Search

Mastoidectomy involves drilling the temporal bone while avoiding the facial nerve, semicircular canals, sigmoid sinus, and tegmen. Optical topographic imaging (OTI) is a novel registration technique that allows rapid registration with minimal navigational error. To date, no studies have examined the use of OTI in skull-base procedures.In this cadaveric study, 8 mastoidectomies were performed in 2 groups-4 free-hand (FH) and 4 OTI-assisted mastoidectomies. Registration accuracy for OTI navigation was quantified with root mean square (RMS) and target registration error (TRE). Procedural time, percent of mastoid resected, and the proximity of the mastoidectomy cavity to critical structures were determined.The average RMS and TRE associated with OTI-based registration were 1.44 mm (±0.83 mm) and 2.17 mm (±0.89 mm), respectively. The volume removed, expressed as a percentage of the total mastoid volume, was 37.5% (±10.2%) versus 31.2% (±2.3%), P = 0.31, for FH and OTI-assisted mastoidectomy. There were no statistically significant differences between FH and OTI-assisted mastoidectomies with respect to proximity to critical structures or procedural time.This work is the first examining the application of OTI neuronavigation in lateral skull-base procedures. This pilot study revealed the RMS and TRE for OTI-based navigation in the lateral skull base are 1.44 mm (±0.83 mm) and 2.17 mm (±0.89 mm), respectively. This pilot study demonstrates that an OTI-based system is sufficiently accurate and may address barriers to widespread adoption of navigation for lateral skull-base procedures.

BACKGROUND Balloon dilation of the eustachian tube is a new therapeutic option for eustachian tube dysfunction. One of the limiting factors of wider adoption of this technique in many parts of the world is the high cost of the devices, in spite of regulatory approval of safety. OBJECTIVE Evaluate the performance and usability of standard less-expensive endovascular balloons for eustachian tube dilation in comparison to an approved device in a preclinical study. STUDY DESIGN Comparative cadaver feasibility study. SETTING University tertiary care facility. METHODS Ten eustachian tube dilations were performed with an approved eustachian tube dilation device. Ten other procedures were carried out with an endovascular balloon of similar dimensions. Cone beam computerized tomography was performed to evaluate the extent of dilation and possible damages. The lumen and mucosal lining were inspected endoscopically post-dilation. Volume measurements were compared before and after the procedure in both groups using contrast enhancement. RESULTS All 20 eustachian tube dilations were carried out successfully. No tissue damages could be identified on cone-beam computerized tomography or via endoscopic examination. There was a statistically significant difference of eustachian tube volumes between pre- and post-dilations, with no statistically significant difference between the devices. CONCLUSION Eustachian tube dilation with a less costly endovascular balloon achieved similar results to an approved eustachian tube dilation device. No damages or any other safety concerns were identified in a cadaver study.

A common concern in individuals with cochlear implants (CIs) is difficulty following conversations in noisy environments and social settings. The ability to accomplish these listening tasks relies on the individual’s working memory abilities and draws upon limited cognitive resources to accomplish successful listening. For some individuals, allocating too much, can result deficits in speech perception and in long term detriments of quality of life. For this study, 31 CI users and NH controls completed a series of online behavioural tests and quality of life surveys, in order to investigate the relationship between visual and auditory working memory, clinical and behavioural measures of speech perception and quality of life and hearing. Results showed NH individuals were superior on auditory working memory and survey outcomes. In CI users, recall performance on the three working memory span tests declined from visual reading span to auditory listening in quiet and then listening in noise and speech perception was predictably worse when presented with noise maskers. Bilateral users performed better on each task compared to unilateral/HA and unilateral only users and reported better survey outcomes. Correlation analysis revealed that memory recall and speech perception ability were significantly correlated with sections of CIQOL and SSQ surveys along with clinical speech perception scores in CI users. These results confirm that hearing condition can predict working memory and speech perception and that working memory ability and speech perception, in turn, predict quality of life. Importantly, we demonstrate that online testing can be used as a tool to assess hearing, cognition, and quality of life in CI users.

