Speech-in-Noise Assessment in the Routine Audiologic Test Battery: Relationship to Perceived Auditory Disability.

OBJECTIVES: Self-assessment of perceived communication difficulty has been used in clinical and research practices for decades. Such questionnaires routinely assess the perceived ability of an individual to understand speech, particularly in background noise. Despite the emphasis on perceived performance in noise, speech recognition in routine audiologic practice is measured by word recognition in quiet (WRQ). Moreover, surprisingly little data exist that compare speech understanding in noise (SIN) abilities to perceived communication difficulty. Here, we address these issues by examining audiometric thresholds, WRQ scores, QuickSIN signal to noise ratio (SNR) loss, and perceived auditory disability as measured by the five questions on the Speech Spatial Questionnaire-12 (SSQ12) devoted to speech understanding (SSQ12-Speech5). DESIGN: We examined data from 1633 patients who underwent audiometric assessment at the Stanford Ear Institute. All individuals completed the SSQ12 questionnaire, pure-tone audiometry, and speech assessment consisting of ear-specific WRQ, and ear-specific QuickSIN. Only individuals with hearing threshold asymmetries ≤10 dB HL in their high-frequency pure-tone average (HFPTA) were included. Our primary objectives were to (1) examine the relationship between audiometric variables and the SSQ12-Speech5 scores, (2) determine the amount of variance in the SSQ12-Speech5 scores which could be predicted from audiometric variables, and (3) predict which patients were likely to report greater perceived auditory disability according to the SSQ12-Speech5. RESULTS: Performance on the SSQ12-Speech5 indicated greater perceived auditory disability with more severe degrees of hearing loss and greater QuickSIN SNR loss. Degree of hearing loss and QuickSIN SNR loss were found to account for modest but significant variance in SSQ12-Speech5 scores after accounting for age. In contrast, WRQ scores did not significantly contribute to the predictive power of the model. Degree of hearing loss and QuickSIN SNR loss were also found to have moderate diagnostic accuracy for determining which patients were likely to report SSQ12-Speech5 scores indicating greater perceived auditory disability. CONCLUSIONS: Taken together, these data indicate that audiometric factors including degree of hearing loss (i.e., HFPTA) and QuickSIN SNR loss are predictive of SSQ12-Speech5 scores, though notable variance remains unaccounted for after considering these factors. HFPTA and QuickSIN SNR loss-but not WRQ scores-accounted for a significant amount of variance in SSQ12-Speech5 scores and were largely effective at predicting which patients are likely to report greater perceived auditory disability on the SSQ12-Speech5. This provides further evidence for the notion that speech-in-noise measures have greater clinical utility than WRQ in most instances as they relate more closely to measures of perceived auditory disability.

Sporadic vestibular schwannoma in a pediatric population: a case series.

PURPOSE: To describe the characteristics, management, and outcomes of pediatric patients with sporadic vestibular schwannoma (sVS). METHODS: This was a case series at a tertiary care center. Patients were identified through a research repository and chart review. Interventions were microsurgery, stereotactic radiosurgery (SRS), and observation. Outcome measures were tumor control, facial nerve function, and hearing. RESULTS: Eight patients over 2006-2022 fulfilled inclusion criteria (unilateral VS without genetic or clinical evidence of neurofibromatosis type 2 (NF2); age ≤ 21) with a mean age of 17 years (14-20). Average greatest tumor length in the internal auditory canal was 9.7 mm (4.0-16.1). Average greatest tumor dimension (4/8 tumors) in the cerebellopontine angle was 19.1 mm (11.3-26.8). Primary treatment was microsurgery in five (62.5%) patients, observation in two (25%), and SRS in one (12.5%). Four (80%) surgical patients had gross total resections, and one (20%) had regrowth post-near total resection and underwent SRS. One observed patient and the primary SRS patient have remained radiographically stable for 3.5 and 7 years, respectively. The other observed patient required surgery for tumor growth after 12 months of observation. Two surgical patients had poor facial nerve outcomes. All post-procedural patients developed anacusis. Mean follow-up was 3 years (0.5-7). CONCLUSIONS: We describe one of the largest reported cohorts of pediatric sVS in the USA. Diligent exclusion of NF2 is critical. Given the high likelihood of eventually requiring intervention and known adverse effects of SRS, microsurgery remains the preferred treatment. However, observation can be considered in select situations.

