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We investigated the association of proton pump inhibitor (PPI) use with the risk of stroke and ischemic heart disease (IHD). The Korean National Health Insurance Service-Health Screening cohort from 2002 to 2003, the participants of which were followed up until 2019, was used. In study I, 45,905 participants who were diagnosed with stroke were matched with 91,810 control I participants. The history of PPI medication was examined. In study II, 40,928 participants who were diagnosed with IHD were matched with 81,856 control II participants. In both study I and study II, the previous history of PPI medication was examined. A propensity score overlap-weighted multivariable logistic regression analysis was conducted to estimate the overlap-weighted odds ratios (ORs) of PPI use for stroke (study I) and IHD (study II). Current PPI use was linked with higher odds for stroke in study I. The odds for stroke were higher in groups with a longer duration of PPI use (OR = 0.96 [95% CI = 0.92–1.00] < 1.55 [1.50–1.61] < 1.62 [1.57–1.68] for < 30 days, 30 to 180 days, and ≥180 days of PPI use). Previous PPI use was linked with higher odds for IHD in study II. The odds for stroke were higher in groups with a longer duration of PPI use (OR = 1.13 [95% CI = 1.08–1.18] < 2.12 [2.04–2.21] < 2.60 [2.51–2.69] for

Abstract Determining the etiology of severe-to-profound sensorineural hearing loss (SP-SNHL) in pediatric subjects is particularly important in aiding the decision for auditory rehabilitation. We aimed to update the etiologic spectrum of pediatric SP-SNHL by combining internal auditory canal (IAC)-MRI with comprehensive and state-of-the-art genetic testings. From May 2013 to September 2020, 119 cochlear implantees under the age of 15 years with SP-SNHL were all prospectively recruited. They were subjected to genetic tests, including exome sequencing, and IAC-MRI for etiologic diagnosis. Strict interpretation of results were made based on ACMG/AMP guidelines and by an experienced neuroradiologist. The etiology was determined in of 65.5% (78/119) of our cohort. If only one of the two tests was done, the etiologic diagnostic rate would be reduced by at least 21.8%. Notably, cochlear nerve deficiency (n = 20) detected by IAC-MRI topped the etiology list of our cohort, followed by DFNB4 (n = 18), DFNB1 (n = 10), DFNB9 (n = 10) and periventricular leukomalacia associated with congenital CMV infection (n = 8). Simultaneous application of state-of-the-art genetic tests and IAC-MRI is essential for etiologic diagnosis, and if lesions of the auditory nerve or central nerve system are carefully examined on an MRI, we can identify the cause of deafness in more than 65% of pediatric SP-SNHL cases.

BackgroundTinnitus retraining therapy (TRT) is a standard treatment for tinnitus that consists of directive counseling and sound therapy. However, it is based on face-to-face education and a time-consuming protocol. Smart device–based TRT (smart-TRT) seems to have many advantages, but the efficacy of this new treatment has been questioned. ObjectiveThe aim of this study was to compare the efficacy between smart-TRT and conventional TRT (conv-TRT). MethodsWe recruited 84 patients with tinnitus. Results were compared between 42 patients who received smart-TRT and 42 control participants who received conv-TRT. An interactive smart pad application was used for directive counseling in the smart-TRT group. The smart pad application included detailed education on ear anatomy, the neurophysiological model of tinnitus, concept of habituation, and sound therapy. The smart-TRT was bidirectional: There were 17 multiple choice questions between each lesson as an interim check. The conv-TRT group underwent traditional person-to-person counseling. The primary outcome measure was the Tinnitus Handicap Inventory (THI), and the secondary outcome measure was assessed using a visual analogue scale (VAS). ResultsBoth treatments had a significant treatment effect, which comparably improved during the first 2 months. The best improvements in THI were –23.3 (95% CI –33.1 to –13.4) points at 3 months and –16.8 (95% CI –30.8 to –2.8) points at 2 months in the smart-TRT group and conv-TRT group, respectively. The improvements on the VAS were also comparable: smart-TRT group: –1.2 to –3.3; conv-TRT: –0.7 to –1.7. ConclusionsTRT based on smart devices can be an effective alternative for tinnitus patients. Considering the amount of time needed for person-to-person counseling, smart-TRT can be a cost-effective solution with similar treatment outcomes as conv-TRT.

