in Children, Adolescents, and Young Adults.

Importance: Prior publications have reported the sporadic development of sensorineural hearing loss (SNHL) after intravenous or high-dose macrolide therapy for adults with comorbid conditions, but investigations of the auditory effect of oral outpatient dosing for children, adolescents, and young adults have been limited. Objective: To determine whether broad-based outpatient use of oral macrolide therapy is associated with increased risk of pediatric SNHL through nationally representative analyses. Design, Setting, and Participants: A retrospective case-control study of 875 matched pairs of children, adolescents, and young adults was performed, matching on age, sex, and the time elapsed since prescription date. All eligible pediatric patients were included, with matched control participants from the TRICARE US military health insurance system who were evaluated between October 1, 2009, and September 30, 2014. Exposures: Oral outpatient macrolide treatment compared with penicillin use among pediatric patients. Main Outcomes and Measures: The clinical outcome of interest was SNHL in children, adolescents, and young adults. Multivariable conditional logistic regression was used to compare the risk of prior macrolide exposure with penicillin exposure, adjusted for other risk factors and potential confounders. Four time frames between exposure and diagnosis were additionally assessed. Results: There were 875 eligible matched pairs of children, adolescents, and young adults included. The mean (SD) age of the participants was 5.7 (4.9) years; 1082 participants were male (62%), 58 were Asian (3%), 254 were Black (15%), 1152 were White (66%), and 286 were of Native American and other (no further breakdown was available in the TRICARE database) race and ethnicity (16%). In multivariable analysis, participants who had SNHL had increased odds of having received a macrolide prescription compared with a penicillin prescription when all time frames from exposure were included (adjusted odds ratio, 1.31; 95% CI, 1.05-1.64). There were significantly higher odds of macrolide exposure than penicillin exposure when diagnosis and testing occurred more than 180 days after antibiotic exposure (adjusted odds ratio, 1.79; 95% CI, 1.23-2.60). Conclusions and Relevance: In this case-control study of a nationally representative patient population, findings suggest that children, adolescents, and young adults with SNHL had increased odds of outpatient oral macrolide use compared with penicillin use, particularly when having received a diagnosis more than 180 days after exposure. Further study of the association of macrolides with SNHL in children, adolescents, and young adults is warranted.

Training Surgeon Scholars: Grant Writing Workshops During Residency.

Surgical residents may have limited experience with grant writing even though it is an important skill for academic physicians. We describe a novel curriculum on the conduct of research and grant literacy delivered at a single otolaryngology training program over 5 years. This workshop series included preparing a draft grant and conducting a mock grant review committee. In a survey of past participants (71% response rate), 91% found the workshops useful for grant writing or reviewing, and many used or planned to use the draft grants for real grant applications. The average number of American Academy of Otolaryngology-Head and Neck Surgery Foundation CORE grants submitted and successfully funded increased among residents at this program in the 4 years after the introduction of the workshop series as compared with the 4 years before. Further improvements continue to be made to the curriculum based on resident feedback.

Factors affecting operative autonomy and performance during otolaryngology training: A multicenter trial.

Objective: Surgical education is changing in an era of new regulations and evolving training cultures. We sought to understand the factors that affect operative experiences during otolaryngology residency. Methods: From December 2019 to December 2020, five otolaryngology training programs used the SIMPL OR smartphone application to evaluate residents after each operation. Residents and attendings rated the trainee's autonomy on a 4-level Zwisch scale, performance on a 5-level scale, and case complexity on a 3-level scale. We examined associations between ratings of autonomy and performance with variables including postgraduate year (PGY), case complexity, gender, week of the academic year (AY), and whether multiple procedures were logged. Results: 78 attendings and 92 residents logged 2984 evaluations. PGY level and week of the AY were positively associated with attending ratings of autonomy and performance (PGY3 vs. PGY2: B = 0.63, p < .001 for autonomy and B = 1.05, p < .001 for performance; week of the AY: B = 0.013, p = .002 for autonomy; B = 0.025, p < .001 for performance). Multiple procedures logged and increasing case complexity were negatively associated with attending ratings (multiple procedures: B = -0.19, p = .04 for autonomy and B = -0.48, p < .001 for performance; hardest vs. easiest 1/3 of cases: B = -1.01, p < .001 for autonomy and B = -0.59, p < .001 for performance). Attending and trainee genders were not associated with attending ratings of autonomy or performance. Conclusion: Resident autonomy and performance were positively associated with PGY level and week of the academic year, and negatively associated with case complexity and multiple procedures. These findings highlight the need to align training level with case complexity to promote quality operative experiences. Level of Evidence: 2.

