Importance: Manual cochlear implant (CI) electrode insertion remains surgeon-dependent and may contribute to intracochlear trauma. Robotic-assisted systems, such as the new Otoarm-Otodrive, offer motorized control at ultra-slow speeds that aim to minimize force fluctuations and pressure changes, potentially improving hearing preservation and surgical consistency. Objective: To describe the institutional experience, surgical workflow integration, and feasibility of robot-assisted cochlear implantation (CI) using the Otoarm-Otodrive system. Design: Retrospective descriptive study of 50 consecutive robot-assisted CI cases. Setting: Tertiary referral otology center in Canada. Participants: Fifty Adult patients undergoing cochlear implantation without cochlear malformation or ossification using a MED-EL device from January to October 2025. Intervention: Robot-assisted cochlear electrode array insertion using the Otoarm-Otodrive (MED-EL) system. Main Outcome Measures: Feasibility (setup and insertion times), insertion depth, intraoperative challenges, and integration into operative workflow. Results: The additional time for robot setup and alignment averaged 374 seconds. Mean electrode insertion duration, performed at a standardized rate of 0.1 mm/second, was 444 seconds. Postoperative Otoplan analysis in 30 cases demonstrated a mean angular insertion depth of 575°. No major complications such as facial nerve palsy or infections, and no device-related complications occurred. All but 1 case achieved full insertion. Conclusions: Robot-assisted cochlear electrode insertion using the Otoarm-Otodrive system is safe, reproducible, and easily integrated into standard CI workflow. Relevance: This first North American experience in using the Otoarm-Otodrive system demonstrates the feasibility of robotic cochlear implant insertion as a step toward achieving atraumatic implantation. Future studies will assess hearing preservation benefits and cost-effectiveness for broader adoption.
In this article, we look at the approval process for medical devices in Canada, and how the Medical Device Single Audit Program (MDSAP) has made it unfeasible for small manufactures to enter the Canadian market. Specifically, we explore how MDSAP has been a barrier in Canada for the entry of hypoglossal nerve stimulators (HGNS), a proven technology with a strong track record in other markets for the treatment of obstructive sleep apnea. This is ultimately preventing Canadian patients access to life-saving medical devices. We hope this commentary will shed light on this barrier and prompt Health Canada to explore other avenues for the approval of medical devices as is the case in other developed countries.
Importance: Evidence regarding the diagnosis of patulous Eustachian tube (PET) remains a challenge. This study employed compliance-over-time (COT) testing with different breathing patterns to reflect tympanic membrane (TM) “respiration” and its oscillatory movement, which is beneficial for the development of diagnostics of PET. Objective: To summarize the clinical characteristics of patients with PET and to assess the diagnostic efficiency of COT testing under single breathing patterns and the COT protocol. Design: Retrospective observational study. Setting: Clinical audiology center in a tertiary-care hospital, December 2018 to October 2024. Participants: One hundred thirty-eight PET patients (189 ears) and 102 healthy controls (204 ears). Exposures: Data were collected on clinical symptoms, pure-tone audiometry, tympanometry, otoscopy, and COT testing. Main Outcome Measures: Positivity rates of otoscopic, COT under the protocol, and COTs under single breathing patterns were compared. Agreements between COT under the protocol and COTs under single breathing patterns were examined. Results: Clinical characteristics of PET included autophony (86.8%), fullness (82.0%), aerophony (91.0%), and symptomatic alleviation after posture changing (76.2%) or sniffing (66.1%). Respiratory fluctuation of the TM was observed in 55.0% of PET ears. 96.3% of PET ears had a positive response in the COT protocol. Among COTs under different breathing tasks, COT under ipsilateral nostril deep breathing exhibited the highest diagnostic accuracy, closely mirroring the sensitivity and specificity of the COT protocol. Conclusion: The COT protocol is a practical and reliable test with high sensitivity and specificity for diagnosing PET in routine clinical settings. Additionally, COT under ipsilateral nostril deep breathing is expected to be a rapid screening method for diagnosing PET. Relevance: The investigated approach holds potential to improve diagnostic efficiency. It may expand diagnostic options for patients with PET.
