Understanding the Retention of Vaping Additives in the Lungs: Model Lung Surfactant Membrane Perturbation by Vitamin E and Vitamin E Acetate.

Deviations from the normal physicochemical and functional properties of pulmonary surfactants are associated with the incidence of lung injury and other respiratory disorders. This study aims to evaluate the alteration of the 2D molecular organization and morphology of pulmonary surfactant model membranes by the electronic cigarette additives α-tocopherol (vitamin E) and α-tocopherol acetate (vitamin E acetate), which have been associated with lung injury, termed e-cigarette or vaping-use-associated lung injury (EVALI). The model membranes used contained a 7:3 molar ratio of DPPC (1,2-dipalmitoyl-sn-glycero-3-phosphocholine) and POPG (1-palmitoyl-2-oleoyl-sn-glycero-3-phosphoglycerol) to which α-tocopherol and α-tocopherol acetate were added to form mixtures of up to 20 mol % additive. The properties of the neat tocopherol additives and DPPC/POPG (7:3) mixtures with increasing molar proportions of additive were evaluated by surface pressure-area isotherms, excess area calculations, Brewster angle microscopy, grazing incidence X-ray diffraction, X-ray reflectivity, and atomic force microscopy. The addition of either additive alters the essential phase balance of the model pulmonary surfactant membrane by generating a greater proportion of the fluid phase. Despite this net fluidization, both tocopherol additives have space-filling effects on the liquid-expanded and condensed phases, yielding negative excess areas in the liquid-expanded phase and reduced tilt angles in the condensed phase. Both tocopherol additives alter the stability of the fluid phase, pushing the eventual collapse of this phase to higher surface pressures than the model membrane in the absence of an additive.

Hearing Rehabilitation in Patients With Neurofibromatosis Type 2: The Quebec's Experience With Auditory Implants.

OBJECTIVE: To review a single-center experience with hearing rehabilitation in patients with neurofibromatosis type 2 (NF2) and to describe the auditory outcomes of cochlear implants (CIs) and auditory brainstem implants (ABI) in this population. STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center. PATIENTS: Twelve adult patients with NF2 who received a CI (n = 10) and/or an ABI (n = 5) between 2000 and 2021. INTERVENTIONS: Insertion of a CI and/or an ABI in NF2 patients with bilateral vestibular schwannomas (VSs). MAIN OUTCOME MEASURES: Patients' demographic data, treatment history, hearing evolution, hearing rehabilitation methods, implant details, and auditory outcomes after implantation. RESULTS: Among those who received a CI, five patients had a stable untreated VS, one patient underwent a cochlear nerve preserving surgery, and four patients received radiotherapy treatments. Six patients became regular users of their device. The median open-set sentence recognition scores were as follows: 0.5% preoperatively, 60% at 1 year postoperatively, and 80% on the most recent audiological evaluation. All patients with an ABI were implanted concomitantly with VS surgical excision, and three of them also received radiotherapy treatments. The median open-set sentence recognition scores were as follows: 4% preoperatively, 26% at 1 year postoperatively, and 0% on the most recent evaluation. Three patients became regular ABI users. CONCLUSION: Despite major technological advances, auditory outcomes with ABIs remain deceiving. Considering the overall improvement in postoperative auditory performances provided by CIs compared with ABIs, cochlear implantation standouts as a primary mean of hearing rehabilitation in NF2 patients.

Assessing the pool activity level (PAL) checklist for use with people with hearing and vision loss.

BACKGROUND: The PAL is a career-completed assessment that indexes cognitive functional ability to inform individualised support. As hearing and vision loss are prevalent, we assessed the PAL for potential bias with hearing or vision impairment. METHODS: We collected PAL responses for 333 adults aged over 60 years in the UK, France, Canada, Greece and Cyprus. All participants had normal cognition based on self-reported status and normal range scores on a cognitive screening test. Using a Kruskal-Wallis test, we compared PAL item response distributions for people with assessed hearing or vision loss compared to those with normal sensory function. RESULTS: There were no differences in response distributions between hearing or vision impaired groups versus those with normal sensory function on any PAL item. CONCLUSION: The PAL reliably indexes cognitive functional ability and may be used to inform support tailored to individual cognitive level amongst older adults with prevalent hearing and vision impairments.

