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Cochlear implants have become an important tool for the treatment of individuals with hearing impairment. A preoperative approach consisting of a multidisciplinary team that fully assesses each cochlear implant candidate will allow the selection of those patients likely to benefit. Cochlear implant technology continues to evolve including electrode design, receiver/stimulator design, and speech-processing modalities. Novel surgical techniques have enhanced the safety of cochlear implantation and have provided access to a growing number of patients. Children with congenital inner ear malformations and those with cochlear ossification are able to benefit from implantation. [ABSTRACT FROM AUTHOR]

Stapedectomy can be used in certain patients with profound sensorineural hearing loss and stapes fixation to improve hearing to a level at which a hearing aid may be effective. This study reviews the outcomes of 11 patients with profound cochlear loss secondary to otosclerosis who underwent stapes surgery performed by the senior author (M.E.G.) over a 25-year period. Postoperative hearing aid usage was effective in 9 of 11 patients. Preoperatively, these patients derived no benefits from hearing aids. Stapedectomy may be of immense value in patients with the proper history and profound cochlear loss. [ABSTRACT FROM AUTHOR]

Patients presenting with chronic dizziness and no identifiable vestibular impairments have been described as having 'extravestibular' symptoms, or 'psychogenic dizziness.' In 2005, Staab and Ruckenstein described a syndrome they referred to as 'chronic subjective dizziness' (CSD), which characterized this concept more clearly. According to Staab and Ruckenstein (2003), the primary physical symptoms of CSD are continual nonvertiginous dizziness or subjective imbalance that persists for 3 mo or longer. Patients suffering from CSD often describe their dizziness as a rocking or swaying when sitting or standing. This case study describes a 41-yr-old female who originally presented with complaints of noise-induced vertigo. The patient's history, imaging studies, and balance function examinations led to the diagnosis of a right-sided superior canal dehiscence (SCD). After surgical repair of the dehiscence, the quantitative electrophysiological tests returned to normal. However, the patient's scores on measures of anxiety, depression, and self-perceived dizziness handicap increased significantly postoperatively. This case illustrates the transformation of a peripheral end-organ impairment (i.e., SCD) into a psychiatric condition (i.e., CSD). [ABSTRACT FROM AUTHOR]

Objective: To report hearing preservation (HP) outcomes based on anticoagulation/antiplatelet use (blood thinner, BT) following cochlear implantation (CI)., Study Design: Retrospective cohort., Setting: Tertiary referral center., Patients: Three hundred twenty-six adults (361 ears: no BT = 210, BT held = 86, BT continued = 65) implanted between 2012 and 2021 with preoperative low-frequency pure-tone average (LFPTA) of 65 dB HL or better., Main Outcome Measure: Postoperative HP, defined as LFPTA ≤80 dB HL, at 1, 3, 6, and 12 months., Results: Compared to no BT, the BT held and continued groups were older (60.6 vs 72.7 vs 73.0 yrs, p < 0.001) and had diabetes (10% vs 28% vs 22%, p < 0.001). Electrode type, steroid use, surgical approach, and preoperative LFPTA were equivalent among groups. Postoperative HP rates were significantly higher for no BT than the BT held and continued groups at 1 month (62% vs 48% vs 43%, p = 0.008), with equivalent results at 3, 6, and 12 months. When patients were stratified by BT type, there were no significant differences in HP outcomes. On multivariate analysis, BT status was not a significant predictor of HP rates at 1 or 12 months. Younger age (OR 0.95, 95% CI 0.94-0.97, p < 0.001) was the only significant predictor of 1- but not 12-month HP., Conclusions: BT use, regardless of whether held for surgery, was associated with inferior early HP outcomes. After controlling for age, BT status was not a significant predictor of HP, suggesting inherently poorer cochlear health in patients who are on BTs., Competing Interests: Conflicts of Interest: M.H.F. is an advisor for Endotheia, Inc. D.S.H. is a consultant for Advanced Bionics, Cochlear Americas, MED-EL GmbH, Stryker, Synthes, Grace Medical, and Oticon. K.O.T. has served as an advisory board member for GlaxoSmithKline. Abstract was presented as a poster presentation at the 2024 Combined Otolaryngology Spring Meeting, American Otological Society, Chicago, Illinois, May 15 to 19., (Copyright © 2024, Otology & Neurotology, Inc.)