Importance: Accurate HPV status diagnosis is essential for managing oropharyngeal squamous cell carcinoma. Objective: We aimed to refine HPV status determination using a cost-effective and reliable approach by integrating the p53 immunohistochemical marker with the conventional p16 marker. We assessed the association between HPV status and the p16/p53 tumor immunohistochemical status and analyzed patient survival based on p16/p53 expression. Design, Setting, Participants, and Exposures: This retrospective, single-center study included 285 patients with oropharyngeal squamous cell carcinoma (2017-2022) with known p16/p53 immunohistochemical profiles. In a subset of 92 patients, HPV status was formally determined using polymerase chain reaction or in situ hybridization. Outcome Measures and Results: The p16/p53 test was an excellent predictor of HPV status (specificity: 100%, sensitivity: 98.48%), significantly outperforming p16 alone ( P < .01). Patients with a p16+/p53WT profile had superior 5-year overall survival (82.2%; 108/131) and recurrence-free survival (79.4%; 104/131). Patients with discordant profiles (p16+/p53MT, p16−/p53WT) had survival outcomes similar to HPV-independent oropharyngeal squamous cell carcinomas. Conclusion: The p16/p53 immunohistochemical profile appears to be a reliable surrogate marker for HPV status and a strong predictor of survival. It could help identify discordant cases, helping prevent inappropriate therapeutic de-escalation. Relevance: With the advancement of artificial intelligence, integrating additional markers into an algorithmic analysis could further refine patient classification and enable more personalized therapeutic approaches.
Importance: Laryngopharyngeal reflux (LPR) is frequently encountered in patients with obstructive sleep apnea (OSA). However, its relationship with OSA severity remains uncertain. Clarifying this association may improve reflux phenotyping and guide otolaryngology-focused evaluation in OSA populations. Objective: To evaluate the association between LPR-related parameters and OSA severity and the relationship between velum obstruction grade and LPR-related measures. Design: Prospective observational study. Setting: Single tertiary academic medical center (Peking University Third Hospital), outpatient sleep clinic. Participants: A total of 196 adults with polysomnography-diagnosed OSA were enrolled. All completed Reflux Symptom Index (RSI) assessment and laryngoscopic Reflux Finding Score (RFS) evaluation. Intervention or Exposures: No intervention. Exposure was OSA severity classified by the apnea-hypopnea index and velum obstruction grade assessed by the Müller maneuver. Clinically defined LPR was operationally defined as RSI > 13 and/or RFS > 7. Main Outcome Measures: Associations between OSA severity, velum obstruction grade, and LPR-related measures. Results: Clinically defined LPR was present in 84 of 196 patients with OSA (42.9%). RFS increased significantly with greater OSA severity ( P < .001), whereas RSI showed only a nonsignificant increasing trend ( P = .070). OSA severity correlated weakly with RSI and more clearly with RFS ( r = 0.16, P = .023; r = 0.33, P < .001, respectively). After adjustment for sex, body mass index, and LSO 2 , moderate and severe OSA were independently associated with LPR compared with mild OSA (moderate: Odds ratio [OR] = 2.53; 95% Confidence interval [CI]: 1.08-5.95; severe: OR = 4.83; 95% CI: 1.59-14.66). Velum obstruction grade was associated with LPR prevalence and RFS. Conclusions: Clinically defined LPR was common in adults with OSA and was independently associated with greater OSA severity. RFS appeared to reflect OSA severity more consistently than symptom-based RSI, suggesting that laryngoscopic findings may better capture reflux-related laryngeal involvement in this population. Relevance: Laryngoscopic assessment may complement symptom questionnaires and support phenotype-informed evaluation of reflux-related findings in OSA. Level of evidence: 3
Importance: Systemic corticosteroids (SCS) are widely prescribed for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP), yet no strict guidelines standardize their use. While data-specific to CRSwNP remains limited, growing evidence from lower respiratory disease supports a dose–response relationship between SCS use and related adverse outcomes that begin at relatively low cumulative doses. Reporting on SCS use among patients with CRSwNP is crucial to better understand prescribing patterns and inform future assessments of potential risks. Objective: This study investigates dispensing patterns of SCS among CRSwNP patients. Design: A population-based retrospective cohort study of community-based pharmacy claims data. The study period was between January 1, 2012 and December 31, 2022. Setting: The province of British Columbia, Canada, home of approximately 5 million residents. Participants: Insured residents diagnosed with CRSwNP and at least 2 years of data on dispenses. Exposures: SCS dispenses were identified for all cohort members. Main Outcome Measures: Cumulative SCS doses were calculated. Dispensed SCS courses were characterized based on administration method, dose, course length, and prescriber specialties. Prednisone prescribing patterns were evaluated. Results: A total of 7000 patients diagnosed with CRSwNP were included in the cohort. Among them, 1527 (21.8%) received 1 gram or more of SCS, an exposure level that has been associated with an increased risk of adverse outcomes in studies of lower respiratory diseases. High cumulative SCS exposure was more common among patients residing in rural areas and those with comorbid respiratory conditions. The mean SCS per patient per year (PPPY) dose was 212.6 mg (SD: 438.2), lower than figures reported in other countries. General practitioners were the most frequent prescribers overall, including among patients without asthma. Otolaryngologists were the second most common prescribers and demonstrated inconsistent prednisone prescribing practices over the study period. Conclusions: Population-based dispensing data showed unwarranted variation in SCS dispensing among CRSwNP patients, which may contribute to differential exposure to SCS-related adverse outcomes. Relevance: There is a need for clear clinical guidelines to standardize SCS exposure among CRSwNP patients, optimize treatment, and support more consistent and appropriate SCS use.
