OBJECTIVE:To evaluate whether tympanic membrane findings and audiometric parameters can distinguish otitis media with ANCA-associated vasculitis (OMAAV) from refractory otitis media with effusion (OME). STUDY DESIGN:Retrospective cohort study. SETTING:Tertiary referral center. PATIENTS:Twenty-one patients with OME-type OMAAV limited to otologic symptoms and 9 with refractory OME requiring differentiation from OMAAV. MAIN OUTCOME MEASURES:Tympanic membrane findings were assessed using the scoring system of OMAAV tympanic membrane (SCOT). Pure-tone audiometry was performed using 3-frequency pure-tone averages and frequency-specific thresholds. Receiver operating characteristic (ROC) and logistic regression analyses evaluated diagnostic performance. RESULTS:The total SCOT score was significantly higher in the OME-type OMAAV group than in the OME group (median, 2 vs. 0; P<0.01), particularly for vascular dilatation and posterior wall swelling. Although the 3-frequency pure-tone averages did not differ significantly, frequency-specific analysis revealed significantly elevated air conduction thresholds at 2000 and 8000 Hz and bone conduction thresholds at 250 and 500 Hz in the OMAAV group. The combination of the SCOT total score and the bone conduction threshold at 500 Hz showed promising diagnostic performance (area under the curve, 0.952), with a sensitivity of 100% and a specificity of 88.9%. CONCLUSION:The combined assessment of tympanic membrane findings using the SCOT score and the bone conduction threshold at 500 Hz may provide useful otologic clues that prompt further evaluation for OMAAV, including ANCA testing, in elderly patients with refractory OME.
OBJECTIVE:To evaluate the impact of vestibular rehabilitation (VR) on patient-reported outcome measures in adults with vestibular migraine (VM). DATABASES REVIEWED:Medline, Embase, and Scopus were reviewed from database inception to May 2025. Additional citation searches were performed. METHODS:The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines were used. Primary studies assessing VR in adults with VM diagnosed using ICHD-3 or equivalent criteria were included. The primary outcome was the change in the Dizziness Handicap Inventory (DHI) and the Activity-Specific Balance Confidence Scale (ABC). Mixed-effects modeling was used for the meta-analysis. RESULTS:Seven studies comprising 272 participants were included. All studies demonstrated improvement in DHI following VR, with individual study treatment effects ranging from -10.57 to -44.7 points reduction. Meta-analysis showed a clinically significant pooled DHI reduction of -23.97 (95% CI: -33.31 to -14.62; P<0.0001). Heterogeneity was high (I2=96%), potentially due to patient selection, duration of disease, duration of VR, adjunctive therapies, timing of outcomes assessment, and VR protocol differences. Funnel plot asymmetry suggested small-study effect. Improvements in the ABC were reported but did not meet clinically significant thresholds. CONCLUSION:On the basis of the included studies, VR is associated with clinically meaningful reductions in DHI among VM patients; however, effects on balance may not be clinically significant. Heterogeneity, limited data, as well as moderate and low quality of evidence for the available outcomes, highlight the importance of future large prospective studies with standardized VR protocols and outcomes.