Objective: To assess the factors that drive a patient's selection of cochlear implant (CI) manufacturer., Study Design: Prospective survey study., Setting: Tertiary referral center., Patients: One hundred twenty-eight adult patients undergoing primary CI., Interventions: Survey administered in the preoperative area., Main Outcome Measures: Sources of information regarding CI manufacturer offerings, factors that were most important in deciding on a manufacturer, and manufacturer ultimately selected., Results: One hundred twenty-eight patients were included (average age, 63.7 years; 97% White). The most cited source of information that patients used to choose a device was his/her audiologist (80.5% of patients). When asked his/her number 1 reason for choosing their CI manufacturer, the most commonly cited reason was technology (e.g., battery life, device pairing), regardless of manufacturer. When asked about specific technology offerings, hearing aid pairing was rated as the most important. The numbers 2 and 3 reasons for choosing a manufacturer were cosmetics/structure of the wearable portion of the device and audiologist recommendation of that manufacturer, respectively. The relative weight given to each of the top 3 reasons differed significantly across the three manufacturers ( p = 0.017)., Conclusions: Audiologists are by far the leading source of information used by patients choosing a CI manufacturer. Patients prioritize technology most when choosing an implant manufacturer, but audiologist recommendation and the cosmetics and structure of the wearable device are also important. CI manufacturers should be mindful of patient priorities when designing and marketing their devices., Competing Interests: Conflicts of interest and source of funding: There are no conflicts of interest. UL1 TR000445 from NCATS/NIH., (Copyright © 2024, Otology & Neurotology, Inc.)

Introduction: Cochlear implants (CIs) provide access to sound and help mitigate the negative effects of hearing loss. As a field, we are successfully implanting more adults with greater amounts of residual hearing than ever before. Despite this, utilization remains low, which is thought to arise from barriers that are both intrinsic and extrinsic. A considerable body of literature has been published in the last 5 years on barriers to adult CI uptake, and understanding these barriers is critical to improving access and utilization. This scoping review aims to summarize the existing literature and provide a guide to understanding barriers to adult CI uptake., Methods: Inclusion criteria were limited to peer-reviewed articles involving adults, written in English, and accessible with a university library subscription. A cutoff of 20 years was used to limit the search. Barriers uncovered in this review were categorized into an ecological framework., Results: The initial search revealed 2,315 items after duplicates were removed. One hundred thirty-one articles were reviewed under full-text, and 68 articles met the inclusion criteria., Discussion: Race, ethnicity, and reimbursement are policy and structural barriers. Public awareness and education are societal barriers. Referral and geographical challenges are forms of organizational barriers. Living context and professional support are interpersonal barriers. At the individual level, sound quality, uncertainty of outcome, surgery, loss of residual hearing, and irreversibility are all barriers to CI uptake. By organizing barriers into an ecological framework, targeted interventions can be used to overcome such barriers., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of Otology & Neurotology, Inc.)

Objective: To assess the minimal clinically important difference (MCID) values for cochlear implant-related speech recognition scores, which have not been previously reported., Study Design: Retrospective cohort., Setting: Tertiary referral center., Patients: Eight hundred sixty-three adult patients who underwent cochlear implantation between 2009 and 2022., Main Outcome Measures: MCID values for consonant-nucleus-consonant (CNC) word scores and AzBio sentences in quiet and noise scores using distribution-based methods (half-standard deviation, standard error of measurement, Cohen's d, and minimum detectable change)., Results: In this cohort, the mean preoperative CNC word score was 13.9% (SD, 15.6). The mean preoperative AzBio sentences in quiet score was 19.1% (SD, 22.1), and the mean preoperative AzBio sentences in noise score was 13.0% (SD, 12.0). The average MCID values of several distribution-based methods for CNC, AzBio in quiet, and AzBio in noise were 7.4%, 9.0%, and 4.9%, respectively. Anchor-based approaches with the Speech, Spatial, and Qualities of hearing patient-reported measure did not have strong classification accuracy across CNC or AzBio in quiet and noise scores (ROC areas under-the-curve ≤0.69), highlighting weak associations between improvements in speech recognition scores and subjective hearing-related abilities., Conclusions: Our estimation of MCID values for CNC and AzBio in quiet and noise allows for enhanced patient counseling and clinical interpretation of past, current, and future research studies assessing cochlear implant outcomes., Competing Interests: Conflicts of interest: A.C.M. serves as CMO and on Board of Directors for Otologic Technologies and has received grant support from Cochlear Americas. M.H.F. is an advisor for Endotheia, Inc. K.O.T. has served as an advisory board member for GlaxoSmithKline. D.S.H. is a consultant for Advanced Bionics, Cochlear Americas, MED-EL GmbH, Stryker, Synthes, Grace Medical, and Oticon. R.H.G. is a consultant for Advanced Bionics, Akouos, Cochlear Americas, Sony, and Skylar Bio., (Copyright © 2024, Otology & Neurotology, Inc.)