Planetary health is a framework that emphasizes the interdependence between human and environmental health. Principles of planetary health are increasingly relevant to Otolaryngologists, who both contribute to climate change and face its consequences for their patients’ health. This commentary applies these principles to Otolaryngology-Head and Neck Surgery, offering recommendations at 3 levels of change: the individual Otolaryngologist, the institution, and the broader system. These recommendations are grounded in 3 principles: reducing demand for care through health promotion and disease prevention, ensuring appropriateness of care by addressing overuse and underuse, and reducing healthcare pollution through adoption of circular economy principles. By embracing planetary health as a guiding principle, Otolaryngologists can reduce their footprint while advancing patient and community health.
IMPORTANCE:Cochlea microcirculation dysfunction has been proposed as a vital etiology for sudden sensorineural hearing loss (SSNHL), wherein insulin resistance acted as a potential risk factor for microcirculatory dysfunctions. The triglyceride glucose (TyG) index, a validated surrogate of insulin resistance, has not been fully evaluated in SSNHL. OBJECTIVE:To evaluate the association between the TyG index and hearing recovery in patients with SSNHL. DESIGN:Retrospective cross-sectional study involving a large, clinically characterized cohort. SETTING:Tertiary university hospital. PARTICIPANTS:A total of 944 adult SSNHL patients were included between January 2018 and March 2024. Eligibility required onset within 14 days and completion of standardized treatment and follow-up audiometry. Patients with conductive, recurrent, or secondary causes of hearing loss were excluded. EXPOSURES:The TyG index was calculated as ln [fasting plasma glucose (mg/dL) × triglycerides (mg/dL)/2]. MAIN OUTCOMES AND MEASURES:Hearing recovery was assessed after 14 days of treatment using Siegel's criteria and categorized as complete or incomplete recovery. RESULTS:Among 944 patients (mean [SD] age, 49.3 [15.6] years; 458 men [48.5%]), 208 (22.0%) achieved complete recovery. Baseline hearing levels and audiogram pattern were similar across TyG tertiles. However, the proportion of patients achieving complete recovery was lower in the highest TyG tertile compared to the 2 lower tertiles (45 [14.3%] vs 77 [24.4%] vs 86 [27.4%]; P < .001, respectively). In fully adjusted logistic regression models, higher TyG index was independently associated with incomplete recovery with an odds ratio (95% CI) of 1.93 (1.14-3.29) in tertile 3 and 1.55 (1.05-2.29) for per unit increase in the TyG index. CONCLUSION:Higher TyG index values were independently associated with poorer hearing recovery in SSNHL. RELEVANCE:The TyG index may help clinicians identify SSNHL patients at risk of poor cochlear recovery, supporting earlier and more targeted management.
