AIM:This study aims to (1) review the literature on cochlear size, measured by the A-value, to assess reported variation across studies, and (2) consolidate cochlear parameters-specifically basal turn diameter (A-value) and width (B-value)-measured using the standardized DICOM viewer OTOPLAN®, and compare these with published data. METHODS:A scoping literature review was conducted using the search term "diameter of cochlear basal turn" to identify studies reporting A-value measurements. To complement this, cochlear measurements obtained with OTOPLAN® were collected from clinical collaborators across multiple international centres. The ratio of B- to A-values, which defines the cochlear basal turn shape, was calculated as previously described by Khurayzi et al. (2021). RESULTS:The literature review identified 38 studies comprising 5,206 A-value measurements (average: 9.08 mm; range: 8.01-10.03 mm). Additionally, 5,580 OTOPLAN® measurements were collected from 43 clinics across 25 countries (mean: 9.07 mm; range: 6.67-11.45 mm). Overall, 68.7% of cochleae exhibited an elliptical basal turn shape. CONCLUSION:Using a large, international multicentre dataset and a standardized measurement tool, this study demonstrates substantial variation in cochlear size and shape across clinical cohorts from different regions. The mean A-value (9.07 mm) is consistent with previously published literature, while the wider observed range highlights greater anatomical variability within a multicentre clinical population than previously reported. The majority of cochleae demonstrate an elliptical basal turn configuration.

IntroductionHealthcare systems contribute up to 5% of global greenhouse gas emissions, with impacts varying across medical specialties. Otorhinolaryngology (ORL) and hearing care must address their specific environmental footprint to meet emerging sustainability goals. This study assessed ORL professionals’ awareness, engagement, and perceived opportunities for implementing sustainable practices.MethodsA 17-item survey was conducted from May 31 to July 25, 2024, among members of the HEARRING group, an international association of ORL experts.Results37 responses from 26 hospitals across 16 countries were collected. While 89.2% of participants expressed interest in sustainability, only 29.7% felt confident explaining sustainable development. Key opportunities included waste reduction (70%), policy development (25%), transportation improvements (20%), and energy efficiency (15%). Major barriers were lack of collective action (59.5%), uncertainty (35.1%), and insufficient workplace support (35.1%). Hospitals commonly engaged in recycling (83.3%), waste reduction (80.6%), and energy conservation (74.3%), but green purchasing and toxic-waste reduction were limited. Awareness of Green Teams was low (30.6%), though those familiar recognized their value.DiscussionDespite strong interest, gaps in knowledge and systemic barriers persist in ORL care. Targeted education, leadership support, and adoption of Green Teams could accelerate sustainable practices and reduce environmental impact.

Abstract Pig vocalizations convey information about the emotional states of individuals, varying with arousal and valence. Studies show that different call types reflect distinct emotional contexts and social interactions for the receivers. However, little is known about the brain mechanisms behind the perception of conspecifics’ vocalizations. This study used BOLD fMRI to explore how pigs’ brains respond to emotionally varied vocalizations, with the aim to identify activity in regions linked to emotion, reward, and social processing. Eight healthy 2-month-old pigs underwent auditory brainstem response (ABR) testing and BOLD fMRI to assess brain responses to pig vocalizations with different hedonic valence. Sounds were delivered via MRI-compatible earphones, and imaging was performed on a 1.5T scanner. Data were analyzed using voxel-based and ROI-based statistics in SPM12 with small volume correction (SVC). Due to hearing anomalies or MRI artefacts, only 5 pigs were included in the final analysis. Functional MRI revealed that vocalizations activated regions of the auditory pathway and the left amygdala (pFWE at peak < 0.05 after SVC for all), with specific differences between positive and negative sounds. Clusters of activated voxels covering part of hippocampal areas, caudate nuclei and putamen were found with both positive and aversive vocal sounds. Limbic regions, including the amygdala and insula (p<0.05), as well as the right hippocampus after SVC (pFWE = 0.015) were uniquely engaged during the perception of negative conspecific vocalizations, indicating distinct processing based on emotional valence. This study shows for the first time that piglets’ brain can process and differentiate emotional vocalizations from other pigs, even under general anesthesia. Positive and negative vocal sound playbacks activated distinct brain regions related to hearing, emotion and reward. These findings highlight pigs’ cognitive and emotional processing of vocal cues. This study is part of a wider research program aimed at developing the fMRI protocol with acoustic stimulation in juvenile pigs.