Objectives: Social media has enabled discussion of relevant topics within otolaryngology. With increasing academic discourse occurring on virtual platforms, it is important to examine who is influencing these discussions. This study thus aims to: (1) identify the top Twitter influencers in otolaryngology and (2) assess the relationship between Twitter influence and academic impact., Study Design: Cross-sectional analysis., Setting: Twitter., Methods: The Right Relevance program was used to identify and rank the top 75 Twitter influencers, excluding organizations, according to the search terms "otolaryngology," "head and neck surgery," "ear nose throat," "rhinology," "head and neck," "laryngology," "facial plastics," and "otology." Demographic data and h-index were collected for each influencer. Correlational analyzes were performed to assess the relationships between Twitter rank and geographic location, sex, subspecialty, and h-index., Results: The majority of the top 75 influencers were otolaryngologists (87%), female (68%), and located in the United States (61%). General otolaryngology (n = 20, 31%) was more well-represented than any individual subspecialty including facial plastics (n = 10, 15%), rhinology (n = 10, 15%), and neurotology (n = 9, 14%). There was a significant relationship between Twitter rank and h-index (Spearman ρ value of -0.32; 95% confidence interval: -0.51 to -0.01; P = .006). Twitter rank was not significantly correlated with subspecialty, sex, or geographic location (P > .05)., Conclusion: The majority of Twitter influencers within otolaryngology were otolaryngologists, female, and located in the United States. Social media influence is positively associated with academic impact among otolaryngologists., (© 2024 The Authors. Otolaryngology–Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Objective: To report speech recognition outcomes and processor use based on timing of cochlear implant (CI) activation., Study Design: Retrospective cohort., Setting: Tertiary referral center., Patients: A total of 604 adult CI recipients from October 2011 to March 2022, stratified by timing of CI activation (group 1: ≤10 d, n = 47; group 2: >10 d, n = 557)., Main Outcome Measures: Average daily processor use; Consonant-Nucleus-Consonant (CNC) and Arizona Biomedical (AzBio) in quiet at 1-, 3-, 6-, and 12-month visits; time to peak performance., Results: The groups did not differ in sex ( p = 0.887), age at CI ( p = 0.109), preoperative CNC ( p = 0.070), or preoperative AzBio in quiet ( p = 0.113). Group 1 had higher median daily processor use than group 2 at the 1-month visit (12.3 versus 10.7 h/d, p = 0.017), with no significant differences at 3, 6, and 12 months. The early activation group had superior median CNC performance at 3 months (56% versus 46%, p = 0.007) and 12 months (60% versus 52%, p = 0.044). Similarly, the early activation group had superior median AzBio in quiet performance at 3 months (72% versus 59%, p = 0.008) and 12 months (75% versus 68%, p = 0.049). Both groups were equivalent in time to peak performance for CNC and AzBio. Earlier CI activation was significantly correlated with higher average daily processor use at all follow-up intervals., Conclusion: CI activation within 10 days of surgery is associated with increased early device usage and superior speech recognition at both early and late follow-up visits. Timing of activation and device usage are modifiable factors that can help optimize postoperative outcomes in the CI population., Competing Interests: Conflict of interest: J.T.H. is a consultant for Cochlear and serves on the advisory board for Advanced Bionics and MED-EL. M.H.F. is an advisor for Endotheia, Inc. K.O.T. has served as an advisory board member for GlaxoSmithKline. D.S.H. is a consultant for Advanced Bionics, Cochlear Americas, MED-EL GmbH, Stryker, Synthes, Grace Medical, and Oticon. R.H.G. is a consultant for Advanced Bionics, Akouos, and Cochlear Americas; is on the clinical advisory board for Frequency Therapeutics; and is on the Board of Directors for the American Auditory Society., (Copyright © 2024, Otology & Neurotology, Inc.)