Objective: To examine changes in datalogging statistics in adult cochlear implant (CI) users during their first post-CI year and evaluate their association with cochlear implant quality of life-35 (CIQOL-35) scores. Study design: Retrospective longitudinal cohort study. Setting: Tertiary medical center. Patients: 104 adult CI users with bilateral hearing loss. Main outcome measures: Hours of device use per day (h/d), percentage of use in various listening environments (quiet, noise, speech, music), and pre-/post-CI CIQOL-35 Profile scores were recorded at 1-, 3-, 6-, and 12-months postactivation. Data were assessed using linear mixed-effects models. Results: Daily hours of CI use increased significantly from 1-month ( 11.2±3.3 h/d) to 3-months ( 11.8±3.2 h/d) postactivation, then plateaued from 3-months to 12-months ( 11.8±3.6 h/d) postactivation. Between 1 and 12 months, the percentage of time spent in Quiet increased (42% vs. 46%, P <0.001), while time spent in speech (31% vs. 28%, P =0.007) and Noise (20% vs. 18%, P =0.025) declined. Device use (h/d) was positively associated with CIQOL-35 scores ( P <0.01). Increased percentage of time in noise was associated with poorer communication, emotional, environment, and social CIQOL-35 scores ( P <0.01). Increased Music percentage was associated with higher Entertainment scores ( P <0.05). Conclusions: Patients increasingly use their CI during the first 3 months postactivation and spend less time listening to speech and noise over the first 12 months. Associations between listening environments and certain CIQOL domains demonstrate that listening patterns and functional abilities might influence each other. Determining causality in future studies may enable more individualized counseling on device use for an improved early CI experience.
OBJECTIVE:The objective was to examine the time-adjusted risk of explantation of bone-anchored hearing devices following wound complications after primary implantation. STUDY DESIGN:Retrospective cohort study at a tertiary care neurotology center. PATIENTS:Adults 18 years or older with primary bone-anchored hearing implants from 2003 to 2025, with available audiogram and medical history. Excluded were patients with incomplete data, prior implantations, or immediate postoperative loss to follow-up. OUTCOMES:The primary outcome was the incidence of device explantation following early (<60 days) or recurrent (>3 episodes) wound complications. The Cox proportional hazards framework with time-dependent modeling was applied for analysis. RESULTS:A total of 1090 surgical ears (666 female, 61.1%; 8 bilateral) underwent primary device implantation, with 127 (11.7%) undergoing explantation; median follow-up was 4.40 years (IQR: 1.66-7.98 y). Patients who underwent explantation were more likely to experience early (HR: 2.30; 95% CI: 1.53-3.45; P<0.001) and frequent (HR: 5.29; 95% CI: 3.62-7.72; P<0.001) wound complications. The cumulative incidence of device explantation at 10 years among patients with frequent wound complications was 60.6% (95% CI: 45.5%-71.5%), compared with 15.6% (95% CI: 11.9%-19.9%) among patients without such complications. After adjustment, frequent wound complications remained significantly associated with the device removal (aHR: 4.60; 95% CI: 2.82-7.51; P<0.001). CONCLUSIONS:Recurrent wound complications are associated with nearly a fivefold increase in hazard for device explantation, supporting the need for risk stratification, monitoring, and earlier intervention.
OBJECTIVE:To evaluate trends in cochlear implant (CI) utilization, provider participation, billing distribution, and inflation-adjusted Medicare part B professional payment following the 2019 FDA and 2022 Medicare eligibility expansions. STUDY DESIGN:Retrospective interrupted time-series analysis using national Medicare fee-for-service claims. SETTING:US Medicare part B fee-for-service claims. PATIENTS:Medicare fee-for-service beneficiaries receiving CI services identified by CPT 69930 from 2012 to 2024; provider and state identifiers were used for distributional analyses. INTERVENTIONS:None; policy exposure analysis only. MAIN OUTCOME MEASURES:Inflation-adjusted Medicare part B professional payment per service, total part B professional payments, procedure volume, provider counts, mean provider volume, billing-state service distribution, reimbursement ratios, and descriptive comparator trends for hypoglossal nerve stimulation (HGNS). RESULTS:Inflation-adjusted Medicare part B professional payment per CI service did not increase significantly after 2019; segmented regression showed a nonsignificant trend toward slope decline (-$172.2/year; P=0.08), while reimbursement ratios remained largely stable. Procedure volume increased to 5918 services in 2024, with total Medicare payments rising to approximately $21 to 22 million without a proportional per service increase. Billing-state mapping demonstrated broader post-2019 service distribution, with more states recording CI services, while mean provider volume remained relatively stable despite growth in the number of unique providers. HGNS, presented descriptively, showed contemporaneous increases in reimbursement and utilization. CONCLUSIONS:Regulatory and coverage expansions were associated with broader billing distribution and increased utilization without sustained growth in inflation-adjusted payment per service. These findings suggest that eligibility expansion alone may not address the broader institutional, geographic, and reimbursement factors that shape scalable CI delivery. LEVEL OF EVIDENCE:Retrospective observational claims analysis; not classifiable within traditional clinical evidence hierarchies.