There is a weak relationship between clinical and self-reported speech perception outcomes in cochlear implant (CI) listeners. Such poor correspondence may be due to differences in clinical and “real-world” listening environments and stimuli. Speech sounds in the real world are often accompanied by visual cues, background environmental noise and is generally in the context of a connected conversation. The aims of this study were to determine if brain responses to naturalistic speech could index speech perception and listening demand in CI users. Accordingly, we recorded high density EEG while CI users listened/watched a naturalistic stimulus (i.e., the television show, “The Office”). We used continuous EEG to quantify “speech neural tracking” (i.e., TRFs, temporal response functions) to the television show audio track and additionally 8–12 Hz (alpha) brain rhythms commonly related to listening effort. Background noise at three different signal-to-noise ratios (SNRs), +5, +10, and +15 dB were presented to vary the difficulty of following the television show mimicking a natural noisy environment. The task included an additional condition of audio-only (no video). After each condition, participants subjectively rated listening demand and the degree of words and conversations they felt they could understand. Fifteen CI users reported progressively higher degrees of listening demand and less words and conversation with increasing background noise. Listening demand and conversation understanding in the audio-only condition was comparable to that of the highest noise condition (+5 dB). The addition of the background noise reduced the degree of speech neural tracking. Mixed effect modeling showed that listening demand and conversation understanding were correlated to cortical speech tracking such that high demand and low conversation understanding lower associated with lower amplitude TRFs. In the high noise condition, greater listening demand was negatively correlated to parietal alpha power such that higher demand was related to lower alpha power. No significant correlations were observed between TRF/alpha and clinical speech perception scores. These results are similar to previous findings showing little relationship between speech perception and quality of life in CI users. However, the physiological responses to complex natural speech may anticipate aspects of quality-of-life measures such as self-perceived listening demand.

OBJECTIVE The Glasgow Benefit Inventory (GBI) is a health-related quality of life instrument used to detect changes in health status following otolaryngologic interventions. Despite its use in cochlear implant literature, assessment of utility, reliability, and validity of GBI in an adult cochlear implants (CI) patient population has yet to be performed. STUDY DESIGN Retrospective case series. SETTING Academic, tertiary referral center. PATIENTS Postlingually deafened, adult CI patients with at least 1 year of device use. INTERVENTIONS Five hundred fifty-two patients were administered GBI questionnaires at least 1 year following CI activation during follow-up visits. MAIN OUTCOME MEASURES GBI total and subscale scoring were compared to either the Hearing Handicap Inventory for Adults or Hearing Handicap Inventory for the Elderly. Moreover, a factor analysis and Cronbach's alpha were performed to determine GBI validity and internal reliability, respectively. RESULTS The average overall GBI score was 38.6 ± 21.7. This was weakly correlated to the reduction in Hearing Handicap Inventory for Adults/Hearing Handicap Inventory for the Elderly (τb = 0.282, p

A common concern for individuals with severe‐to‐profound hearing loss fitted with cochlear implants (CIs) is difficulty following conversations in noisy environments. Recent work has suggested that these difficulties are related to individual differences in brain function, including verbal working memory and the degree of cross‐modal reorganization of auditory areas for visual processing. However, the neural basis for these relationships is not fully understood. Here, we investigated neural correlates of visual verbal working memory and sensory plasticity in 14 CI users and age‐matched normal‐hearing (NH) controls. While we recorded the high‐density electroencephalogram (EEG), participants completed a modified Sternberg visual working memory task where sets of letters and numbers were presented visually and then recalled at a later time. Results suggested that CI users had comparable behavioural working memory performance compared with NH. However, CI users had more pronounced neural activity during visual stimulus encoding, including stronger visual‐evoked activity in auditory and visual cortices, larger modulations of neural oscillations and increased frontotemporal connectivity. In contrast, during memory retention of the characters, CI users had descriptively weaker neural oscillations and significantly lower frontotemporal connectivity. We interpret the differences in neural correlates of visual stimulus processing in CI users through the lens of cross‐modal and intramodal plasticity., People with hearing loss who have a cochlear implant (CI) have altered neural processing when engaged in a visual working memory task. During the visual stimulus encoding, CI users had greater visual and auditory cortex activation compared with normal‐hearing controls. Greater connectivity between temporal and frontal areas was observed for CI users compared with normal‐hearing controls.