Development and validation of the Montreal cognitive assessment for people with hearing impairment (MoCA-H).

BACKGROUND: Hearing impairment is common among older adults and affects cognitive assessments for identification of dementia which rely on good hearing function. We developed and validated a version of the Montreal Cognitive Assessment (MoCA) for people with hearing impairment. METHODS: We adapted existing MoCA 8.1 items for people with hearing impairment by presenting instructions and stimuli in written rather than spoken format. One Attention domain and two Language domain items required substitution by alternative items. Three and four candidate items respectively were constructed and field-tested along with the items adapted to written form. We used a combination of individual item analysis and item substitution to select the set of alternative items to be included in the final form of the MoCA-H in place of the excluded original items. We then evaluated the performance and reliability of the final tool, including making any required adjustments for demographic factors. RESULTS: One hundred and fifty-nine hearing-impaired participants, including 76 with normal cognition and 83 with dementia, completed the adapted version of the MoCA. A further 97 participants with normal hearing completed the standard MoCA as well as the novel items developed for the MoCA-H to assess score equivalence between the existing and alternative MoCA items and for independence from hearing impairment. Twenty-eight participants were retested between 2-4 weeks after initial testing. After the selection of optimal item set, the final MoCA-H had an area under the curve of 0.973 (95% CI 0.952-0.994). At a cut-point of 24 points or less sensitivity and specificity for dementia was 92.8% and 90.8%, respectively. The intraclass correlation for test-retest reliability was 0.92 (95%CI 0.78-0.97). CONCLUSION: The MoCA-H is a sensitive and reliable means of identifying dementia among adults with acquired hearing impairment.

The Correlation of Congenital CMV Infection and the Outcome of Cochlear Implantation.

OBJECTIVES: Cytomegalovirus (CMV) infection is the most common intrauterine viral infection, affecting approximately 0.5-2.5% of all live births in the world. The majority of patients are asymptomatic at birth, but several clinical consequences are related to this infection, including neurosensory hearing loss. The cochlear implant is the treatment of choice when the hearing loss is severe to profound. Compare the audiological evolution after cochlear implant surgery in a group of children born with congenital CMV infection compared to a control group of children born with a genetic cause of congenital hearing loss. Determine prognostic factors predicting the outcome of patients with congenital hearing loss secondary to CMV infection following cochlear implantation. METHODS: Our retrospective study aimed at the analysis of 48 patients with cochlear implants, 25 patients with congenital CMV, and 23 patients in the control group with cochlear cause of hearing loss, who were matched for gender, age of onset, and type of hearing loss. Primary outcomes are auditory evolution with the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and the multimedia audiologic test (MAT). Secondary outcomes are evaluation of prognostic factors for the CMV group, like MRI severity sign, antiviral treatment, and neuropsychological disorder. RESULTS: For the MAT, the results are 73.9% in the CMV group and 81.6% in the control group (P = .03). For the IT-MAIS, the results are 29.3/40 in the CMV group and 29.2/40 in the control group (P = .96). In the CMV group, the children treated with antiviral treatment have IT-MAIS difference of 28.5/40 compared to 23.2/40 for the children without antiviral treatment (P = .03). We found a little trend in the correlation between auditory results and the presence of neuropsychological disorders, but there are no statistically significant results. CONCLUSION: The results of the audiological tests in the CMV group allow an adequate functioning, even if lower than in the control group. There are benefits of implantation in patients with CMV, and audiological results are still satisfactory for proper functioning. CMV patients enjoy superior results in terms of hearing, with antiviral treatment.

A randomized controlled trial to test the efficacy of trans-tympanic injections of a sodium thiosulfate gel to prevent cisplatin-induced ototoxicity in patients with head and neck cancer.

