Predictors of persistent postural-perceptual dizziness (PPPD) and similar forms of chronic dizziness precipitated by peripheral vestibular disorders: a systematic review.

BACKGROUND: The literature on predictors of persistent postural-perceptual dizziness (PPPD) following peripheral vestibular insults has not been systematically reviewed. METHODS: We systematically reviewed studies on predictors of PPPD and its four predecessors (phobic postural vertigo, space-motion discomfort, chronic subjective dizziness and visual vertigo). Investigations focused on new onset chronic dizziness following peripheral vestibular insults, with a minimum follow-up of 3 months. Precipitating events, promoting factors, initial symptoms, physical and psychological comorbidities and results of vestibular testing and neuroimaging were extracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: We identified 13 studies examining predictors of PPPD or PPPD-like chronic dizziness. Anxiety following vestibular injury, dependent personality traits, autonomic arousal and increased body vigilance following precipitating events and visual dependence, but not the severity of initial or subsequent structural vestibular deficits or compensation status, were the most important predictors of chronic dizziness. Disease-related abnormalities of the otolithic organs and semi-circular canals and age-related brain changes seem to be important only in a minority of patients. Data on pre-existing anxiety were mixed. CONCLUSIONS: After acute vestibular events, psychological and behavioural responses and brain maladaptation are the most likely predictors of PPPD, rather than the severity of changes on vestibular testing. Age-related brain changes appear to have a smaller role and require further study. Premorbid psychiatric comorbidities, other than dependent personality traits, are not relevant for the development of PPPD.

The impact of the COVID-19 pandemic on the lifestyle and behaviours, mental health and education of students studying healthcare-related courses at a British university.

BACKGROUND: The COVID-19 pandemic has affected most industries, including health education. In this study, we surveyed students studying healthcare-related courses at our university on how their lifestyles and behaviours, mental health and education had been affected by the pandemic. METHODS: Mixed methods cross-sectional study. RESULTS: Two hundred thirty-three students responded to the questionnaire. Lifestyle and behaviours: 51.5% of the participants changed their diet (n=120); 45.5% (n=106) exercised less; 66.5% (n=155) experienced a change in sleep; 51.1% (n=119) reported a change in appetite. Mental health: 84.2% (n=196) reported worrying too much about different things; 61.9% (n=144) could not stop or control worrying; 71.2% experienced trouble relaxing on several days or more (n=166). At least sometimes, 72.1% (n=168) felt unable to cope with things they had to do; 8.5% (n=20) never, or almost never, felt confident about handling personal problems. Education: 65.7% (n=153) struggled to complete learning outcomes with online delivery; 82% (n=191) worried about practical skills being affected; 60.5% (n=141) worried about the impact of COVID-19 on their future career. Almost half (48.9%, n=114) believed that online teaching should be part of the standard curriculum. CONCLUSION: In general, there was a negative impact on behaviours, lifestyle and mental health and virtual education was perceived as necessary in making up for the loss of face to face experiences. Students' mental health and educational needs have been affected by the current pandemic and healthcare educational facilities must respond to these needs to ensure students continue to receive the support they need.

Running a paediatric ambulatory sleep service in a pandemic and beyond.

OBJECTIVES: In response COVID-19, re-establishing safe elective services was prioritised in the UK. We assess the impact on face-to-face hospital attendance, cost and efficiency of implementing a virtual sleep clinic (intervention 1) to screen for children requiring level 3 ambulatory sleep studies using newly implemented ENT-UK guidelines for obstructive sleep apnoea (OSA) investigation (intervention 2). OBJECTIVES: (1) compare the proportion of children attending sleep clinic undertaking a sleep study before and after implementation of these interventions; (2) compare clinic cancellations and first-time success rates of sleep studies before and after intervention. DESIGN: Retrospective analysis. SETTING: District general hospital paediatric sleep clinic. PARTICIPANTS: Children aged 3 months to 16 years referred to sleep clinic by ENT for investigation of OSA over 3 months immediately following interventions (1 June 2020 - 1 September 2020) to the same period in the previous year (1 June 2019 - 1 September 2019). MAIN OUTCOME MEASURES: Number of children attending sleep clinic, date of birth/age of children attending sleep clinic, number of children undergoing sleep study, diagnostic outcomes, number of appointment cancellations, number of first-time sleep study failures. RESULTS: Post intervention, there was a significant reduction in the proportion of children undertaking ambulatory sleep studies, and nonsignificant reductions in appointment cancellations and in first-time sleep study failures. CONCLUSIONS: The introduction of the virtual sleep clinic meant that only those children requiring a sleep study attended a face-to-face appointment, which led to reduced face-to-face attendance. There were also unintended cost-effectiveness and efficiency benefits, with potential longer-term learning implications for the wider sleep community and other diagnostic services.

