PURPOSE:Pediatric obstructive sleep-disordered breathing (SDB) is frequently diagnosed using single-night home sleep apnea testing (HSAT). However, concerns persist regarding diagnostic accuracy due to night-to-night variability and the first-night effect, defined as systematic differences between the first and subsequent nights. Previous research on pediatric polysomnography has yielded conflicting findings regarding these phenomena. This study assesses the presence of a first-night effect and quantifies night-to-night variability in respiratory parameters among children undergoing HSAT. METHODS:This retrospective study analyzed respiratory polygraphy data collected over two consecutive nights from a real-world, unselected population of children with suspected SDB. The primary outcome was the difference in apnea-hypopnea index (AHI) between the first and second nights, commonly referred to as the first-night effect. Secondary outcomes included differences in other respiratory parameters and between-night accuracy in diagnosing obstructive sleep apnea (OSA). RESULTS:Forty-eight children (median age: 6.7 years, 75% male) were included in the analysis. No systematic differences were detected between the first and second nights in AHI or other respiratory parameters, suggesting an absence of the first-night effect. Nevertheless, for some participants, measurements varied widely between nights. This resulted in 29% of children changing the diagnostic category of OSA between nights. CONCLUSION:Pediatric HSAT in this real-world population with mostly mild SDB symptoms demonstrates no significant first-night effect; however, moderate night-to-night variability exists in some children. Clinicians must consider this variability when interpreting HSAT results in cases where clinical presentation and single-night HSAT outcomes conflict; a multi-night assessment may be warranted to improve diagnostic accuracy.

Cochlear implants restore hearing in patients with moderate to profound sensorineural hearing loss by electrically stimulating the auditory nerve. This includes individuals with residual low-frequency acoustic hearing, which can enhance auditory rehabilitation if preserved despite implantation. However, residual hearing is lost in approximately half of these patients due to surgical trauma and subsequent inflammatory and fibrotic tissue response. To support hearing preservation, electrocochleography and electrode impedance measured via the implant provide objective feedback on cochlear health, but each with limited accuracy. Although combining electrocochleography with impedance has been proposed to address the constraints of each individual biomarker, it remains unclear whether a joint analysis improves monitoring of residual hearing. Here we present prospective longitudinal data from 31 implanted cochleae (108 observations) collected perioperatively and over 24 weeks of follow-up. Combined analysis of electrocochleography and impedance in a linear model improved monitoring performance for residual hearing (averaged low-frequency air-conduction pure-tone thresholds; R2marg= 0.71) compared with electrocochleography alone (R2marg = 0.63) or impedance alone (R2marg = 0.48). Findings indicate that electrocochleography and impedance are complementary biomarkers of cochlear health, and that multimodal analysis can improve telemetry-based objective monitoring of residual hearing after cochlear implantation.

Hypothesis: We hypothesize a large anatomic variability with a positive correlation between retrotympanic recess volume and depth classification and an inverse correlation between recess volume and facial nerve distance. Background: The retrotympanum consists of various bony recesses and is of particular interest given its frequent involvement in cholesteatoma. As the structures are only partly accessible with established imaging techniques due to their size, we propose here to systematically analyze the different retrotympanic subsites and describe topographic relationships using synchrotron-based X-ray phase contrast imaging (SR X-PCI). Methods: Ten fresh-frozen human temporal bones underwent SR X-PCI at the TOMCAT beamline at the Swiss Light Source. Microtomographic data sets were acquired and segmented for visual inspection. In each specimen, sinus tympani, facial recess, posterior sinus, and lateral tympanic sinus were present and were identified for further analysis. Results: Among the volumes of retrotympanic recesses, the posterior sinus was on average the smallest and sinus tympani the largest. A positive correlation was observed between the volumes of the sinus tympani and facial recess and their respective A-B-C classifications. Moreover, an inverse correlation between volume and distance to the facial nerve was found for the different retrotympanic recesses. In addition, a previously undescribed recess located above the facial recess, termed the suprafacial recess, was identified in 7 specimens, and its volume was quantified. Conclusion: SR X-PCI enabled 3D visualization and volumetric analysis of retrotympanic subspaces. Our findings confirmed the complex and variable anatomy of this region and revealed a consistent presence of a previously underreported suprafacial recess.