A Subset of Intracanalicular Vestibular Schwannomas Demonstrates Minimal Growth Over a 10-Year Period.

OBJECTIVE: Vestibular schwannomas (VS) commonly undergo magnetic resonance imaging (MRI) surveillance, but long-term data to support the ideal frequency is limited. Herein, we aim to investigate intracanalicular VS growth predictors and long-term growth rates (GR). STUDY DESIGN: Retrospective chart review. SETTING: Two tertiary care centers. PATIENTS: Sporadic intracanalicular VS with initial conservative management and at least two sequential MRIs. INTERVENTION: Serial MRI. MAIN OUTCOME MEASURES: VS were categorized by baseline internal auditory canal tertile sublocalization (fundus, midpoint, porus) and size (≤100, 100-200, >200 mm3). Throughout follow-up, volumetric GR (mm3/yr) were determined (baseline-3 yrs, 3-5 yrs, 5-10 yrs) and treatment rates were assessed. RESULTS: Ninety-nine intracanalicular VS were identified (mean follow-up of 6.1 ±â€Š4.5 yrs). Mean GR before 5-year follow-up were comparable for baseline tertile involvement and size. After 5-year follow-up, mean GR of VS involving the fundus at baseline were lower than those involving the midpoint and fundus (6.17 ±â€Š21.16 and 119.74 ±â€Š117.57 mm3/yr, respectively; p = 0.034). Mean GR of VS with less than or equal to 100 mm3 at baseline (-7.29 ±â€Š25.44 mm3/yr) were lower than those with 100 to 200 mm3 (86.55 ±â€Š103.99 mm3/yr; p = 0.011) and more than 200 mm3 (45.70 ±â€Š35.71 mm3/yr; p = 0.031). Vestibular schwannomas involving the midpoint and fundus had greater treatment rates compared with VS involving only the fundus (p < 0.001). CONCLUSIONS: Baseline tertile involvement and size may predict long-term intracanalicular VS growth where fundal tumors or those less than or equal to 100 mm3 exhibit little long-term growth. Extending surveillance after 5-year follow-up may be reasonable for fundal VS.

Immediate postoperative non-invasive positive pressure ventilation following midface microvascular free flap reconstruction.

BACKGROUND: There is a rare need for postoperative non-invasive positive pressure ventilation (NIPPV) following microvascular reconstruction of the head and neck. In midface reconstruction, the free flap vascular pedicle is especially vulnerable to the compressive forces of positive pressure delivery. CASE: A 60 year old female with Amyotrophic Lateral Sclerosis (ALS) presented with squamous cell carcinoma of the anterior maxilla, for which she underwent infrastructure maxillectomy and fibula free flap reconstruction. To avoid tracheotomy, the patient was extubated postoperatively and transitioned to NIPPV immediately utilizing a full-face positive pressure mask with a soft and flexible sealing layer. The patient was successfully transitioned to NIPPV immediately after extubation. The free flap exhibited no signs of vascular compromise postoperatively, and healed very well. CONCLUSION: Postoperative non-invasive positive pressure ventilation can be successfully applied following complex microvascular midface reconstruction to avoid tracheotomy in select patients without vascular compromise of the free flap.