Objectives: Evaluate potential effects of calcium channel blockers (CCB) and bisphosphonates (BP) on residual hearing following cochlear implantation., Methods: Medications of 303 adult hearing preservation (HP) candidates (low frequency pure tone average [LFPTA] of 125, 250, and 500 Hz ≤80 dB HL) were reviewed. Postimplantation LFPTA of patients taking CCBs and BPs were compared to controls matched by age and preimplantation LFPTA., Results: Twenty-six HP candidates were taking a CCB (N = 14) or bisphosphonate (N = 12) at implantation. Median follow-up was 1.37 years (range 0.22-4.64y). Among subjects with initial HP, 29% (N = 2 of 7) CCB users compared to 50% (N = 2 of 4) controls subsequently lost residual hearing 3-6 months later (OR = 0.40, 95% CI = 0.04-4.32, p =  0.58). None of the four BP patients with initial HP experienced delayed loss compared to 50% (N = 2 of 4) controls with initial HP (OR = 0.00, 95% CI = 0.00-1.95, P  =  0.43). Two CCB and one BP patients improved to a LFPTA <80 dB HL following initial unaided thresholds that suggested loss of residual hearing., Discussion: There were no significant differences in the odds of delayed loss of residual hearing with CCBs or BPs., Conclusion: Further investigation into potential otoprotective adjuvants for maintaining residual hearing following initial successful hearing preservation is warranted, with larger cohorts and additional CCB/BP agents.

Objective: To assess speech recognition and hearing preservation (HP) outcomes with the Advanced Bionics Mid-Scala and SlimJ electrodes., Study Design: Retrospective cohort., Setting: Tertiary referral center., Patients: A total of 237 adult patients implanted between 2013 and 2020 (Mid-Scala, n = 136; SlimJ, n = 101)., Main Outcome Measures: Consonant-nucleus-consonant (CNC) and AzBio (Arizona Biomedical) scores at 6 and 12 months; postoperative HP, defined as low-frequency pure-tone average ≤ 80 dB HL; scalar position., Results: Mean CNC scores did not significantly differ between Mid-Scala and SlimJ recipients at 6 (45.8% versus 46.0%, p = 0.962) and 12 (51.9% versus 48.8%, p = 0.363) months. Similarly, mean AzBio in quiet scores were equivalent for both groups at 6 (55.1% versus 59.2%, p = 0.334) and 12 (60.6% versus 62.3%, p = 0.684) months. HP rates were significantly higher with the SlimJ (48.4%) than the Mid-Scala (30.8%; p = 0.033). Scalar translocations were 34.8 and 16.1% for the Mid-Scala and SlimJ groups, respectively ( p = 0.019). Ears with postoperative HP had significantly fewer scalar translocations (16.7% versus 37.2%, p = 0.048), and postoperative HP was associated with higher AzBio in noise scores at the most recent follow-up interval (38.7% versus 25.1%, p = 0.042). CNC, AzBio in quiet and noise, low-frequency pure-tone average shifts, and PTA at 6 and 12 months were not significantly different between patients with scala tympani insertions of the SlimJ versus the Mid-Scala ( p > 0.05)., Conclusions: Compared with the Mid-Scala, the lateral wall electrode has superior HP rates and fewer scalar translocations, whereas speech recognition scores are equivalent between both electrode arrays. These findings can help providers with electrode selection and patient counseling., Competing Interests: J.T.H. is a consultant for Cochlear and serves on the advisory board for Advanced Bionics and MED-EL. D.S.H. is a consultant for Advanced Bionics Corp., Cochlear Corp., MED-EL GmbH, Stryker, Synthes, Grace Medical, and Oticon. K.O.T. has served as an advisory board member for GlaxoSmithKline. The remaining authors disclose no conflicts of interest., (Copyright © 2023, Otology & Neurotology, Inc.)

Objective: To investigate whether revision surgery with the same device results in a change in three key indicators of electrode positioning: scalar location, mean modiolar distance ( M ¯ ), and angular insertion depth (AID)., Methods: Retrospective analysis of a cochlear implant database at a university-based tertiary medical center. Intra-operative CT scans were obtained after initial and revision implantation. Electrode array (EA) position was calculated using auto-segmentation techniques. Initial and revision scalar location, M ¯ , and AID were compared., Results: Mean change in M ¯ for all ears was -0.07 mm (SD 0.24 mm; P  = 0.16). The mean change in AID for all ears was -5° (SD 67°; P  = 0.72). Three initial implantations with pre-curved EAs resulted in a translocation from Scala Tympani (ST) to Scala Vestibuli (SV). Two remained translocated after revision, while one was corrected when revised with a straight EA. An additional five translocations occurred after revision., Conclusions: In this study examining revision cochlear implantation from a single manufacturer, we demonstrated no significant change in key indicators of EA positioning, even when revising with a different style of electrode. However, the revision EA is not necessarily confined by the initial trajectory and there may be an increased risk of translocation.