Abstract The slim modiolar electrode has been reported to ensure better modiolar proximity than previous conventional perimodiolar electrodes and consistently high scala tympani localization. Nonetheless, variability in modiolar proximity exists even among slim modiolar electrodes, still leaving room for further improvement of modiolar proximity, which may positively affect functional outcomes. Given this, the pull-back maneuver was reported to increase the modiolar proximity of slim modiolar electrodes in a cadaveric study, but in vivo repositioning effects remain to be established. Here we identified that the pull-back maneuver led to better modiolar proximity than conventional insertion while maintaining a similar angular insertion depth. Notably, the reduced electrode-modiolus distance from the pull-back maneuver was associated with significantly lower impedances across electrodes postoperatively as well as reduced intraoperative electrophysiological thresholds than conventional insertion. Among adult cochlear implant recipients, this maneuver resulted in significantly better sentence recognition scores at three months postoperatively when compared to those with a conventional insertion; however, this benefit was not observed at later intervals. Collectively, slim modiolar electrodes with the pull-back maneuver further enhance the modiolar proximity, possibly leading to better open-set sentence recognition, at least in the early postoperative stage.

BackgroundDespite the increasing prevalence of hearing loss, the cost and psychological barriers to the use of hearing aids may prevent their use in individuals with hearing loss. Patients with hearing loss can benefit from smartphone-based hearing aid apps (SHAAs), which are smartphone apps that use a mobile device as a sound amplifier. ObjectiveThe aim of this study is to determine how ear, nose, and throat outpatients perceive SHAAs, analyze the factors that affect their perceptions, and estimate the costs of an annual subscription to an app through a self-administered questionnaire survey of smartphone users and hearing specialists. MethodsThis study used a cross-sectional, multicenter survey of both ear, nose, and throat outpatients and hearing specialists. The questionnaire was designed to collect personal information about the respondents and their responses to 18 questions concerning SHAAs in five domains: knowledge, needs, cost, expectations, and information. Perception questions were rated on a scale of 1 (strongly disagree) to 5 (strongly agree). Questions about the expected cost of SHAAs were included in the questionnaire distributed to hearing experts. ResultsAmong the 219 smartphone users and 42 hearing specialists, only 8 (3.7%) respondents recognized SHAAs, whereas 18% (47/261) of respondents reported considering the use of an assistive device to improve their hearing capacity. The average perception score was 2.81 (SD 1.22). Among the factors that shaped perceptions of SHAAs, the needs category received the lowest scores (2.02, SD 1.42), whereas the cost category received the highest scores (3.29, SD 1.14). Age was correlated with the information domain (P

Although tinnitus retraining therapy (TRT) based on Jastreboff’s classical neurophysiological model is efficacious in most patients, its effects on the cortical activity changes responsible for the improvement of tinnitus are still unclear. In this study, we compared pre- and post-TRT resting-state quantitative electroencephalography (rs-qEEG) findings to identify power changes that could explain TRT-induced improvements. Thirty-seven patients with severe tinnitus were enrolled in the study, and rs-qEEG data recorded before the initial TRT sessions and 6 months after TRT were compared. In addition, associations between the changes in qEEG and percentage improvements in Tinnitus Handicap Inventory (THI) scores and numeric rating scale (NRS) scores of tinnitus loudness and tinnitus perception were examined. The mean THI score decreased significantly 6 months after the initial TRT session. Also, significant improvements were observed 6 months after the initial TRT session compared with the pre-treatment scores in NRS loudness, distress, and perception. As compared with the pre-TRT status, post-TRT 6 months status showed significantly decreased powers in the left primary and secondary auditory cortices for the gamma frequency band. Changes in the alpha 1 frequency band power in the right insula and orbitofrontal cortex (OFC) appeared to be positively correlated with the percentage changes in NRS distress. These results suggested that TRT improved tinnitus-related distress by reducing the power of the top-down autonomic response modulator or peripheral physiological responses to emotional experiences. That is, TRT induced habituation via modulation of functional connections between the auditory system and the limbic and autonomic nervous systems. Our results confer additional basis for understanding the neurophysiological model and the newly suggested integrative model of tinnitus by De Ridder et al. (2014) in the context of the long-term efficacy of TRT.

Delivery of substances into the inner ear via local routes is increasingly being used in clinical treatment. Studies have focused on methods to increase permeability through the round window membrane (RWM) and enhance drug diffusion into the inner ear. However, the clinical applications of those methods have been unclear and few studies have investigated the efficacy of methods in an inner ear injury model. Here, we employed the medium chain fatty acid caprate, a biologically safe, clinically applicable substance, to modulate tight junctions of the RWM. Intratympanic treatment of sodium caprate (SC) induced transient, but wider, gaps in intercellular spaces of the RWM epithelial layer and enhanced the perilymph and cochlear concentrations/uptake of dexamethasone. Importantly, dexamethasone co–administered with SC led to significantly more rapid recovery from noise-induced hearing loss at 4 and 8 kHz, compared with the dexamethasone-only group. Taken together, our data indicate that junctional modulation of the RWM by SC enhances dexamethasone uptake into the inner ear, thereby hastening the recovery of hearing sensitivity after noise trauma.