Introduction First-year resident physicians began training in July 2020 in an environment of decreased clinical case exposure and increased feelings of insecurity secondary to the coronavirus (COVID-19) pandemic. To support resident learning, the University of Toronto Department of Otolaryngology - Head & Neck Surgery piloted a novel virtual case-based discussion series for first-year residents. Methods A weekly virtual resident-led case-based discussion series was designed. In 2020/2021, six residents (“Cohort 1”) and four staff otolaryngologists participated. A Likert survey retrospectively evaluated participant comfort level on a scale of 1 to 5, from “not well prepared or comfortable” to “very well prepared or comfortable” in seven clinical areas, at the beginning of the post-graduate year (PGY-1) August 2020, and in May 2021. Qualitative data collected assessed strengths and weaknesses of the intervention. In July 2021, the new 2021/2022 PGY-1 cohort (“Cohort 2”) also completed cross-sectional surveys in August 2021 and March 2022 to assess their comfort levels with consult management at the two separate timepoints. Results Cases presented revealed areas for practical, systemic, and cultural improvement. With respect to clinical decision making, both “Cohort 1” and “Cohort 2” residents reported increased comfort level in all areas assessed. “Cohort 1” residents reported percentage increase in comfort level addressing all consults of 28%, triaging consults overnight of 24%, pediatric consults of 30%, otology consults of 32%, airway consults of 30%, epistaxis consults of 28%, and peritonsillar abscess consults of 24%. “Cohort 2” residents reported increase in comfort level managing all consults of 32%, triaging consults overnight of 30%, pediatric consults of 38%, otology consults of 2%, airway consults of 30%, epistaxis consults of 18%, and peritonsillar abscess consults of 24%. All respondents agreed the intervention would benefit residents of other programs as a prolonged orientation to residency and a safe and confidential forum to discuss best practices. Discussion A weekly case discussion series potentially improves both resident education and patient care. It facilitated real-time discussion of topics relevant to self-perceived knowledge deficits, timely advice on management of a new and changing population of COVID patients and brought to attention hidden curriculum topics for exploration. Conclusion The case series described could be applied to benefit residents in Otolaryngology and other surgical specialty programs nationwide during, and following, the pandemic.

In use of the academic abstracts and the plain language summaries published on Journal of Social and Political Psychology, Kerwer et al.(2021)found undergraduates understood the plain language summaries better and gave them higher scores on the credibility, confidence to evaluate, and acquired ability to make decisions. These ratings are suggested as the index of easiness effect for reading plain language summaries. Kerwer et al. also found the plain language summaries lifted the readers’ intention to access the full text. On the other hand, they failed to find the association of participants’ knowledge background and summary style on each rating. Without the replication evidence based on the local materials, it is insufficient to claim the generalization of easiness effect across languages and cultures. This on-Internet replication study employed twelve abstracts from Chinese Journal of Psychology and the post-publication summaries on social media. The procedure followed the original study except the language fluency test and epitemistic emotion test. In terms of the prior power analysis, this replication study planned to collect at least 80 participants’ responses. The analysis plan and criterion followed the original study. The results confirmed the replications of comprehensibility and the easiness effect, and revealed the higher intention to access the full text. On the other hand, the alternative findings included the association of knowledge background and summary style, and post-test accuracies among the summary styles were nearly equal. Based on the language difference between original and replication studies, we discussed the plausible causes how the participants’ knowledge background altered the ratings among summary styles. The current results also indicated methodological limitations such as the lack of writing norms and the immature readability scale. For the potential applications of Chinese plain language summary, we suggested evidence-based guidelines are required for examining the positive and negative sides of easiness effect.