Evaluation of Asymmetries in Speech-in Noise Abilities in Audiologic Screening for Vestibular Schwannoma.

OBJECTIVES: Measures of speech-in-noise, such as the QuickSIN, are increasingly common tests of speech perception in audiologic practice. However, the effect of vestibular schwannoma (VS) on speech-in-noise abilities is unclear. Here, we compare the predictive ability of interaural QuickSIN asymmetry for detecting VS against other measures of audiologic asymmetry. METHODS: A retrospective review of patients in our institution who received QuickSIN testing in addition to a regular audiologic battery between September 2015 and February 2019 was conducted. Records for patients with radiographically confirmed, unilateral, pretreatment VSs were identified. The remaining records excluding conductive pathologies were used as controls. The predictive abilities of various measures of audiologic asymmetry to detect VS were statistically compared. RESULTS: Our search yielded 73 unique VS patients and 2423 controls. Receiver operating characteristic curve analysis showed that QuickSIN asymmetry was more sensitive and specific than pure-tone average asymmetry and word-recognition-in-quiet asymmetry for detecting VS. Multiple logistic regression analysis revealed that QuickSIN asymmetry was more predictive of VS (odds ratio [OR] = 1.23, 95% confidence interval [CI] [1.10, 1.38], p < 0.001) than pure-tone average asymmetry (OR = 1.04, 95% CI [1.00, 1.07], p = 0.025) and word-recognition-in-quiet asymmetry (OR = 1.03, 95% CI [0.99, 1.06], p = 0.064). CONCLUSION: Between-ear asymmetries in the QuickSIN appear to be more efficient than traditional measures of audiologic asymmetry for identifying patients with VS. These results suggest that speech-in noise testing could be integrated into clinical practice without hindering the ability to identify retrocochlear pathology.

Comprehensive measures of sound exposures in cinemas using smart phones.

OBJECTIVES: Sensorineural hearing loss from sound overexposure has a considerable prevalence. Identification of sound hazards is crucial, as prevention, due to a lack of definitive therapies, is the sole alternative to hearing aids. One subjectively loud, yet little studied, potential sound hazard is movie theaters. This study uses smart phones to evaluate their applicability as a widely available, validated sound pressure level (SPL) meter. Therefore, this study measures sound levels in movie theaters to determine whether sound levels exceed safe occupational noise exposure limits and whether sound levels in movie theaters differ as a function of movie, movie theater, presentation time, and seat location within the theater. DESIGN: Six smart phones with an SPL meter software application were calibrated with a precision SPL meter and validated as an SPL meter. Additionally, three different smart phone generations were measured in comparison to an integrating SPL meter. Two different movies, an action movie and a children's movie, were measured six times each in 10 different venues (n = 117). To maximize representativeness, movies were selected focusing on large release productions with probable high attendance. Movie theaters were selected in the San Francisco, CA, area based on whether they screened both chosen movies and to represent the largest variety of theater proprietors. Measurements were analyzed in regard to differences between theaters, location within the theater, movie, as well as presentation time and day as indirect indicator of film attendance. RESULTS: The smart phone measurements demonstrated high accuracy and reliability. Overall, sound levels in movie theaters do not exceed safe exposure limits by occupational standards. Sound levels vary significantly across theaters and demonstrated statistically significant higher sound levels and exposures in the action movie compared to the children's movie. Sound levels decrease with distance from the screen. However, no influence on time of day or day of the week as indirect indicator of film attendance could be found. CONCLUSIONS: Calibrated smart phones with an appropriate software application as used in this study can be utilized as a validated SPL meter. Because of the wide availability, smart phones in combination with the software application can provide high quantity recreational sound exposure measurements, which can facilitate the identification of potential noise hazards. Sound levels in movie theaters decrease with distance to the screen, but do not exceed safe occupational noise exposure limits. Additionally, there are significant differences in sound levels across movie theaters and movies, but not in presentation time.