A safe and comparable alternative to BIPP packing following tympanoplasty for tympanic membrane perforation.

PURPOSE: To compare two post-operative ear packing methods following tympanoplasty for tympanic membrane perforation. METHODS: A prospective study of patients undergoing tympanoplasty for tympanic membrane perforation over a 2-year period was undertaken across two district general hospitals. Data, including demographics, pre-operative ear state, and graft type used for repair were recorded. Ears were packed using one of two distinct methods. Pack A: gelatin sponge, chloramphenicol ointment and an antibiotic-soaked ear wick. Pack B: antibiotic-soaked gelatin sponge, bismuth iodoform paraffin paste (BIPP) impregnated gauze dressing. The primary outcome measure was post-operative complications associated with each packing method RESULTS: One hundred and fifty-three tympanoplasties were performed during this period: 68 underwent Pack A and 85 underwent Pack B. Chi squared test showed no significant association between pack type and complication rate (p = 0.572). Univariate analysis suggested that age (p = 0.047) and concurrent bony canaloplasty (p = 0.006) significantly increased complication rates. Pre-operative ear status, indication, graft type and gender did not affect complication rate. CONCLUSIONS: BIPP-impregnated ribbon gauze and chloramphenicol/wick are both comparable methods for packing an ear following tympanoplasty for tympanic membrane perforation. This is useful information both for surgeons who commonly use BIPP and have a patient with a known iodine allergy, or who is not known to be allergic to iodine but has been packed with BIPP previously, and for those who do not have access to BIPP and wish to use a pack with comparable success.

The tinnitus patient information pack: usefulness in intrusive tinnitus.

PURPOSE: The purpose of this paper is to determine a tinnitus patient information pack's (TPIP) usefulness in patients suffering with tinnitus with respect to their need for further tinnitus retraining therapy (TRT) and in reducing TRT cancellations and non-attenders. DESIGN/METHODOLOGY/APPROACH: The paper consists of prospective case series in a district general hospital ENT out-patient department. FINDINGS: Patients with tinnitus-related symptoms constitute around 2 per cent of the ENT OPD workload at the West Middlesex Hospital, Chelsea & Westminster NHS Trust, London, i.e., 365 patients with intrusive tinnitus were referred by the ENT surgeon for TRT; 56/365 patients (15.3 per cent) failed to attend and 60 (16.4 per cent) cancelled their appointments. The following year, a TPIP was administered to all tinnitus sufferers, despite the affliction's intrusiveness, and told to contact the audiology department if they felt that TRT was required, which resulted in 43/233 patients (18.5 per cent) over a one-year period self-referring for TRT; 2/233 (0.9 per cent) did not attend, and 1/233 (0.4 per cent) were cancelled appointments. PRACTICAL IMPLICATIONS: The patient-focussed TPIP acts as an initial therapy for the tinnitus sufferer by providing reassurance and self-therapy. This results in patients who are less likely to seek TRT, leading to more efficient clinical resource usage (p<0.01). ORIGINALITY/VALUE: The data suggest that all tinnitus sufferers presenting to ENT clinics could be handed a TPIP and empowered with the decision whether they require further intervention.

TORS for OSA: a practice, pitfalls and literature review.

PURPOSE: Trans-oral robotic surgery (TORS) is increasingly employed in obstructive sleep apnoea (OSA) management. Objective outcomes are generally assessed through polysomnography. Pre-operative magnetic resonance imaging (MRI) can be a useful adjunct in objective upper airway assessment, in particular the tongue base, providing useful information for surgical planning and outcome assessment, though care must be taken in patient positioning during surgery. The purpose of this paper is to identify pitfalls in this process and suggest a protocol for pre-operative MRI scanning in OSA. DESIGN/METHODOLOGY/APPROACH: This study is a four-patient prospective case-series and literature review. Outcome measures include pre- and post-operative volumetric changes in the pharynx as measured on MRI and apnoea-hypopnea indices (AHI), with cure being OSA resolution or a 50 per cent reduction in AHI. FINDINGS: All patients achieved AHI reduction and/or OSA cure following TORS, despite a decrease in pharyngeal volume measurements at the tongue base level. This study and others lacked standardisation in the MRI scanning protocol, which resulted in an inability to effectively compare pre- and post-operative scans. Pitfalls were related to variation in head/tongue position, soft-tissue marker usage and assessed area boundary limits. PRACTICAL IMPLICATIONS: TORS appears to be effective in OSA management. A new protocol for patient positioning and anatomical landmarks is suggested. ORIGINALITY/VALUE: The findings could provide directly comparable data between scans and may allow correlation between tongue base volumetric changes and AHI through subsequent and historical study meta-analysis.