Background Sudden Sensorineural Hearing Loss (SSNHL) is a medical emergency requiring immediate attention as delayed treatment can lead to permanent and devastating consequences. Primary care physicians are likely the first to be presented with SSNHL and therefore have the crucial role of recognizing it and initiating timely and appropriate management. The aim of this study was to gain insight into the current knowledge and practice trends pertaining to the diagnosis and management of SSNHL among family physicians in Canada. Methods An 18-question survey targeting Canadian family physicians was marketed through two, physician-only discussion groups on the social media platform Facebook. Responses were collected between August 1st and December 22nd 2019 then aggregated and quantified. Results 52 family physicians submitted responses. 94.2% (n = 49) reported that in their practice, unilateral SSNHL warrants urgent referral to otolaryngology and 84.6% (n = 44) reported that unilateral sudden-onset hearing loss warrants urgent referral for audiological testing. 73.1% of participants (n = 38) reported that they would attempt to differentiate between conductive and sensorineural hearing loss if presented with unilateral, acute or sudden-onset hearing loss. 61.5% (n = 32) would rely on tuning fork tests to inform management decisions, as compared to 94.2% (n = 49) relying on case history and 88.5% (n = 46) on otoscopy. 76.9% (n = 40) would prescribe corticosteroids if presented with confirmed, unilateral SSNHL. Conclusion The majority of family physicians in the study would make appropriate referral and treatment decisions in the management of SSNHL, understanding it is a medical emergency. Tuning fork tests are under-utilized for informing management decisions compared to other means of differentiating conductive and sensorineural hearing loss. Further research is needed to understand why some family physicians do not prescribe corticosteroids for treatment of SSNHL, which may then identify any gaps in knowledge or inform improvements in clinical protocol. Graphical abstract

Background Homeless individuals frequently experience poor access to healthcare, delayed clinical presentation, and higher disease burden. Providing subspecialty otolaryngology care to this population can be challenging. We previously reported on the prevalence of hearing impairment in Toronto’s homeless community. As a secondary objective of this study, we sought to define otolaryngology specific need for this population. Methods One hundred adult homeless individuals were recruited across ten homeless shelters in Toronto, Canada using a stratified random sampling technique. An audiometric evaluation and head and neck physical examination were performed by an audiologist and otolaryngology resident, respectively. Basic demographic and clinical information was captured through verbal administration of a survey. Descriptive statistics were used to estimate frequency of otolaryngology specific diseases for this population. Results Of the 132 individuals who were initially approached to participant, 100 (76%) agreed. There were 64 males, with median age of 46 years (IQR 37–58 years). The median life duration of homelessness was 24 months (IQR 6–72 months). Participants had a wide range of medical comorbidities, with the most common being current tobacco smoking (67%), depression (36%), alcohol abuse (32%), and other substance abuse (32%). There were 22 patients with otolaryngology needs as demonstrated by one or more abnormal findings on head and neck examination. The most common finding was nasal fracture with significant nasal obstruction (6%). Eleven patients required referral to a staff otolaryngologist based on concerning or suspicious findings, including two head and neck masses, 6 were later seen in follow-up. Conclusion There were substantial otolaryngology needs amongst a homeless population within a universal healthcare system. Future research should focus on further elucidating head and neck related issues in this population and expanding the role of the otolaryngologist in providing care to homeless individuals.