Glomangiopericytoma Presenting as a Middle Ear Mass.

We describe an unusual case of glomangiopericytoma presenting as a mass filling the middle ear, enveloping the ossicles, and extending into the mastoid antrum without bony destruction. Management involved three surgeries and stereotactic radiosurgery, which achieved short-term local control with no evidence of disease on MRI imaging 12 months after radiation. Facial nerve function and hearing were preserved. This is the first report to our knowledge of a glomangiopericytoma presenting as a primary temporal bone lesion. Treatment with surgery and stereotactic radiosurgery for residual or recurrent disease is a reasonable approach to achieve local control and functional preservation. Laryngoscope, 134:1426-1430, 2024.

Deep Learning Method for Rapid Simultaneous Multistructure Temporal Bone Segmentation.

OBJECTIVE: To develop and validate a deep learning algorithm for the automated segmentation of key temporal bone structures from clinical computed tomography (CT) data sets. STUDY DESIGN: Cross-sectional study. SETTING: A total of 325 CT scans from a clinical database. METHOD: A state-of-the-art deep learning (DL) algorithm (SwinUNETR) was used to train a prediction model for rapid segmentation of 9 key temporal bone structures in a data set of 325 clinical CTs. The data set was manually annotated by a specialist to serve as the ground truth. The data set was randomly split into training (n = 260) and testing (n = 65) sets. The model's performance was objectively assessed through external validation on the test set using metrics including Dice, Balanced accuracy, Hausdorff distances, and processing time. RESULTS: The model achieved an average Dice coefficient of 0.87 for all structures, an average balanced accuracy of 0.94, an average Hausdorff distance of 0.79 mm, and an average processing time of 9.1 seconds per CT. CONCLUSION: The present DL model for the automated simultaneous segmentation of multiple structures within the temporal bone from CTs achieved high accuracy according to currently commonly employed objective analysis. The results demonstrate the potential of the method to improve preoperative evaluation and intraoperative guidance in otologic surgery.

Estimation of Cochlear Implant Insertion Depth Using 2D-3D Registration of Postoperative X-Ray and Preoperative CT Images.

OBJECTIVE: To improve estimation of cochlear implant (CI) insertion depth in postoperative skull x-rays using synthesized information from preoperative CT scans. STUDY DESIGN: Retrospective cohort. SETTING: Tertiary referral center. PATIENTS: Ten adult cochlear implant recipients with preoperative and postoperative temporal bone computed tomography (CT)scans and postoperative skull x-ray imaging. INTERVENTIONS: Postoperative x-rays and digitally reconstructed radiographs (DRR) from preoperative CTs were registered using 3D Slicer and MATLAB to enhance localization of the round window and modiolus. Angular insertion depth (AID) was estimated in unmodified and registration-enhanced x-rays and DRRs in the cochlear view. Linear insertion depth (LID) was estimated in registered images by two methods that localized the proximal CI electrode or segmented the cochlea. Ground truth assessments were made in postoperative CTs. MAIN OUTCOME MEASURES: Errors of insertion depth estimates were calculated relative to ground truth measurements and compared with paired t t ests. Pearson correlation coefficient was used to assess inter-rater reliability of two reviewer's measurements of AID in unmodified x-rays. RESULTS: In postoperative x-rays, AID estimation errors were similar with and without registration enhancement (-1.3 ± 20.7° and -4.8 ± 24.9°, respectively; mean ± SD; p = 0.6). AID estimation in unmodified x-rays demonstrated strong interrater agreement (ρ = 0.79, p < 0.05) and interrater differences (-15.0 ± 35.3°) comparable to estimate errors. Registering images allowed measurement of AID in the cochlear view with estimation errors of 14.6 ± 30.6° and measurement of LID, with estimate errors that were similar between proximal electrode localization and cochlear segmentation methods (-0.9 ± 2.2 mm and -2.1 ± 2.7 mm, respectively; p = 0.3). CONCLUSIONS: 2D-3D image registration allows measurement of AID in the cochlear view and LID using postoperative x-rays and preoperative CT imaging. The use of this technique may reduce the need for postimplantation CT studies to assess these metrics of CI electrode position. Further work is needed to improve the accuracy of AID assessment in the postoperative x-ray view with registered images compared with established methods.