Abstract The switchable‐memory operation of a feedback silicon nanowire transistor with a dual‐gate structure is demonstrated. The single transistor exhibits volatile memory characteristics with a retention time longer than 3600 s, as well as a switching capability with a subthreshold swing lower than 7 mV dec−1. A gate‐controlled memory window forms around a gate voltage of 0 V owing to the positive feedback loop in the channel region, allowing a program/erase endurance of more than 1000 cycles. The memory transistor, with switching capability, opens up the possibility of overcoming not only the scaling limit faced by conventional volatile memory but also the inherent drawback of the separation of the building blocks for memory and logic.

Temporal bone trauma can cause hearing loss and in case of prolonged conductive hearing loss, traumatic ossicular injury should be considered. Separation of the incudostapedial joint is the most common lesion, and stapediovestibular dislocation is relatively rare but can easily cause perilymphatic fistula. Here, we report a very rare case of external stapediovestibular dislocation after trauma, ending up with successful surgical outcome. A 27-year-old man with non-progressive hearing loss on the right side since childhood visited the clinic. Audiogram showed a conductive hearing loss with air-bone gap of 55 dB on the right side. Temporal bone CT revealed the disruption of ossicular chain. An exploratory tympanotomy identified multiple ossicular disruptions including external stapediovestibular dislocation with shiny fibrous membrane sealing the oval window. Ossicular chain reconstruction was performed using the total ossicular replacement prosthesis of titanium. A postoperative audiogram showed a recovery of air-bone gap less than 10 dB. To the best of our knowledge, this is the first case of external long-standing stapediovestibular dislocation, with oval window completely sealed with fibrous membrane, ending up with successful hearing recovery by surgery. This case would help dealing with such condition which can be encountered in the clinic. [ABSTRACT FROM AUTHOR]

Othematoma is a condition in which blood collects beneath the perichondral layer of the pinna. Recurrent auricular hematoma can be a challenging medical problem, with complications resulting in ear deformity, therefore, appropriate management is important. Improper treatment can result in a deformity known as ‘cauliflower ear’ or ‘wrestler’s ear.’ We report a case of othematoma that was inappropriately treated and present a review of current treatment options. [ABSTRACT FROM AUTHOR]

In this paper, we demonstrate nondestructive readout memory characteristics of a bistable resistor (biristor) with an n+-p-n+ Si nanowire (SiNW) channel on a bendable substrate. The SiNW channel is fabricated using a top--down route, which is compatible with the current complementary metal-oxide-semiconductor technology. The SiNW biristor shows the outstanding memory characteristics such as a retention time of 10 s and a current sensing margin of ~23-μA at room temperature. These memory characteristics originate from a positive feedback process resulting from impact ionization near the p-n junction. Moreover, the positive feedback mechanism is comprehensively investigated using device simulation. [ABSTRACT FROM AUTHOR]

In this paper, we describe the feedback and tunneling operations of a dual top gate field-effect transistor (FET) with a p+-i-n+ doped silicon nanowire channel. The transistor functions selectively in either a feedback FET (FBFET) or a tunneling FET mode by modulating the source-to-drain voltage, and it features an outstanding subthreshold swing characteristic of 6.15 mV dec–1 with an on/off current ratio (Ion/Ioff) of approximately 106 in the feedback operating mode and of 41.3 mV dec–1 with Ion/Ioff of ∼107 in the tunneling operating mode. Moreover, our device in the FBFET operation mode has memory characteristics with a retention time of 104 s and a program/erase endurance up to 103 cycles owing to the positive feedback loop in the channel region. This study demonstrates the promising potential of our devices in the development of multifunctional electronics. [ABSTRACT FROM AUTHOR]

In this study we investigate the influence of substrate materials on the electrical characteristics of feedback field-effect transistors (FETs) when subjected to bending fatigue. Each of our transistors are composed of a p+–i–n+ doped silicon nanowire and dual-top metal gates. Feedback FETs on Ecoflex substrates feature outstanding stability compared to those on polyethersulphone and polydimethysiloxane substrates, even at a bending strain of 11.67%. The threshold voltage shift is within the range of 0.3 V, and the on-current only decreases by 15.5% (or less), when compared to the initial flat conditions. Moreover, our devices have outstanding reliability, even after 5000 cycles of repeated bending. [ABSTRACT FROM AUTHOR]

In this study, we propose newly designed feedback field-effect transistors that utilize the positive feedback of charge carriers in single-gated silicon channels to achieve steep switching behaviors. The band diagram, I–V characteristics, subthreshold swing, and on/off current ratio are analyzed using a commercial device simulator. Our proposed feedback field-effect transistors exhibit subthreshold swings of less than 0.1 mV dec−1, an on/off current ratio of approximately 1011, and an on-current of approximately 10−4 A at room temperature, demonstrating that the switching characteristics are superior to those of other silicon-based devices. In addition, the device parameters that affect the device performance, hysteresis characteristics, and temperature-dependent device characteristics are discussed in detail. [ABSTRACT FROM AUTHOR]