OBJECTIVE Explore patient characteristics associated with tinnitus improvement after cochlear implantation. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral. PATIENTS Adults with bilateral severe-to-profound hearing loss and tinnitus. INTERVENTIONS Unilateral cochlear implantation. RESULTS From 1996 to 2018, 358 patients endorsed pre-implant tinnitus and had ascertainable tinnitus status at 1-year. Clinically significant improvement in Tinnitus Handicap Inventory (THI) (reduction by at least 7-points) was observed in 262 (73.2%) patients, of whom 155 (59.2%) reported complete resolution. Of the 24 characteristics explored, four were identified as independent predictors of improved tinnitus in logistic regression models. In a multivariable model including identified independent predictors, each 10-percentage point increase in baseline hearing in noise test was associated with an 14% reduction in odds of tinnitus resolution or clinically significant improvement (odds ratio [OR] 0.86, 95% confidence limits [CL] 0.77, 0.96) and preoperative use of a hearing aid in the contralateral ear was associated with a 72% reduction (OR 0.28; 95% CL 0.11, 0.73). Each 10-point increase in baseline Hearing Handicap Inventory for Adults (HHI) score was associated with a 28% increase in odds of tinnitus improvement (OR 1.28; 95% CL 1.07, 1.54). Higher baseline burden of tinnitus was associated with higher odds of tinnitus improvement (OR 1.21 per 10-point THI increase, 95% CL 1.04, 1.40). CONCLUSIONS Worse residual hearing and higher baseline hearing and tinnitus handicap are associated with higher odds of tinnitus improvement. Expectations of patients seeking reduced tinnitus burden following cochlear implantation should be managed by counselling regarding odds of tinnitus improvement compared to those with similar residual hearing and tinnitus burden.

BACKGROUND: Given that hearing loss is associated with increased social isolation, reduced earning potential and neurocognitive disease, findings of uncorrected hearing loss in the homeless population have important policy implications. We sought to estimate the prevalence of hearing impairment in an adult homeless population. METHODS: We recruited adult (age ≥ 18 yr) homeless people across 10 homeless shelters in Toronto between April and June 2018 using a 2-stage sampling technique. Participants were interviewed by 1 interviewer using a modified survey that had been used in previous studies looking at other health needs in homeless populations. A comprehensive head and neck examination and audiometric evaluation were performed in each participant by an otolaryngologist and an audiologist. Descriptive statistics were estimated. Audiometric data were standardized directly for age and sex to facilitate direct comparisons with the general Canadian population. RESULTS: Of the 132 people invited, 100 (75.8%) agreed to participate. The median age was 46 (interquartile range [IQR] 37–58) years. The median duration of homelessness was 24 (IQR 6–72) months. Although most participants (78) had some form of extended health care benefits through social assistance, only 22/78 (28%) were aware that hearing tests and hearing aids were covered through these programs. After direct standardization for age and sex, the proportions of participants with a speech-frequency and high-frequency hearing loss were 39.5% (95% confidence interval [CI] 30.4%–49.3%) and 51.9% (95% CI 42.2%–61.4%), respectively. Nineteen participants were hearing aid candidates, only 1 of whom owned functional hearing aids. Rates of speech-frequency hearing loss (39.5%, 95% CI 30.4%–49.3% v. 19.2%, 95% CI 16.9%–21.7%) and high-frequency hearing loss (51.9%, 95% CI 42.2%–61.4% v. 35.5%, 95% CI 33.1%–37.7%) were substantially higher than in the general Canadian population. INTERPRETATION: Our results suggest that homeless adults have a high prevalence of hearing impairment, even when living within a system of universal health insurance; awareness of health care benefits through social assistance programs was poor. Results from this study may prompt initiatives surrounding homeless outreach and health screening.

OBJECTIVES Our primary objective was to investigate the long-term usage of cochlear implants (CIs) in children who underwent sequential bilateral CI (SeqBCI), and to study factors that impact usage. Our secondary objective was to understand the difference in subjective benefit and educational/employment status, between users and non-users of the second CI (CI2). STUDY DESIGN Prospective case series. SETTING Tertiary academic centers. PATIENTS Sixty-eight young adults who underwent SeqBCI as children. INTERVENTIONS Pediatric SeqBCI. MAIN OUTCOME MEASURES The main outcome measures were the current usage of the first CI (CI1) and CI2, factors that determine usage, current perceptions of their CIs, educational/employment status, and Speech, Spatial and Qualities of Hearing scale (SSQ12) scores. RESULTS Sixty five (95.6%) participants were using CI1 for over 8 h/d and the rest were using CI1 for 4 to 8 h/d. Fourty four (64.7%) participants used CI2 for at least 4 h/d, 10 (15%) indicated that they rarely used CI2 (