Virtual Reality Simulation for the Middle Cranial Fossa Approach: A Validation Study.

BACKGROUND AND OBJECTIVES: Virtual reality (VR) surgical rehearsal is an educational tool that exists in a safe environment. Validation is necessary to establish the educational value of this platform. The middle cranial fossa (MCF) is ideal for simulation because trainees have limited exposure to this approach and it has considerable complication risk. Our objectives were to assess the face, content, and construct validities of an MCF VR simulation, as well as the change in performance across serial simulations. METHODS: Using high-resolution volumetric data sets of human cadavers, the authors generated a high-fidelity visual and haptic rendering of the MCF approach using CardinalSim software. Trainees from Neurosurgery and Otolaryngology-Head and Neck Surgery at two Canadian academic centers performed MCF dissections on this VR platform. Randomization was used to assess the effect of enhanced VR interaction. Likert scales were used to assess the face and content validities. Performance metrics and pre- and postsimulation test scores were evaluated. Construct validity was evaluated by examining the effect of the training level on simulation performance. RESULTS: Twenty trainees were enrolled. Face and content validities were achieved in all domains. Construct validity, however, was not demonstrated. Postsimulation test scores were significantly higher than presimulation test scores ( P < .001 ). Trainees demonstrated statistically significant improvement in the time to complete dissections ( P < .001 ), internal auditory canal skeletonization ( P < .001 ), completeness of the anterior petrosectomy ( P < .001 ), and reduced number of injuries to critical structures ( P = .001 ). CONCLUSION: This MCF VR simulation created using CardinalSim demonstrated face and content validities. Construct validity was not established because no trainee included in the study had previous MCF approach experience, which further emphasizes the importance of simulation. When used as a formative educational adjunct in both Neurosurgery and Otolaryngology-Head and Neck Surgery, this simulation has the potential to enhance understanding of the complex anatomic relationships of critical neurovascular structures.

Single-cell transcriptomic atlas reveals increased regeneration in diseased human inner ear balance organs.

Mammalian inner ear hair cell loss leads to permanent hearing and balance dysfunction. In contrast to the cochlea, vestibular hair cells of the murine utricle have some regenerative capacity. Whether human utricular hair cells regenerate in vivo remains unknown. Here we procured live, mature utricles from organ donors and vestibular schwannoma patients, and present a validated single-cell transcriptomic atlas at unprecedented resolution. We describe markers of 13 sensory and non-sensory cell types, with partial overlap and correlation between transcriptomes of human and mouse hair cells and supporting cells. We further uncover transcriptomes unique to hair cell precursors, which are unexpectedly 14-fold more abundant in vestibular schwannoma utricles, demonstrating the existence of ongoing regeneration in humans. Lastly, supporting cell-to-hair cell trajectory analysis revealed 5 distinct patterns of dynamic gene expression and associated pathways, including Wnt and IGF-1 signaling. Our dataset constitutes a foundational resource, accessible via a web-based interface, serving to advance knowledge of the normal and diseased human inner ear.

