Latest Publications

Ear Hear. 2022 Dec 8. doi: 10.1097/AUD.0000000000001305. Online ahead of print.

NO ABSTRACT

PMID:36477611 | DOI:10.1097/AUD.0000000000001305

Biosensors (Basel). 2022 Nov 10;12(11):999. doi: 10.3390/bios12110999.

ABSTRACT

(1) Background: During a cochlear implant insertion, the mechanical trauma can cause residual hearing loss in up to half of implantations. The forces on the cochlea during the insertion can lead to this mechanical trauma but can be highly variable between subjects which is thought to be due to differing anatomy, namely of the scala tympani. This study presents a systematic investigation of the influence of different geometrical parameters of the scala tympani on the cochlear implant insertion force. The influence of these parameters on the insertion forces were determined by testing the forces within 3D-printed, optically transparent models of the scala tympani with geometric alterations. (2) Methods: Three-dimensional segmentations of the cochlea were characterised using a custom MATLAB script which parametrised the scala tympani model, procedurally altered the key shape parameters (e.g., the volume, vertical trajectory, curvature, and cross-sectional area), and generated 3D printable models that were printed using a digital light processing 3D printer. The printed models were then attached to a custom insertion setup that measured the insertion forces on the cochlear implant and the scala tympani model during a controlled robotic insertion. (3) Results: It was determined that the insertion force is largely unaffected by the overall size, curvature, vertical trajectory, and cross-sectional area once the forces were normalised to an angular insertion depth. A Capstan-based model of the CI insertion forces was developed and matched well to the data acquired. (4) Conclusion: By using accurate 3D-printed models of the scala tympani with geometrical alterations, it was possible to demonstrate the insensitivity of the insertion forces to the size and shape of the scala tympani, after controlling for the angular insertion depth. This supports the Capstan model of the cochlear implant insertion force which predicts an exponential growth of the frictional force with an angular insertion depth. This concludes that the angular insertion depth, rather than the length of the CI inserted, should be the major consideration when evaluating the insertion force and associated mechanical trauma caused by cochlear implant insertion.

PMID:36354508 | DOI:10.3390/bios12110999

Eur Arch Otorhinolaryngol. 2022 Sep 26. doi: 10.1007/s00405-022-07638-7. Online ahead of print.

ABSTRACT

OBJECTIVES OF REVIEW: To review the literature for the evidence base for the aetiology and management of referred otalgia, looking particularly at non-malignant, neuralgic, structural and functional issues.

TYPE OF REVIEW: Systematic review.

SEARCH STRATEGY: A systematic literature search was undertaken from the databases of EMBASE, CINAHL, MEDLINE®, BNI, and Cochrane Library according to predefined inclusion and exclusion criteria.

EVALUATION METHOD: All relevant titles, abstracts and full text articles were reviewed by three authors who resolved any differences by discussion and consultation with senior author.

RESULTS: 44 articles were included in our review. The overall quality of evidence was low, with the vast majority of the studies being case-series with three cohort and four randomised-controlled trials included. The prime causes and management strategies were focussed on temporomandibular joint dysfunction (TMJD), Eagle syndrome and neuralgia. Our meta-analyses found no difference on the management strategies for the interventions found.

CONCLUSIONS: Referred otalgia is common and treatment should be aimed at the underlying pathology. Potential aetiologies are vast given the extensive sensory innervation of the ear. An understanding of this and a structured approach to patient assessment is important for optimal patient management.

PMID:36163556 | DOI:10.1007/s00405-022-07638-7

Curr Opin Otolaryngol Head Neck Surg. 2022 Aug 25. doi: 10.1097/MOO.0000000000000839. Online ahead of print.

ABSTRACT

PURPOSE OF REVIEW: Autoimmune inner ear disease (AIED) is a rare, but likely underrecognized cause of hearing loss. However, hearing loss is common in systemic autoimmune disease and it is important for the clinician to be familiar with the spectrum of disease. In this article, we will review the developments in diagnosis and management of AIED, with a focus on the outcomes and potential pitfalls of cochlear implantation.

