More than 40 years of cochlear implant research: A bibliometric analysis.

OBJECTIVES: Cochlear implantation is the most effective treatment for patients with severe-to-profound sensorineural hearing loss. Much scientific work has been published since their inception. There is a need for a critical reflection on how and what we publish on cochlear implantation. METHODS: All Science Citation Index Expanded featured articles between 1980 and 2022 with the word 'cochlear implants' or 'cochlear implantation' were collected from the Web of Science database. Separate characteristics, such as the publication dates, the journals, the number of citations, the countries of origin, the authors, the institutions and co-occurring keywords, were assessed. RESULTS: 13,934 articles were included in the data analysis. The journals of of Otology and Neurotology, Ear and Hearing and of Pediatric Otorhinolaryngology represent the top three most publishing journals. Hannover Medical School, the University of Melbourne and the University of Northern Iowa represent the top three most publishing institutions. DISCUSSION: The amount of scientific publications on cochlear implant technology has increased for the last 40 years. Besides the focus on speech perception, the research landscape on cochlear implantation is broad and diverse. The number of countries and institutions contributing to these publications is limited. CONCLUSION: This bibliometric analysis serves as a quantitative overview of the research landscape on cochlear implantation.

Effectiveness of Training: Airway Management of Tracheostomized Pediatric Patients by Pediatric Residents and Anesthesiology Residents.

To evaluate the effect of training on increasing baseline knowledge of pediatrics and anesthesia residents about airway management of pediatric patients with tracheostomy. It is a prospective, descriptive, before and after survey study. A questionnaire was conducted to measure the baseline knowledge of pediatrics and anesthesia residents about airway management in patients with pediatric tracheotomy. The same questionnaire was repeated after the education. Of the 63 participants, 42 were pediatric residents and 21 were anesthesiology residents. While the number of participants who answered the cuff part, inner cannula part, obturator part and balloon part of the tracheostomy tube correctly before the training was 27, 4, 10, and 12, respectively, these numbers increased to 53, 52, 57, and 55 after the training. There was a statistically significant improvement after the training in the correct response of the cuff, inner cannula, obturator, and balloon sections. A statistically significant improvement was observed in the answers received after the training for all 7 questions regarding the clinical scenario of accidental decannulation and tracheostomy bleeding compared to the pre-training. There was a statistical improvement in part where the participants rated themselves. In conclusion, training increases the ability of healthcare professionals to cope with life-threatening complications related to pediatric tracheotomy. A standardized education program on pediatric tracheostomy should be included in the routine programs of associated departments such as emergency medicine, anesthesia, and pediatrics residencies.

Comprehensiveness of online sources for patient education on hereditary hearing impairment.

Introduction: The present study aimed at investigating the readability of online sources on hereditary hearing impairment (HHI). Methods: In August 2022, the search terms "hereditary hearing impairment", "genetic deafness", hereditary hearing loss", and "sensorineural hearing loss of genetic origin" were entered into the Google search engine and educational materials were determined. The first 50 websites were determined for each search. The double hits were removed and websites with only graphics or tables were excluded. Websites were categorized into either a professional society, a clinical practice or a general health information website. The readability tests to evaluate the websites included: Flesch Reading Ease, Flesch-Kincaid grade level, Gunning-Fog Index, Simple Measure of Gobbledygook, Coleman-Liau Index, Automated Readability Index. Results: Twentynine websites were included and categorized as from 4 professional societies, 11 from clinical practices and 14 providing general information. All analyzed websites required higher reading levels than sixth grade. On average 12-16 years of education is required to read and understand the websites focused on HHI. Although general health information websites have better readability, the difference was not statistically significant. Discussion: The readability scores of every type of online educational materials on HHI are above the recommended level indicating that not all patients and parents can comprehend the information they seek for on these websites.

Evaluation of a Less Invasive Cochlear Implant Surgery in OPA1 Mutations Provoking Deafblindness.

Cochlear implantation (CI) for deafblindness may have more impact than for non-syndromic hearing loss. Deafblind patients have a double handicap in a society that is more and more empowered by fast communication. CI is a remedy for deafness, but requires revision surgery every 20 to 25 years, and thus placement should be minimally invasive. Furthermore, failed reimplantation surgery will have more impact on a deafblind person. In this context, we assessed the safety of minimally invasive robotically assisted cochlear implant surgery (RACIS) for the first time in a deafblind patient. Standard pure tone audiometry and speech audiometry were performed in a patient with deafblindness as part of this robotic-assisted CI study before and after surgery. This patient, with an optic atrophy 1 (OPA1) (OMIM#165500) mutation consented to RACIS for the second (contralateral) CI. The applicability and safety of RACIS were evaluated as well as her subjective opinion on her disability. RACIS was uneventful with successful surgical and auditory outcomes in this case of deafblindness due to the OPA1 mutation. RACIS appears to be a safe and beneficial intervention to increase communication skills in the cases of deafblindness due to an OPA1 mutation. The use of RACIS use should be widespread in deafblindness as it minimizes surgical trauma and possible failures.