The effect of haptic degrees of freedom on task performance in virtual surgical environments.

Force and touch feedback, or haptics, can play a significant role in the realism of virtual reality surgical simulation. While it is accepted that simulators providing haptic feedback often outperform those that do not, little is known about the degree of haptic fidelity required to achieve simulation objectives. This article evaluates the effect that employing haptic rendering with different degrees of freedom (DOF) has on task performance in a virtual environment. Results show that 6-DOF haptic rendering significantly improves task performance over 3-DOF haptic rendering, even if computed torques are not displayed to the user. No significant difference could be observed between under-actuated (force only) and fully-actuated 6-DOF feedback in two surgically-motivated tasks.

Signal to noise ratio quantifies the contribution of spectral channels to classification of human head and neck tissues ex vivo using deep learning and multispectral imaging.

Significance: Accurate identification of tissues is critical for performing safe surgery. Combining multispectral imaging (MSI) with deep learning is a promising approach to increasing tissue discrimination and classification. Evaluating the contributions of spectral channels to tissue discrimination is important for improving MSI systems. Aim: Develop a metric to quantify the contributions of individual spectral channels to tissue classification in MSI. Approach: MSI was integrated into a digital operating microscope with three sensors and seven illuminants. Two convolutional neural network (CNN) models were trained to classify 11 head and neck tissue types using white light (RGB) or MSI images. The signal to noise ratio (SNR) of spectral channels was compared with the impact of channels on tissue classification performance as determined using CNN visualization methods. Results: Overall tissue classification accuracy was higher with use of MSI images compared with RGB images, both for classification of all 11 tissue types and binary classification of nerve and parotid ( p < 0.001 ). Removing spectral channels with SNR > 20 reduced tissue classification accuracy. Conclusions: The spectral channel SNR is a useful metric for both understanding CNN tissue classification and quantifying the contributions of different spectral channels in an MSI system.

Automated Radiomic Analysis of Vestibular Schwannomas and Inner Ears Using Contrast-Enhanced T1-Weighted and T2-Weighted Magnetic Resonance Imaging Sequences and Artificial Intelligence.

OBJECTIVE: To objectively evaluate vestibular schwannomas (VSs) and their spatial relationships with the ipsilateral inner ear (IE) in magnetic resonance imaging (MRI) using deep learning. STUDY DESIGN: Cross-sectional study. PATIENTS: A total of 490 adults with VS, high-resolution MRI scans, and no previous neurotologic surgery. INTERVENTIONS: MRI studies of VS patients were split into training (390 patients) and test (100 patients) sets. A three-dimensional convolutional neural network model was trained to segment VS and IE structures using contrast-enhanced T1-weighted and T2-weighted sequences, respectively. Manual segmentations were used as ground truths. Model performance was evaluated on the test set and on an external set of 100 VS patients from a public data set (Vestibular-Schwannoma-SEG). MAIN OUTCOME MEASURES: Dice score, relative volume error, average symmetric surface distance, 95th-percentile Hausdorff distance, and centroid locations. RESULTS: Dice scores for VS and IE volume segmentations were 0.91 and 0.90, respectively. On the public data set, the model segmented VS tumors with a Dice score of 0.89 ± 0.06 (mean ± standard deviation), relative volume error of 9.8 ± 9.6%, average symmetric surface distance of 0.31 ± 0.22 mm, and 95th-percentile Hausdorff distance of 1.26 ± 0.76 mm. Predicted VS segmentations overlapped with ground truth segmentations in all test subjects. Mean errors of predicted VS volume, VS centroid location, and IE centroid location were 0.05 cm 3 , 0.52 mm, and 0.85 mm, respectively. CONCLUSIONS: A deep learning system can segment VS and IE structures in high-resolution MRI scans with excellent accuracy. This technology offers promise to improve the clinical workflow for assessing VS radiomics and enhance the management of VS patients.