Objectives.:Several studies have demonstrated the benefits of tonotopic fitting on speech-in-noise perception in new cochlear implant (CI) users. However, these studies used different coding strategies (CIS, HDCIS, FSP, FS4, or mixed) with different frequency spectra. The aim of this study was to assess the impact of fine structure (FS) cues on speech perception in noise and in quiet and music perception, in new CI users with a tonotopic fitting map. Methods.:A prospective, randomized, double-blind, 2-period crossover study was performed from April 2023 to June 2024. All participants had tonotopic fitting determined by using flat-panel computed tomography (CT) and reconstruction software based on the Greenwood function. 24 new CI users aged 18 years or older with either bilateral severe-to-profound sensorineural hearing loss or complete hearing loss for less than 5 years were recruited at a single tertiary referral center. Participants were randomized to FS followed by conventional coding, or the reverse sequence, for 6-week periods with speech and music assessments after each period. Results.:FS cues significantly improved speech recognition in noise for high signal-to-noise ratio (SNR = +9 dB, Mean Effect (ME) = 6.0%, Standardized effect size (SES) = 0.62, p = 0.010). A period effect was observed beyond + 6 dB of SNR (SNR = +9 dB, p = 0.010; SNR = +6 dB, p = 0.018) without a statistically significant group effect. Speech recognition and tonal audiometry in quiet were not affected by FS coding. Melodic contour identification was enhanced by FS cues (ME = 7.2%, SES = 0.51, p = 0.030), and, in an exploratory subset analysis, low-frequency pitch discrimination was also improved (ME = 8.5 Hz, SES = 0.72, p = 0.04). Over 75% of the participants retained the tonotopic map with FS coding after study completion. Conclusion.:FS coding strategies on tonotopic maps may improve speech recognition in noise at favorable SNRs, without compromising speech understanding in quiet. It may also enhance selected complex sound perception aspects, particularly pitch- and contour-related processing, while benefits for subjective music perception appear less consistent.

In addition to pure-tone audiometry tests and electrophysiological tests, a comprehensive hearing evaluation includes assessing a subject’s ability to understand speech in quiet and in noise. In fact, speech audiometry tests are commonly used in clinical practice; however, they are time-consuming as they require manual scoring by a hearing professional. To address this issue, we developed an automated speech recognition (ASR) system for scoring subject responses at the phonetic level. The ASR was built using a deep neural network and trained with pre-recorded French speech materials: Lafon’s cochlear lists and Dodelé logatoms. Next, we tested the performance and reliability of the ASR in clinical settings with both normal-hearing and hearing-impaired listeners. Our findings indicate that the ASR’s performance is statistically similar to manual scoring by expert hearing professionals, both in quiet and in noisy conditions. Moreover, the test–retest reliability of the automated scoring closely matches that of manual scoring. Together, our results validate the use of this deep neural network in both clinical and research contexts for conducting speech audiometry tests in quiet and in noise.

Objective Automated air‐conduction pure‐tone audiograms through Bayesian estimation and machine learning (ML) classification have recently been proposed in the literature. Although such ML‐based audiometry approaches represent a significant addition to the field, they remain unsuited for daily clinical settings, in particular for listeners with asymmetric or conductive hearing loss, severe hearing loss, or cochlear dead zones. The goal here is to expand on previously proposed ML approaches and assess the performance of this improved ML audiometry for a large sample of listeners with a wide range of hearing status. Methods First, we describe the changes made to the ML method through the addition of: (1) safety limits to test listeners with a wide range of hearing status, (2) transient responses to cater for cochlear dead zones or nonmeasurable thresholds, and importantly, (3) automated contralateral masking to test listeners with asymmetric or conductive hearing loss. Next, we compared the performance of this improved ML audiometry with conventional and manual audiometry in a large cohort ( n = 109 subjects) of both normal‐hearing and hearing‐impaired listeners. Results Our results showed that for all audiometric frequencies tested, no significant difference was found between hearing thresholds obtained using manual audiometry on a clinical audiometer as compared to both the manual and automated improved ML methods. Furthermore, the test–retest difference was not significant with the automated improved ML method for each audiometric frequency tested. Finally, when examining cross‐clinic reliability measures, significant differences were found for most audiometric frequencies tested. Conclusions Together, our results validate the use of this improved ML‐based method in adult clinical tests for air‐conduction audiometry.