Is an 'Introduction to ENT course' the answer for safe ENT care?

ENT presentations are common both in primary care and accident and emergency departments. Unfortunately, many clinicians are not comfortable handling ENT emergencies due to a lack of knowledge and skill stemming from an undergraduate level onwards. An 'Introduction to ENT' course has been cited as an answer to bridge the gap in knowledge and promote confidence in doctors. A pre- and post-course analysis was performed on 29 participants attending an 'Introduction to ENT' course using a standardised questionnaire. Five were excluded from our analysis. Of the remaining 24, there was a lack of significant changes on the amount of ENT knowledge gained (pre-course mean score 2.71 vs post-course mean 4.63, p = 0), confidence in dealing with ENT emergencies (pre-course mean score 2.54 vs post-course mean score 4.58, p = 0) and confidence performing ENT procedures (pre-course mean score 2.375 vs post-course mean score 4.46, p = 0). We feel that the course alone is insufficient in providing a basic and safe emergency ENT service. We suggest a period of shadowing be introduced in addition to the compulsory induction programme for junior doctors rotating through ENT.

Soft, fortified ice-cream for head and neck cancer patients: a useful first step in nutritional and swallowing difficulties associated with multi-modal management.

Patients with head and neck cancer have complex swallowing and nutritional concerns. Most patients are malnourished, and treatment modalities within the aerodigestive tract have profound effects on future swallowing and nutrition. The objective of this study is to investigate whether the introduction of fortified soft ice-cream to post-operative head and neck cancer patients would increase compliance with oral-feeding regimes. Using a questionnaire study, an ice-cream machine that produces fortified soft ice-cream was introduced onto our ward, and 30 patients were asked to fill out questionnaires based on their experience in addition to their oral-feeding regime. Results indicate that overall patient satisfaction and compliance with oral-feeding regimes increased: 77% felt that the taste was excellent and also felt that it was easy to eat; 60% felt that it eased the symptoms associated with their symptoms, in particular its cold temperature. We conclude from the results that the inability of patients undergoing multi-modal treatment for upper aerodigestive tract cancer to enjoy normal foods and its effects on their quality of life is underestimated. Providing a food to that is palatable, familiar and acceptable as it is safe and nutritionally sound can increase compliance with oral-feeding regimes. The ice-cream was safe to use in the early post-operative period, especially soothing in patients undergoing upper aerodigestive radiotherapy and high in protein and calorific content. Our practice may have wider benefits, including patients with oral and oropharyngeal infections, the elderly and patients with neurological dysphagia resulting from stroke.

Follow-up in head and neck cancer: patients' perspective.

PURPOSE: The purpose of this paper is to determine head and neck cancer patients' perspective of their follow-up regime and to suggest ways in which these perspectives can be incorporated into current practice. DESIGN/METHODOLOGY/APPROACH: This is a prospective survey-based study. A total of 263 patients consecutively attending a head and neck cancer clinic completed a survey about their experience of the follow-up process in the post-treatment period between January 2009 and October 2009. FINDINGS: The paper finds that, of the patients, 67 per cent (n = 176) felt that the clinic met the goals they hoped would be achieved during their visit; 84 per cent (n = 221) felt that their follow-up visits were too frequent. In total 60 per cent (n = 159) were booked to see both an allied health professional and the attending clinician. Of these, 84 per cent (n = 134/159) felt that issues addressed at follow-up with the clinician duplicated those addressed by the allied healthcare professionals. When asked about their opinion of a less intensive follow-up system based on patients reporting problems and requesting appointments, 73 per cent (n = 192) favoured it. When asked who they would like to contact first in such a system, most patients (n = 118, 45 per cent) stated a clinical nurse specialist. PRACTICAL IMPLICATIONS: Current follow-up regimes may be too prescriptive in their approach without taking patient perspective into consideration. Patients felt that being seen intensively for the first year, then having visits tapered off over the next two years and finally being seen according to symptoms thereafter to be appropriate and felt that this represented an overall better system. ORIGINALITY/VALUE: These data suggest the need for a more patient-focused, individualised approach to follow-up in head and neck cancer.

