BACKGROUND:Primary acquired cholesteatomas (PAC) are typically mass-like rounded opacities beginning in the lateral epitympanum that result in osseous erosion. Uncommon presentations of acquired cholesteatoma have been described in the Otolaryngology literature, including en-plaque or sheet-like appearance. PURPOSE:To describe findings of histologically confirmed sheet-like cholesteatoma (SLC) and evaluate the diagnostic performance of two experienced head and neck radiologists for the detection of SLC on temporal bone CT (TBCT). MATERIALS AND METHODS:Retrospective review of 13 SLC patients, 16 PAC patients, and 8 patients with no cholesteatoma was performed. All patients underwent TBCT and had surgical and pathologic confirmation of disease presence/absence. Two radiologists (45 and 29 years-experience), blinded to diagnosis and study design, independently evaluated the TBCTs for cholesteatoma using a 5-point Likert scale (1-5; higher scores indicating greater confidence in the presence of cholesteatoma). Diagnostic performance was evaluated with receiver operating characteristic (ROC) analysis, with area under the curve (AUC) calculated for each reader. Sensitivity and specificity were calculated. Inter-reader agreement was measured by Cohen's kappa (κ). RESULTS:SLC did not appear as a discrete, solid mass on CT. 61% (8/13) appeared as plaque-like thickening of the tympanic membrane (all with history of perforation/instrumentation), without obvious osseous erosion. 38% (5/13) showed curvilinear, shell-like lamellated tissue in the middle ear (3/5) or mastoid (2/5). For SLC detection, sensitivity and specificity were 43% and 100% (reader 1), and 53% and 71% (reader 2), respectively. For PAC, sensitivity, specificity were 94% and 100% (reader 1) and 94% and 100% (reader 2), respectively. Mean Likert scores for SLC were 3 (reader 1) and 2.3 (reader 2), with moderate agreement (ć=0.49; 95% CI:0.13-0.86); for PAC, scores were 4.7 and 4.4, with excellent agreement (ć=0.80; 95% CI:0.54-1.00). CONCLUSIONS:SLC is an uncommon subtype of cholesteatoma with potentially subtle imaging features, without the typical nodular appearance of a PAC, posing a diagnostic challenge. Radiologists should be aware of this variant and report findings cautiously to support accurate clinical management.

Falls constitute a significant public health concern worldwide and have been associated with increased morbidity and mortality across all ages. Identifying potentially modifiable risk factors for falls is a key public health priority. Literature surrounding the association between hearing loss (HL) and falls remains inconclusive. To conduct a systematic review and meta-analysis to comprehensively synthesize evidence surrounding the impact of HL on falls. PubMed, Embase, and Cochrane Library from database inception through April 9, 2024. Observational studies investigating the association between HL and falls were selected. Only studies reporting covariate-adjusted estimates were included to minimize confounding. Two independent reviewers evaluated studies for eligibility, extracted data, and assessed the risk of bias of included studies. Using a random-effects model, adjusted estimates were pooled in meta-analyses. Heterogeneity was evaluated using subgroup and sensitivity analyses, and publication bias was assessed. The cross-sectional odds and longitudinal risk of falls among patients with HL compared with those without HL. A total of 5 071 935 participants were included from 27 studies; approximately 49.2% of participants were female, and 14 studies were conducted in Asia, 7 in North America, 3 in Europe, and 3 in Oceania, represented by Australia. Patients with HL exhibited an increased cross-sectional odds of falls (odds ratio, 1.51; 95% CI, 1.37-1.67; I2 = 64%) and longitudinal risk of falls (risk ratio, 1.17; 95% CI, 1.06-1.29; I2 = 69%) than those without HL. Further stratification by self-reported or validated hearing assessments, fall reporting duration, continent, community-dwelling adults, and studies adjusting for other sensory deficits identified as fall risk factors by the World Falls Guideline did not change significance. These results remained robust to sensitivity analyses, and publication bias was absent. This systematic review and meta-analysis found that overall, HL may be a risk factor for falls. With a rapidly aging global population, it is crucial to acknowledge the public health concerns surrounding falls and consider if HL could be a potentially modifiable risk factor. Nonetheless, further randomized clinical trials are needed to elucidate any benefit of treating HL on fall prevention.