RECENT FINDINGS: Hearing loss in AIED tends to be progressive and bilateral, but up to 40% can present as sudden hearing loss and one-third can present unilaterally. HSP-70 serology may help with diagnosis and may predict steroid response. Cochlear implantation provides excellent hearing and quality of life outcomes in patients deafened by AIED. Intracochlear fibrosis/ossification is found intraoperatively in the majority (54%) of patients undergoing cochlear implantation. A large percentage (32%) of patients has fluctuating impedances postimplantation, which may interfere with implant performance and mapping.

SUMMARY: Diagnosis of AIED is largely clinical, and a strong index of suspicion is required. Multidisciplinary care is crucial for optimal management. Cochlear implant outcomes are generally excellent, but the clinician needs to be cognizant of the pitfalls of encountering intracochlear fibrosis intraoperatively and likelihood of implant performance fluctuation related to ongoing inflammation in the cochlea.

PMID:36004773 | DOI:10.1097/MOO.0000000000000839

Otol Neurotol. 2022 Aug 1;43(7):734-741. doi: 10.1097/MAO.0000000000003574. Epub 2022 Jul 19.

ABSTRACT

OBJECTIVE: This study aimed to establish hearing outcomes after cochlear implantation in patients with otosclerosis.

MATERIALS AND METHODS: We conducted a systematic review and narrative synthesis. Databases searched were as follows: MEDLINE, PubMed, Embase, Web of Science, Cochrane Collection, and ClinicalTrials.gov . No limits were placed on language or year of publication. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

RESULTS: Searches identified 474 abstracts and 180 full texts, with 68 studies meeting the inclusion criteria and reporting outcomes in a minimum of 481 patients with at least 516 implants. Patient-reported outcome measures (PROMs) were reported in five studies involving 51 patients. Intraoperative adverse events/surgical approach details and preoperative radiological assessment were reported in 46 and 38 studies, respectively. The methodological quality of included studies was modest, predominantly consisting of case reports and noncontrolled case series with small numbers of patients. Most studies were Oxford Centre for Evidence Based Medicine grade IV.

DISCUSSION: Access to good rehabilitation support is essential to achieving the good hearing outcomes and PROMs that can be expected by 12 months after implantation in most cases. There was a significant association between the radiological severity of otosclerosis and an increase in surgical and postoperative complications. Postoperative facial nerve stimulation can occur and may require deactivation of electrodes and subsequent hearing detriment.

CONCLUSIONS: Hearing outcomes are typically good, but patients should be counseled on associated surgical complications that may compromise hearing. Modern diagnostic techniques may help to identify potentially difficult cases to aid operative planning and patient counseling. Further work is needed to characterize PROMs in this population.

PMID:35861644 | DOI:10.1097/MAO.0000000000003574

Clin Otolaryngol. 2022 Jul 14. doi: 10.1111/coa.13963. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the value of scalp surface potentials to identify and manage partial short circuits to ground in cochlear implant electrodes.

DESIGN: A retrospective review of patients with suspected partial short circuits.

MAIN OUTCOME MEASURE: Electrical output of individual electrodes was measured using scalp surface potentials for patients reporting a change in hearing function. Electrical output was compared to functional performance and impedance measurements to determine if devices with suspected partial short circuits were experiencing a decrease in performance as a result of reduced electrical output. Electrical output was checked in an artificial cochlea for two implants following explant surgery to confirm scalp surface potential results.

RESULTS: All patients with suspected partial short circuits (n=49) had reduced electrical output, a drop in impedances to approximately ½ of previously stable measurements or to below 2 kOhms, an atypical electrical field measurement (EFI) and a decline in hearing function. Only devices with an atypical EFI showed reduced electrical output. Results of scalp based surface potentials could be replicated in an artificial cochlea following explantation of the device. All explant reports received to date (n=42) have confirmed partial short circuits, with an additional 4 devices failing integrity tests.

CONCLUSION: Surface potential measurements can detect partial shorts and had 100% correlation with atypical EFI measurements, which are characteristic of a partial short to ground in this device. Surface potentials can help determine the degree to which the electrode array is affected, particularly when behavioural testing is limited or not possible.

PMID:35833359 | DOI:10.1111/coa.13963

Otol Neurotol. 2022 Jul 1;43(6):702-708. doi: 10.1097/MAO.0000000000003536.

ABSTRACT

OBJECTIVE: To analyse the 2 and 5-year outcomes of a cohort of patients with newly diagnosed vestibular schwannoma patients.

STUDY DESIGN: Longitudinal cohort study.