INTRODUCTION:Cochlear implantation is a recent approach proposed to treat single-sided deafness (SSD) and asymmetric hearing loss (AHL). Several cohort studies showed its effectiveness on tinnitus and variable results on binaural hearing. The main objective of this study is to assess the outcomes of cochlear implantation and other treatment options in SSD/AHL on quality of life.METHODS:This prospective multicenter study was conducted in 7 tertiary university hospitals and included an observational cohort study of SSD/AHL adult patients treated using contralateral routing of the signal (CROS) hearing aids or bone-anchored hearing systems (BAHSs) or who declined all treatments, and a randomized controlled trial in subjects treated by cochlear implantation, after failure of CROS and BAHS trials. In total, 155 subjects with SSD or AHL, with or without associated tinnitus, were enrolled. After 2 consecutive trials with CROS hearing aids and BAHSs on headband, all subjects chose any of the 4 treatment options (abstention, CROS, BAHS, or cochlear implant [CI]). The subjects who opted for a CI were randomized between 2 arms (CI vs. initial observation). Six months after the treatment choice, quality of life was assessed using both generic (EuroQoL-5D, EQ-5D) and auditory-specific quality-of-life indices (Nijmegen Cochlear implant Questionnaire [NCIQ] and Visual Analogue Scale [VAS] for tinnitus severity). Performances for speech-in-noise recognition and localization were measured as secondary outcomes.RESULTS:CROS was chosen by 75 subjects, while 51 opted for cochlear implantation, 18 for BAHSs, and 11 for abstention. Six months after treatment, both EQ-5D VAS and auditory-specific quality-of-life indices were significantly better in the "CI" arm versus "observation" arm. The mean effect of the CI was particularly significant in subjects with associated severe tinnitus (mean improvement of 20.7 points ± 19.7 on EQ-5D VAS, 20.4 ± 12.4 on NCIQ, and 51.4 ± 35.4 on tinnitus). No significant effect of the CI was found on binaural hearing results. Before/after comparisons showed that the CROS and BAHS also improved significantly NCIQ scores (for CROS: +7.7, 95% confidence interval [95% CI] = [4.5; 10.8]; for the BAHS: +14.3, 95% CI = [7.9; 20.7]).CONCLUSION:Cochlear implantation leads to significant improvements in quality of life in SSD and AHL patients, particularly in subjects with associated severe tinnitus, who are thereby the best candidates to an extension of CI indications.

To demonstrate the non-inferiority of perioperative comfort in patients undergoing otosclerosis surgery under local anesthesia versus general anesthesia and to compare audiometric results, quality of life and complications. A prospective non-interventional study was performed. Patients undergoing otosclerosis surgery between January 2019 and March 2021 at the University Hospital of Rennes were included consecutively. Perioperative comfort of LA versus GA (at ward admission, surgery, recovery and 48 h following surgery) was measured on a visual analogue scale at 10 days postoperatively and quality of life by the Glasgow Benefit Inventory at 3 months. Complications and audiometric results were also assessed. To demonstrate the non-inferiority of LA versus GA with a margin of 1.5 points on the comfort VAS, a power of 80