Remote Intraoperative Neural Response Telemetry: Technique and Results in Cochlear Implant Surgery.

OBJECTIVE: Present results with remote intraoperative neural response telemetry (NRT) during cochlear implantation (CI) and its usefulness in overcoming the inefficiency of in person NRT. STUDY DESIGN: Case series. SETTING: Tertiary academic otology practice. PATIENTS: All patients undergoing primary or revision CI, both adult and pediatric, were enrolled. INTERVENTIONS: Remote intraoperative NRT performed by audiologists using a desktop computer to control a laptop in the operating room. Testing was performed over the hospital network using commercially available software. A single system was used to test all three FDA-approved manufacturers' devices. MAIN OUTCOME MEASURES: Success rate and time savings of remote NRT. RESULTS: Out of 254 procedures, 252 (99.2%) underwent successful remote NRT. In two procedures (0.7%), remote testing was unsuccessful, and required in-person testing to address technical issues.Both failed attempts were due to hardware failure (OR laptop or headpiece problems). There was no relation between success of the procedure and patient/surgical factors such as difficult anatomy, or the approach used for inner ear access. The audiologist time saved using this approach was considerable when compared with in-person testing. CONCLUSIONS: Remote intraoperative NRT testing during cochlear implantation can be performed effectively using standard hardware and remote-control software. Especially important during the Covid-19 pandemic, such a procedure can reduce in-person contacts, and limit the number of individuals in the operating room. Remote testing can provide additional flexibility and efficiency in audiologist schedules.

Fully Automated Measurement of Cochlear Duct Length From Clinical Temporal Bone Computed Tomography.

OBJECTIVES/HYPOTHESIS: To present and validate a novel fully automated method to measure cochlear dimensions, including cochlear duct length (CDL). STUDY DESIGN: Cross-sectional study. METHODS: The computational method combined 1) a deep learning (DL) algorithm to segment the cochlea and otic capsule and 2) geometric analysis to measure anti-modiolar distances from the round window to the apex. The algorithm was trained using 165 manually segmented clinical computed tomography (CT). A Testing group of 159 CTs were then measured for cochlear diameter and width (A- and B-values) and CDL using the automated system and compared against manual measurements. The results were also compared with existing approaches and historical data. In addition, pre- and post-implantation scans from 27 cochlear implant recipients were studied to compare predicted versus actual array insertion depth. RESULTS: Measurements were successfully obtained in 98.1% of scans. The mean CDL to 900° was 35.52 mm (SD, 2.06; range, [30.91-40.50]), the mean A-value was 8.88 mm (0.47; [7.67-10.49]), and mean B-value was 6.38 mm (0.42; [5.16-7.38]). The R2 fit of the automated to manual measurements was 0.87 for A-value, 0.70 for B-value, and 0.71 for CDL. For anti-modiolar arrays, the distance between the imaged and predicted array tip location was 0.57 mm (1.25; [0.13-5.28]). CONCLUSION: Our method provides a fully automated means of cochlear analysis from clinical CTs. The distribution of CDL, dimensions, and cochlear quadrant lengths is similar to those from historical data. This approach requires no radiographic experience and is free from user-related variation. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:449-458, 2022.

Influence of electrode to cochlear duct length ratio on post-operative speech understanding outcomes.

OBJECTIVE: To assess whether the pre-operative electrode to cochlear duct length ratio (ECDLR), is associated with post-operative speech recognition outcomes. STUDY DESIGN: A retrospective chart review study. SETTING: Tertiary referral center. PATIENTS: The study included sixty-one adult CI recipients with a pre-operative computed tomography scan and a speech recognition test 12 months after implantation. INTERVENTIONS: The average of two raters' cochlear duct length (CDL) measurements and the length of the recipient's cochlear implant electrode array formed the basis for the electrode-to-cochlear duct length ratio (ECLDR). Speech recognition tests were compared as a function of ECDLR and electrode array length itself. MAIN OUTCOME MEASURES: The relationship between ECDLR and percent correct on speech recognition tests. RESULTS: A second order polynomial regression relating ECDLR to percent correct on the CNC words speech recognition test was statistically significant, as was a fourth order polynomial regression for the AzBio Quiet test. In contrast, there was no statistically significant relationship between speech recognition scores and electrode array length. CONCLUSIONS: ECDLR values can be statistically associated to speech-recognition outcomes. However, these ECDLR values cannot be predicted by the electrode length alone, and must include a measure of CDL.