SETTING: Tertiary skull base referral unit.

PATIENTS: Six hundred and seventy-one consecutive patients referred to the Cambridge Skull Base Unit between 2005 and 2010.

MAIN OUTCOME MEASURES: 1) Treatment outcomes, 2) hearing preservation, 3) facial nerve function, and 4) gross tumor control.

RESULTS: At initial diagnosis, 440/671(65.6%) of patients entered a watch, wait and rescan (WWR) pathway, 208/671 (31%) underwent primary microsurgical excision and 23/671 (3.4%) primary radiotherapy. Of patients who entered WWR, 144/440 (32.7%) exhibited tumor growth necessitating secondary intervention at a mean of 22.7 months; 67.4% had radiotherapy and 32.6% surgery. Radiotherapy was successful at achieving tumor control in 95% of cases. Primary surgery via the translabyrinthine route was performed in the majority of cases allowing for a radiologically clear surgical resection in 93% of cases.

CONCLUSION: The Cambridge philosophy of treating the newly diagnosed vestibular schwannoma aims at preserving functional status where possible. In patients with small tumors it is recommended that they are placed on to a WWR pathway, of which 67.3% will not exhibit any growth by 5 years. If small tumors grow more than 2 mm by serial scanning, radiotherapy offers a high rate of tumor control. In patients with larger tumors more than 20 mm we would advocate microsurgical excision by the translabyrinthine route which offers excellent functional outcomes and gross tumor control.

PMID:35709433 | DOI:10.1097/MAO.0000000000003536

Otol Neurotol. 2022 Jun 1;43(5):e548-e557. doi: 10.1097/MAO.0000000000003512. Epub 2022 Feb 15.

ABSTRACT

HYPOTHESIS: Stimulation-Current-Induced Non-Stimulating Electrode Voltage Recordings (SCINSEVs) can help detect extracochlear electrodes for a variety of Cochlear Implant (CI) devices.

BACKGROUND: Extracochlear electrodes (EEs) occur in 9 to 13% of cochlear implantations and commonly go unnoticed without imaging. Electrodes on the electrode array located extracochlearly are associated with non-auditory stimulation and a decrease in speech outcomes. We have previously shown that SCINSEVs, with hardware and software from one manufacturer, could detect EEs. Here, we test the generalizability to other manufacturers.

METHODS: Fresh-frozen human cadaveric heads were implanted with Cochlear Ltd. CI522 (CI-A) and MED-EL's FLEX24 (CI-B) electrodes. Contact impedances and SCIN- SEVs were measured, with Cochlear Ltd. research Custom Sound software (Transimpedance Matrix) and MED-EL's clinical MAESTRO (Impedance Field Telemetry), for full insertion and EEs in air, saline and soft tissue. An automated detection tool was optimized and tested for these implants. Intra-operative SCINSEVs with EEs were collected for clinical purposes for six patients.

RESULTS: The pattern of SCINSEVs changed in the transition zone from intracochlear to extracochlear electrodes, even with low contact impedances on EEs. Automated detection in the cadaveric specimens, with two or more EEs in saline or soft tissue, showed a mean 91% sensitivity and specificity for CI-A and 100% sensitivity and specificity for CI-B. Quantification of EEs showed significant correlations of r = 0.69 between estimated and actual EEs for CI-A and r = 0.76 for CI-B.

CONCLUSION: The applicability of SCINSEVs to detect extra- cochlear electrodes could be expanded to other cochlear implant companies despite differences in electrode array design and measurement software.

PMID:35617005 | DOI:10.1097/MAO.0000000000003512

Eur Arch Otorhinolaryngol. 2022 May 13. doi: 10.1007/s00405-022-07399-3. Online ahead of print.

ABSTRACT

PURPOSE: Primary: To determine the rate of occult cervical metastases in primary temporal bone squamous cell carcinomas (TBSSC). Secondary: to perform a subgroup meta-analysis of the risk of occult metastases based on the clinical stage of the tumour and its risk based on corresponding levels of the neck.

METHODS: A systematic review and meta-analysis of papers searched through Medline, Cochrane, Embase, Scopus and Web of Science up to November 2021 to determine the pooled rate of occult lymph node/parotid metastases. Quality assessment of the included studies was assessed through the Newcastle-Ottawa scale.