Importance Cochlear implants are an effective technique for enhancing speech perception abilities in quiet environments for people with severe to profound deafness. Nevertheless, complex sound signals perception, such as music perception, remains challenging for cochlear implant users. Objective To assess the benefit of a tonotopic map on music perception in new cochlear implant users. Design, Setting, and Participants A prospective, randomized, double-blind, 2-period crossover study including 26 new cochlear implant users was performed over a 6-month period (June 2021 to November 2021). An anatomical tonotopic map was created using postoperative flat-panel computed tomography and a reconstruction software based on Greenwood function. New cochlear implant users older than 18 years with bilateral severe to profound sensorineural hearing loss or complete hearing loss for less than 5 years were selected in the University Hospital Centre of Rennes in France. The trial was conducted from June to November 2021 (inclusion) and to February 2022 (end of the assessment procedure at 12 weeks postactivation), and the analysis itself was completed in December 2022. Intervention Each participant was randomized to receive a conventional map followed by a tonotopic map or vice versa. Main Outcomes and Measures Participants performed pitch-scaling tasks (multidimensional qualitative assessment, melodic contour identification, melodic recognition test) after 6 weeks of each setting. Results Thirteen participants were randomized to each sequence. Two of the 26 participants recruited (1 in each sequence) had to be excluded due to the COVID-19 pandemic. The multidimensional qualitative assessment (Gabrielsson test), melodic contour identification, and melodic recognition scores were significantly higher with the tonotopic setting than the conventional one (mean effect [ME], 7.8; 95% CI, 5.0-10.5; ME, 12.1%; 95% CI, 5.7%-18.4%; ME, 14.4%, 95% CI, 8.5%-20.2%; and ME, 2.1, 95% CI, 1.7-2.5, respectively). Among the different dimensions evaluated by the Gabrielsson test, the mean scores for clarity, spaciousness, fullness, nearness, and total impression were significantly higher with tonotopic fitting. Ninety-two percent of the participants kept the tonotopy-based map after the study period. Conclusions In this randomized clinical trial of patients with new cochlear implants, a tonotopic-based fitting was associated with better results in perception of complex sound signals such as music listening experience.

Importance:Cochlear implants are an effective technique for enhancing speech perception abilities in quiet environments for people with severe to profound deafness. Nevertheless, complex sound signals perception, such as music perception, remains challenging for cochlear implant users. Objective:To assess the benefit of a tonotopic map on music perception in new cochlear implant users. Design, Setting, and Participants:A prospective, randomized, double-blind, 2-period crossover study including 26 new cochlear implant users was performed over a 6-month period (June 2021 to November 2021). An anatomical tonotopic map was created using postoperative flat-panel computed tomography and a reconstruction software based on Greenwood function. New cochlear implant users older than 18 years with bilateral severe to profound sensorineural hearing loss or complete hearing loss for less than 5 years were selected in the University Hospital Centre of Rennes in France. The trial was conducted from June to November 2021 (inclusion) and to February 2022 (end of the assessment procedure at 12 weeks postactivation), and the analysis itself was completed in December 2022. Intervention:Each participant was randomized to receive a conventional map followed by a tonotopic map or vice versa. Main Outcomes and Measures:Participants performed pitch-scaling tasks (multidimensional qualitative assessment, melodic contour identification, melodic recognition test) after 6 weeks of each setting. Results:Thirteen participants were randomized to each sequence. Two of the 26 participants recruited (1 in each sequence) had to be excluded due to the COVID-19 pandemic. The multidimensional qualitative assessment (Gabrielsson test), melodic contour identification, and melodic recognition scores were significantly higher with the tonotopic setting than the conventional one (mean effect [ME], 7.8; 95% CI, 5.0-10.5; ME, 12.1%; 95% CI, 5.7%-18.4%; ME, 14.4%, 95% CI, 8.5%-20.2%; and ME, 2.1, 95% CI, 1.7-2.5, respectively). Among the different dimensions evaluated by the Gabrielsson test, the mean scores for clarity, spaciousness, fullness, nearness, and total impression were significantly higher with tonotopic fitting. Ninety-two percent of the participants kept the tonotopy-based map after the study period. Conclusions:In this randomized clinical trial of patients with new cochlear implants, a tonotopic-based fitting was associated with better results in perception of complex sound signals such as music listening experience. Trial Registration:ClinicalTrials.gov Identifier: NCT04922619.

To date, pure-tone audiometry remains the gold standard for clinical auditory testing. However, pure-tone audiometry is time-consuming and only provides a discrete estimate of hearing acuity. Here, we aim to address these two main drawbacks by developing a machine learning (ML)-based approach for fully automated bone-conduction (BC) audiometry tests with forehead vibrator placement. Study 1 examines the occlusion effects when the headphones are positioned on both ears during BC forehead testing. Study 2 describes the ML-based approach for BC audiometry, with automated contralateral masking rules, compensation for occlusion effects and forehead-mastoid corrections. Next, the performance of ML-audiometry is examined in comparison to manual and conventional BC audiometry with mastoid placement. Finally, Study 3 examines the test-retest reliability of ML-audiometry. Our results show no significant performance difference between automated ML-audiometry and manual conventional audiometry. High test-retest reliability is achieved with the automated ML-audiometry. Together, our findings demonstrate the performance and reliability of the automated ML-based BC audiometry for both normal-hearing and hearing-impaired adult listeners with mild to severe hearing losses.