ImportanceRecent studies suggested that laryngopharyngeal reflux disease may be associated with chronic nasal symptoms.ObjectiveTo investigate the prevalence and the pre- to posttreatment clinical findings of nasopharyngeal reflux disease (NRD) in patients with idiopathic chronic nasal complaints without allergy or chronic rhinosinusitis.DesignProspective uncontrolled preliminary study.SettingUniversity Hospital.ParticipantsPatients with chronic idiopathic nasal complaints, without rhinosinusitis, allergic rhinitis, or other common sinonasal diseases.InterventionFrom July 2022 to November 2024, patients underwent a 24 hour nasopharyngeal pH-testing (Dx-pH system) for detecting NRD. Patients with NRD were treated with alginates or antacids for 3 months.Main OutcomesLaryngopharyngeal and nasal symptoms and findings were evaluated from pre- to posttreatment with reflux symptom score (RSS), Sinonasal Outcome Test-22 (SNOT-22), and reflux sign assessment (RSA).ResultsThirty-three patients (15 females; mean age 50.1 ± 16.4 years) were evaluated. NRD was identified in 26 patients (78.8%) with a mean of 85.6 ± 64.3 reflux events, predominantly alkaline (pH > 6.0). Endoscopic findings included mulberry inferior turbinate (72.2%), crusts (38.9%), and dry nasal mucosa (27.8%). Posttreatment analysis revealed a significant reduction in RSS from 141.4 ± 100.9 to 95.2 ± 82.6 (P = .015). While baseline SNOT-22 scores showed nonsignificant reduction posttreatment (46.2 ± 19.1 vs 36.0 ± 31.0), nasal RSA decreased significantly (P = .023). Nasal dryness was positively associated with the total upright reflux time (pH < 6.5; rs = .575; P = .016) and the number of acid reflux events (rs = .523; P = .026), while the RSA pharynx was associated with the supine reflux time (rs = .573; P = .016).ConclusionNasopharyngeal reflux, predominantly alkaline, shows high prevalence (78.8%) with characteristic endoscopic findings. Anti-reflux treatment significantly improves reflux symptoms and nasal scores, though overall sinonasal quality of life shows modest change.
Importance To our knowledge, this represents the first adult-only, fully endoscopic, three-arm comparative cohort of autograft, allograft, and xenograft materials in type I tympanoplasty. Objective To compare graft-take, audiometric outcomes, operative time, and complications among perichondrium, MegaDerm, and Biodesign in adult endoscopic type I tympanoplasty. Design: Retrospective comparative cohort study. Setting: Tertiary referral center. Participants: Adults who underwent endoscopic type I tympanoplasty with perichondrium, MegaDerm or Biodesign between October 2021 and March 2025. Patients with revision surgery, concomitant otologic procedures, active middle-ear disease, profound sensorineural hearing loss, preoperative air-bone gap (ABG) ≥50 dB, or follow-up <3 months were excluded. Intervention or Exposures Endoscopic type I tympanoplasty using perichondrium (autograft), MegaDerm (allograft), or Biodesign (xenograft). Main Outcome Measures: Graft-take rate, hearing gain (air-conduction and ABG), operative time, and complications. Results Ninety-three ears were analyzed (perichondrium n = 33; MegaDerm n = 21; Biodesign n = 39). Three-month graft-take rates were similar, and final graft-take rates remained comparable across groups (3 months: 90.9%, 90.5%, 94.9%; P = .6862; final: 84.8%, 85.7%, 84.6%; P > .999). Air-conduction (AC) and ABG improved significantly within all groups. Between-group differences were not significant for AC gain (13.79 ± 9.84 vs 7.24 ± 12.46 vs 9.14 ± 10.01 dB; P = .0804) or ABG gain (9.58 ± 10.46 vs 8.82 ± 10.37 vs 7.58 ± 8.46 dB; P = .7757); the proportion achieving postoperative ABG ≤20 dB was similar ( P = .475). Operative time was significantly longer for perichondrium (98.23 ± 32.35, 68.52 ± 20.84, and 74.88 ± 17.27; P < .0001). Complications were infrequent (otomycosis, n = 3; myringitis, n = 1), and no facial palsy, intractable vertigo, profound sensorineural hearing loss(SNHL), or dysgeusia occurred. Conclusion: In adult endoscopic type I tympanoplasty, perichondrium, MegaDerm, and Biodesign demonstrated comparable short-term graft-take and audiometric outcomes, while commercially available grafts were associated with shorter operative time. Relevance: These findings support patient-centered graft selection balancing donor-site considerations, operative efficiency, and cost; prospective studies with standardized follow-up and patient-reported outcomes are warranted.