Parvalbumin-expressing inhibitory neurons (PVNs) stabilize cortical network activity, generate gamma rhythms, and regulate experience-dependent plasticity. We found that PVNs act like a volume knob in the mouse auditory cortex (ACtx), bi-directionally adjusting neural and perceptual sensitivity to sound level over a 20 dB range. PVN-based gain adjustments were "sticky," such that a single bout of PVN activation at 40 Hz-but not at 1 or 70 Hz-sustainably dampened ACtx sound responsiveness, enhanced feedforward inhibition, and behaviorally desensitized mice to loudness. We then developed a mouse model of adult-onset hyperacusis by demonstrating ACtx hyperactivity, PVN hypofunction, and loudness hypersensitivity following a restricted noise-induced cochlear lesion. We found that several minutes of 40-Hz PVN stimulation in noise-exposed mice sustainably dampened ACtx hyperactivity and restored normal loudness sensitivity for 1 week. These findings demonstrate that sensory disorders caused by permanent peripheral injuries can be reversed by patterned stimulation of cortical circuits that directly regulate perception.

Importance Falls constitute a significant public health concern worldwide and have been associated with increased morbidity and mortality across all ages. Identifying potentially modifiable risk factors for falls is a key public health priority. Literature surrounding the association between hearing loss (HL) and falls remains inconclusive. Objective To conduct a systematic review and meta-analysis to comprehensively synthesize evidence surrounding the impact of HL on falls. Data Sources PubMed, Embase, and Cochrane Library from database inception through April 9, 2024. Study Selection Observational studies investigating the association between HL and falls were selected. Only studies reporting covariate-adjusted estimates were included to minimize confounding. Data Extraction and Synthesis Two independent reviewers evaluated studies for eligibility, extracted data, and assessed the risk of bias of included studies. Using a random-effects model, adjusted estimates were pooled in meta-analyses. Heterogeneity was evaluated using subgroup and sensitivity analyses, and publication bias was assessed. Main Outcomes and Measures The cross-sectional odds and longitudinal risk of falls among patients with HL compared with those without HL. Results A total of 5 071 935 participants were included from 27 studies; approximately 49.2% of participants were female, and 14 studies were conducted in Asia, 7 in North America, 3 in Europe, and 3 in Oceania, represented by Australia. Patients with HL exhibited an increased cross-sectional odds of falls (odds ratio, 1.51; 95% CI, 1.37-1.67; I-2 = 64%) and longitudinal risk of falls (risk ratio, 1.17; 95% CI, 1.06-1.29; I-2 = 69%) than those without HL. Further stratification by self-reported or validated hearing assessments, fall reporting duration, continent, community-dwelling adults, and studies adjusting for other sensory deficits identified as fall risk factors by the World Falls Guideline did not change significance. These results remained robust to sensitivity analyses, and publication bias was absent. Conclusions and Relevance This systematic review and meta-analysis found that overall, HL may be a risk factor for falls. With a rapidly aging global population, it is crucial to acknowledge the public health concerns surrounding falls and consider if HL could be a potentially modifiable risk factor. Nonetheless, further randomized clinical trials are needed to elucidate any benefit of treating HL on fall prevention.

BACKGROUND AND PURPOSE:Sudden sensorineural hearing loss (SSNHL) is a dramatic and often frightening condition that benefits from prompt treatment. While most cases of SSNHL are idiopathic, a retrocochlear pathology is expected to account for some presenting cases of SSNHL. This study aims to assess the presence of retrocochlear pathology in SSNHL and ascertain whether clinical features could help determine their presence on MRI. MATERIALS AND METHODS:A retrospective cohort study was conducted using a patient data registry from 2015 to 2022. Patients who underwent MRI of the internal auditory canals for SSNHL at a single center were included. MRs were reviewed for relevant positive findings and incidental actionable findings. Clinical features recorded included laterality of hearing loss, tinnitus, dizziness, vertigo, and pure tone average (PTA) thresholds from audiograms. Treatment decisions were documented. Exclusion criteria included previous temporal bone pathology, trauma, surgery, or missed MR appointments. RESULTS:Eight hundred forty-one patients (929 ears; mean age 53.6 years ±15.7 [standard deviation]) were included. MRs showed no retrocochlear pathology in 874 ears (94.1%). Twenty-five ears had relevant tumors (2.7%). Nine patients with tumors underwent surgery or radiation. All tumors were visible on noncontrast cisternographic sequences. Twenty-one ears (2.3%) had findings suggestive of labyrinthitis. Additional relevant findings included enlarged endolymphatic ducts and small cochlear nerves. Patients with a PTA ≥49.5 dB had 5.3 times higher odds of having a tumor or labyrinthitis on MRI (P < .001), and those with tinnitus had 4.2 times higher odds (P = .02). No statistical difference was found in steroid use between patients with or without labyrinthitis features (P = .38). CONCLUSIONS:Most patients showed no retrocochlear pathology on MRI, with only 2.7% having relevant tumors. To screen for urgent pathology, a noncontrast MR protocol may be feasible. Clinical features such as high PTA values and tinnitus may increase the odds of finding a treatable retrocochlear condition.