High-Fidelity Virtual Reality Simulation for the Middle Cranial Fossa Approach-Modules for Surgical Rehearsal and Education.

BACKGROUND: Virtual reality simulation has gained prominence as a valuable surgical rehearsal and education tool in neurosurgery. Approaches to the internal auditory canal, cerebellopontine angle, and ventral brainstem region using the middle cranial fossa are not well explored by simulation. OBJECTIVE: We hope to contribute to this paucity in simulation tools devoted to the lateral skull base, specifically the middle cranial fossa approach. METHODS: Eight high-resolution microcomputed tomography scans of human cadavers were used as volumetric data sets to construct a high-fidelity visual and haptic rendering of the middle cranial fossa using CardinalSim software. Critical neurovascular structures related to this region of the skull base were segmented and incorporated into the modules. RESULTS: The virtual models illustrate the 3-dimensional anatomic relationships of neurovascular structures in the middle cranial fossa and allow a realistic interactive drilling environment. This is facilitated by the ability to render bone opaque or transparent to reveal the proximity to critical anatomy allowing for practice of the virtual dissection in a graduated fashion. CONCLUSION: We have developed a virtual library of middle cranial fossa approach models, which integrate relevant neurovascular structures with aims to improve surgical training and education. A ready extension is the potential for patient-specific application and pathology.

Outcomes in Patients Meeting Cochlear Implant Criteria in Noise but Not in Quiet.

OBJECTIVE: Evaluate outcomes in cochlear implant (CI) recipients qualifying in AzBio noise but not quiet, and identify factors associated with postimplantation improvement. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary otology/neurotology clinic. PATIENTS: This study included 212 implanted ears. The noise group comprised 23 ears with preoperative AzBio more than or equal to 40% in quiet and less than or equal to 40% in +10 signal-to-noise ratio (SNR). The quiet group included 189 ears with preoperative AzBio less than 40% in quiet. The two groups displayed similar demographics and device characteristics. INTERVENTIONS: Cochlear implantation. MAIN OUTCOME MEASURES: AzBio in quiet and noise. RESULTS: Mean AzBio quiet scores improved in both the quiet group (pre-implant: 12.7%, postimplant: 67.2%, p < 0.001) and noise group (pre-implant: 61.6%, postimplant: 73.8%, p = 0.04). Mean AzBio +10 SNR also improved in the quiet group (pre-implant: 15.8%, postimplant: 59.3%, p = 0.001) and noise group (pre-implant: 30.5%, postimplant: 49.1%, p = 0.01). However, compared with the quiet group, fewer ears in the noise group achieved within-subject improvement in AzBio quiet (≥15% improvement; quiet group: 90.3%, noise group: 43.8%, p < 0.001) and AzBio +10 SNR (quiet group: 100.0%, noise group: 45.5%, p < 0.001). Baseline AzBio quiet (p < 0.001) and Consonant-Nucleus-Consonant (CNC) scores (p = 0.004) were associated with within-subject improvement in AzBio quiet and displayed a higher area under the curve than either aided or unaided pure-tone average (PTA) (both p = 0.01). CONCLUSIONS: CI patients qualifying in noise display significant mean benefit in speech recognition scores but are less likely to benefit compared with those qualifying in quiet. Patients with lower baseline AzBio quiet scores are more likely to display postimplant improvement.