Objective: To develop a haptic software tool for creating digital twin models for virtual or physical interaction based on cone beam (CB) computed tomography (CT) temporal bone imaging and to evaluate the quality of resulting 3D-printed models. Background: Temporal bone surgery involves drilling near critical structures with anatomic variation. Patient-specific models for rehearsal and surgical planning might be clinically valuable but require processing of clinical imaging data into accurate “digital twins”. This processing remains a major obstacle to widespread clinical adoption. Methods: This technical proof-of-concept study utilized clinical CBCT of a cadaver head. The imaging data were processed using the VES-tool, a custom-developed visualization engine that uses haptic interaction for guided processing with tools for segmentation of anatomical structures, hole patching, and cleaning. Resulting digital twins were 3D-printed for mastoidectomy by 2 surgeons. The models were evaluated with the Mowry questionnaire by primary surgeons and, using video-based assessment, by 5 additional experts. Results: The VES-tool was iteratively developed to guide processing into digital twin models with features supporting interactive segmentation. The resulting 3D-printed models were rated at 48 and 50 points by the 2 primary surgeons, respectively, exceeding the established 40-point cutoff for educational benefit. Video-based panelists rated models lower (average 31.8 points), although 3 of 5 scored the models above the modified 30-point cutoff for video-based rating. Conclusions: VES-tool effectively converts clinical imaging into high-quality digital twins rated as highly useful for surgical practice. This pipeline facilitates patient-specific surgical rehearsal and the creation of diverse anatomic libraries for otosurgical training.
Objective: To examine the association of habitual sniffing with mastoid cell development and contralateral ear abnormalities in acquired pars flaccida cholesteatoma. Study design: Retrospective comparative study. Setting: Two tertiary referral hospitals. Patients: A total of 124 adults (133 ears) underwent primary surgery for acquired pars flaccida cholesteatoma between 2012 and 2026. Intervention(s): Primary cholesteatoma surgery. Main outcome measure(s): Mastoid cell development score classified according to the Japan Otological Society criteria and abnormal contralateral ear findings. Results: Habitual sniffing was identified in 67 of 133 ears (50.4%). The sniffing group had higher MC scores than the non-sniffing group, indicating better mastoid cell development (1.48±0.68 vs. 1.17±0.67; effect size r =0.222; P =0.010). Ordinal logistic regression showed that habitual sniffing was independently associated with better mastoid cell development [odds ratio (OR)=2.35; 95% confidence interval (CI), 1.15-4.87; P =0.020]. Among 110 ears with evaluable contralateral endoscopic findings, contralateral abnormalities were more frequent in the sniffing group than in the nonsniffing group (71.4% vs. 35.2%; OR=4.536; P =0.0002). Binary logistic regression showed that habitual sniffing was independently associated with abnormal contralateral ear findings (OR=4.57; 95% CI, 1.94-11.34; P =0.0007). Conclusions: Habitual sniffing was associated with better mastoid cell development and frequent contralateral ear abnormalities in acquired pars flaccida cholesteatoma, suggesting a distinct pathophysiologic subgroup related to dynamic negative pressure loading.