BACKGROUND: Cisplatin-induced hearing loss is frequent and severe. Antioxidants such as sodium thiosulfate (STS) can neutralize the effects of cisplatin. The objective of the trial was to test the efficacy of trans-tympanic injections of a STS gel to prevent cisplatin-induced ototoxicity. METHODS: Eligible participants were newly diagnosed patients with stage III or IV squamous cell carcinoma of the mouth, oropharynx, hypopharynx, or larynx and scheduled to be treated by concurrent chemoradiation (CCR). Patients with asymmetric hearing were not eligible. The planed treatment included cisplatin 100 mg/m2 at days 1, 22 and 43. A baseline pre-treatment complete audiometric evaluation (pure tone at frequencies ranging from 0.5 to 14 kHz, bone conduction at 0.5-4 kHz and DPOAEs) was performed. Adverse effects were noted according to CTCAE. On the day before the beginning of CCR, eligible and consenting patients were randomized to receive a trans-tympanic injection of the gel either in the left ear or in the right ear. A final post-treatment complete audiometric evaluation was scheduled to be performed 1 month after the end of CCR by audiologists kept blind to the ear assignment. For the main outcome, the permanent threshold shift (PTS) in decibel (dB) was calculated as the difference between the final and baseline measures at all pure tone frequencies at 0.5-14 kHz for each patient and for each ear. The main outcome was assessed blindly in a mixed linear model with the PTS as the dependent variable and intervention, frequency, their interaction and radiation dose to the cochlea as independent variables. RESULTS: Between January 2015 and April 2016, 13 patients were randomized. The trial was stopped in June 2016 for poor accrual. The average loss of hearing over all frequencies was 1.3 dB less for treated ears compared to control ears. Although not statistically (p = 0.61) nor clinically significant, the difference was in favor of the treated ears for all frequencies between 3 and 10 kHz. CONCLUSIONS: Our trial suggests that STS deposited on the round window was safe for the middle and inner ears. More work is needed to improve the efficacy of trans-tympanic injections of cisplatin antidotes. TRIAL REGISTRATION: ClinicalTrials.gov, NTC02281006 , Registered 3 November 2014.

Comparative Impacts of Scala Vestibuli Versus Scala Tympani Cochlear Implantation on Auditory Performances and Programming Parameters in Partially Ossified Cochleae.

OBJECTIVE: To compare scala vestibuli versus scala tympani cochlear implantation in terms of postoperative auditory performances and programming parameters in patients with severe scala tympani ossification. STUDY DESIGN: Retrospective case-control study. SETTING: Tertiary referral center. PATIENTS: One hundred three pediatric and adult patients who underwent cochlear implant surgery between 2000 and 2016. Three groups were formed: a scala vestibuli group, a scala tympani with ossification group, and a scala tympani without ossification group. Patients were matched based on their age, sex, duration of deafness, and side of implantation (ratio of 1:2:2). INTERVENTIONS: Postoperative evaluation of auditory performances and programming parameters following intensive functional rehabilitation program completion. MAIN OUTCOME MEASURES: Multimedia adaptive test (MAT), hearing in noise test (HINT SNR +10 dB, HINT SNR +5 dB, and HINT SNR +0 dB), impedances, neural response telemetry thresholds (NRT), neural response imaging thresholds (NRI), comfortable levels (C-levels), and threshold levels (T-levels) were compared between groups. RESULTS: Twenty-one patients underwent scala vestibuli cochlear implantation: 19 adults and two children. Auditory performances were similar between groups, although sentence recognition in a noisy environment was slightly higher in the scala vestibuli group. Impedance values were also higher in the scala vestibuli group, but all other programming parameters were similar between groups. CONCLUSIONS: We present the largest series of patients with scala vestibuli cochlear implantation. This approach provides at least comparable auditory performances without having any deleterious effects on programming parameters. This viable and useful insertion route might be the primary surgical alternative when facing partial cochlear ossification.

Single-sided deaf tactical unit officer treated with cochlear implantation.

OBJECTIVES: To demonstrate the efficacy of cochlear implantation for management of a severe single-sided deaf tactical unit officer. Showing that hearing improvement provided by cochlear implantation was sufficient for him to return to work as a police tactical officer. METHODS: Case report. RESULTS: A 43 years-old man working as a tactical unit officer suffered from a work-related severe single-sided hearing loss. He tried unsuccessfully many types of hearing aids including a contralateral routing of sound (CROS) system and a bone conduction hearing aid with a headband. He was finally treated with cochlear implantation which provided enough localization and hearing abilities for a complete return to work as a tactical unit officer. DISCUSSION: This case report demonstrates that cochlear implantation was very successful for a patient suffering from severe single-sided hearing loss. The current literature demonstrates benefits from cochlear implant over CROS and osseointegrated devices in unilateral hearing loss. Nevertheless, literature does not report any case of patient suffering from single-sided deafness that received a cochlear implant and a complete bilateral hearing rehabilitation that allowed him to return to work as a police tactical officer. CONCLUSION: Cochlear implantation was the only effective treatment to provide our patient enough localization and hearing abilities for a complete return to work as a police tactical officer. As no consensus has been established about selection criteria for cochlear implantation in single-sided deafness, we suggest that the patient's occupation should be considered when reviewing his candidacy for cochlear implantation.