OBJECTIVES:While cochlear implants (CIs) have provided benefits for speech recognition in quiet for subjects with severe-to-profound hearing loss, speech recognition in noise remains challenging. A body of evidence suggests that reducing frequency-to-place mismatch may positively affect speech perception. Thus, a fitting method based on a tonotopic map may improve speech perception results in quiet and noise. The aim of our study was to assess the impact of a tonotopic map on speech perception in noise and quiet in new CI users. DESIGN:A prospective, randomized, double-blind, two-period cross-over study in 26 new CI users was performed over a 6-month period. New CI users older than 18 years with bilateral severe-to-profound sensorineural hearing loss or complete hearing loss for less than 5 years were selected in the University Hospital Centre of Rennes in France. An anatomical tonotopic map was created using postoperative flat-panel computed tomography and a reconstruction software based on the Greenwood function. Each participant was randomized to receive a conventional map followed by a tonotopic map or vice versa. Each setting was maintained for 6 weeks, at the end of which participants performed speech perception tasks. The primary outcome measure was speech recognition in noise. Participants were allocated to sequences by block randomization of size two with a ratio 1:1 (CONSORT Guidelines). Participants and those assessing the outcomes were blinded to the intervention. RESULTS:Thirteen participants were randomized to each sequence. Two of the 26 participants recruited (one in each sequence) had to be excluded due to the COVID-19 pandemic. Twenty-four participants were analyzed. Speech recognition in noise was significantly better with the tonotopic fitting at all signal-to-noise ratio (SNR) levels tested [SNR = +9 dB, p = 0.002, mean effect (ME) = 12.1%, 95% confidence interval (95% CI) = 4.9 to 19.2, standardized effect size (SES) = 0.71; SNR = +6 dB, p < 0.001, ME = 16.3%, 95% CI = 9.8 to 22.7, SES = 1.07; SNR = +3 dB, p < 0.001 ME = 13.8%, 95% CI = 6.9 to 20.6, SES = 0.84; SNR = 0 dB, p = 0.003, ME = 10.8%, 95% CI = 4.1 to 17.6, SES = 0.68]. Neither period nor interaction effects were observed for any signal level. Speech recognition in quiet ( p = 0.66) and tonal audiometry ( p = 0.203) did not significantly differ between the two settings. 92% of the participants kept the tonotopy-based map after the study period. No correlation was found between speech-in-noise perception and age, duration of hearing deprivation, angular insertion depth, or position or width of the frequency filters allocated to the electrodes. CONCLUSION:For new CI users, tonotopic fitting appears to be more efficient than the default frequency fitting because it allows for better speech recognition in noise without compromising understanding in quiet.

L’objectif de cette étude est de déterminer quels indices (prosodie, expressions faciales ou contexte) sont privilégiés par les enfants équipés d’implants cochléaires (IC) lorsqu’ils interprètent les états émotionnels des personnes. Vingt-et-un enfants porteurs d’IC et 110 enfants normo-entendants ont visionné une série de 24 vidéos dans lesquelles nous avons manipulé la valence émotionnelle (positive ou négative) de trois indices. Les enfants devaient identifier l’état émotionnel du protagoniste et justifier leur réponse. Les résultats ont montré que les utilisateurs d’IC donnaient la priorité au contexte plutôt qu’aux expressions faciales ou à la prosodie. Pour les utilisateurs d’IC, l’âge chronologique est corrélé à une plus grande prise en compte des expressions faciales, tandis que la durée d’utilisation de l’IC n’a pas influencé la reconnaissance des émotions. Nos résultats fournissent des informations précieuses qui devraient participer à améliorer le contenu de la prise en charge orthophonique pour les enfants utilisateurs d’IC. La présentation multimodale a semblé perturber les enfants utilisateurs d’IC. Nous devons les encourager à tenir compte de tous les indices, tant linguistiques que paralinguistiques.