Objective: To report our experience for adults undergoing cochlear implantation (CI) for single-sided deafness (SSD)., Methods: This is a retrospective case series for adults with SSD who underwent CI between January 2013 and May 2021 at our institution. CNC and AzBio speech recognition scores, Tinnitus Handicap Inventory (THI), Speech, Spatial, and Qualities of Hearing Scale (SSQ12), datalogging, and the Cochlear Implant Quality of Life (CIQOL)-10 Global measure were utilized., Results: Sixty-six adults underwent CI for SSD (median 51.3 years, range 20.0-74.3 years), and 57 (86.4%) remained device users at last follow-up. Compared to pre-operative performance, device users demonstrated significant improvement in speech recognition scores and achieved peak performance at six months post-activation for CNC (8.0% increased to 45.6%, p < 0.0001) and AzBio in quiet (12.2% increased to 59.5%, p < 0.0001). THI was decreased at 6 months post-implantation (58.1-14.6, p < 0.0001), with 77% of patients reporting improved or resolved tinnitus. Patients demonstrated improved SSQ12 scores as well as the disease-specific CIQOL-10 Global questionnaire. Duration of deafness was not associated with significant differences in speech recognition performance. Average daily wear time was positively associated with CNC and AzBio scores as well as post-operative CIQOL-10 scores., Conclusions: Herein we present the largest cohort of adult CI recipients with SSD with data on speech recognition scores, tinnitus measures, and SSQ12. Novel insights regarding the correlation of datalogging, duration of deafness, and CI-specific quality of life (CIQOL-10) metrics are discussed. Data continue to support CI as an efficacious treatment option for SSD., Level of Evidence: 4 Laryngoscope, 133:2362-2370, 2023., (© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: We reviewed a cohort of patients with untreated sporadic vestibular schwannoma (VS) and examined the relationship between high-frequency hearing loss (HFHL) in the non-VS ear and long-term hearing outcomes in the VS-affected ear. We hypothesized that the progression of HFHL is associated with accelerated hearing decline in sporadic VS., Study Design: Retrospective cohort study., Setting: Tertiary center., Patients: We studied 102 patients with sporadic VS diagnosed from 1999 to 2015 with ≥5 years of observation (median, 6.92; interquartile range, 5.85-9.29). Sixty-six patients had AAO-HNS class A/B hearing at presentation and were included in analysis., Interventions: Audiometry, serial magnetic resonance imaging for observation of VS., Main Outcome Measures: Four-frequency pure tone average (PTA) and word recognition scores (WRS) in the VS-affected ear. Decline in high-frequency PTA (average of thresholds at 4000, 6000, and 8,000 Hz) was defined as ≥10 dB during the study period. Decline in WRS was defined as ≥10%., Results: Compared with those without, patients with progressive HFHL in the non-VS ear were more likely to experience a decline in WRS in the VS ear (80% vs. 54%, p = 0.031). However, the same group showed no difference (52% vs. 41%, p = 0.40) in decline in PTA of the VS ear., Conclusions: Patients with observed VS who experience progressive HFHL in the non-VS ear are more likely to experience significant declines in speech understanding in the VS-affected ear over time. Patients with a history of presbycusis may have an increased risk of losing serviceable hearing because of sporadic VS., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2023, Otology & Neurotology, Inc.)

Objective: To quantify the roles and relationships between age at implantation, duration of deafness (DoD), and daily processor use via data logging on speech recognition outcomes for postlingually deafened adults with cochlear implants., Study Design: Retrospective case review., Setting: Cochlear implant (CI) program at a tertiary medical center., Patients: Six-hundred fourteen postlingually deafened adult ears with CIs (mean age, 63 yr; 44% female) were included., Main Outcome Measures: A stepwise multiple regression analysis was completed to investigate the combined effects of age, DoD, and daily processor use on CI-aided speech recognition (Consonant-Nucleus-Consonant monosyllables and AzBio sentences)., Results: Results indicated that only daily processor use was significantly related to Consonant-Nucleus-Consonant word scores ( R2 = 0.194, p < 0.001) and AzBio in quiet scores ( R2 = 0.198, p < 0.001), whereas neither age nor DoD was significantly related. In addition, there was no significant relationship between daily processor use, age at implantation, or DoD and AzBio sentences in noise ( R2 = 0.026, p = 0.005)., Conclusions: Considering the clinical factors of age at implantation, DoD, and daily processor use, only daily processor use significantly predicted the ~20% of variance in postoperative outcomes (CI-aided speech recognition) accounted for by these clinical factors., Competing Interests: The authors disclose no conflicts of interest directly related to this series. J.T.H. is a consultant for Advanced Bionics and Cochlear. D.S.H. is as consultant for Med El, Cochlear, and Advanced Bionics. R.H.G. is on the audiology advisory board for Cochlear and Advanced Bionics, and on the clinical advisory board for Frequency Therapeutics., (Copyright © 2023, Otology & Neurotology, Inc.)