Cholesteatoma is an abnormal accumulation of keratinizing squamous epithelium within the middle ear that can behave in a locally destructive manner and erode the ossicular chain. Chronic inflammation and Eustachian tube dysfunction is thought to drive this process. We present a temporal bone specimen from a 38-year-old woman with a lifelong history of right-sided otorrhea and conductive hearing loss, who died of hypoxic-ischemic brain injury after cardiac arrest. Histologic examination revealed a cholesteatoma eroding the incus, with marked regional variation in perimatrix inflammation ranging from mild fibrosis to dense inflammatory infiltration with neovascularization. Notably, areas of more severe inflammation corresponded to a thicker, hyperplastic epithelial matrix, illustrating within a single specimen the spatial link between the inflammatory microenvironment and epithelial proliferation proposed to underlie cholesteatoma progression and local tissue destruction.
OBJECTIVE:To evaluate the audiological efficacy, patient-reported outcomes, and safety of an active middle ear implant (AMEI) in children and adults with distinct coupling options. STUDY DESIGN:Prospective, longitudinal, multicenter, noninterventional observational study with repeated within-subject measures and a 12-month follow-up. SETTING:Nine tertiary referral centers in Germany, Austria, and Poland. PATIENTS:Adults and children with sensorineural, conductive, or mixed hearing loss. Adults were grouped by coupling method: incus long process (LP), incus short process (SP), round window (RW), or stapes head (SH); multiple couplers were used in children. INTERVENTION:AMEI with coupler. MAIN OUTCOME MEASURES:The primary outcome was the difference in speech recognition thresholds for 50% speech recognition (SRT50) in quiet between unaided preoperative and aided 12-month postactivation. Secondary outcomes included SRT50 in noise, sound-field thresholds, patient-reported outcomes, air- and bone-conduction thresholds, and adverse events. RESULTS:Audiological outcomes were evaluated in 67 patients. SRT50 in quiet significantly improved across all subgroups, with large effect sizes (Cohen dz>0.8): 17.9±9.3 dB (LP), 18.3±8.4 dB (SP), 25.3±6.3 dB (RW), 23.1±17.6 dB (SH), and 21.6±9.4 dB in children. SRT50 in noise improved by 4.3 to 9.2 dB, and functional gains ranged from 18.3 to 39.2 dB. Patients reported positive impacts on quality of life and perceived quality of hearing. Two device explantations and 2 revision surgeries occurred. Exploratory analyses showed no statistically detectable differences between coupling approaches. CONCLUSION:AMEI use was associated with significant audiological and patient‑reported improvements in adults and children. Within the limitations of this observational study, including limited power and baseline heterogeneity, no statistically detectable differences in outcomes were observed between coupling approaches. Coupler selection should therefore remain guided by anatomic and clinical considerations.
INTRODUCTION:The Vibrant Soundbridge (VSB) has been used to rehabilitate hearing loss for more than 2 decades in patients who are unable to benefit from hearing aids. Despite their long-term use, long-term outcome data remain limited. The first Symphonix Vibrant Soundbridge implantation in the UK was performed at the Queen Elizabeth Hospital Birmingham in 1997, placing this center in a unique position to evaluate long-term results. METHODS:A retrospective review of all patients who underwent VSB implantation between 1997 and 2002 at the Queen Elizabeth Hospital was conducted. Institutional approval was obtained (CARMS-22238). RESULTS:Fourteen patients were implanted for sensorineural hearing loss between 1997 and 2002 with a mean follow-up of 25 years. Two were early nonusers due to explantation following infection and employment challenges. There were 2 revision surgeries for FMT refixation and zero cases of incus necrosis. Three patients were lost to follow-up (n=2) or deceased (n=1) with a mean 10.3 years of use. Average use of the remaining 9 users was 17.7 years. A single device failure occurred at 5 years, equating to one failure over 170 usage-years. At the latest follow-up (range: 9 to 26 y post-op), there was a mean 18.4 dB reduction in unaided cochlear thresholds and 9 patients became eligible for cochlear implantation. CONCLUSIONS:The data indicate that audiometric benefit from the VSB can be sustained over the longer term in patients whose cochlear thresholds remain within eligibility criteria. Device nonuse was mainly due to reduced cochlear reserve over time, while device failure appears to be rare.