A Bibliometric Analysis of Publications on Tinnitus: A Study Based on Web of Science Data From 1980 to 2020.

BACKGROUND: The incidence of tinnitus has been increasing together with its patient impact and societal costs. Much research has been conducted in the field of tinnitus, especially on treatment modalities because there still is no cure. This study aims to analyze the evolutions and developments in the scientific output relating to tinnitus. METHODS: We analyzed the Science Citation Index Expanded featured articles in the Web of Science Core Collection relating to tinnitus from 1980 to 2020. The publications were analyzed by characteristics such as the countries and institutions, journals, the most cited articles and references, and the most frequently used words in the abstracts and keywords. RESULTS: In total, 8282 articles relating to tinnitus were identified in the Web of Science. The number of publications has been significantly increasing after the 1990s. Of the 8282 articles, a major part originated from the American and European institutions. Most articles originated from high-impact journals, which consequently also covered the most cited papers. A major interest was seen in areas about treatment and pathogenic mechanisms. CONCLUSION: This bibliometric analysis here indicated an increasing trend in tinnitus research from 1980 to 2020, particularly with the increase in tinnitus burden and the societal costs by it. Specific interest has been seen in the specific tinnitus pathophysiological mechanisms and treatment. Individual researchers and institutions will gain a new perspective on their future studies based on the bibliometric data in our paper.

First Study in Men Evaluating a Surgical Robotic Tool Providing Autonomous Inner Ear Access for Cochlear Implantation.

Image-guided and robot-assisted surgeries have found their applications in skullbase surgery. Technological improvements in terms of accuracy also opened new opportunities for robotically-assisted cochlear implantation surgery (RACIS). The HEARO® robotic system is an otological next-generation surgical robot to assist the surgeon. It first provides software-defined spatial boundaries for orientation and reference information to anatomical structures during otological and neurosurgical procedures. Second, it executes a preplanned drill trajectory through the temporal bone. Here, we report how safe the HEARO procedure can provide an autonomous minimally invasive inner ear access and the efficiency of this access to subsequently insert the electrode array during cochlear implantation. In 22 out of 25 included patients, the surgeon was able to complete the HEARO® procedure. The dedicated planning software (OTOPLAN®) allowed the surgeon to reconstruct a three-dimensional representation of all the relevant anatomical structures, designate the target on the cochlea, i.e., the round window, and plan the safest trajectory to reach it. This trajectory accommodated the safety distance to the critical structures while minimizing the insertion angles. A minimal distance of 0.4 and 0.3 mm was planned to facial nerve and chorda tympani, respectively. Intraoperative cone-beam CT supported safe passage for the 22 HEARO® procedures. The intraoperative accuracy analysis reported the following mean errors: 0.182 mm to target, 0.117 mm to facial nerve, and 0.107 mm to chorda tympani. This study demonstrates that microsurgical robotic technology can be used in different anatomical variations, even including a case of inner ear anomalies, with the geometrically correct keyhole to access to the inner ear. Future perspectives in RACIS may focus on improving intraoperative imaging, automated segmentation and trajectory, robotic insertion with controlled speed, and haptic feedback. This study [Experimental Antwerp robotic research otological surgery (EAR2OS) and Antwerp Robotic cochlear implantation (25 refers to 25 cases) (ARCI25)] was registered at clinicalTrials.gov under identifier NCT03746613 and NCT04102215. Clinical Trial Registration: https://www.clinicaltrials.gov, Identifier: NCT04102215.

Endoscopic Endonasal Removal of Stray Bullets in the Fossa Pterygopalatine in Innocent Young Bystanders of Conflicts in Somalia in a Period of Six Months.