RESULTS: Overall, 13 out of 3301 screened studies met the inclusion criteria, for a total of 1120 patients of which 550 had TBSCC. Out of the 267 patients who underwent a neck dissection, 33 had positive lymph nodes giving a pooled rate of occult metastases of 14% (95% CI 10-19%). Occult metastases rate varied according to Modified Pittsburg staging system, being 0% (0-16%) among 12 pT1, 7% (2-20%) among 43 pT2 cases, 21% (11-38%) among 45 pT3, and 18% (11-27%) among 102 pT4 cases. Data available showed that most of the positive nodes were in Level II.

CONCLUSION: The rate of occult cervical metastases in TBSCC increases with pathological T category with majority of nodal disease found in level II of the neck.

PMID:35562514 | DOI:10.1007/s00405-022-07399-3

Laryngoscope Investig Otolaryngol. 2022 Feb 8;7(2):540-563. doi: 10.1002/lio2.749. eCollection 2022 Apr.

ABSTRACT

OBJECTIVE: Establish anatomical considerations, audiological outcomes, and optimal management in patients with branchiootic/branchiootorenal syndrome (BO/BOR).

METHODS: Databases reviewed: Medline, Pubmed, Embase, Web of Science, Cochrane Collection, and ClinicalTrials.gov. Clinical or radiological studies of patients with BOR syndrome describing either the audiological profile or anatomical changes were included. Articles in which BOR syndrome was associated with other syndromes, and those that were focused only on general and genetic aspects of BOR syndrome were excluded. Articles were assessed using Oxford Centre for Evidence-Based Medicine (OCEBM) grading system and the Brazzelli risk of bias tool for nonrandomized studies.

RESULTS: Searches identified 379 articles. Of these, 64 studies met the inclusion criteria, reporting outcomes in 482 patients from at least 95 families. In 308 patients, hearing loss was categorized as sensorineural (29%), conductive (20%), and mixed (51%). Hearing outcomes were variable in terms of onset, pattern, and severity; ranging from mild to profound deafness. One hundred sixty-nine patients presented with inner ear anomalies, 145 had middle, and 151 had external ear abnormalities. In 44 studies, 58 ear operations were described. Mixed outcomes were reported in patients managed with hearing aids or middle ear surgery; however, successful cochlear implantation was described in all five cases.

CONCLUSION: The anatomical and audiological profiles of patients with BO/BOR are variable. A range of surgical procedures were described, however lacked objective outcome measures. Given the range of anatomical variants, management decisions should be made on an individual basis including full audiological and radiological assessment.

LEVEL OF EVIDENCE: NA.

PMID:35434312 | PMC:PMC9008175 | DOI:10.1002/lio2.749

IEEE Trans Biomed Eng. 2022 Apr 13;PP. doi: 10.1109/TBME.2022.3167113. Online ahead of print.

ABSTRACT

GOAL: Advances in computational models of biological systems and artificial neural networks enable rapid virtual prototyping of neuroprosthetics, accelerating innovation in the field. Here, we present an end-to-end computational model for predicting speech perception with cochlear implants (CI), the most widely-used neuroprosthetic.

METHODS: The model integrates CI signal processing, a finite element model of the electrically-stimulated cochlea, and an auditory nerve model to predict neural responses to speech stimuli. An automatic speech recognition neural network is then used to extract phoneme-level speech perception from these neural response patterns.

RESULTS: Compared to human CI listener data, the model predicts similar patterns of speech perception and misperception, captures between-phoneme differences in perceptibility, and replicates effects of stimulation parameters and noise on speech recognition. Information transmission analysis at different stages along the CI processing chain indicates that the bottleneck of information flow occurs at the electrode-neural interface, corroborating studies in CI listeners.

CONCLUSION: An end-to-end model of CI speech perception replicated phoneme-level CI speech perception patterns, and was used to quantify information degradation through the CI processing chain.

SIGNIFICANCE: This type of model shows great promise for developing and optimizing new and existing neuroprosthetics.

PMID:35417340 | DOI:10.1109/TBME.2022.3167113

Otol Neurotol. 2022 Jun 1;43(5):538-546. doi: 10.1097/MAO.0000000000003507. Epub 2022 Feb 24.