Otic barotrauma (OBT) is traumatic injury of the middle ear and tympanic membrane resulting from a high-pressure differential existing between the middle ear and external environment. Commonly, individuals may experience slight changes in pressure while driving to different elevations, scuba diving, or in commercial air travel resulting in mild symptoms (e.g., slight aural discomfort). However, it is possible for these same activities to cause OBT, such as during commercial air travel, which is an increasingly common issue encountered by otolaryngologists and otologists given the wide adoption of air travel; over the past 50 years, the number of passengers has increased from 310 million to 3.7 billion annually, with an estimate of 1 million passengers flying at any given moment. The overall prevalence of OBT though varies considerably by types of activities that individuals participate in (e.g., scuba diving) and risk factors such as history of otitis media and head and neck cancers. To help address this clinical issue, this chapter provides an overview of the pathophysiology, diagnosis, and medical and surgical management of OBT.

Temporal bone fractures (TBFs) present complex diagnostic and management challenges. Due to the large amount of force required to fracture the temporal bone (TB), several other injuries may also be present. The severity and number injuries may result in incomplete or evaluation of the TB, which may delay diagnosis and proper follow-up care. The management of TBF overall focuses on restoring functional deficits and reducing regional and intracranial complications due to injury to structures within the TB. This chapter will provide an overview of the diagnosis and medical and surgical management of TBF.

Objectives:Age-related hearing loss (presbycusis) is a prevalent condition traditionally attributed to inner ear dysfunction. Little is known about age-related changes in the ossicular joints or their contribution to presbycusis. Herein, we performed an otopathologic evaluation of the ossicular joints in cases of presbycusis without a clear sensorineural explanation. Methods:Histopathologic analysis of the incudomallear (IM) and incudostapedial (IS) joints was performed in specimens from the National Temporal Bone Registry with audiometrically confirmed presbycusis but without histologically observed sensorineural, strial, or mixed features; deemed cases of "indeterminate" presbycusis. Specimens identified as "indeterminate" presbycusis (IP, n = 18) were compared to specimens with histologically confirmed sensorineural presbycusis (n = 16) and strial presbycusis (n = 11). Presbycutic specimens were also compared to age-matched controls (n = 9) and young controls (n = 14). Results:The synovial space at the center of the IM joint was wider in the IP group (194 ± 36.8 μm) compared to age-matched controls (138 ± 36.5 μm), young controls (149 ± 32.2 μm), and ears with sensorineural presbycusis (148 ± 52.7 μm) (p < .05). The synovial space within the IS joint was wider in the IP group (105 ± 33.0 μm) when compared to age-matched controls (57.9 ± 13.1 μm) and ears with sensorineural presbycusis (62.3 ± 31.2 μm) (p < .05). Conclusion:IP ears have wider IM and IS joints when compared to ears with sensorineural presbycusis and age-matched controls. Findings point to a potential middle ear source of high frequency conductive hearing loss in a subset of presbycutic ears. Level of Evidence:Retrospective study.

Traumatic brain injury (TBI) is a major public health issue globally and in the United States. The Centers for Disease Control (CDC) defines TBI as an insult (blow or bump to the head) or penetrating head injury affecting the normal function of the brain. TBI can vary in severity, and in the United States, the majority are mild and clinically often described as a "concussion." Recent research over the past decade has demonstrated that there is a growing societal cost involved in the management of the long-term physical and psychosocial sequelae of TBI. Following a head injury, trauma may also occur to the lateral skull base, which is an area that includes critical neurovascular structures within the middle and posterior fossae and temporal bone, which, similar to TBI, may greatly affect quality of life. Given the rising incidence of TBI and growing public health concern, understanding the epidemiologic patterns of these types of injuries is important for identifying and managing populations at risk.

Summary Parvalbumin-expressing inhibitory neurons (PVNs) stabilize cortical network activity, generate gamma rhythms, and regulate experience-dependent plasticity. Here, we observed that activation or inactivation of PVNs functioned like a volume knob in the mouse auditory cortex (ACtx), turning neural and behavioral classification of sound level up or down over a 20dB range. PVN loudness adjustments were “sticky”, such that a single bout of 40Hz PVN stimulation sustainably suppressed ACtx sound responsiveness, potentiated feedforward inhibition, and behaviorally desensitized mice to loudness. Sensory sensitivity is a cardinal feature of autism, aging, and peripheral neuropathy, prompting us to ask whether PVN stimulation can persistently desensitize mice with ACtx hyperactivity, PVN hypofunction, and loudness hypersensitivity triggered by cochlear sensorineural damage. We found that a single 16-minute bout of 40Hz PVN stimulation session restored normal loudness perception for one week, showing that perceptual deficits triggered by irreversible peripheral injuries can be reversed through targeted cortical circuit interventions.