OBJECTIVES The aim of this study was to prospectively assess pain and associated analgesic consumption after otological surgery comparing two prescription patterns. STUDY DESIGN A prospective nonrandomized consecutive cohort study. METHODS 125 adult patients undergoing ambulatory otologic surgery-cochlear implantation and endaural middle ear surgery, were assigned (according to surgeon's preference) and prospectively studied in two arms: 1) acetaminophen 500 mg + ibuprofen 400 mg; 2) acetaminophen 500 mg + codeine 30 mg. Pain levels, medication dose, disposal patterns of opioids, and suspected side effects were evaluated. RESULTS All patients reported mild to moderate pain. There was a statistically significant reduction of pain from day to day, which was on average 0.26 lower than the day before. Sufficient pain control could be achieved with both drug regimens with no significant difference in pain levels. Only 50% of patients who were prescribed opioids used them. Additionally, the median tablet intake was 3 tablets while 10 to 20 tablets were prescribed. The majority of patients (97%) did not dispose of these drugs safely. CONCLUSION Adequate analgesia was achieved in both arms of this study. Pain control following otologic surgery with a combination of acetaminophen and nonsteroidal anti-inflammatory drugs is recommended unless contraindications or chronic opioid use are present. If opioids such as codeine (30 mg) are prescribed, the amount should be reduced as low as possible, such as five tablets, based on our studied population. LEVEL OF EVIDENCE Level 3-a prospective nonrandomized consecutive cohort study Laryngoscope, 2021.

Moderate noise exposure may cause acute loss of cochlear synapses without affecting the cochlear hair cells and hearing threshold; thus, it remains "hidden" to standard clinical tests. This cochlear synaptopathy is one of the main pathologies of noise-induced hearing loss (NIHL). There is no effective treatment for NIHL, mainly because of the lack of a proper drug-delivery technique. We hypothesized that local magnetic delivery of gene therapy into the inner ear could be beneficial for NIHL. In this study, we used superparamagnetic iron oxide nanoparticles (SPIONs) and a recombinant adeno-associated virus (AAV) vector (AAV2(quad Y-F)) to deliver brain-derived neurotrophic factor (BDNF) gene therapy into the rat inner ear via minimally invasive magnetic targeting. We found that the magnetic targeting effectively accumulates and distributes the SPION-tagged AAV2(quad Y-F)-BDNF vector into the inner ear. We also found that AAV2(quad Y-F) efficiently transfects cochlear hair cells and enhances BDNF gene expression. Enhanced BDNF gene expression substantially recovers noise-induced BDNF gene downregulation, auditory brainstem response (ABR) wave I amplitude reduction, and synapse loss. These results suggest that magnetic targeting of AAV2(quad Y-F)-mediated BDNF gene therapy could reverse cochlear synaptopathy after NIHL.

Objective Meniere's disease (MD) is a clinical disorder that often provides challenges in diagnosis and management. High-quality evidence to guide care providers is sparse, which can result in significant practice variations. Quality indicators (QIs) are one method that can be used to standardize and measure accepted care practices to improve healthcare quality and patient outcomes. Here, we developed practical, high-yield QIs that serve to measure and inform the quality of care provided to patients with MD. Study design Modified RAND Corporation University of California, Los Angeles appropriateness methodology for QI development. Setting Multicenter nine-member expert panel. Patients NA. Interventions NA. Main outcome measure Final QIs deemed appropriate measures of quality care with agreement by the expert panel. Results Twenty-seven candidate indicators were identified after literature review. After the first round of evaluations, the panel agreed on three candidate indicators as appropriate QIs. A subsequent expert panel meeting provided a platform to discuss disagreements. Two agreed-upon QIs were revised during this discussion before final evaluations. The expert panel ultimately agreed upon five QIs as appropriate measures of high-quality care after completing final evaluations and reviewing updated literature. The five quality indicators measure audiometric documentation, minimization of electrocochleography, use of intratympanic dexamethasone, use of intratympanic gentamycin, and rate of labyrinthectomy/vestibular neurectomy in refractory MD patient. Conclusions This study proposes five QIs that cover key aspects of care for MD, such as accurate diagnosis and management options including initial destructive therapies. These QIs can serve multiple purposes, the most important of which is to galvanize quality improvement initiatives.