ABSTRACT Objective To evaluate whether tongue base motion patterns, assessed by submental ultrasonography during unilateral hypoglossal nerve stimulation (HNS), are associated with treatment response in obstructive sleep apnea patients. Methods This cross‐sectional study included 64 patients with unilateral HNS. Standardized submental B‐mode ultrasound was performed to assess tongue‐base motion under awake stimulation. Two independent, blinded raters evaluated the magnitude of anterior tongue base movement in the axial and sagittal planes. Further, the symmetry of bilateral tongue protrusion and tongue shape was classified. The primary endpoint was the correlation between apnea‐hypopnea (AHI) reduction and ultrasonographic findings. Results Ultrasonographic assessment showed substantial to excellent agreement between the two raters. No significant correlation was found between AHI reduction and anterior tongue displacement in either the axial (Spearman's ρ = 0.20, p = 0.12) or sagittal plane (ρ = −0.08, p = 0.64). Clinically meaningful bilateral activation was present in 33% of patients but was not associated with treatment outcome (ρ = 0.03, p = 0.84). Neither tongue shape was predictive of AHI improvement (buckling p = 0.13 and trough sign p = 0.79). Tongue movement patterns were not associated with stimulation voltage. Conclusion Ultrasonographic assessment of tongue base motion under HNS does not correlate with treatment response. Neither symmetry, magnitude, nor qualitative shape was associated with AHI reduction. These findings suggest that visible tongue motion may not reliably reflect functional improvement in the airway. Future research should define the role of ultrasound in HNS evaluation and optimization. Level of Evidence 3b. Trial Registration ClinicalTrials.gov Identifier: NCT06154577

BackgroundTo evaluate current clinical practices, attitudes, and considerations regarding hearing and structure preservation (HSP) in cochlear implant surgery among international experts.MethodsA cross-sectional online survey comprising 42 structured items was distributed to 75 HEARRING members, including surgeons, audiologists, and scientists. The questionnaire covered HSP indications and candidate evaluation, electrode array selection, surgical techniques, fitting strategies, and training.ResultsThirty-one experts from 16 countries completed the survey. Most respondents (87.1%) supported HSP surgery in all patients with normal cochlear anatomy, regardless of the severity of hearing loss, primarily to preserve cochlear structures and optimize long-term outcomes. Strong consensus emerged regarding atraumatic principles, including slow electrode array insertion, flexible electrode arrays, round window access, and routine intraoperative corticosteroid use. Image-based planning was unanimously endorsed for electrode array selection, and all experts favoured longer electrode arrays even in patients with functional low-frequency hearing. Variability persisted in the adoption of genetic testing, perioperative management, intraoperative monitoring, and fitting strategies, although anatomy-based fitting was most frequently selected. Training of surgeons and audiologists was universally regarded as essential.ConclusionsThis survey demonstrates a clear evolution toward a shared expert framework for HSP-oriented cochlear implantation surgery, with several principles approaching consensus. Remaining variability highlights a) areas for future research and development and b) supports the continued international collaboration toward standardized HSP practice.

BACKGROUND:Research on the hearing implant journey in older adults is scarce. AIMS/OBJECTIVES:To conduct a multicenter scoping survey on the clinical routine in the treatment of hearing loss, specifically cochlear implantation, in older adults. MATERIALS AND METHODS:A survey comprising 39 questions on the treatment of hearing loss in older adults was sent to 20 cochlear implant clinics worldwide. RESULTS:Most respondents referred to older adults in the context of cochlear implantation as adults aged 60 years or older with postlingual, mostly progressive hearing loss with different aetiologies. Preoperative assessment in older adults should go beyond standard audiometric tests, including cognitive screening and involving a multidisciplinary team. Significant others and social support play a key role in the rehabilitation process in older adult CI recipients and users. CONCLUSIONS AND SIGNIFICANCE:A guideline for the management of cochlear implantation in older adults is needed.