A virtual surgical environment for rehearsal of tympanomastoidectomy.

This article presents a virtual surgical environment whose purpose is to assist the surgeon in preparation for individual cases. The system constructs interactive anatomical models from patient-specific, multi-modal preoperative image data, and incorporates new methods for visually and haptically rendering the volumetric data. Evaluation of the system's ability to replicate temporal bone dissections for tympanomastoidectomy, using intraoperative video of the same patients as guides, showed strong correlations between virtual and intraoperative anatomy. The result is a portable and cost-effective tool that may prove highly beneficial for the purposes of surgical planning and rehearsal.

Multispectral Imaging for Automated Tissue Identification of Normal Human Surgical Specimens.

OBJECTIVE: Safe surgery requires the accurate discrimination of tissue intraoperatively. We assess the feasibility of using multispectral imaging and deep learning to enhance surgical vision by automated identification of normal human head and neck tissues. STUDY DESIGN: Construction and feasibility testing of novel multispectral imaging system for surgery. SETTING: Academic university hospital. SUBJECTS AND METHODS: Multispectral images of fresh-preserved human cadaveric tissues were captured with our adapted digital operating microscope. Eleven tissue types were sampled, each sequentially exposed to 6 lighting conditions. Two convolutional neural network machine learning models were developed to classify tissues based on multispectral and white-light color images (ARRInet-M and ARRInet-W, respectively). Blinded otolaryngology residents were asked to identify tissue specimens from white-light color images, and their performance was compared with that of the ARRInet models. RESULTS: A novel multispectral imaging system was developed with minimal adaptation to an existing digital operating microscope. With 81.8% accuracy in tissue identification of full-size images, the multispectral ARRInet-M classifier outperformed the white-light-only ARRInet-W model (45.5%) and surgical residents (69.7%). Challenges with discrimination occurred with parotid vs fat and blood vessels vs nerve. CONCLUSIONS: A deep learning model using multispectral imaging outperformed a similar model and surgical residents using traditional white-light imaging at the task of classifying normal human head and neck tissue ex vivo. These results suggest that multispectral imaging can enhance surgical vision and augment surgeons' ability to identify tissues during a procedure.

Mastoid Obliteration Using Autologous Bone Dust Following Canal Wall Down Mastoidectomy.

OBJECTIVE: To describe a technique for mastoid obliteration following canal wall down (CWD) mastoidectomy for chronic otitis media with cholesteatoma, and review its early results in producing a dry, safe ear, and a small mastoid cavity. STUDY DESIGN: Retrospective review. SETTING: Tertiary referral center. PATIENTS: Forty-three consecutive CWD procedures using bone dust obliteration for chronic otitis media. INTERVENTION: All patients underwent CWD mastoidectomy and, if indicated, concurrent tympanoplasty and ossicular chain reconstruction. Bone dust harvested from healthy mastoid cortex was used to obliterate selected portions of the tympanomastoid defect. Temporalis fascia and/or an inferiorly-based periosteal flap were used for coverage of the bone dust. MAIN OUTCOME MEASURES: Postoperative infection, need for mastoid bowl cleaning, incidence of recurrent cholesteatoma, need for revision surgical intervention. RESULTS: At mean follow-up of 29 months, 95% of ears have remained dry and safe since mastoid obliteration, with a lack of symptoms and no evidence of recurrent disease. Cholesteatoma recurrence rate was 5%. Postoperative otorrhea, while rare, was managed successfully with topical medication in all affected patients. Clinical, radiographic, and surgical appearance of grafted bone dust suggests good take with long-term viability. CONCLUSIONS: The described technique used for mastoid obliteration using autologous bone dust and cartilage is simple, effective, and safe to reduce the size of the mastoid cavity in patients undergoing CWD mastoidectomy. It might help to reduce morbidity by improving the surgeon's control over mastoid bowl size and shape.