Importance The injections of platelet-rich plasma (PRP) in the olfactory clefts of patients with olfactory dysfunction (OD) is an emerging treatment. To date, no study investigated the effectiveness of multiple PRP injections. Objective To evaluate the effectiveness and usefulness of multiple injections of PRP in the olfactory clefts of patients with OD. Design Prospective controlled study. Setting Monocentric medical center. Participants Patients with long-lasting OD treated with PRP injections and controls who underwent olfactory training with multiple psychophysical olfactory assessments. Intervention Two PRP injections into the olfactory clefts at 4- to 6-month intervals. Main Outcomes Outcomes included adverse events, dose-effect relationships, and olfactory function changes measured by threshold, discrimination, and identification (TDI) testing with minimal clinically important difference (MCID). Results Eighty-three subjects completed the evaluations. Patients had anosmia (n = 39), hyposmia (n = 27), and parosmia (n = 17). The mean duration of OD was 49.1 ± 46.9 months. Seventy-seven patients received 2 injections. Transient epistaxis was the primary adverse event (46.2%). The mean injected PRP volume ranged from 1.4 to 1.7 mL. TDI significantly increased after both first and second injections across all OD subgroups. MCID was achieved in 49.4% after a first injection and 28.9% after a second. MCID was reached in 63 cases (75.9%) from baseline to final evaluation. Baseline TDI strongly predicted post-second injection TDI ( r s = .919; P = .001), but the first PRP response didn’t significantly predict second response ( r s = −.201; P = .069). TDI did not significantly change in the control groups. MCID was achieved in 22.2% and 40% controls at the first and second TDI evaluations. Conclusion and Relevance Two injections of PRP demonstrate significant improvement in psychophysical olfactory evaluations. Future studies are needed to determine the optimal number of injections and identify predictors of therapeutic effectiveness.
Importance: Thyroid radiofrequency ablation (RFA) is a minimally invasive alternative to surgery for thyroid nodules. Despite strong international evidence, thyroid RFA was only approved by Health Canada in April 2023. Understanding the experiences of early adopters can inform the broader adoption of RFA in Canada and other healthcare systems. Objective: To describe the implementation experiences of early adopters of thyroid RFA in Canada and identify barriers and facilitators to adoption. Design: Multiple methods. Setting: All 8 listed RFA facilities in Canada. Participants: Physicians performing thyroid RFA (n = 9). Main Outcome Measures: Survey and semi-structured interviews. Results: Most participants reported low RFA volumes (median [IQR] = 2.0 [0.6-3.0] cases/month) and short wait times (1.5 [1.0-2.0] months). For thyroid surgery on similar nodules, participants performed higher volumes (7.5 [6.0-10.2] cases/month, P = .01) and had longer wait times (6.0 [5.5-8.5] months, P < .01). Four major themes emerged: (1) financial barriers and inequity; (2) impact on the healthcare system; (3) learning curve; and (4) motivators and facilitators. Financial barriers were driven by the RFA generator ($40 500 CAD) and single-use probes ($1500-$2500 CAD). RFA was funded privately out-of-pocket in most physician practices (n = 7) and rarely publicly covered (n = 2). Motivators and facilitators included patient-centred benefits, professional development, institutional support, and potential resource savings. Conclusions: Thyroid RFA adoption in Canada is in its infancy, characterized by low procedural volumes, few providers, and geographical disparities. Early adopters reported positive experiences with RFA. However, inconsistent funding models, billing codes, and policy frameworks have resulted in inequitable access for patients. Relevance: Many healthcare systems are in the early stages of RFA adoption, similar to Canada. This study identifies key experiences, barriers, and facilitators applicable to physicians, leaders, and policymakers globally who are interested in adopting RFA.