Background: The aim of this study was to find out how candidacy criteria have evolved differently across the globe. Methods: Candidacy criteria and outcome measurements applied in 19 HEARRING clinics were analyzed. Results: Candidacy criteria vary between clinics. Overall, both bilateral implantation and cochlear implantation in patients with single-sided deafness are becoming more frequent. Conclusion : Standardized outcome measurement instruments need to be applied to provide access to the hearing world to all patients with hearing loss who would benefit from cochlear implantation.

OBJECTIVES:To describe the treatment choice in a cohort of subjects with single-sided deafness (SSD) and asymmetric hearing loss (AHL). To assess the reliability of the treatment trials.DESIGN:In this national, multicentre, prospective study, the choice of subjects was made after two consecutive trials of Contralateral Routing Of the Signal (CROS) hearing aids and a Bone Conduction Device (BCD) on a headband. Subjects could proceed with one of these two options, opt for cochlear implantation or decline all treatments.SETTING:Seven tertiary university hospitals.PARTICIPANTS:One hundred fifty-five subjects with SSD or AHL fulfilling the candidacy criteria for cochlear implantation, with or without associated tinnitus.MAIN OUTCOME MEASURES:After the two trials, the number of subjects choosing each option was described. Repeated assessments of both generic and auditory-specific quality of life were conducted, as well as hearing assessments (speech recognition in noise and horizontal localization).RESULTS:CROS was chosen by 75 subjects, followed by cochlear implantation (n = 51), BCD (n = 18) and abstention (n = 11). Patients who opted for cochlear implantation had a poorer quality of life (P = .03). The improvement of quality of life indices after each trial was significantly associated with the final treatment choice (P = .008 for generic indices, P = .002 for auditory-specific indices). The follow-up showed that this improvement had been overestimated in the CROS group, with a long-term retention rate of 52.5%.CONCLUSIONS:More than one third of SSD/AHL subjects are unsatisfied after CROS and BCD trials. Repeated quality of life assessments help counselling the patient for his/her treatment choice.

Background: A prospective longitudinal multicentre study was conducted to assess the one-year postsurgical hearing preservation profile of the EVOTM electrode array. Methods: Fifteen adults presenting indications of electro-acoustic stimulation (pure-tone audiometry (PTA) thresholds ≤70 dB below 750 Hz) were implanted with the EVO™ electrode array. Hearing thresholds were collected at five time-points from CI activation to twelve months (12M) after activation. Hearing thresholds and hearing preservation profiles (HEARRING group classification) were assessed. Results: All subjects had measurable hearing thresholds at follow-up. No case of complete loss of hearing or minimal hearing preservation was reported at any time point. At activation (Nact = 15), five participants had complete hearing preservation, and ten participants had partial hearing preservation. At the 12M time point (N12m = 6), three participants had complete hearing preservation, and three participants had partial hearing preservation. Mean hearing loss at activation was 11 dB for full range PTA and 25 dB for PTAs low-frequency (125–500 Hz). Conclusions: This study provides the first longitudinal follow-up on associated hearing profiles to the EVO™ electrode array, which are comparable to the literature. However, other studies on larger populations should be performed.

Petrous bone pneumatization may be related to cerebrospinal fluid (CSF) leak secondary to vestibular schwannoma surgery. To assess the association between petrous bone pneumatization and CSF leak in vestibular schwannoma surgery. A retrospective study included 222 consecutive vestibular schwannoma patients treated via a retrosigmoid or translabyrinthine approach in a 17-year period in one University Hospital. Association of CSF leak and petrous bone pneumatization, as seen on CT scans, was assessed on ANOVA and Student’s t or Chi-squared test in case of non-parametric distribution. One hundred and 75 resections were performed on a retrosigmoid approach and 47 on a translabyrinthine approach. Mean age was 53.6 ± 12.9 years. Mean follow-up was 5 years 6 months. Twenty-six patients (11.7%) showed CSF leak and 8 (3.6%) meningitis. Approach (p = 0.800), gender (p = 0.904), age (p = 0.234), body-mass index (p = 0.462), tumor stage (p = 0.681) and history of schwannoma surgery (p = 0.192) did not increase the risk of CSF leak. This risk was unrelated to mastoid pneumatization (p = 0.266). There was a highly significant correlation between internal acousticus meatus (IAM) posterior wall pneumatization and CSF leak after retrosigmoid surgery (p = 0.008). Eustachian tube packing in the translabyrinthine approach did not decrease risk of CSF leak (p = 0.571). Degree of petrous bone pneumatization was not significantly related to risk of CSF leak, but pneumatization of the posterior IAM wall increased this risk in retrosigmoid surgery. Eustachian tube packing in the translabyrinthine approach is not sufficient to prevent postoperative CSF leak. Both approaches had similar rates of CSF leaks, around 12%.

