Variables Affecting Cochlear Implant Performance After Loss of Residual Hearing.

OBJECTIVE: Determine variables that influence post-activation performance for cochlear implant (CI) recipients who lost low-frequency acoustic hearing. METHODS: A retrospective review evaluated CNC word recognition for adults with normal to moderately severe low-frequency hearing (preoperative unaided thresholds of ≤70 dB HL at 250 Hz) who were implanted between 2012 and 2021 at a tertiary academic center, lost functional acoustic hearing, and were fit with a CI-alone device. Performance scores were queried from the 1, 3, 6, 12, and 24-month post-activation visits. A linear mixed model evaluated the effects of age at implantation, array length (long vs. mid/short), and preoperative low-frequency hearing (normal to mild, moderate, and moderately severe) on speech recognition with a CI alone. RESULTS: 113 patients met the inclusion criteria. There was a significant main effect of interval (p < 0.001), indicating improved word recognition post-activation despite loss of residual hearing. There were significant main effects of age (p = 0.029) and array length (p = 0.038), with no effect of preoperative low-frequency hearing (p = 0.171). There was a significant 2-way interaction between age and array length (p = 0.018), indicating that older adults with mid/short arrays performed more poorly than younger adults with long lateral wall arrays when functional acoustic hearing was lost. CONCLUSION: CI recipients with preoperative functional low-frequency hearing experience a significant improvement in speech recognition with a CI alone as compared to preoperative performance-despite the loss of low-frequency hearing. Age and electrode array length may play a role in post-activation performance. These data have implications for the preoperative counseling and device selection for hearing preservation candidates. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:1868-1873, 2024.

Surgical Outcomes of Modified Technique for Transcutaneous Bone Conduction Hearing Aid Implantation.

OBJECTIVE: To detail a modified surgical technique for implantation of the Osia 2 Bone Conduction Hearing Aid (BCHA) system and to assess intra- and postoperative outcomes of this technique. METHODS: A retrospective review was performed for cases undergoing implantation of an Osia 2 BCHA at a tertiary academic medical center. Modifications were made to the surgical procedure including: horizontal or curvilinear incisions, placement of the osseointegrated screw slightly superior to the plane of the external auditory canal, and double layer wound closure. Data regarding outcomes including demographics, incision type, surgical time, drilling requirements, and complications were collected using the electronic medical record. RESULTS: A total of twenty-eight cases were evaluated with 57.1% and 42.9% utilizing horizontal and curved incisions, respectively. The median age for recipients was 43.1 years with six pediatric cases included in the study. Median operative time was 58 min (43-126 min). The majority of cases required minimal (60.7%) or no drilling (28.6%) with a significant increase in operative time for those requiring moderate drilling versus minimal to no drilling (F = 8.02, p = 0.002). There were no intraoperative complications. One (3.6%) postoperative seroma occurred which resolved with conservative management. CONCLUSION: The proposed modified surgical technique is a safe and effective method for implantation of the transcutaneous BCHA system with a low complication rate. Keys include incision design, implant placement, and two-layered closure to minimize wound tension. These modifications can improve ease of the procedure and reduce operative time. These techniques also appear to be applicable to the pediatric population. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:2401-2404, 2024.

Incidence of Cochlear Implant Electrode Contacts in the Functional Acoustic Hearing Region and the Influence on Speech Recognition with Electric-Acoustic Stimulation.