ABSTRACT: In Somalia, which is located in the horn of Africa, a fragile and insecure state structure allowed the strengthening of terrorist groups provoking armed conflicts. Stray bullet injuries can be defined as an accidental bullet wound caused by an anonymous attacker and are usually associated with celebratory gunfire or urban violence. The anatomy of the pterygopalatine fossa (PPF) is complex and penetrating foreign body injuries pose even a greater challenge for the surgeon to operate in this area. Endoscopic approaches facilitate the removal of foreign bodies from the paranasal sinuses, orbital cavity, and aerodigestive system, minimizing potential risks. This study presents a series of removal of stray bullets found in the PPF, as a result of urban violence in Somalia in a period of 6 months. Patient demographics, foreign body origin, treatment modalities, and surgery details were evaluated and assessed. All patients were male and aged 16, 2, and 24 years, respectively. The surgeries were quite straightforward with surgery times recorded as 25, 44, and 22 minutes, respectively. The endoscopic endonasal approach proved to provide safe and sufficient access for removal. Surprisingly, even the foreign body in the PPF of a 2-year-old patient could be removed with an endoscopic endonasal approach and did not require an external approach. The management of foreign body removal in the PPF is challenging due to the potential risks of iatrogenic vascular and nervous tissue injury. The endoscopic endonasal approach for removal proved efficient in 3 cases regardless of age and anatomical dimensions.

A Novel Three-Dimensional Robot Arm Steered Camera for Ear Surgery.

ABSTRACT: Ear surgery requires magnified imaging of anatomical structures from its beginning to achieve safe and successful surgical outcomes. The historical evolution of magnification in otology has developed from monocular to binocular, and to three-dimensional and even to digital in modern times. Current technological advancements pursue high-quality visualization for the best surgical outcomes but also ergonomic for surgeons. Here, we evaluated the usability of such new technology in common otological surgeries like cochlear implantation and stapedectomy for the first time in patients. A three-dimensional camera mounted to a robot arm has hands-free control by goggles worn by the surgeon on a head mount. The camera at a distance of the patients but can also be draped in a sterile way that it forms a barrier tent between patient and surgical personnel in the theatre. The main reason to evaluate the feasibility of this new exoscope was driven by COVID-19 obligate measures for elective surgery such as hearing restoration. This new technology can be considered an important advantage for the surgeons working in microsurgery to perform their elective operations without aerosolization of the drill rinsing water possibly containing contaminated tissue. From a subjective point of view, the image quality is equivalent to conventional microscopes to provide safe otologic surgery.

The Epidemiology and Management of Maxillofacial Fractures at a Tertiary Care Hospital in a Conflict-Torn Region in Somalia.

ABSTRACT: The etiology of maxillofacial fractures (MFFs) varies according to the geographical location and density of the population. This study aimed to analyze the etiology, pattern, and treatment of MFFs. Epidemiological characteristics and treatment modalities of MFFs have never been evaluated in Somalia. The study included 45 patients who were operated on for MFFs at a tertiary care hospital in Somalia (2018-2019). Patient demographics, fracture causes, types, associated non-facial injuries, treatment modalities, and hospitalization-time were evaluated. The most common etiological factors of the MFFs were explosion (24.4%) and assault (24.4%), followed by gunshot (22.2%), sports accident (15.6%), motor vehicle accident (11.1%), and fall from height (2.2%) patients, respectively. The main site of injury was the mandible bone (64.4%) followed by nasal bone, maxilla, zygomatic, and orbital region. The most common non-facial injuries of the MFFs were soft tissue laceration (37.8%) followed by femoral fracture (6.7%), clavicle fracture (4.4%), and femoral fracture with chest injuries (2.2%). The most applied treatment was open reduction microplate +/- intermaxillary fixation (77.8%). Due to the size of the mandible fractures, an iliac autograft (6.7%) was performed. The mean length of the hospital stay was 11.8 ±â€Š8.4 days (range, 1-45 days), and some patients (15.6%) needed intensive care due to severe injuries. This will be the first study aiming to analyze the etiology, pattern, and treatment of MFFs in Somalia. This study deals with the social aspects of Somalia, and it shows that MFFs develop as a result of highly interpersonal violence in a young man.

A New Pathogenic Variant in POU3F4 Causing Deafness Due to an Incomplete Partition of the Cochlea Paved the Way for Innovative Surgery.

Incomplete partition type III (IP-III) is a relatively rare inner ear malformation that has been associated with a POU3F4 gene mutation. The IP-III anomaly is mainly characterized by incomplete separation of the modiolus of the cochlea from the internal auditory canal. We describe a 71-year-old woman with profound sensorineural hearing loss diagnosed with an IP-III of the cochlea that underwent cochlear implantation. Via targeted sequencing with a non-syndromic gene panel, we identified a heterozygous c.934G > C p. (Ala31Pro) pathogenic variant in the POU3F4 gene that has not been reported previously. IP-III of the cochlea is challenging for cochlear implant surgery for two main reasons: liquor cerebrospinalis gusher and electrode misplacement. Surgically, it may be better to opt for a shorter array because it is less likely for misplacement with the electrode in a false route. Secondly, the surgeon has to consider the insertion angles of cochlear access very strictly to avoid misplacement along the inner ear canal. Genetic results in well describes genotype-phenotype correlations are a strong clinical tool and as in this case guided surgical planning and robotic execution.