Importance: Post-tonsillectomy pain remains difficult to manage in children despite standard analgesia. Topical sucralfate may reduce pain by coating the tonsillar bed and promoting mucosal recovery. Objective: To evaluate the efficacy and safety of topical sucralfate in reducing post-tonsillectomy pain and accelerating recovery in children. Design: Systematic review and meta-analysis of randomized controlled trials. Setting: PubMed, Web of Science, Cochrane Library, and Google Scholar were searched until July 2025. Participants: Children aged ≤18 undergoing tonsillectomy. Interventions: Topical sucralfate applied to the tonsillar bed intraoperatively or given postoperatively as an oral rinse. Main Outcomes and Measures: The overall effect size for the primary outcome (postoperative pain during the first postoperative week) was presented as standardized mean differences (SMDs), while secondary outcomes (analgesic use, return to oral intake, and adverse events) were reported as descriptive comparisons across trials. Results: Six randomized trials involving 485 children aged 3 to 12 years were included. Topical sucralfate reduced postoperative pain, with the greatest benefit observed from postoperative day 2 onward compared with placebo. On postoperative day 1, sucralfate lowered pain scores (5 trials; n = 432; SMD, −1.01; 95% confidence interval, −1.45 to −0.57; P < .00001). Sucralfate reduced systemic analgesic use and supported an earlier return to oral intake. Adverse events, including bleeding, nausea, and vomiting, occurred at similar rates in both groups. Conclusions: Topical sucralfate is a safe and effective adjunct after pediatric tonsillectomy. It reduces early postoperative pain and improves functional recovery. Relevance: These findings support topical sucralfate as a simple, low-cost option for postoperative analgesia in children. Larger trials are needed to confirm these benefits.
Importance: Otitis media with effusion (OME) is common in children, often persisting for more than 3 months, which can lead to hearing loss. Effective treatments are needed to manage this condition. Objective: To evaluate the efficacy and safety of autoinflation for persistent OME in children. Design: Retrospective cohort study. Setting: The study was conducted at a tertiary pediatric hospital. Participants: A total of 131 children with persistent OME were enrolled from January 2020 to July 2025. Seventy-one children received autoinflation treatment, and 60 children were assigned to the control group. Exposure or Intervention: The autoinflation group received twice-daily autoinflation treatment for 1 to 3 months in addition to medical therapy. The control group received only medical therapy. Main Outcome Measures: Efficacy was evaluated based on cure rates assessed by tympanometry and otoacoustic emissions before and after treatment. Safety was assessed through the frequency and severity of adverse events. Results: In the autoinflation group after 3 months, 60.8% of ears were cured, and 13.3% showed improvement. In the control group, only 20.0% of ears were cured, and 20.0% improved. Univariate analysis indicated that recurrent OME and recurrent/prolonged respiratory tract infections were significant risk factors for autoinflation failure. Approximately half of the children experienced mild ear pain during the first week, which was generally tolerable. Conclusion: Autoinflation appears to be safe and effective in children with persistent OME. Treatment failure is more common in children with recurrent/prolonged respiratory infections or recurrent OME, especially in those with a history of middle ear surgery (adenoidectomy with tympanostomy tube insertion). Although autoinflation is a low-risk alternative to surgery for suitable patients, it should be avoided in children with skull base or orbital defects, craniofacial anomalies, or active infection or inflammation. Relevance: This retrospective cohort study supports the use of autoinflation as a treatment option for persistent OME. Identifying risk factors for treatment failure may help guide clinical decisions.
Importance Sudden sensorineural hearing loss (SSNHL) significantly impacts quality of life. Identifying genetic and serological markers could improve early diagnosis and prognosis. Objectives This study aimed to investigate the potential correlation between the miR-204-5p rs718447 polymorphism and the occurrence of SSNHL in the Chinese Han population. Design A hospital-based, case-control study. Setting The Third People’s Hospital of Hubei Province in China. Participants One hundred forty patients with idiopathic SSNHL and 140 age-frequency-matched and sex-frequency-matched healthy controls of Chinese Han ethnicity. Exposures Genotyping was performed using the LightCycler 480 Real-Time PCR system. miR-204-5p expression was measured by RT-qPCR, while enzyme-linked immunosorbent assay was utilized to determine the interleukin-1β (IL-1β) concentration. Main Outcome Measures: Primary: Association between rs718447 genotypes and SSNHL risk. Secondary: Diagnostic/prognostic performance of miR-204-5p; correlations with IL-1β and fibrinogen (FIB) levels. Results In the SSNHL group, miR-204-5p was significantly elevated ( P < .01). The A allele [odds ratio (OR) = 0.470, 95% confidence interval (CI): 0.297-0.744] and AG/AA genotypes (OR = 0.486, 95% CI: 0.297-0.793) were identified as potential protective factors against SSNHL, whereas the GG genotype was associated with an increased risk of SSNHL. miR-204-5p expression progressively increased as hearing loss worsened from mild to severe, and GG genotype patients demonstrated higher miR-204-5p expression ( P < .01). The SSNHL group exhibited significantly higher IL-1β and FIB concentrations, especially GG carriers ( P < .01). Additionally, high miR-204-5p expression (OR = 3.039, 95% CI: 1.435-6.439, P = .004) and the GG genotype at rs718447 (OR = 2.853, 95% CI: 1.095-7.433, P = .032) were associated with poorer hearing recovery outcomes, with the GG genotype showing a correlation with poorer outcomes, consistent with a potential link involving miR-204-5p-associated inflammation and coagulation abnormalities. Conclusion The miR-204-5p rs718447 polymorphism was associated with susceptibility to SSNHL. Relevance These findings identify rs718447 and miR-204-5p as potential biomarkers for SSNHL. Future studies should validate these results in larger, multicenter cohorts and explore the underlying mechanisms to assess their utility in personalized treatment strategies.