Outcomes review of modern hearing preservation technique in cochlear implant.

INTRODUCTION: Preservation of residual hearing in cochlear implantation is a main concern for patients and otologists. New electrode arrays as well as development of minimally invasive technique have allowed the expansion of indication criteria for cochlear implantation. The loss of residual low-frequency hearing is thought to be the result of many factors. Opinions differ in regards with the electrodes array characteristics, the surgical implantation technique and the pharmacological therapy used. OBJECTIVE: The aim of this research is to analyze the available information pertaining to hearing preservation with cochlear implantation. RESULTS: Both cochleostomy and round window approaches are adequate, but should rely on the anatomic position of the round window membrane. No electrode design had a higher rate of hearing preservation, either a standard or shorter length was used, or a straight or contoured array. The speed of insertion has a significant impact on hearing preservation and vestibular function. A slow insertion should be used for all cochlear implant insertion, hearing preservation or not. However, the optimal speed of insertion is still unclear. Moreover, the use of steroids regardless of the route or the timing, along with intraoperative topical steroids, had a positive impact on hearing preservation. CONCLUSION: Classic atraumatic insertion maneuvers, very slow and delicate insertion and the use of intraoperative corticosteroids improve hearing outcomes. Whichever the surgeon's preferences, all surgical modifications are aimed at the same goal: protection of the delicate intracochlear structures with preservation of residual low-frequency hearing to improve speech perception abilities.

Improving Quality of Life With Nabilone During Radiotherapy Treatments for Head and Neck Cancers: A Randomized Double-Blind Placebo-Controlled Trial.

OBJECTIVES: Patients treated for head and neck carcinomas experience a significant deterioration of their quality of life during treatments because of severe side effects. Nabilone has many properties that could alleviate symptoms caused by radiotherapy and improve patients' quality of life. The aim of the present study was to compare the effects of nabilone versus placebo on the quality of life and side effects during radiotherapy for head and neck carcinomas. METHODS: Fifty-six patients were randomized to nabilone or placebo. Patients filled the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC QLQ-H&N35; three independent questionnaires assessing appetite, nausea, and toxicity; and a visual analog scale for pain. These data were collected before radiotherapy, each week during radiotherapy, and 4 weeks after radiotherapy. Patients were weighed every week. RESULTS: Nabilone did not lengthen the time necessary for a 15% deterioration of quality of life (P = .4279), and it was not better than placebo for relieving symptoms like pain (P = .6048), nausea (P = .7105), loss of appetite (P = .3295), weight (P = .1454), mood (P = .3214), and sleep (P = .4438). CONCLUSION: At the dosage used, nabilone was not potent enough to improve the patients' quality of life over placebo.

Improving audiologic performance with partial insertion of a compressed array despite intracochlear retention of four electrodes during revision cochlear implant surgery: A case report.

OBJECTIVE AND IMPORTANCE: To report a case of partial extraction of the electrode array during revision cochlear implant surgery and to discuss the surgical management of this rare complication. Clinical presentation The safety of revision cochlear implant surgery has long been demonstrated. Only five cases of partial extraction of the electrode array with intracochlear retention have been reported in the literature. In this report, we describe the case of a 12-year-old boy with post-meningitis deafness who suffered this complication. INTERVENTION: Despite intracochlear retention of four electrodes, the surgical team was able to perform partial insertion of a Med-El compressed array: a total of 8 electrodes out of 12 were implanted in the same scala tympani. Five months after the surgery, the patient had access for the first time to open-set speech recognition. He could recognize 77% of open-set sentences in silence compared to 14% after initial implant activation. Seven months after the surgery, the patient was implanted in his contralateral ear with a Med-El Pulsar split array and now benefits from bilateral auditory stimulation. CONCLUSION: Partial insertion of a compressed array represents a viable option when facing incomplete extraction of a cochlear implant electrode array. Indeed, our patient's audiologic performance improved significantly and the results seem to surpass those obtained with partial insertion of a conventional electrode array.