Labyrinthine concussion has been the term used to describe sensorineural hearing loss following head trauma in the absence of fracture involving the labyrinth. This chapter will provide an overview of the diagnosis and management of labyrinthine concussion.

Implantable tubes, shunts, and other medical conduits are crucial for treating a wide range of conditions from ears and eyes to brain and liver but often impose serious risks of device infection, obstruction, migration, unreliable function, and tissue damage. Efforts to alleviate these complications remain at an impasse because of fundamentally conflicting design requirements: Millimeter-scale size is required to minimize invasiveness but exacerbates occlusion and malfunction. Here, we present a rational design strategy that reconciles these trade-offs in an implantable tube that is even smaller than the current standard of care. Using tympanostomy tubes (ear tubes) as an exemplary case, we developed an iterative screening algorithm and show how unique curved lumen geometries of the liquid-infused conduit can be designed to co-optimize drug delivery, effusion drainage, water resistance, and biocontamination/ingrowth prevention in a single subcapillary–length-scale device. Through extensive in vitro studies, we demonstrate that the engineered tubes enabled selective uni- and bidirectional fluid transport; nearly eliminated adhesion and growth of common pathogenic bacteria, blood, and cells; and prevented tissue ingrowth. The engineered tubes also enabled complete eardrum healing and hearing preservation and exhibited more efficient and rapid antibiotic delivery to the middle ear in healthy chinchillas compared with current tympanostomy tubes, without resulting in ototoxicity at up to 24 weeks. The design principle and optimization algorithm presented here may enable tubes to be customized for a wide range of patient needs.

Abstract Objective Scleroderma is a complex chronic progressive immune‐mediated disease that causes fibrosis of the skin and internal organs, and vasculopathy. Ear involvement has been poorly studied in patients with scleroderma. Vasculitic and autoimmune mechanisms are considered as possible etiologies on hearing impairment, however, this etiology still unclear. Herein, we reviewed three cases of scleroderma from a temporal bone repository. Methods The national temporal bone database was reviewed for cases with scleroderma. Clinical case review and correlative otopathologic analysis. Middle and inner ear otopathologic analysis was performed following hematoxylin and eosin staining under light microscopy. Findings were compared to three age‐matched controls. Results Two patients (three cases) with a history of serologically confirmed scleroderma were identified. Both individuals reported tinnitus and demonstrated bilateral moderate to severe down‐sloping sensorineural hearing loss on audiometry. Histologically, the incudomallear joint space was diminished and ossicles appeared demineralized. A loss of hyaline cartilage, and obliteration of the incudomallear and incudostapedial joint synovial spaces was observed. Decreased caliber and intimal hyperplasia of arteries adjacent to ossicles was also identified. Mild diffuse atrophy of stria vascularis in the middle and apical turns of cochlea were found. Hair cell populations were normal. Total spiral ganglion neurons were lower in cases of scleroderma (range 29%–51%) compared to age‐matched controls. Conclusion Fibrosis, inflammation, and vascular changes were observed in the middle and inner ear in patients with scleroderma. Findings have implications for understanding hearing and vestibular dysfunction in this patient population. Level of evidence Retrospective study.

Objectives Universal mask wearing due to COVID-19 has introduced barriers to clear communication. In hearing impaired individuals this can impact informed surgical consent. For cochlear implant candidates, who do not rely on sign language, real-time transcription with a stenographer (CART) is the gold-standard in assistive technologies. If CART is not available, speech to text (STT) applications have been advertised as solutions, but their transcription accuracy with or without an N95 mask is not well-established. Herein, we sought to investigate the transcription accuracy of three STT solutions for iPhone and compare their performance to the CART service at our institution. Methods Three native English speakers and three non-native English speakers read two passages (a cochlear implant consent and the non-medical 'Rainbow passage') with and without an N95 mask. Error rates from the comparison of the transcript (from either the STT app or CART) with the original passage were calculated. Results The CART service had the lowest error rate of all testing conditions (4.79-7.14%). Ava 24/7 (15.0 +/- 9.49%) and the iPhone dictation (15.6 +/- 6.65%) had significantly lower average error rates than the Live Transcribe (37.7 +/- 20.3%) (P < 0.0001) application. Neither the presence of an N95 nor the type of passage had a statistically significant impact on the error rate. Conclusion CART should be used to augment communication with patients who are hard of hearing. If CART is not available, a STT application such as Ava 24/7 or the native iPhone dictation application may be considered, even in the context of medical terminology.