BACKGROUND:Non-implantable bone conduction (BC) hearing systems are well-established for individuals with conductive or mixed hearing loss. OBJECTIVE:To evaluate the audiological performance of two wearing options-an adhesive adapter and headband-worn unilaterally and bilaterally using the same non-implantable BC hearing device Contact Forte (BHM Inc., Grafenschachen, Austria). MATERIAL AND METHODS:Fifteen normal hearing adults with simulated bilateral conductive hearing losses participated in the study. Speech understanding in quiet and in noise were measured unaided and with BC devices worn unilaterally, bilaterally, with adhesive adapters, and mounted on headbands. Sound quality was rated using a questionnaire. RESULTS:At 50 dB SPL word recognition scores in quiet improved, on average, by 58% (unilateral), and 69% (bilateral) with adhesive adapters and by 65% and 74% with headbands. At 65 dB mean scores were above 95% in all aided conditions. In noise, speech presented speech reception thresholds decreased by 2.3-3.6 dB. With two devices, an additional benefit of 4.4 dB SNR (p<.001) was observed for speech from the side of the second device. Participants favored the bilateral configurations. CONCLUSION AND SIGNIFICANCE:Both wearing options showed comparable improvements in speech understanding. Bilateral fittings led to better speech understanding for one configuration and were favored subjectively.

OBJECTIVE:To compare patient-reported outcome measures (PROMs) across different palatopharyngeal surgical modifications without tonsillectomy for snoring and obstructive sleep apnea (OSA). DATA SOURCES:MEDLINE, Embase, Web of Science, ClinicalTrials, CINAHL, Cochrane Library, ICTRP. REVIEW METHODS:We conducted a systematic review and meta-analysis, including original studies of adult patients undergoing palatopharyngeal surgery without tonsillectomy for snoring and OSA. To reduce confounding, we excluded tonsillectomy, as tonsil size is a major predictor of outcome. Primary PROMs included changes in daytime sleepiness, as measured by the Epworth Sleepiness Scale (ESS), and snoring intensity, assessed on a visual analog scale, analyzed by surgical technique using random-effects models. RESULTS:Fifty-five studies with 1815 patients were included. Overall, palatopharyngeal surgery without tonsillectomy reduced ESS by a mean of 3.3 points (95% CI, 2.7 to 3.9) and snoring intensity by 4.1 points (95% CI, 3.7 to 4.6). Among surgical techniques, suture palatopharyngoplasty, muscle relocation, cold-steel techniques, and powered instruments showed the largest reductions in both daytime sleepiness and snoring. Meta-regression analyses showed no evidence for declining treatment effectiveness with longer follow-up durations for both PROMs. Heterogeneity across studies was considerable, with a moderate overall risk of bias. CONCLUSION:Palatopharyngeal surgery without tonsillectomy effectively improves patient-reported daytime sleepiness and snoring intensity, with outcomes varying by surgical techniques. Suture palatopharyngoplasty, muscle relocation, cold-steel techniques, and the use of powered instruments appear to be most effective in improving PROMs. These results inform surgical planning and counseling in patients seeking surgical treatment for snoring and daytime sleepiness. TRIAL REGISTRATION:PROSPERO: CRD42024559063.