OBJECTIVES: To investigate the incidence of electrode contacts within the functional acoustic hearing region in cochlear implant (CI) recipients and to assess its influence on speech recognition for electric-acoustic stimulation (EAS) users. STUDY DESIGN: Retrospective review. SETTING: Tertiary referral center. PATIENTS: One hundred five CI recipients with functional acoustic hearing preservation (≤80 dB HL at 250 Hz). INTERVENTIONS: Cochlear implantation with a 24-, 28-, or 31.5-mm lateral wall electrode array. MAIN OUTCOME MEASURES: Angular insertion depth (AID) of individual contacts was determined from imaging. Unaided acoustic thresholds and AID were used to calculate the proximity of contacts to the functional acoustic hearing region. The association between proximity values and speech recognition in quiet and noise for EAS users at 6 months postactivation was reviewed. RESULTS: Sixty percent of cases had one or more contacts within the functional acoustic hearing region. Proximity was not significantly associated with speech recognition in quiet. Better performance in noise was observed for cases with close correspondence between the most apical contact and the upper edge of residual hearing, with poorer results for increasing proximity values in either the basal or apical direction ( r14 = 0.48, p = 0.043; r18 = -0.41, p = 0.045, respectively). CONCLUSION: There was a high incidence of electrode contacts within the functional acoustic hearing region, which is not accounted for with default mapping procedures. The variability in outcomes across EAS users with default maps may be due in part to electric-on-acoustic interference, electric frequency-to-place mismatch, and/or failure to stimulate regions intermediate between the most apical electrode contact and the functional acoustic hearing region.

Influence of the Frequency-to-Place Function on Recognition with Place-Based Cochlear Implant Maps.

OBJECTIVE: Comparison of acute speech recognition for cochlear implant (CI) alone and electric-acoustic stimulation (EAS) users listening with default maps or place-based maps using either a spiral ganglion (SG) or a new Synchrotron Radiation-Artificial Intelligence (SR-AI) frequency-to-place function. METHODS: Thirteen adult CI-alone or EAS users completed a task of speech recognition at initial device activation with maps that differed in the electric filter frequency assignments. The three map conditions were: (1) maps with the default filter settings (default map), (2) place-based maps with filters aligned to cochlear SG tonotopicity using the SG function (SG place-based map), and (3) place-based maps with filters aligned to cochlear Organ of Corti (OC) tonotopicity using the SR-AI function (SR-AI place-based map). Speech recognition was evaluated using a vowel recognition task. Performance was scored as the percent correct for formant 1 recognition due to the rationale that the maps would deviate the most in the estimated cochlear place frequency for low frequencies. RESULTS: On average, participants had better performance with the OC SR-AI place-based map as compared to the SG place-based map and the default map. A larger performance benefit was observed for EAS users than for CI-alone users. CONCLUSION: These pilot data suggest that EAS and CI-alone users may experience better performance with a patient-centered mapping approach that accounts for the variability in cochlear morphology (OC SR-AI frequency-to-place function) in the individualization of the electric filter frequencies (place-based mapping procedure). LEVEL OF EVIDENCE: 3 Laryngoscope, 133:3540-3547, 2023.

Update on MR Imaging of Soft Tissue Tumors of Head and Neck.

This article reviews soft tissue tumors of the head and neck following the 2020 revision of WHO Classification of Soft Tissue and Bone Tumours. Common soft tissue tumors in the head and neck and tumors are discussed, along with newly added entities to the classification system. Salient clinical and imaging features that may allow for improved diagnostic accuracy or to narrow the imaging differential diagnosis are covered. Advanced imaging techniques are discussed, with a focus on diffusion-weighted and dynamic contrast imaging and their potential to help characterize soft tissue tumors and aid in distinguishing malignant from benign tumors.

Accuracy and patient perceived difficulty of utilizing ototopical antibiotic therapy.

PURPOSE: To examine how patients self-administer ear drops, ascertain their perceived difficulty in performing the task and determine if they are able to deliver the correct dosage. MATERIALS AND METHODS: This is a prospective cohort study performed in an otology outpatient clinic with twenty-one subjects with a condition requiring ototopical antibiotics. The number of ear drops applied as well as skills performed during ear drop application was measured. Patient reported difficulty and confidence in application of ear drops data was also obtained. RESULTS: The mean number of drops applied was 2.91 ± 2.1 (target = 3 drops) with a large variance in drop application, range of 0.6 to 9.2 drops. If "correct dosage" is considered 85-115% of the intended dose, then almost half of patients, 47.6%, underdosed with 23.8% that over dosed. Patients reported that the average difficulty in applying drops to themselves was 3.6 (1 being easy and 10 being difficult). Patients reported a high confidence level in applying the correct dose of ear drops of 6.7 (1 being not confident and 10 being very confident). CONCLUSIONS: In our study of 21 patients self-administering ear drops, only 28.6% of patients were able to correctly apply the appropriate treatment dose, with almost half of patients underdosing. Questionnaire data indicated that most patients were unaware they were administering an incorrect dose. Inaccurate administration of ear drops could be problematic and lead to longer durations of symptoms, false treatment failures, and increased costs.