OBJECTIVES:To synthesize evidence on attrition across the adult cochlear implant care pathway by identifying (1) stages at which adults disengage or experience delay and (2) patient-, provider-, and system-level factors associated with attrition at each stage. DATA SOURCES:PubMed/MEDLINE, Scopus, CINAHL, and the Cochrane Library. METHODS:A scoping review was conducted in accordance with PRISMA-ScR guidelines. Databases were searched from inception to August 2025, with an update in January 2026. Empirical studies reporting disengagement, delay, or nonprogression at any stage of the adult cochlear implant care pathway were included. Findings were synthesized using a pathway-based framework to map attrition across stages of care. RESULTS:Seventeen studies met the inclusion criteria. Attrition was reported across multiple stages of the adult cochlear implant care pathway, with evidence concentrated at prereferral (n=3), referral-to-assessment (n=4), and postassessment and presurgical stages (n=10). No study examined surgery-to-device activation as a discrete attrition stage, and evidence relating to postactivation follow-up was limited. Early attrition was commonly linked to under-referral, limited candidacy awareness, and socioeconomic barriers, whereas later stages reflected logistical constraints, decisional uncertainty, perceived benefit, and cumulative care burden. Attrition definitions varied substantially across studies, limiting direct cross-study comparison. CONCLUSIONS:This review reframes cochlear implant underutilization as a cumulative, pathway-based phenomenon rather than a single patient decision. Conceptualizing nonprogression across discrete stages provides a structured framework for understanding where and why disengagement occurs and may inform stage-specific strategies to improve access to and progression through cochlear implant services.
OBJECTIVE:Identify common characteristics in patients who had hearing improvement after cerebellopontine angle (CPA) meningioma resection. PATIENTS:Adult patients who underwent hearing-preservation-intent CPA meningioma resection. INTERVENTIONS:Data collected included patient, tumor, and surgical factors. Surgical approaches were retrosigmoid, combined petrosal, or anterior petrosectomy. MAIN OUTCOME MEASURES:Preoperative and postoperative word recognition scores (WRS), pure-tone average (PTA), and AAO-HNS hearing classification. RESULTS:Fifteen female patients (mean age: 52.5±14.4 y) underwent resection of CPA meningiomas (mean CPA dimension: 3.2±1.6 cm). Facial nerve function (House-Brackmann grade I or II) was preserved in all cases. Six of 10 (60%) of patients with serviceable preop hearing had hearing preserved, and 3 patients (20%) demonstrated improvement in AAO-HNS hearing class. These patients had preoperative WRS ranging from 0% to 32% and PTA from 32.5 to 42.5 dB. Tumors were inframeatal, retromeatal, or intracanalicular, with gross total resection in 2 cases. Median AAO-HNS hearing class improved from D to B, and mean WRS increased from 21.3% to 80.3% (P=0.01). Patients with hearing improvement had a worse mean preoperative WRS than patients without improvement (21.3% vs. 80%, P<0.01). No other single variable-including tumor CPA and IAC dimensions, location, surgical approach, extent of resection, age, or PTA-was predictive of hearing improvement. CONCLUSIONS:Hearing improvement was observed in a subset of CPA meningioma patients, particularly those with disproportionately poor WRS relative to PTA. These patients may benefit from a hearing-preservation surgical strategy.