Importance:Many cochlear implant candidates retain residual hearing, which can improve speech perception and overall outcomes. However, residual hearing is frequently lost during implantation. Intraoperative electrocochleography may enable monitoring of residual hearing, but its clinical relevance is currently limited due to reliance on expert interpretation, the absence of real-time analysis algorithms, and signal variability. Objective:To assess whether automated analysis of intraoperative cochlear microphonic amplitude decreases (events) is associated with hearing preservation and to evaluate additional electrocochleography features enhancing potential predictive performance. Design, Setting, and Participants:This multicenter, cross-sectional cohort study included adults receiving a cochlear implant with a preoperative hearing threshold not greater than 85 dB hearing level at 0.5 kHz and cochlear microphonic amplitude of 5 μV or higher across 3 tertiary referral centers in Melbourne, Australia; Bern, Switzerland; and Zurich, Switzerland. Intraoperative real-time electrocochleography and impedance data were collected between 2017 and 2025, with audiometric follow-up 3 months postoperatively. Exposures:Cochlear implantation with the Slim Straight Electrode array (Cochlear Limited). Main Outcomes and Measures:Primary outcome was binary hearing preservation at 3 months postoperatively, defined as less than 25% loss relative to the preoperative low-frequency pure-tone average at 0.25 to 1 kHz. Primary variables assessed as possible predictors included magnitude, location, and persistence of cochlear microphonic events. Post hoc analysis explored associated changes in the auditory nerve neurophonic:cochlear microphonic amplitude ratio and cochlear microphonic phase. Results:A total of 112 patients met inclusion criteria and were analyzed (median [IQR] age at surgery, 68 [58-75] years; 57 [51%] female and 55 [49%] female). Cochlear microphonic events persisting or occurring near the end of insertion were associated with loss of residual hearing (adjusted odds ratio, 31.58 [95% CI, 6.36-205.36] and 52.96 [95% CI, 8.02-472.63], respectively), independent of age, preoperative hearing, and participating hospital. Events with rising amplitude ratio between auditory nerve neurophonic and cochlear microphonic were associated with better hearing preservation (mean difference in hearing preservation, 24.4% [95% CI, 7.3%-41.5%]). Stable cochlear microphonic phase showed a similar trend (mean difference in hearing preservation, 20.9% [95% CI, 2.9%-38.9%]). Conclusions and Relevance:This cross-sectional study demonstrates the feasibility of automated intraoperative electrocochleography for possible prediction of hearing preservation during cochlear implantation. Persistent cochlear microphonic events near the end of insertion were associated with hearing loss. Additional electrocochleography features may improve signal interpretation. These findings support the development of real-time feedback systems to guide cochlear implantation.

OBJECTIVE:To quantify how surgical behavior influences intracochlear mechanical stress during cochlear implantation using objective multi-sensor data from a large cohort of specialist cochlear implant (CI) surgeons. METHODS:Thirty internationally recognized surgeons each performed bilateral insertions in mechanically representative artificial temporal bone models. Insertion force, pressure, and electrode kinematics were captured, and six trauma-related metrics were combined into a composite soft-surgery score. Associations with surgical experience, self-assessment, and handling behaviors were analysed using nonparametric statistics. RESULTS:Marked variability was observed across all metrics. Surgeons with < 50 lifetime insertions performed significantly worse than experienced colleagues. Self-assessment showed no correlation with objective outcomes. Excessively slow insertions and frequent electrode regrasping were associated with higher pressure exposure, greater force variation, and increased intracochlear implant motion. Post-insertion handling contributed substantially to intracochlear stress. CONCLUSION:Surgical behavior decisively influences intracochlear mechanical stress in CI. Steady, uninterrupted advancement at slow to moderate speed, avoidance of array regrasping, and careful post-insertion handling reduce mechanical load. Because self-assessment proved unreliable even among specialist CI surgeons, structured training with quantitative feedback and intraoperative monitoring is essential to refine soft-surgery technique, preserve residual hearing, and optimize hearing outcomes. LEVEL OF EVIDENCE:N/A.

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.

Objective. Preoperative imaging is vital for cochlear implant surgeries, aiding diagnosis, and surgical planning. This study evaluated global practices and the value of preoperative imaging through an international survey. Methods. A cross-sectional survey was conducted among international cochlear implantation experts using a 112-item questionnaire. The study explored imaging modalities, anatomical targets, evaluated parameters, and different imaging approaches' perceived value and risks. Participants were recruited from a global consortium of otolaryngology, otology, neurotology, and cochlear implant surgery professionals. Results. Thirty-nine practitioners from 36 centers in 16 countries completed the survey (95.1% response rate). All used computed tomography (CT) and magnetic resonance imaging (MRI) for preoperative evaluation; MRI was deemed more valuable for diagnosis and candidacy assessment, while CT was preferred for surgical planning. Nearly half utilized additional imaging modalities, with functional MRI being the most common (20.5%). Additionally, 79.5% of respondents reported using image-based surgical planning software. Discussion. Results show a universal reliance on CT and MRI for cochlear implant evaluations, with MRI aiding diagnosis and CT focusing on surgical planning. Advanced imaging techniques may emerge in specific clinical cases. Implications for practice. Modern imaging practices and their potential changes can enhance protocol development and improve preoperative evaluations, ultimately boosting patient safety and outcomes in cochlear implantation.