ABSTRACT

OBJECTIVE: To review the outcomes of cochlear implants (CI) in patients with neurofibromatosis type 2 (NF2) in a large cohort, and identify factors associated with poor hearing benefit.

STUDY DESIGN: Fifteen-year retrospective national observational case series.

SETTING: United Kingdom regional NF2 multidisciplinary teams.

PATIENTS: Consecutive patients with NF2 receiving a CI.

INTERVENTIONS: CI for hearing rehabilitation.

MAIN OUTCOME MEASURES: 1) Audiometric performance at 9 to 12 months after implantation using City University of New York (CUNY) sentence recognition score, and Bamford- Kowal-Bench (BKB) word recognition score in quiet (BKBq), and in noise (BKBn). 2) CI use at most recent review.

RESULTS: Sixty four consecutive patients, median age 43 years, were included. Nine to 12 months mean audiometric scores were: CUNY 60.9%, BKBq 45.8%, BKBn 41.6%. There was no difference in audiometric outcomes between VS treatment modalities. At most recent review (median 3.6 years from implantation), 84.9% with device in situ/available data were full or part-time users. Between 9 and 12 months and most recent review there was an interval reduction in mean audiometric scores: CUNY -12.9%, BKBq -3.3%, BKBn -4.9%. Larger tumor size and shorter duration of profound hearing loss were the only variables associated with poorer audiometric scores. Tumor growth at the time of surgery was the only variable associated with CI non-use. Individual patient response was highly variable.

CONCLUSIONS: CI can provide significant and sustained auditory benefits to patients with NF2 independent of tumor treatment modality, with the majority of those implanted becoming at least part-time users. Larger datasets are required to reliably assess the role of independent variables.

PMID:35213477 | DOI:10.1097/MAO.0000000000003507

J Int Adv Otol. 2022 Jan;18(1):71-73. doi: 10.5152/iao.2022.21316.

ABSTRACT

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome is a multisystem, progressive neurodegenerative condition, and the most common mitochondrial cytopathy. While not a primary characteristic, sensorineural hearing loss is a common additional symptom reported in up to 78% of cases. This article presents 2 cases of cochlear implantation in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome. Both cases demonstrated significantly improved speech recognition, with results significantly better than previous case reports. Cochlear implants are an appropriate treatment for severe-profound hearing loss in mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome. While anesthetic risks and cognitive skills need to be taken into consideration, routine programming and rehabilitation pathways may be appropriate for this cohort.

PMID:35193849 | DOI:10.5152/iao.2022.21316

J Neurosurg. 2022 Feb 18:1-8. doi: 10.3171/2022.1.JNS211544. Online ahead of print.

ABSTRACT

OBJECTIVE: The growth characteristics of vestibular schwannomas (VSs) under surveillance can be studied using a Bayesian method of growth risk stratification by time after surveillance onset, allowing dynamic evaluations of growth risks. There is no consensus on the optimum surveillance strategy in terms of frequency and duration, particularly for long-term growth risks. In this study, the long-term conditional probability of new VS growth was reported for patients after 5 years of demonstrated nongrowth. This allowed modeling of long-term VS growth risks, the creation of an evidence-based surveillance protocol, and the proposal of a cost-benefit analysis decision aid.

METHODS: The authors performed an international multicenter retrospective analysis of prospectively collected databases from five tertiary care referral skull base units. Patients diagnosed with sporadic unilateral VS between 1990 and 2010 who had a minimum of 10 years of surveillance MRI showing VS nongrowth in the first 5 years of follow-up were included in the analysis. Conditional probabilities of growth were calculated according to Bayes' theorem, and nonlinear regression analyses allowed modeling of growth. A cost-benefit analysis was also performed.

RESULTS: A total of 354 patients were included in the study. Across the surveillance period from 6 to 10 years postdiagnosis, a total of 12 tumors were seen to grow (3.4%). There was no significant difference in long-term growth risk for intracanalicular versus extracanalicular VSs (p = 0.41). At 6 years, the residual conditional probability of growth from this point onward was seen to be 2.28% (95% CI 0.70%-5.44%); at 7 years, 1.35% (95% CI 0.25%-4.10%); at 8 years, 0.80% (95% CI 0.07%-3.25%); at 9 years, 0.47% (95% CI 0.01%-2.71%); and at 10 years, 0.28% (95% CI 0.00%-2.37%). Modeling determined that the remaining lifetime risk of growth would be less than 1% at 7 years 7 months, less than 0.5% at 8 years 11 months, and less than 0.25% at 10 years 4 months.