Background The SVV tests the ability of a person to perceive the gravitational vertical. A tilt in SVV indicates vestibular imbalance in the roll plane, and thus injuries to the utricle or its connecting nerves. A validated bedside method (et, al., 2009, 72(19):1689–1692, Neurol, Zwergal) is the bucket method, in which the subject estimates the true vertical by attempting to properly align a straight line visible on the bottom of a bucket that is rotated at random by the examiner. In our study, the subjects need to align the plumb line on the Visual Vertical iOS app to the vertical direction. Methods Measurements of the SVV were made in 22 healthy subjects (16 females and 6 males). Each subject conducted 10 iterations of bucket test and 10 iterations of iOS app test. The reliability and validity of the iOS app was analyzed by SPSS21. Results Cronbach’s α for the plumb line method was 0.976, and the iOS app was 0.978. Statistical comparison of SVV values measured by the iOS app and the bucket method showed no significant difference in distribution (Mann Whitney U test U = 0.944). Conclusion The Visual Vertical iOS app is an effective and accessible substitute to the plumb line for the measurement of the validated bucket test.

Purpose The effects of image doubling on logarithmic progression chart visual acuity were investigated by simulating diplopia on a computer monitor. Methods Ten participants (6M, 4F) aged 21-28 years (mean 22.4 ± 2.3) were assessed viewing with their left eye while wearing their best correction. Stimuli were eight rows of five Sloan letters, from 0.4 to -0.3 logMAR (6/15 to 6/3) arranged in logarithmic progression format, generated on an HD monitor. Stimuli were generated with different magnitudes of doubling, different directions of doubling, and different intensity ratios between the ghost image and main images. Results When the ghost image had the same intensity as the main image, there was a significant effect of doubling magnitude on visual acuity, with the mean acuity being -0.11 logMAR (6/4.7) for no doubling. Acuity thresholds (logMAR) increased when doubling exceeded 1 min of arc, reaching a level of 0.12 logMAR (6/7.9) for doubling of 16 min of arc. There were no significant effects of orientation on acuity, nor were there significant orientation-doubling magnitude interaction effects of visual acuity. Image doubling magnitude level affected visual acuity differently for different ghost image intensities, with the highest acuity elevation occurring when ghost and main images were equal or nearly equal. For faint ghost image intensities (10% and 20%) image doubling did not significantly affect visual acuity. Conclusions Image doubling will degrade visual acuity if doubling is greater than 1 min of arc, and ghost images are sufficiently intense. However, even with very obvious visually-disturbing image doubling, visual acuity remains only slightly reduced.

OBJECTIVE Assess speech outcomes in unilateral cochlear implant (CI) recipients after addition of a wireless contralateral routing of signals (CROS) microphone. STUDY DESIGN Prospective cohort study. SETTING Ambulatory. PATIENTS Sixteen adult unilateral CI users with nonserviceable hearing on the contralateral side were recruited. Those with AzBio sentence scores of 40 to 80% or Hearing in Noise Test - Quiet (HINT-Q) scores of 60 to 90% with a CI alone were eligible participants. INTERVENTION Speech testing was carried out with the CROS on and off. MAIN OUTCOME MEASURE Speech recognition. RESULTS In the consonant-nucleus-consonant test presented in quiet from the front, word scores were 64.4 (CI) and 63.8% (CI + CROS) (p = 0.72), and phoneme scores were 80.2 (CI) and 80.8% (CI + CROS) (p = 0.65). In AzBio sentence testing in quiet, with the signals projected from the contralateral, front, or ipsilateral to the CI, speech perception with the CI alone was 60.8, 75.9, and 79.1%. With the addition of the CROS microphone, using the same speaker arrangement, speech perception was 69.8 (p