Hearing Preservation in Pediatric Recipients of Cochlear Implants.

OBJECTIVE: To determine factors that influence low-frequency hearing preservation following pediatric cochlear implantation and compare hearing preservation outcomes between 20 and 24 mm depth lateral wall electrodes. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary academic referral center. PATIENTS: Pediatric cochlear implant recipients (under the age of 18) who presented preoperatively with a low-frequency pure tone average (LFPTA; 125, 250 and 500 Hz) ≤ 70 dB HL. INTERVENTION: Cochlear implantation MAIN OUTCOME MEASURES:: Multiple logistic regression evaluating the influence of variables on change in LFPTA including preoperative low-frequency hearing, lateral wall or perimodiolar electrode, progressive vs stable hearing, side, time from surgery, and the presence or the absence of enlarged vestibular aqueduct. A second analysis reviews the 12-month postactivation hearing preservation of a subset of subjects implanted with modern lateral wall electrodes. RESULTS: A total of 105 subjects were included from the last 10 years for our multiple logistic regression analysis. This demonstrated a significant correlation of poorer preoperative low-frequency hearing with change in LFPTA. A significant negative effect of electrode type, specifically perimodiolar electrodes was also seen. Forty-five subjects from the last 3 years undergoing cochlear implantation with a lateral wall electrode demonstrated an overall 12-month preservation rate (LFPTA < 90 dB) of 82%. Differences in preservation rates existed between different electrodes. CONCLUSION: Preservation of low-frequency hearing following cochlear implantation is predicted both by preoperative low-frequency hearing as well as type of electrode implanted. Consistent low-frequency hearing preservation is possible in pediatric subjects receiving lateral wall electrodes, although differences exist between electrode types.

Sulcus Vocalis (Type III): Prevalence and Strobovideolaryngoscopy Characteristics.

OBJECTIVES: The reported prevalence of sulcus vocalis (SV)/type III, a pathologic groove in the vibratory margin of the vocal fold, varies greatly in the literature. Difficulties in visualizing the defect and a variety of descriptions have complicated the evaluation of SV. The objective of this study was to determine the prevalence of SV by reviewing strobovideolaryngoscopy (SVL) examinations in subjects with and without dysphonia. STUDY DESIGN: Retrospective chart review. METHODS: Charts and SVL images were reviewed for subjects with and without dysphonia and analyzed using standard statistical techniques. RESULTS: SVL images were reviewed for 94 nondysphonia subjects and 100 dysphonia subjects. For all subjects, 19.6% had type I, 2.1% had type II, and 5.7% had type III/SV. Per vocal fold, 14.7% had type I, 1.3% had type II, 3.1% had type III/SV and 13.1% had scar. The prevalence of SV per subject was not significantly different between the two groups (8% of dysphonia subjects, 3.2% of nondysphonia subjects). Male gender, decreased amplitude, decreased waveform, and hypodyamic motion were significantly higher in the dysphonia SV subjects compared with the non-SV subjects. All other SVL characteristics were not significantly different in subjects with SV compared with non-SV subjects. CONCLUSIONS: We report a prevalence of SV/type III at 3.1% (per vocal fold) and 5.7% (per subject). Higher frequencies of male gender and waveform abnormalities were seen in the dysphonia SV subjects only. There were no significant differences in nondysphonia subjects with or without SV.