CONCLUSIONS: This multicenter study evaluates the conditional probability of VS growth in patients with long-term VS surveillance (6-10 years). On the basis of these growth risks, the authors posited a surveillance protocol with imaging at 6 months (t = 0.5), annually for 3 years (t = 1.5, 2.5, 3.5), twice at 2-year intervals (t = 5.5, 7.5), and a final scan after 3 years (t = 10.5). This can be used to better inform patients of their risk of growth at particular points along their surveillance timeline, balancing the risk of missing late growth with the costs of repeated imaging. A cost-benefit analysis decision aid was also proposed to allow units to make their own decisions regarding the cessation of surveillance.

PMID:35180698 | DOI:10.3171/2022.1.JNS211544

Laryngoscope Investig Otolaryngol. 2022 Jan 5;7(1):226-236. doi: 10.1002/lio2.720. eCollection 2022 Feb.

ABSTRACT

OBJECTIVES: As the population ages and implantation criteria are relaxed, more patients with complex comorbidities are becoming eligible for cochlear implantation (CI). These patients have higher risks associated with general anesthesia. This systematic review assesses outcomes and complications following CI under local anesthetic to examine utility for patients deemed not suitable or at high risk for general anesthesia.

METHODS: A systematic review and meta-analysis performed according to the 2020 PRISMA guidelines. Databases searched were MEDLINE, PubMed, EMBASE, CINAHL, Web of Science Core Collection, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials and ClinicalTrials.gov. There were no limitations on year of publication or language.

RESULTS: Then, 132 unique were identified. After screening abstracts and full texts for eligibility criteria a total of 18 articles were included. In the nine studies where audiological data were reported, all patients demonstrated improvement in audiological outcomes following implantation under local anesthetic (LA). Only minor complications of transient vertigo, wound infection, facial nerve paralysis, confusion, and tinnitus were reported but all were transient. Meta-analysis showed surgical time was significantly shorter under LA.

CONCLUSIONS: CI under LA is safe for patients with comorbidities which preclude them from general anesthesia, with minimal complications and an improved cost-effectiveness profile. However, larger scale, robust trials are required to assess this further.

PMID:35155802 | PMC:PMC8823255 | DOI:10.1002/lio2.720

Otol Neurotol. 2022 Apr 1;43(4):452-459. doi: 10.1097/MAO.0000000000003493.

ABSTRACT

OBJECTIVES: To investigate the combined effect of changing pulse shape and grounding configuration to manage facial nerve stimulation (FNS) in cochlear implant (CI) recipients.

PATIENTS: Three adult CI recipients with severe FNS were offered a replacement implant when standard stimulation strategies and programming adjustments did not resolve symptoms. Our hypothesis was that the facial nerve was less likely to be activated when using anodic pulses with "mixed-mode" intra-cochlear and extra-cochlear current return.

INTERVENTION: All patients were reimplanted with an implant that uses a pseudo-monophasic anodic pulse shape, with mixed-mode grounding (stimulus mixed-mode anodic)-the Neuro Zti CI (Oticon Medical). This device also allows measurements of neural function and loudness with monopolar, symmetric biphasic pulses (stimulus MB), the clinical standard used by most CIs as a comparison.

MAIN OUTCOME MEASURES: The combined effect of pulse shape and grounding configuration on FNS was monitored during surgery. Following CI activation, FNS symptoms and performance with the Neuro Zti implant were compared with outcomes before reimplantation.

RESULTS: FNS could only be recorded using stimulus MB for all patients. In clinical use, all patients reported reduced FNS and showed an improvement in Bamford-Kowal-Bench sentences recognition compared with immediately before reimplantation. Bamford-Kowal-Bench scores with a male speaker were lower compared with measurements taken before the onset of severe FNS for patients 1 and 2.

CONCLUSIONS: In patients where CI auditory performance was severely limited by FNS, charge-balanced pseudo-monophasic stimulation mode with a mixed-mode grounding configuration limited FNS and improved loudness percept compared with standard biphasic stimulation with monopolar grounding.