OBJECTIVE:To quantify superior semicircular canal (SSC) roof thickness using ultra-high-resolution photon-counting detector CT (PCD-CT) and to evaluate its cross-sectional association with age and sex. STUDY DESIGN:Retrospective cross-sectional study. SETTING:Tertiary referral center. PATIENTS:576 ears from 288 consecutive patients (mean age 42.7±27.3 y; range 0-89; 154 males, 134 females) undergoing clinically indicated temporal bone PCD-CT. MAIN OUTCOME MEASURE:Minimal SSC roof thickness on Pöschl-plane reconstructions (0.2 mm slice thickness), with intrarater and inter-rater reliability assessed. RESULTS:Reliability was excellent (intrarater ICC 0.966; inter-rater ICC 0.939). A linear mixed-effects model in the full cohort revealed a significant age × sex interaction (B=0.004, P=0.016): females showed no cross-sectional age-related change (B=0.000 mm/year), while males showed a small positive association (B=0.004 mm/year; ∼0.04 mm/decade). In a prespecified pediatric subgroup (<20 years; 84 patients), males showed significant cross-sectional thickening (+0.031 mm/year, P=0.001) and a similar trend in females (+0.020 mm/year), and females had thicker SSC roofs than males (0.88 vs. 0.70 mm at 7.7 years; P=0.039). The interaction was nonsignificant within both the pediatric (P=0.431) and adult (P=0.204) subgroups separately, indicating that the full-cohort interaction likely reflects the developmental phase difference between childhood and adulthood. CONCLUSIONS:SSC roof thickness does not decrease with age during adulthood, while active cross-sectional thickening occurs during childhood, suggesting that bony coverage is largely established during the first two decades of life. Adult-onset SSCDS likely reflects the interaction between congenitally thin coverage and secondary factors-intracranial pressure dynamics, mechanical events, and biomechanical changes-rather than progressive resorption.
HYPOTHESIS:The goal of this research is to gain deeper insight into the Eustachian tube mechanics using sheep cadaver to improve clinical management of ET diseases. BACKGROUND:Sheep are widely used to study the mechanics of the ET. However, the anatomic suitability of using sheep to study the human ET is poorly characterized. The aim of this study is to measure ET opening in cadaveric sheep specimens to understand its mechanics and compare the sheep ET anatomy to the human anatomy. METHODS:Five fresh-frozen sheep cadavers were used to study the ET mechanics. Using an in situ testing approach coupled with a µCT X-ray scanner, a muscle group was incrementally loaded. Results were compared with an unloaded human cadaver specimen to assess translatability. RESULTS:In all five sheep specimens, a gradual ET opening occurred upon loading the soft palate muscle group, but complete opening was not achieved. Comparison revealed significant structural differences between sheep and human cadaver anatomy, including ET orientation, relative position to surrounding bone structures, and muscle group angles. CONCLUSION:The developed method allowed to accurately track the ET opening in sheep. There were significant differences between human and sheep, which questions the suitability of using sheep to study the ET. As a result, future use of sheep to study the human ET has considerable limitations.
BACKGROUND:Bilateral vestibulopathy (BVP) causes chronic postural instability refractory to treatments, leading to a reduced quality of life and increased risk of falls. However, the severity of postural instability varies considerably among individuals with BVP. OBJECTIVE:This study aimed to identify clinical factors associated with postural instability in patients with BVP. METHODS:Fifty-two patients with BVP (26 males, 26 females; mean age: 57.0±15.5 y) were enrolled. Associations between postural stability assessed by center of pressure (COP) velocity during posturography (4 conditions: eyes open, eyes closed, eyes open with foam rubber, and eyes closed with foam rubber) and clinical parameters were examined using the Spearman rank correlation. Extent of vestibular dysfunction was quantified as the number of abnormal vestibular end organs assessed by the video head impulse test and vestibular evoked myogenic potentials. Multiple regression analyses were performed to identify factors associated with COP velocity, including extent of vestibular dysfunction, Dizziness Handicap Inventory (DHI), and Hospital Anxiety and Depression Scale (HADS) scores. RESULTS:Correlation analyses of COP velocity measured under the 4 posturography conditions revealed significant positive correlations with age and the number of abnormal vestibular function tests. In contrast, no significant correlations were observed with illness duration, caloric test results, DHI, or HADS. Multiple regression analyses demonstrated that the number of abnormal vestibular function tests was the only factor significantly associated with COP velocity across all 4 posturography conditions. CONCLUSIONS:In patients with BVP, postural instability is positively correlated with the number of abnormal vestibular end organs. Conversely, demographic factors (age, sex), subjective level of disability (DHI score), and psychological status (HADS score) are weakly, if at all, correlated with postural instability.