Global Research on Maxillofacial Fracture Over the Last 40 Years: A Bibliometric Study.

ABSTRACT: Maxillofacial injuries are widely investigated worldwide as it consists a significant portion of trauma patients. Many researchers from various regions have reported the clinical and statistical analyses of maxillofacial fractures (MFFs) as the statistical data of MMFs are of great importance for both effective control and prevention of these cases. The number of studies concerning the diagnosis and treatment modalities of MFFs has significantly increased over the years. The bibliometric method was used to analyze publication outputs, countries, journals, most citations, and trends. In this study, the bibliometric analysis method was used in the publications related to MFFs published between 1980 and 2019, which were Science Citation Index Expanded indexed in the Web of Science database. Bibliometric analysis is applied to evaluate existing data in an evidence-based manner. The highest number of scientific articles on MFFs came from the USA, which was also the most cited country among others. When the distribution of the words in abstracts and titles by years was examined, it was seen that there was a significant change in the words "navigation," "computer," and "technology" between 2009 and 2012. The authors predict that our study would provide a novel perspective to the studies about MFFs and contribute to the researchers about the limits of the topic, and being aware of the active journals that publish the papers on this issue would facilitate the work of the researchers.

Global Research on Hereditary Hearing Impairment Over the Last 40 Years: A Bibliometric Study.

BACKGROUND: Research on hereditary hearing impairment has had several boosts to identify deafness-causing genes. The number of studies regarding the diagnosis and treatment modalities of hereditary hearing impairment is enormous and increasing; however, little or no research has been conducted for evaluating the development of scientific output and trends in the field. Here, we provide a comprehensive overview of centers that focus their research on hereditary hearing impairment and their scientific output. METHODS: Bibliometric analysis of the publications related to hereditary hearing impairment published between 1980 and 2019 were used in this study, which were also indexed in Web of Science database. RESULTS: The highest number of scientific articles on hereditary hearing impairment came from the United States, and it was also the most cited country. The University of Iowa is a leading center in the domain of hereditary hearing impairment in the world over the last 40 years. Fudan University, Central South University, and Harvard Medical School are also institutions that have had a focus on hereditary hearing impairment. CONCLUSIONS: There is a progressive increase in scientific papers on hereditary hearing impairment over the last 40 years that we have found in our bibliometric study. We identified key centers in the scientific research on hereditary hearing impairment in the world and also key journals that focus on hereditary hearing impairment. This information can facilitate new researchers in this field to seek collaboration with experienced partners, better synthesize the orientation and boundaries of the subject, and find target journals. Ultimately, we provided a certain benchmark value for key centers that perhaps should have a more prominent role in constructing experimental research or even clinical guidelines.

A New Pathogenic Variant in the TRIOBP Associated with Profound Deafness Is Remediable with Cochlear Implantation.

BACKGROUND AND OBJECTIVES: A rare type of nonsyndromic autosomal recessive hereditary hearing loss is caused by pathogenic mutations in the TRIOBP gene mostly involving exons 6 and 7. These mutations cause hearing loss originating from dysfunction of sensory inner ear hair cells. Of all the affected siblings, 2 brothers and 1 sister, part of an Afghan family, were referred to our clinic for diagnostic workup and candidacy selection for cochlear implantation (CI). METHODS: Molecular analysis showed a homozygous c.1342C > T p. (Arg448*) pathogenic variant in exon 7 of the TRIOBP gene (reference sequence NM_001039141.2) in all 3 affected siblings. Clinical audiometry demonstrated profound sensorineural hearing loss in all 3 affected siblings (2 males and 1 female), and they were implanted unilaterally. RESULTS: One month after activation, the pure-tone averages with the CI processor were between 30 and 23 dBHL. Ten months after the first activation of the implant, open-set speech audiometry test could be performed for the first time in the 2 younger CI recipients (S5 and S9), and they could identify up to a maximum 77% phonemes correctly. The oldest brother (S12) could not yet perform open-set speech audiometry at that moment. CONCLUSIONS: Implant outcomes are better with normal inner ear anatomy in general. The earlier congenital patients are implanted, the better their outcomes. Here, we demonstrate both statements are true in a homozygous c.1342C > T p. (Arg448*) pathogenic variant in the TRIOBP gene in all 3 affected siblings.