Current RF SOC devices are highly complex with many modules with different functions and wireless standards. This complexity results in thousands of tests needed even for production testing. Characterization and engineering test flow will demand even more tests. It takes a lot of time to develop, debug and bring the program into production. This is especially true for new engineers which can take months or years to develop on their own. Typical solution would be to develop a test library to generate all the tests. However, not all test library are build the same. And typical” 1st generation” are done to get the job done. They can be difficult to debug and may need hack codes for special or customized test. In addition, some libraries have grown so complex that it takes a long time to learn how to use them. With experiences gained from development of many projects and Java coding, a new better next generation test library was developed. This paper described a new improved version of such a test library which provides more features & benefits, more user friendly and easy to learn. The paper first describes the need for test library and typical issues with existing test libraries. The benefits and new features of the next generation test library will be introduced. The structure and use model of this user-friendly RF SOC test library will be described. How and why development time and cost will be reduced. Complicated hacking codes can be eliminated. Future-proofing the library, it is designed to allow new wireless standards and tests to be added. Debugging and setup features will also be described. Efficient and ease of importing user input, registers setup and design pattern will help even new users create test program efficiently and quickly. This library is also designed to ease learning curve when using it. A beginner can develop a new kind of RF SOC offline program within one month. Framework to allow easy usage allows users to stay at a higher level helps them to focus on test strategies.

This paper describes a new CPU subsystem featured in a 5G mobile SoC. The High-Performance (HP) core achieves a 3GHz clock frequency with full production yield across the fabrication range and operating environment. In contrast to previously published work [1], a third, balanced-performance (BP), gear is introduced which features a power-optimized implementation of the high-performance (HP) core. Physical implementation differences of the BP and HP cores are illustrated, while circuit techniques developed to enable full-yield 3GHz operation are detailed. A die photograph alongside a more detailed HP core CAD drawing are shown in Fig. 4.1.7 and the cluster topology, including architectural features, is summarized in Fig. 4.1.1.

Background: Robotics is currently being adopted across the spectrum of neurosurgery from deep brain stimulation to spine surgery instrumentation. Mastoidectomy is a cognitively demanding procedure that involves careful removal of bone around the critical structures of the temporal bone. Herein, we report a pilot study that serves as a proof of concept for real-time, multiparameter recording during mastoidectomy. Methods: This pilot study involved the iterative development of a platform for the real time recording of video, 3D position, velocity, acceleration, and force data during the performance of mastoidectomy using cadaveric specimens. Results: Across all 8 replicates, the average distance traveled by the drill tip in the x, y, and z axes was 39.88 mm (±11.98 mm), 38.52 mm (±8.24 mm), 31.40 mm (±7.89 mm), respectively. The overall average ranges for velocity and acceleration of the drill tip in the x axis were 412.81 mm/s (±91.12 mm/s) and 6383.05 mm/s2 (±941.05 mm/s2). The range of forces recorded was 8.52 N (±2.90 N), 40.94 N (±9.81 N), and 35.42 N (±11.06 N) in the x-, y-, and z-axis, respectively. Conclusions: This study represents a proof-of-concept that the mechanical parameters associated with surgeon-performed mastoidectomy can be recorded in real-time. This represents a crucial step in understanding the human drilling process which incorporates visual and haptic sensory input with experiential and explicit knowledge using fuzzy logic feedback. Ultimately, data collected using this methodology may provide the groundwork for the development of an algorithm for robotic mastoidectomy.