Objective: This report describes a case of otogenic central skull base osteomyelitis (CSBO) requiring complex surgical intervention and reviews the literature on management of this entity. Patient: A 76-year-old man presented with a nearly 20-year history of chronic otomastoiditis and cholesteatoma with ultimate progression to severe CSBO with involvement of the petrous apex, clivus, and craniocervical junction. Interventions: CSBO was managed with culture-directed antibiotic therapy, hyperbaric oxygen, and surgical intervention including serial combined endoscopic transmastoid and transsphenoidal debridements. Main outcome measures: Symptom resolution, antibiotic holiday, and stable disease on surveillance imaging. Results: With antibiotic treatment and surgical debridement including creation of a drainage pathway from the skull base to the sphenoid sinus, intermittent stretches of disease quiescence were realized over the course of nearly a decade. Despite extensive debridement and skull base reconstruction, the patient ultimately succumbed to the disease process. Conclusions: CSBO poses significant management challenges to the otologist. Herein, we present a rare case of CSBO managed over a prolonged period of time with antibiotics and combined anterior and lateral skull base debridement.

During the COVID-19 pandemic, the utility of portable audiometry became more apparent as elective procedures were deferred in an effort to limit exposure to health care providers. Herein, we retrospectively evaluated mobile-based audiometry in the emergency department and outpatient otology and audiology clinics. Air conduction thresholds with mobile audiometry were within 5 dB in 66% of tests (95% CI, 62.8%-69.09%) and within 10 dB in 84% of tests (95% CI, 81.4%-86.2%) as compared with conventional audiometry. No significant differences were noted between mobile-based and conventional audiometry at any frequencies, except 8 kHz (P < .05). The sensitivity and specificity for screening for hearing loss were 94.3% (95% CI, 91.9%-96.83%) and 92.3% (95% CI, 90.1%-94.4%), respectively. While automated threshold audiometry does not replace conventional audiometry, mobile audiometry is a promising screening tool when conventional audiometry is not available.

Abstract Objective Surgical education is changing in an era of new regulations and evolving training cultures. We sought to understand the factors that affect operative experiences during otolaryngology residency. Methods From December 2019 to December 2020, five otolaryngology training programs used the SIMPL OR smartphone application to evaluate residents after each operation. Residents and attendings rated the trainee's autonomy on a 4‐level Zwisch scale, performance on a 5‐level scale, and case complexity on a 3‐level scale. We examined associations between ratings of autonomy and performance with variables including postgraduate year (PGY), case complexity, gender, week of the academic year (AY), and whether multiple procedures were logged. Results 78 attendings and 92 residents logged 2984 evaluations. PGY level and week of the AY were positively associated with attending ratings of autonomy and performance (PGY3 vs. PGY2: B = 0.63, p < .001 for autonomy and B = 1.05, p < .001 for performance; week of the AY: B = 0.013, p = .002 for autonomy; B = 0.025, p < .001 for performance). Multiple procedures logged and increasing case complexity were negatively associated with attending ratings (multiple procedures: B = −0.19, p = .04 for autonomy and B = −0.48, p < .001 for performance; hardest vs. easiest 1/3 of cases: B = −1.01, p < .001 for autonomy and B = −0.59, p < .001 for performance). Attending and trainee genders were not associated with attending ratings of autonomy or performance. Conclusion Resident autonomy and performance were positively associated with PGY level and week of the academic year, and negatively associated with case complexity and multiple procedures. These findings highlight the need to align training level with case complexity to promote quality operative experiences. Level of Evidence 2.

Sports-related injuries, such as concussion, during childhood may result in considerable morbidity, including a range of negative developmental consequences. Auditory dysfunction is generally recognized to be a possible sequela of sports-related concussion; however, few epidemiologic studies have quantified the association between hearing quality and sports-related activity in the pediatric population. The National Health and Nutrition Examination Survey for the 2015-2016 cycle was utilized to determine the association of sports activities and hearing quality. Subjective abnormal hearing quality was more frequent among children who played football than those that did not (36.5% vs 26.8%; odds ratio, 1.56 [95% CI, 1.23-2.00]; P = .001). Other sports, such as basketball and soccer, did not have this association with hearing quality (P = .496 and P = .852, respectively). Our findings suggest a notable association between practice of a potentially high concussion sport and hearing quality. Children practicing football are 1.56 times more likely to report abnormal hearing quality. Level of Evidence: 4.