Importance Progress in vestibular implantation offers hope for patients with bilateral vestibulopathy. However, surgically opening the semicircular canals risks breaching the membranous labyrinth, which may induce sensorineural hearing loss. A robotic drill sensing force and torque might prevent membranous labyrinth rupture. Primary objective To assess the feasibility of force- and torque-based automatic cessation in a hand-guided robotic drill for fenestrating the bony semicircular canals without rupturing the membranous labyrinth. Secondary objective To fit an electrode dummy through the fenestrations. Design Feasibility study using human cadaveric temporal bones. Setting Laboratory. Participants Ten formalin-fixed human temporal bones. Intervention After performing a cortical mastoidectomy and skeletonizing the semicircular canals, a hand-guided robotic drill was used to drill 2 fenestrations in each semicircular canal. A silicone electrode dummy was inserted through each fenestration. Main outcome measures Proportion of fenestrations with intact membranous labyrinth, as evaluated with a surgical microscope. Proportion of fenestrations allowing electrode insertion without additional manipulation. Results A total of 60 fenestrations were made in 30 semicircular canals from 10 temporal bones. Technical issues related to drill bit fixation occurred in 6 fenestrations. The remaining 54 fenestrations were all made without visible damage to the membranous labyrinth. In 81% of these fenestrations (44/54), the electrode could be advanced without requiring additional manipulation. The technical issue was related to improper alignment of the drill bit, leading to incorrect force and torque sensing. Conclusions Force- and torque-based automatic cessation in a hand-guided robotic drill is feasible for fenestrating the bony semicircular canals without rupturing the membranous labyrinth. However, improved burr fixation is required for consistent and reliable performance. Relevance The investigated approach holds potential to improve safety and precision in semicircular canal surgery, such as vestibular implantation. This may expand treatment options for patients with residual inner ear function.
Importance Robotic-assisted cochlear implantation has the potential to reduce surgical variability, enhance insertion precision, and minimize intracochlear trauma; however, real-world clinical evidence remains limited. Objective To evaluate the safety, accuracy, and early hearing outcomes of robot-assisted cochlear implant (CI) electrode array insertion using the OTODRIVE ® system. Design Retrospective cohort study. Setting A tertiary academic CI center. Participants Adult patients who underwent robot-assisted cochlear implantation between the dates of February 2025 and August 2025. Intervention or Exposures Robot-assisted electrode array insertion with preoperative planning using the OTOPLAN software. Main Outcome Measures Intraoperative safety outcomes; audiologic performance, including unaided and aided pure-tone averages (PTAs) and AzBio sentence scores; and imaging-based electrode insertion accuracy, including angular insertion depth (AID) and electrode contact insertion on postoperative cone-beam computed tomography. Results The review identified 39 patients, mean age of 59.5 ± 19.2 years, with 59% male participants. The most common etiology of hearing loss (HL) was idiopathic sudden sensorineural HL. Mean total surgical time was 122.2 ± 49.4 minutes. No intraoperative complications or robotic-related adverse events occurred. Audiologic outcomes demonstrated significant improvement, with a mean preoperative unaided PTA of 92.4 ± 16.7 dB HL, improving to a postoperative aided PTA of 31.6 ± 6.3 dB HL. Mean AzBio sentence recognition scores increased from 18.1% preoperatively to 75.7% postoperatively, representing a 57.6% absolute improvement. Mean cochlear duct length was 34.6 ± 1.6 mm, and the planned versus achieved AIDs were 582.7° ± 35.2° and 569.0° ± 38.9°, respectively. Full insertion was achieved in 89.7% of implanted ears, with no tip fold-overs or electrode malposition identified. Conclusions Robot-assisted cochlear implantation using the OTODRIVE ® system was safely integrated into clinical practice in this cohort, with reproducible electrode insertion and early postoperative audiologic outcomes. Relevance These findings support the feasibility and safety of integrating robotic systems into routine CI surgery.