Primary Larynx Cryptococcus neoformans Infection: A Distinctive Clinical Entity.

Cryptococcus neoformans can directly infect the vocal cords. Endoscopic findings were undistinctive from most infiltrative diseases. Tissue biopsy was essential for the diagnosis. Inhaled corticosteroids can predispose to the infection, and fluconazole 400 mg daily for at least 6 weeks appeared to be minimal to achieve a permanent cure.

OCTO "Outcomes of cochlear implant for the octogenarians: audiologic and quality-of-life".

OBJECTIVE: The aim of this study is to assess the impact on quality of life, hearing performance, and surgical complications among patients aged 80 years and older, at the time of cochlear implantation. DESIGN: Retrospective chart review and quality of life assessment. SETTING: Tertiary referral center. PATIENTS: All elderly cochlear implant recipients aged 80 years and older (30 patients), who underwent implantation through the Quebec Cochlear Implant Program. INTERVENTION(S): Postoperative validated quality-of-life questionnaire with clinical and audiologic data extraction using the medical record. MAIN OUTCOME MEASURE(S): The validated "Glasgow Benefit Inventory" questionnaire was used to quantify the impact on quality of life. Audiologic preoperative and postoperative evaluation consisted of speech recognition scores (MAT and HINT scores). Complications were retrospectively collected after each cochlear implantation. RESULTS: A majority of them reported using their cochlear implant almost always with great quality-of-life benefits (increase +37.5 on the GBI). They also experienced a significant improvement in audiologic performance as seen with speech recognition scores (p < 0.0001). There were very few surgical complications, but 4 patients had delayed complications (otalgia, tinnitus, and hyperacusis). CONCLUSION: This is the most extensive study on the impact of quality of life for patients aged 80 years and older who received a cochlear implant. The audiologic benefit in this population is undeniable, and the quality-of-life improvement is comparable to studies made on much younger patients. It is also well-tolerated surgery with relatively low risk but with possible delayed complications. Given all these results, there should be no concerns regarding implantation in well-selected octogenarians.

Stapes surgery in profound hearing loss due to otosclerosis.

OBJECTIVES: This study was designed to determine the effectiveness of stapes surgery in patients with profound hearing loss related to far-advanced otosclerosis and if improvement in hearing is sufficient to avoid the need for cochlear implantation. STUDY DESIGN: Retrospective chart review. METHODS: We retrospectively studied the charts of 16 patients who had stapes surgery in 1 or 2 ears between 2005 and 2010 for far-advanced otosclerosis. These patients were all candidates for a cochlear implant according to our institution's criteria but were offered stapes surgery first. Preoperative and postoperative audiologic data, surgical data, postoperative satisfaction, and telephone use were noted. RESULTS: Sixteen patients were included, 3 of which had had bilateral surgery. Status of the oval window was evaluated at the time of surgery. Sixteen footplates had bipolar otosclerosis, and 3 had obliterative otosclerosis. Average gain in air-conduction threshold pure-tone average was 33 dB (range, 13-52 dB) and average gain in speech perception scores was 54.4% (range, 0%-93%); 94% of the patients were satisfied by the surgery, and 94% were able to use the phone postoperatively. Overall, 87% of the patients had sufficient improvement to no longer be candidates for cochlear implantation. CONCLUSION: Stapes surgery in patients with profound hearing loss due to otosclerosis is safe and can restore enough hearing to make ears aidable and averting the need to consider cochlear implantation. LEVEL OF EVIDENCE: 3, Retrospective series.

Cochlear reimplantations: technical and surgical failures.