PMID:35085112 | PMC:PMC8915992 | DOI:10.1097/MAO.0000000000003493

Expert Rev Med Devices. 2021 Dec;18(sup1):95-128. doi: 10.1080/17434440.2021.2014321. Epub 2022 Jan 3.

ABSTRACT

INTRODUCTION: Hearables are ear devices used for multiple purposes including ubiquitous/remote monitoring of vital signals. This can support early detection, prevention, and management of urgent/non-urgent healthcare needs. This review therefore seeks to analyze the challenges and capabilities of hearables used to monitor human physiological signals.

AREAS COVERED: Studies were identified via search (Medline, Embase, Web of Science, Cochrane Library, Scopus) and conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Bias assessment used the Mixed Methods Appraisal Tool 2018 and Quality Assessment of Diagnostic Accuracy Studies 2nd Edition. 92/631 studies met the inclusion criteria and were qualitatively analyzed. The outcomes, applications, advantages, and limitations were discussed according to the vital signal measured. The bias risk ranged from low to high, with most studies facing moderate-to-high risk in subject selection due to small sample sizes.

EXPERT OPINION: Most studies reported good outcomes for ear signal acquisition compared to reference devices. To improve practicability and implementation, wireless connectivity, battery life, impact of motion/environmental artifacts and comfort need to be addressed going forward. Hearable technologies have also shown potential synergies with hearing aids. In future, multimodal ear-sensing devices opens the possibility of comprehensive health monitoring within daily life.

PMID:34904507 | DOI:10.1080/17434440.2021.2014321

Front Surg. 2021 Oct 27;8:789184. doi: 10.3389/fsurg.2021.789184. eCollection 2021.

ABSTRACT

[This corrects the article on p. 723897 in vol. 8, PMID: 34660676.].

PMID:34778368 | PMC:PMC8579103 | DOI:10.3389/fsurg.2021.789184

Otol Neurotol. 2022 Jan 1;43(1):e1-e13. doi: 10.1097/MAO.0000000000003353.

ABSTRACT

OBJECTIVE: To determine outcomes following cochlear implantation (CI) in children with autism spectrum disorder (ASD).

DATABASES REVIEWED: MEDLINE, Embase, Web of science, Cochrane Library, and Clinicaltrial.gov.

METHODS: The review was performed according to the PRISMA statement. Primary outcomes measures were changes in speech perception and speech production scores. Secondary outcome measures included communication mode, device use, parental recommendation of implant, postoperative hyperacusis, and quality of life measures. Pooled analysis of outcomes was performed if possible.

RESULTS: Twenty-four studies reported on 159 children with ASD. There were improvements in speech perception in 78% of cases and in speech expression in 63% of cases, though the extent of this improvement was variable. Seventy-four percent of children with ASD and CI are nonoral communicators. Intermittent/nonuse rate was 31%. Hearing outcomes are worse compared to children with other disabilities. The vast majority of parents would recommend CI based on their experiences.

CONCLUSION: Outcome in children with ASD and CI are highly variable and significantly poorer compared to non-ASD children. Despite this, most parents report positive experiences and the evidence supports the use of CI in children with ASD.

PMID:34739429 | DOI:10.1097/MAO.0000000000003353

Nat Commun. 2021 Oct 29;12(1):6260. doi: 10.1038/s41467-021-26491-6.

ABSTRACT

Cochlear implants restore hearing in patients with severe to profound deafness by delivering electrical stimuli inside the cochlea. Understanding stimulus current spread, and how it correlates to patient-dependent factors, is hampered by the poor accessibility of the inner ear and by the lack of clinically-relevant in vitro, in vivo or in silico models. Here, we present 3D printing-neural network co-modelling for interpreting electric field imaging profiles of cochlear implant patients. With tuneable electro-anatomy, the 3D printed cochleae can replicate clinical scenarios of electric field imaging profiles at the off-stimuli positions. The co-modelling framework demonstrated autonomous and robust predictions of patient profiles or cochlear geometry, unfolded the electro-anatomical factors causing current spread, assisted on-demand printing for implant testing, and inferred patients' in vivo cochlear tissue resistivity (estimated mean = 6.6 kΩcm). We anticipate our framework will facilitate physical modelling and digital twin innovations for neuromodulation implants.

PMID:34716306 | PMC:PMC8556326 | DOI:10.1038/s41467-021-26491-6