Introduction: Intratympanic corticosteroids (ITCs) are used to treat patients with idiopathic sudden sensorineural hearing loss (ISSNHL) when systemic therapy has been unsuccessful. However, the efficacy of this treatment remains uncertain. METHODS:We retrospectively analysed ISSNHL patients at a tertiary reference centre, who received ITC injections following unsuccessful systemic corticosteroid therapy administered either orally or intravenously. Patients were eligible for ITC if they showed insufficient improvement after systemic treatment, defined as a remaining hearing loss of ≥30 dB HL in at least three frequencies. They received three intratympanic injections of 0.3-0.5 mL dexamethasone (4 mg/mL) within 10-14 days from first to last injection. Changes in pure-tone audiometry were assessed. RESULTS:A total of 34 patients met the inclusion criteria for the study. The mean pure tone average (PTA) improvement was 10.62 dB HL. A total of 18 (53%) patients showed hearing improvement of ≥10 dB HL (of these: n = 11 (32%) ≥20 dB HL, n = 2 (6%) ≥30 dB HL). Sixteen (47%) patients had an improvement of less than 10 dB HL. In addition to the PTA analysis, individual frequencies at 0.5 kHz, 1 kHz, 2 kHz, and 4 kHz were examined and showed significant improvements, with p values ranging from 0.007 to 0.037. Regarding the World Health Organization grading of hearing impairment, 13 (38.2%) patients improved by at least one category. Concomitant vestibular syndrome (n = 5) showed a marginally non-significant trend (p = 0.066) towards less improvement. There was no significant correlation between age and degree of hearing loss (p = 0.123). Complications of ITC were minimal, with only 1 patient reporting a temporary headache following injection. CONCLUSION:In patients with persistent ISSNHL after systemic corticosteroid therapy, ITC injections resulted in limited hearing improvement. Despite the low risks associated with this therapy, its routine use should be considered on a case-by-case evaluation. .

To estimate incidence rates of adverse events associated with bone-conduction hearing implants from primary literature and to compare rates among different technological designs. A systematic literature review and meta-regression was conducted to estimate incidence rates of minor and major complications and their consequences (i.e., revision surgery, explantation, re-implantation and becoming a non-user) while testing for effects of device design, age group, mean follow-up time and study type. These four designs of bone-conduction systems were included: 1) active transcutaneous with electromagnetic transducer (aBCIem), 2) active transcutaneous with piezoelectric transducer (aBCIpz), 3) passive transcutaneous (tBAHA), and 4) passive percutaneous (pBAHA). The final dataset included 170 articles reporting on 6451 implantations and 1847 minor and 668 major events. Mean follow-up time was a significant predictor of incidence rates (p < 0.001), with lower rates reported in studies with longer follow-up times. After adjusting to the median follow-up time, the pooled incidence rate of minor complications was significantly lower in aBCIem (p < 0.05) compared to other designs. For both major events and revision surgery, pooled incidence rates were significantly higher in pBAHA compared to aBCIem (p < 0.001) and tBAHA (p < 0.001), but not compared to aBCIpz (Major: p = 0.197; Revision: p = 0.248). Becoming a non-user occurred significantly more frequently in tBAHA compared to other designs (p < 0.005). No statistically significant differences were found in rates of explantation and explantation with re-implantation. When comparing across multiple studies, adverse event rates should be adjusted for different lengths of follow-up. Synthesizing published evidence without considering follow-up time may lead to false conclusions.