CONCLUSION: Cochlear implant surgeons should have a good knowledge of how to diagnose device failures and how to deal with medical complications related to cochlear implantation. Electrode array misplacement may be due to unidentified inner ear malformation. Use of peroperative telemetry and radiographic examination should help to avoid such complications. OBJECTIVES: To review our experience of cochlear implant revision surgery and to compare our series to the literature. To report two cases of electrode array misplacement into the vestibular system and to discuss how to prevent this complication. SUBJECTS AND METHODS: This was a retrospective review of cochlear implant revision surgery in a tertiary reference center. RESULTS: Of 487 cochlear implantations, 3.8% of adults and 4.5% of children underwent a revision surgery. The mean time to device failure was 7.6 years in children and 1.5 year in adults. Causes of revision were seven hard failures, four soft failures, and nine medical reasons. Among the medical reasons, four patients had skin flap infection associated with an extended endaural approach. Audiologic performances were stable or improved following reimplantation in 90% of cases. We had two cases of electrode array misplaced into the vestibular system.

Bat rabies in the United States and Canada from 1950 through 2007: human cases with and without bat contact.

BACKGROUND: Since the 1980s, rare cases of rabies in humans in Canada and the United States have been almost exclusively caused by the bat-variant virus. METHODS: We reviewed indigenously acquired cases of bat-variant rabies in humans in Canada and the United States from 1950 through 2007. RESULTS: Of 61 cases identified, 5 occurred after organ transplantation and were excluded from further analysis. A bite was reported by 22 (39%) of the case patients, 9 (16%) had a direct contact (i.e., were touched by a bat) but no history of a bite, 6 (11%) found bats in their home (2 [4%] in the room where they slept) but reported no direct contact, and 19 (34%) reported no history of bat exposure whatsoever. With the exception of California (8 cases) and Texas (7 cases), no state or province had >3 cases. Of the case patients, 76% were men, and 40% were 10-29 years of age. The median incubation period was 7 weeks (<10 weeks in 72% of cases). The incidence of bat-variant rabies cases increased from 2.2 per billion person-years in 1950-1989 to 6.7 per billion person-years in 1990-2007. Of 36 case patients with bat rabies described since 1990, 16 had no history of direct bat contact; 2 (13%) of the 16 would have qualified for rabies postexposure prophylaxis on the basis of exposure criteria expanded in 1995 to include bats that were in the same room as a sleeping person. The incidence of rabies for this type of exposure was 0.6 cases per billion person-years. CONCLUSION: The true preventable proportion of cases and the number needed to treat with rabies postexposure prophylaxis to prevent 1 case would be useful information to inform the current guidelines.

Cochlear reimplantation: causes of failure, outcomes, and audiologic performance.

OBJECTIVES/HYPOTHESIS: To review Quebec's experience with cochlear reimplantation in adults and children and describe failure rates, causes of revision, surgical findings, and the impact of reimplantation on audiologic performances. STUDY DESIGN: Retrospective analysis of all 45 cochlear implant revision surgeries (43 reimplantations) performed on 16 adults and 25 children at the Centre Hospitalier Universitaire de Québec (Hôtel-Dieu de Québec) in Quebec City, between 1987 and 2005. METHODS: : Data on patient demographics, failure sources including review of manufacturer's investigation reports, surgical findings, and outcomes (electrode insertion, complications, and audiologic performances). RESULTS: Mean length of device use before explantation was 5.5 years and ranged from 3 months to 17 years. Explantation was related to documented hard failure (53.3%), traumatic device failure (13.3%, only in children), extrusion of electrode array or scalp flap infection (13.3%), a decrease in performance or soft failure (11.1%), intratemporal pathology (6.7%), and a perilymphatic fistula (2.2%). Overall revision rates of 8.0% and 5.4% were obtained for children and adults, respectively. Total device failure rates of 6.2% in children and 3.3% in adults were calculated. Failure rates decreased with each new generation of Nucleus devices. Perioperative complications were uncommon. A moderate amount of fibrosis was found in the cochlea lumen, and sometimes osteoneogenesis made the reinsertion challenging. Electrode reinsertion depth was mostly comparable with the initial surgery. Speech perception abilities were maintained after reimplantation. CONCLUSIONS: Management of implant failures, including revision surgeries, is becoming an increasingly important part of cochlear implant program activity. It appears more commonly in children because of trauma. Medical and audiologic outcomes are generally excellent. Revision implantation appears to be a safe and effective procedure.