The use of complementary and alternative medicine by nurses.

BACKGROUND: Complementary and alternative medicine (CAM) use is common among patients attending the department of the authors of this article. With expanding roles of nurses in various clinics, the nurses are often asked for their advice on CAM use by their patients. CAM education is not part of the nursing curriculum in various parts of the world. The aim of this study was to establish the use of CAM by nurses along with their knowledge base and attitudes towards it. METHODS: A questionnaire-based study based on the published literature was used among qualified nurses. The data were collected and analysed using SPSS for Windows. RESULTS: The response rate was 86% (531/621; females were 91% and the mean age was 32 years (range 20-63). Eighty percent of the responders admitted to use of CAM and 41% were using CAM at the time. The most commonly mentioned CAM were massage, cod liver oil and cranberry juice. CAM was mostly used for relaxation, joint pain and urinary tract infection. Only five nurses believed CAM was not effective and 74% would recommend CAM use to others. Ninety-three percent of nurses did not have any formal education on CAM. Most nurses would consider some education on CAM to enable them to counsel their patients. CONCLUSIONS: The use of CAM is high among nurses. As patients are increasingly relying on nurses for advice on its use, it is important for nurses to be educated about CAM in order to guide their patients.

Using a microscope to change a speech valve.

Replacing a speech valve can be a difficult procedure to learn and perform. In this letter the authors propose a method using an operating microscope, which their department has found useful in performing this procedure, and in teaching trainees.

Secondary Obliteration Surgery for Troublesome Mastoid Cavities: A Prospective Series of 228 Pediatric and Adult Cases.

OBJECTIVE: To present the results of a 15-year longitudinal study in a pediatric and adult population with secondary obliteration of troublesome mastoid cavities. STUDY DESIGN: Prospective longitudinal study. PATIENTS: Children (≤16 yrs) and adults who had obliteration surgery (228 ears) between 2000 and 2017. INTERVENTIONS: Therapeutic. SETTING: Tertiary referral center. MAIN OUTCOME MEASURES: 1) Incidence of recurrent or residual cholesteatoma; 2) creation of a dry ear at 5 years postsurgery; 3) postoperative complications; 4) waterproof status of ear; 5) number of subsequent ear surgery required. RESULTS: Thirty-one pediatric and 197 adult cases contributed to the study. At 5 years 11 of 98 (10.8%) had been lost to follow-up. Using Kaplan-Meier survival analysis, the residual rate after 5 years was 4.2% (95% CI: 0.3%-8.2%) and the recurrence rate was 1% (95% CI: 0.0%-3.0%). Of the 223 ears available for assessment, 209 (93.7%) achieved a dry state, 6 (2.7%) had intermittent discharge, 6 (2.7%) had flap necrosis requiring flap trimming, and 1 (0.4%) developed meatal stenosis. Using a cross-sectional analysis at 12 months of follow-up, the otorrhea risk was 19.2% and the risk of definitive waterproofing was 10.9%. There was a reoperation risk of 10% within 5 years which included second-stage ossiculoplasty. CONCLUSIONS: Secondary mastoid obliteration is a safe and useful technique in treating the troublesome mastoid cavity in both children and adults. It is associated with a low cholesteatoma recidivism rate and high rate of a trouble-free ear in the long term.

The use of complementary and alternative medicine by patients attending a general otolaryngology clinic: can we afford to ignore it?