OBJECTIVE:To evaluate the clinical implementation of preoperative, anatomy-tailored planning for electrode selection in cochlear implantation, quantify planning accuracy under routine conditions, and identify factors associated with deviations from the planned angular insertion depth (AID). METHODS:We retrospectively analyzed 71 consecutive implantations; 17 cases were excluded due to unsuccessful segmentation/fusion, yielding 54 implanted ears. Before 2023 (Group A, n=32), electrode choice followed surgeon preference independent of cochlear duct length (CDL). From 2023 (Group B, n=22), automated OTOPLAN-based planning targeted an AID of 600° (cap 650°). Pre- and postoperative computed tomography scans provided cochlear metrics and postoperative AID. Planning accuracy was defined as the difference between planned and achieved AID. Linear models assessed demographic/clinical, anatomical, and surgical predictors. Speech outcomes at 6 months used Freiburger monosyllables at 65 dB HL. RESULTS:Group B showed deeper and more consistent insertions (median AID 568° [IQR 62°]) than Group A (527° [IQR 99°]; p<0.01). Median planning deviation was -9∘ (IQR 78°) with no relationship to planned depth ( R2=0.008, p=0.514). Greater inaccuracies were found in patients with shorter CDL (p=0.001) and in cases with observed intraoperative resistance (p<0.001). CONCLUSION:cochlear anatomy exhibited substantial inter-individual variability. Implementing preoperative, anatomy-tailored planning was associated with the selection of longer arrays, deeper and more consistent AID, and overall high planning accuracy. Deviations from the planned position were primarily linked to shorter CDL and intraoperative resistance, whereas deeper targets themselves did not reduce accuracy. Audiological performance at 6 months did not differ significantly between groups, although a modest trend favored the planned cohort. These findings support the feasibility of routine, examiner-independent planning and suggest that patient-specific anatomical markers should inform the selection of an appropriate electrode array.

BackgroundCochlear implants (CIs) are an established treatment for severe sensorineural hearing loss and are increasingly used in patients with substantial residual hearing. Preservation of residual hearing is associated with improved outcomes, including speech understanding in noise, natural sound perception, and spatial hearing. Manual electrode insertion, however, is limited by hand tremor and abrupt maneuvers, which can cause intracochlear trauma. Motorized insertion tools (MITs) have been developed to enable slow, continuous, and highly controlled electrode advancement.MethodsWe conducted the first clinical evaluation of the OTOARM/OTODRIVE MIT system. Twenty-six patients underwent implantation with lateral wall electrodes using MIT and were compared with a matched retrospective cohort who received manual insertion. Surgical workflow integration, electrode positioning, residual hearing, speech comprehension, and patient-reported outcome measures (PROMs) were assessed at 1 and 6 months postoperatively.ResultsMIT integration into the surgical routine was feasible without major workflow disruptions. Angular insertion depth and electrode positioning did not differ significantly between groups. Patients with favorable preoperative hearing showed slightly better postoperative low-frequency pure tone thresholds in the MIT group, although statistical significance was not reached. Speech comprehension outcomes were comparable between groups. PROMs indicated greater gains in several subscales for the MIT-assisted cohort, despite incomplete data and limited statistical power.ConclusionMIT-assisted cochlear implantation was feasible and demonstrated a tendency toward improved hearing preservation and subjective benefit. However, the small sample size, retrospective controls, and incomplete PROM data limit definitive conclusions. Larger, blinded and randomized trials are needed to determine the clinical value of MIT systems for both objective and patient-reported outcomes.

Objective: Ensuring the correct positioning of the electrode array during cochlear implant surgery is crucial for achieving optimal results. Electrical impedance measurements have recently emerged as a promising alternative to radiological imaging for electrode localization after surgery. This study aims to assess the performance of various machine learning algorithms to regress electrode locations using impedance telemetry. Methods: We conducted a comprehensive performance analysis on a selection of different models and features in an evaluation dataset of 118 cases. A final evaluation was performed on a hold-out dataset consisting of 13 cases. All cases used the same lateral wall electrode array with a length of 28 mm. Model performance was benchmarked against existing models, emphasizing those previously published. Results: The best-performing model for predicting linear insertion depth (Extremely Randomized Trees) achieved a mean absolute error of 0.8 mm +/- 0.6 mm (mean +/- standard deviation) using leave-one-out cross-validation. We further reviewed the models in terms of feature importance and sensitivity to improve their interpretability and reliability. The gradient direction of the impedance matrix was found as one of the most important features. Conclusion: Our results demonstrate that our machine learning approach is superior to previous models and has potential for use in routine clinical practice. In future studies, it needs to be confirmed that the models can generalize to other, i.e., shorter or longer, electrode arrays. Significance: The presented method for localizing implanted electrode contacts could also be relevant for neural prostheses with similar boundary conditions, such as vestibular implants.