Purpose Magnetic resonance imaging (MRI) is often used to visualize and diagnose soft tissues. Hearing implant (HI) recipients are likely to require at least one MRI scan during their lifetime. However, the MRI scanner can interact with the implant magnet, resulting in complications for the HI recipient. This survey, which was conducted in two phases, aimed to evaluate the safety and performance of MRI scans for individuals with a HI manufactured by MED-EL (MED-EL GmbH, Innsbruck, Austria). Methods A survey was developed and distributed in two phases to HEARRING clinics to obtain information about the use of MRI for recipients of MED-EL devices. Phase 1 focused on how often MRI is used in diagnostic imaging of the head region of the cochlear implant (CI) recipients. Phase 2 collected safety information about MRI scans performed on HI recipients. Results 106 of the 126 MRI scans reported in this survey were performed at a field strength of 1.5 T, on HI recipients who wore the SYNCHRONY CI or SYNCHRONY ABI. The head and spine were the most frequently imaged regions. 123 of the 126 scans were performed without any complications; two HI recipients experienced discomfort/pain. One recipient required reimplantation after an MRI was performed using a scanner that had not been approved for that implant. There was only one case that required surgical removal of the implant to reduce the imaging artefact. Conclusion Individuals with either a SYNCHRONY CI or SYNCHRONY ABI from MED-EL can safely undergo a 1.5 T MRI when it is performed according to the manufacturer’s safety policies and procedures.

PURPOSE:To provide more data on the clinical presentation and natural evolution of facial nerve schwannomas and to provide guidance for therapeutic decision making.METHODS:A retrospective case review of eighty patients diagnosed with a facial nerve schwannoma between 1990 and 2018 in ten tertiary referral centers in Europe was performed. Patients' demographics, symptomatology, audiometry, anatomical site (segments involved), size and whenever possible volume measurement were registered.RESULTS:At presentation, transient or persistent facial palsy was the most common symptom, followed by hearing loss. The schwannoma involved more than one segment in the majority of the patients with the geniculate ganglion being most commonly involved. Initial treatment consisted of a wait and scan approach in 67.5%, surgery in 30% and radiation therapy in 2.5% of the patients. Tympanic segment schwannomas caused mainly conductive hearing loss and were more prone to develop facial palsy at follow-up. Internal auditory canal or cerebellopontine angle schwannomas presented with significantly more sensorineural hearing loss.CONCLUSIONS:Although modern imaging has improved diagnosis of this tumor, choosing the best treatment modality remains a real challenge. Based on the literature review and current findings, more insights into the clinical course and the management of facial nerve schwannomas are provided.

Background: The RONDO is a single-unit device that merges both the OPUS 2 behind-the-ear audio processor and the coil into a single housing. The study aims to assess the perceived auditory abilities and opinions of newly implanted subjects using the OPUS 2 and/or the RONDO in everyday life. Material and methods: We studied 83 newly implanted subjects who received the RONDO and OPUS 2 and were free to use whichever processor they preferred or a combination of the two. User satisfaction was evaluated after at least 4 weeks of use (after the first fitting) using the device-specific RONDO questionnaire. Results: Results showed that 77% of subjects were satisfied with the RONDO in general, and 92% of subjects either preferred to use the RONDO or liked both audio processors equally while wearing eyeglasses. Overall, 91% of subjects would recommend the RONDO to other CI users. RONDO was significantly (p<0.05) preferred at home, for cultural events, or when wearing glasses; OPUS 2 was preferred for sport or while wearing a cap. Conclusions: The RONDO was associated with a high degree of user satisfaction among newly implanted CI users and offers CI users further options in terms of wearer comfort and cosmetic appearance. Thus, CI users can, if they wish, switch from the OPUS 2 to the RONDO without affecting their hearing ability or speech understanding.