BACKGROUND: There is growing interest in use of complementary and alternative medicine (CAM) among the general population. Little information is available, however, on CAM use in adults attending an otolaryngology outpatient clinic in the UK. OBJECTIVE: The purpose of this article is to study the prevalence and pattern of CAM use among adult patients attending the ear, nose, and throat (ENT) clinic in a UK teaching hospital. STUDY DESIGN: A cross-sectional study was used. SUBJECTS AND METHODS: All patients on their primary visit to an ENT clinic were asked to complete an anonymous questionnaire for a 14-week period from October 2005 to January 2006. RESULTS: Based on 1366 completed questionnaires, 53% (728/1366) were female and 47% (638/1366) were male. Twenty-nine percent (395/1366) were older than 60 years, and 56% (763/1366) were married. Twenty percent (275/1366) had a university education. Sixty-one percent (833/1366) had used CAM, almost 36% in the preceding 12 months. The popular remedies were cod liver oil (368/833), garlic (197/833), cranberry (181/833), aloe vera (176/833), primrose oil (174/833), and Echinacea (163/833). Nonherbal therapies included massage (230/833), acupuncture (186/833), aromatherapy (135/833), chiropractic (121/833), reflexology (119/833), and homeopathy (110/833). Seventeen percent (143/833) used CAM for their current illness. Only 8% (64/833) found CAM ineffective; yet, 57% (473/833) would recommend CAM to others. Fifty-one percent (421/833) failed to inform their primary physician of their CAM use. CONCLUSION: Despite concerns over CAM efficacy, safety, and cost effectiveness, use of CAM is popular among patients attending an ENT clinic. Their use is not generally related to their presenting illness. Otolaryngologists should be aware of current trends in CAM use when managing patients, including possible interactions with other medication.

Complementary and alternative medicine use by otolaryngology patients: a paradigm for practitioners in all surgical specialties.

There is growing interest in complementary and alternative medicine (CAM) amongst the general population. Little information is available on CAM use in otolaryngology patients in the UK. Despite concerns over safety, efficacy and cost-effectiveness, CAM use is common amongst ENT patients. Patients perceive these medications as possible boosters to their immune system. It is becoming increasingly important that health care providers in all specialties ask their patients about CAM use and are aware of the implications it carries. The objective is to study the prevalence and pattern of CAM use among adult and paediatric ENT patients in a UK teaching hospital. A cross-sectional study was done by sending anonymous questionnaire to all outpatient and elective inpatients over a 3-month period. Response rate was 73% (1,789/2,440). Prominent demographics: female, married, over-50 s. Sixty percent had used CAM, 35% in last year. Most common herbs: cod liver oil (n = 481), garlic (n = 255), cranberry (n = 224); non-herbal: massage (n = 287), acupuncture (n = 233), aromatherapy (n = 170). Most commonly cited reasons for using CAM: general health, enhanced immunity and prevention/treatment of common illnesses like the common cold, asthma and bodily aches and pains.

The prevalence of oilseed rape hypersensitivity in a mixed cereal farming population.

BACKGROUND: Oilseed rape production is widespread in cereal growing areas. Many patients attending our clinics for seasonal allergy claim that they are allergic to it. AIM: To determine the prevalence of oilseed rape allergy in our population. POPULATION: General population within a mixed cereal farming area attending a rhinology and allergy clinic in a district general hospital, UK. METHODS & MATERIALS: Retrospective chart analysis. The results of 1475 consecutive patients who underwent skin prick allergy testing over a 2-year period (January 2003-December 2005) and of 640 consecutive patients over a 1-year period (September 2008-September 2009) were analysed and compared. RESULTS: Allergy to house dust mite was found to be most common (n = 526, 25%) followed by grass pollen (n = 519, 24%) and cereals (n = 429, 20%). Oilseed rape hypersensitivity was relatively uncommon, comprising only 2% of the population tested (n = 28). CONCLUSION: Oilseed rape does not cause significant allergy, even in areas of high production. It is likely that those patients exhibiting oilseed rape allergy may in fact be symptomatic due to the effect of other allergens, acting either synergistically with the oilseed rape allergen, or more likely, in spite of it.

Transanal small bowel evisceration following digital reduction of a chronically prolapsing rectum.

Evisceration of the small bowel through a rectal perforation is rare. This is the case of a 66 year-old female presenting to the Accident and Emergency Department with transanal evisceration of her small bowel resulting from attempted digital reduction and subsequent tear of her chronically prolapsing rectum. Reduction of the prolapsed small bowel and primary repair of the rectal tear were carried out at laparotomy. The management of this case is discussed.

Call-fleming syndrome: an extraordinary complication of tonsillectomy.

A 36 years old woman underwent tonsillectomy for recurrent tonsillitis. At about one week in the postoperative period, she developed sudden onset severe ("thunderclap"), recurrent headaches and focal neurological signs including visual disturbances, ataxia and myoclonic jerks. Serial imaging with MRI, MRA and CT angiography revealed reversible white matter focal edema and segmental cerebral vasoconstriction. A diagnosis of Call-Fleming syndrome was made based on her symptoms and imaging findings, and she was started on nimodipine. She made a slow recovery but still has slight unilateral foot drop even 12 months since the initial event. This is the first case of Call-Fleming syndrome occurring following an ENT procedure.