Detection of complications during rehabilitation and postoperative follow-up after cochlear implantation is essential, especially in children and cognitively impaired patients. Electrode array migration can affect outcomes and must be detected early. Traditional radiographic methods, although effective, are costly and expose patients to radiation. This case report discusses the use of a previously published impedance-based model for cochlear implant array localization in a child with Aymé-Gripp syndrome. Impedance telemetry data and X-ray images were collected at the time of initial surgery and before and after the required revision surgery. The impedance-based model was used to estimate the insertion depth of the most basal cochlear implant electrode within the cochlea. The resulting estimates were compared with the electrode positions from radiographs to assess the accuracy and applicability of the model. 20 months after implantation, the patient suddenly stopped tolerating the CI audio processor. Retrospectively, the impedance-based model revealed substantial electrode migration, which was confirmed by postoperative radiography. The proposed model, which uses routine impedance telemetry data without radiation exposure, offers a cost-effective alternative to radiography. Early detection and intervention, particularly in complex cases, improves outcomes and reduces costs, highlighting the importance of objective monitoring.

OBJECTIVES:This study investigates the impact of placing steroid-eluting stents in the frontal sinus outflow tract on the need for postoperative interventions and postoperative changes in symptoms. METHODS:We performed a retrospective case-control study between January 2018 and December 2022 in 21 patients in each group with and without a steroid-eluting stent placed in the frontal sinus outflow tract. The outcome between the two groups was investigated regarding the need for revision surgery and changes in pre- and postoperative symptoms. RESULTS:Comparison between the two groups in the postoperative course revealed no statistically significant differences with respect to postoperative interventions. Further analysis of the postoperative symptoms demonstrated statistically significant reduced hyposmia, rhinorrhea, and nasal obstruction in the group with stenting after surgery than before surgery, whereas pain and rhinorrhea were reported significantly less frequently in the group without stenting in the postoperative course. CONCLUSIONS:This study revealed no statistically significant differences in the postoperative course between the stenting and no-stenting group regarding early postoperative interventions (local intervention, revision surgery). Accordingly, this study is the first to show no significant difference in the postoperative intervention rates, whereas previous studies have all shown a significant difference in the need for postoperative interventions.

Objective:The effectiveness of various palatopharyngeal surgeries is currently poorly understood. This study compares various palatopharyngeal surgery techniques without tonsillectomy for reducing the apnea-hypopnea index (AHI). Data Sources:Embase, MEDLINE, Web of Science, ClinicalTrials, CINAHL, the Cochrane Library, and International Clinical Trials Registry Platform. Review Methods:We included studies of palatopharyngeal surgery in adults reporting AHI outcomes, excluding those with tonsillectomy or combined surgeries. A random-effects model was used to pool effect sizes. Surgical techniques were categorized into cold steel, muscle relocation, suture, radiofrequency, laser, powered instruments, and implants. The primary outcome was the reduction in AHI. Secondary outcomes were the AHI responder rate, AHI reduction over the follow-up duration, and the outcomes by publication year. Results:From 3793 screened records, 45 studies with 1501 patients were included. Overall, palatopharyngeal surgery reduced AHI by 5.2/h (95% CI, 2.7-7.7; P < .0001). Powered instruments showed the greatest AHI reduction (26.3/h; 95% CI, 18.9-33.7), followed by muscle relocation (20.2/h; 95% CI, 3.7-36.7) and suture techniques (15.3/h; 95% CI, 9.6-21.0). Palatal implants (2.6/h; 95% CI, 0.4-4.7) and laser techniques (4.5/h; 95% CI, 1.3-7.8) showed modest effects, whereas radiofrequency (0.4/h; 95% CI, -2.0 to 2.8) and cold steel (6.6/h; 95% CI, -0.2 to 13.5) had no significant impact. The overall responder rate was 51% (95% CI, 41-60), with powered instruments, relocation, and suture techniques demonstrating the highest rates. Conclusion:Palatopharyngeal surgery techniques significantly differ in reducing AHI. Powered instruments, muscle relocation, and suture techniques are most effective. Trial Registration:PROSPERO identifier: CRD42024559063.