OBJECTIVE:To evaluate the longitudinal association between tinnitus burden and domain-specific cochlear implant-related quality of life in adult cochlear implant recipients. STUDY DESIGN:Retrospective chart review. SETTING:Single academic tertiary-care center. PATIENTS:One hundred eighty-one adult cochlear implant recipients (aged 19-91 y; mean 61.4±17.5). INTERVENTIONS:Quality of life questionnaires. MAIN OUTCOME MEASURES:Tinnitus Handicap Inventory (THI) and Cochlear Implant Quality of Life instruments (CIQOL-35 Profile and CIQOL-10 Global) were assessed preoperatively and at 6 and 12 months postoperatively. RESULTS:Following implantation, tinnitus severity decreased and CI-specific quality of life improved across all CIQOL domains by 6 months and remained stable at 12 months. In adjusted linear mixed-effects models (n=128), greater persistent tinnitus burden was independently associated with poorer CI-specific quality of life across multiple domains, including Emotional, Social, Entertainment, Communication, Listening Effort, and Global Functioning. The strongest association was observed in the Emotional domain (β=-2.17 per 10-point increase in THI). These findings remained directionally consistent in sensitivity analyses adjusting for baseline clinical characteristics and postoperative speech performance. CONCLUSIONS:Cochlear implantation improves both tinnitus severity and cochlear implant-specific quality of life. However, persistent tinnitus burden remains independently associated with poorer patient-reported outcomes across multiple domains, particularly in emotional functioning.
HYPOTHESIS:This study aimed to evaluate the effectiveness of a less invasive drug delivery device, the pyro-drive jet injector-intratympanic (PJI-IT), as an alternative to the conventional intratympanic injection (ITI). BACKGROUND:Conventional ITI using fine needles can cause damage to the tympanic membrane and hearing loss. A safer, less invasive delivery platform would be valuable for the local treatment of inner-ear disorders. METHODS:Lipid nanoparticles (LNPs) containing firefly luciferase (Fluc) mRNA were injected into the middle ears of male guinea pigs (n=30) using the needle-free PJI-IT, which created a small, temporary perforation of the tympanic membrane through a high-pressure liquid jet. Conventional fine [30-gauge (30G)] needle injection was used as control. Perforation size and closure time were measured microscopically. Bioluminescence imaging was performed to evaluate Fluc protein production. Auditory brainstem responses (ABRs) were recorded before and after the injection to assess auditory function. RESULTS:The PJI-IT and the 30G needle provided comparable amounts of Fluc protein in the tympanic cavity and cochlea. Compared with the conventional needle, the PJI-IT caused a smaller perforation of the tympanic membrane, which was closed faster. Auditory function was virtually preserved after injection using the PJI-IT, whereas injection using the conventional fine needle induced significant ABR threshold elevations. CONCLUSIONS:The PJI-IT has the potential to be a safe and minimally invasive instrument for intratympanic injections. The preserved auditory function and rapid healing of the perforated tympanic membrane suggest its clinical availability, especially for the repeated administration of biological agents such as mRNA regenerative medicine.