Assessment of Potential Risk Factors for the Development of Persistent Postural-Perceptual Dizziness: A Case-Control Pilot Study.

Objectives: (1) To assess whether neuroticism, state anxiety, and body vigilance are higher in patients with persistent postural-perceptual dizziness (PPPD) compared to a recovered vestibular patient group and a non-dizzy patient group; (2) To gather pilot data on illness perceptions of patients with PPPD. Materials and Methods: 15 cases with PPPD and two control groups: (1) recovered vestibular patients (n = 12) and (2) non-dizzy patients (no previous vestibular insult, n = 12). Main outcome measures: Scores from the Big Five Inventory (BFI) of personality traits, Generalized Anxiety Disorder - 7 (GAD-7) scale, Body Vigilance Scale (BVS), Dizziness Handicap Inventory (DHI), modified Vertigo Symptom Scale (VSS) and Brief Illness Perception Questionnaire (BIPQ). Results: Compared to non-dizzy patients, PPPD cases had higher neuroticism (p = 0.02), higher introversion (p = 0.008), lower conscientiousness (p = 0.03) and higher anxiety (p = 0.02). There were no differences between PPPD cases and recovered vestibular patients in BFI and GAD-7. PPPD cases had higher body vigilance to dizziness than both control groups and their illness perceptions indicated higher levels of threat than recovered vestibular patients. Conclusion: PPPD patients showed statistically significant differences to non-dizzy patients, but not recovered vestibular controls in areas such as neuroticism and anxiety. Body vigilance was increased in PPPD patients when compared with both recovered vestibular and non-dizzy patient groups. PPPD patients also exhibited elements of negative illness perception suggesting that this may be the key element driving the development of PPPD. Large scale studies focusing on this area in the early stages following vestibular insult are needed.

Persistent Postural-Perceptual Dizziness-A Systematic Review of the Literature for the Balance Specialist.

OBJECTIVE: To present a systematic review of the current data on persistent postural-perceptual dizziness (PPPD), a useful and relatively new diagnosis for a disorder that has previously been known by many different names. In addition, to discuss diagnostic criteria and management strategies for this condition with the otologist in mind. DATA SOURCES: CINAHL, Embase, PubMed, Medline, PsycINFO, PubMed, Google Scholar. REVIEW METHOD: The phrase "persistent postural-perceptual dizziness" and its acronym "PPPD" were used. RESULTS: From 318 articles, 15 were selected for full analysis with respect to PPPD. Most were case-control studies, with one consensus paper from the Bárány Society available. Overall, the pathophysiology of PPPD remains relatively poorly understood, but is likely to be a maladaptive state to a variety of insults, including vestibular dysfunction and not a structural or psychiatric one. Cognitive behavioral therapy, vestibular rehabilitation, selective serotonin uptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs) all seem to have a role in its management. CONCLUSIONS: PPPD is useful as a diagnosis for those treating dizziness as it helps to define a conglomeration of symptoms that can seem otherwise vague and allows for more structured management plans in those suffering from it.

Trends in Intraoperative Testing During Cochlear Implantation.

OBJECTIVE: No consensus guidelines exist regarding intraoperative testing during cochlear implantation and wide variation in practice habits exists. The objective of this observational study was to survey otologists/neurotologists to understand practice habits and overall opinion of usefulness of intraoperative testing. STUDY DESIGN: Cross-sectional survey. SETTING: A web-based survey was sent to 194 practicing Otologists/Neurotologists. MAIN OUTCOME MEASURES: Questions included practice setting and experience, habits with respect to electrodes used, intraoperative testing modalities used, overall opinion of intraoperative testing, and practice habits in various scenarios. RESULTS: Thirty-nine of 194 (20%) completed the survey. For routine patients, ECAPs and EIs were most commonly used together (38%) while 33% do not perform testing at all. Eighty-nine percent note that testing "rarely" or "never" changes management. Fifty-one percent marked the most important reason for testing is the reassurance provided to the family and/or the surgeon. CONCLUSION: Intraoperative testing habits and opinions regarding testing during cochlear implantation vary widely among otologic surgeons. The majority of surgeons use testing but many think there is minimal benefit and that surgical decision-making is rarely impacted. The importance of testing may change as electrodes continue to evolve.