Importance Evidence regarding the mechanism of tinnitus in patients with normal full-frequency hearing remains limited. This study investigated the auditory brainstem response (ABR) waveform patterns in these patients to address this unmet need, which is of considerable assistance in the clinical management of tinnitus with normal hearing. Objective This study aims to investigate the potential underlying mechanisms of tinnitus with normal full-frequency (125 Hz-16 kHz) hearing threshold by analyzing waveform alterations in ABR among tinnitus patients. Design Cross-sectional study. Setting Otolaryngology outpatient of a tertiary referral hospital. Participants Patients aged 20 to 40 years with unilateral subjective tinnitus and normal hearing (pure-tone thresholds ≤25 dB HL across 0.125-16 kHz) were recruited. Age-matched healthy volunteers with normal full-frequency hearing (0.125-16 kHz) and without tinnitus served as controls. Exposures Participants were categorized according to the presence of unilateral subjective tinnitus. Main Outcome Measures The primary outcomes included pure-tone audiometry testing (0.125-16 kHz) and ABR testing using 80 dB nHL click stimuli with alternating polarity (19.9 Hz, 1024 scans). Results The study included 136 adult subjects with normal hearing at all frequencies, including 60 unilateral tinnitus patients and 76 normal volunteers. Results showed no significant differences in ABR waveform characteristics between affected and unaffected ears in unilateral tinnitus patients (( P > .05). However, compared with normal volunteers, unilateral tinnitus patients exhibited significantly prolonged latencies of waves I, III, and V on the tinnitus side (all P < .05), with median differences (95% CI) of 0.08 (0.04-0.11), 0.07 (0.00-0.12), and 0.15 (0.09-0.20), respectively. In addition, the interpeak latency between waves III and V was also prolonged, with a median difference of 0.08 (95% CI: 0.03-0.13). Conclusion Tinnitus patients with normal full-frequency hearing exhibit differences in the ABR waves, which may be associated with abnormal middle ear muscle activity. Emotional responses may trigger abnormal middle ear muscle activity via the serotonin system, which in turn affects auditory signal transmission through the trigeminal system, leading to tinnitus and abnormal ABR wave patterns. Relevance Future research will focus on the middle ear muscles as a potential breakthrough point, exploring the relationship between abnormal electrical activity in these muscles and tinnitus, as well as the electrical activity of the trigeminal nerve nuclei. Level of Evidence 3.
Importance Tinnitus, affecting 10% to 15% of the global population, is a debilitating condition often linked to hearing loss and neurological disorders. While air pollution is a known risk factor for respiratory and cardiovascular diseases, its association with tinnitus remains underexplored. Objective This study investigates the association between air pollution, polygenic risk score (PRS), and tinnitus prevalence. Design Cross-sectional analysis. Setting UK Biobank (UKB) population-based cohort. Participants Seventy-nine thousand two hundred seventy-seven individuals from the UKB with available tinnitus, air pollution, and genetic data. Exposures Air pollution measures (PM 2.5 , PM 2.5–10 , PM 10 , NO 2 , and NO x ). A composite air pollution score was calculated, and PRS was derived from 6 tinnitus-associated single-nucleotide polymorphisms. Main outcome measures Prevalence, frequency, and severity of tinnitus. Logistic regression models were used, adjusting for sociodemographic, health, and hearing-related covariates. Results Each interquartile range increase in air pollution score was associated with higher odds of current tinnitus (OR = 1.06, 95% CI: 1.03-1.08, P < .001), particularly transient tinnitus (OR = 1.04, P = .008). PRS was independently associated with prevalent tinnitus ( P < .001), and higher OR were observed among individuals with both high air pollution exposure and high PRS (OR = 1.34, 95% CI: 1.18-1.52, P < .001). Individual pollutants showed weaker associations. Conclusion A joint association of air pollution exposure and genetic susceptibility with tinnitus prevalence was observed in this cross-sectional analysis, highlighting the importance of integrated environmental and genetic assessments in auditory health. Relevance Our findings emphasize the potential value of integrating environmental and genetic factors for risk stratification of tinnitus in populations.