OBJECTIVE:To apply a semiautomatic method for quantifying cochlear nerve cross-sectional area (CSA) based on 3D models from MRI picture and to evaluate the association between CSA at different nerve locations and postoperative speech perception in cochlear implant (CI) users. STUDY DESIGN:Retrospective cohort study. SETTING:University Medical Center, tertiary academic referral center. PATIENTS:Twenty adult patients with asymmetric hearing loss undergoing a MED-EL cochlear implant (Synchrony 2, FLEX electrode series; MED-EL, Innsbruck, Austria) between 2020 and 2024. INTERVENTION:Preoperative MRI images were used for manual segmentation for the cochlear nerve (CN) and facial nerve (FN) followed by 3D reconstruction. CSA of the CN (ACN) and FN (AFN) was automatically quantified along the entire nerve course. Postoperative speech perception was assessed using word recognition scores (WRS) at the first fitting. MAIN OUTCOME MEASURES:Semiautomatic CSA measurements showed excellent agreement with manual measurements (RANC=0.95±0.06). CSA near the cochlear aperture exhibited the strongest correlation with postoperative speech perception. Peak correlation for polysyllabic tests at approximately 10% of the normalized nerve length (Rmax=0.74) and for monosyllabic tests at approximately 24% (Rmax=0.56). CONCLUSION:This study establishes a reliable semiautomatic method for cochlear nerve CSA quantification and identifies the nerve region near the cochlear aperture as a promising imaging biomarker for predicting postoperative speech outcomes in CI patients.
OBJECTIVE:To evaluate the feasibility and safety of active MRI surveillance as an alternative to immediate surgical re-exploration in patients with small, asymptomatic postoperative cholesteatoma recurrence. STUDY DESIGN:Prospective single-arm pilot study. SETTING:Secondary referral otology center. PATIENTS:Patients with prior cholesteatoma surgery demonstrating postoperative recurrence ≤5 mm on non-echo-planar diffusion-weighted MRI without otologic symptoms, suspicious findings on otoscopy for cholesteatoma, or radiologic proximity to critical structures. INTERVENTION:Structured active surveillance with serial non-echo-planar diffusion-weighted MRI scans at 12- to 18-month intervals. MAIN OUTCOME MEASURES:Surgery-free survival (SFS) is defined as the time from baseline MRI demonstrating recurrence to surgical intervention. The secondary outcome included the annual lesion growth rate. RESULTS:Thirteen patients were included in the longitudinal analysis with a mean follow-up of 43±17 months. Ten patients (77%) remained surgery-free throughout the surveillance. Three patients (23%) required surgical intervention due to lesion enlargement or symptom development. The mean lesion growth rate was 0.32±1.0 mm/year. Three patients (23%) demonstrated spontaneous radiologic regression during follow-up. Kaplan-Meier analysis demonstrated cumulative SFS of 100% at 24 months and 91% (95% CI: 74-100) at 36 months. CONCLUSIONS:In selected patients with small, asymptomatic postoperative cholesteatoma recurrence, active MRI surveillance may safely defer surgical re-exploration. These findings support further prospective evaluation of imaging-guided surveillance strategies for the management of MRI-detected recurrence.
Hypothesis: Electrical stimulation of the external ear mediates cardiovascular changes in anesthetized rats. Background: Auricular vagus nerve stimulation (aVNS) has been proposed as a noninvasive treatment for cardiovascular disease. Stimulation is typically achieved via electrodes placed on the external ear, but the exact mechanisms by which aVNS induces cardiovascular changes remains unclear. In particular, the relative contributions of sympathetic and parasympathetic pathways have not been well elucidated. In this study, we use a rodent model to determine the hemodynamic effects of stimulating two auricular regions and assess the autonomic pathways mediating these responses. Methods: Bipolar transcutaneous electrical stimulation was applied to the external ear of adult Sprague-Dawley rats. Cardiovascular parameters including mean arterial pressure (MAP), photoplethysmography (PPG), and cardiac electrical activity were recorded. Cervical vagotomies and hexamethonium sympathetic blockade were performed to assess the parasympathetic and sympathetic contributions to evoked cardiovascular responses. Results: Electrical stimulation at the concha resulted in significant changes in MAP and PPG. MAP changes were larger with stimulation in the concha compared with the anterior pinna. MAP responses increased in a dose-dependent manner with increasing current amplitude. Bilateral vagotomy resulted in persistent but decreased evoked cardiovascular responses. Complete autonomic blockade using intravenous hexamethonium resulted in the absence of any evoked cardiovascular responses with aVNS. Conclusion: Cardiovascular changes from aVNS are mediated by modulation of both parasympathetic and sympathetic activity.