Objective: To quantify the effect of datalogging on speech recognition scores and time to achievement for a "benchmark" level of performance within the first year, and to provide a data-driven recommendation for minimum daily cochlear implant (CI) device usage to better guide patient counseling and future outcomes., Study Design: Retrospective cohort., Setting: Tertiary referral center., Patients: Three hundred thirty-seven adult CI patients with data logging and speech recognition outcome data who were implanted between August 2015 and August 2020., Main Outcome Measures: Processor datalogging, speech recognition scores, achievement of "benchmark speech recognition performance" defined as 80% of the median score for speech recognition outcomes at our institution., Results: The 1-month datalogging measure correlated positively with word and sentences scores at 1, 3, 6, and 12 months postactivation. Compared with age, sex, and preoperative performance, datalogging was the largest predictive factor of benchmark achievement on multivariate analysis. Each hour/day increase of device usage at 1 month resulted in a higher likelihood of achieving benchmark consonant-nucleus-consonant and AzBio scores within the first year (odds ratio = 1.21, p < 0.001) as well as earlier benchmark achievement. Receiver operating characteristic curve analysis identified the optimal data logging threshold at an average of 12 hours/day., Conclusions: Early CI device usage, as measured by 1-month datalogging, predicts benchmark speech recognition achievement in adults. Datalogging is an important predictor of CI performance within the first year postimplantation. These data support the recommended daily CI processor utilization of at least 12 hours/day to achieve optimal speech recognition performance for most patients., Competing Interests: Conflict of interest: R.H.G. is a consultant for Advanced Bionics, Akouos, and Cochlear Americas; a clinical advisory board member for Frequency Therapeutics; and on the Board of Directors for the American Auditory Society. D.S.H. is a consultant for Advanced Bionics Corp., Cochlear Corp., MED-EL GmbH, Stryker, Synthes, Grace Medical, and Oticon. J.T.H. is a consultant for Advanced Bionics and Cochlear Americas., (Copyright © 2023, Otology & Neurotology, Inc.)

Objective: To develop a machine learning-based referral guideline for patients undergoing cochlear implant candidacy evaluation (CICE) and to compare with the widely used 60/60 guideline., Study Design: Retrospective cohort., Setting: Tertiary referral center., Patients: 772 adults undergoing CICE from 2015 to 2020., Interventions: Variables included demographics, unaided thresholds, and word recognition score. A random forest classification model was trained on patients undergoing CICE, and bootstrap cross-validation was used to assess the modeling approach's performance., Main Outcome Measures: The machine learning-based referral tool was evaluated against the 60/60 guideline based on ability to identify CI candidates under traditional and expanded criteria., Results: Of 587 patients with complete data, 563 (96%) met candidacy at our center, and the 60/60 guideline identified 512 (87%) patients. In the random forest model, word recognition score; thresholds at 3000, 2000, and 125; and age at CICE had the largest impact on candidacy (mean decrease in Gini coefficient, 2.83, 1.60, 1.20, 1.17, and 1.16, respectively). The 60/60 guideline had a sensitivity of 0.91, a specificity of 0.42, and an accuracy of 0.89 (95% confidence interval, 0.86-0.91). The random forest model obtained higher sensitivity (0.96), specificity (1.00), and accuracy (0.96; 95% confidence interval, 0.95-0.98). Across 1,000 bootstrapped iterations, the model yielded a median sensitivity of 0.92 (interquartile range [IQR], 0.85-0.98), specificity of 1.00 (IQR, 0.88-1.00), accuracy of 0.93 (IQR, 0.85-0.97), and area under the curve of 0.96 (IQR, 0.93-0.98)., Conclusions: A novel machine learning-based screening model is highly sensitive, specific, and accurate in predicting CI candidacy. Bootstrapping confirmed that this approach is potentially generalizable with consistent results., (Copyright © 2023, Otology & Neurotology, Inc.)

Introduction  The middle fossa craniotomy (MFCs) is commonly utilized for spontaneous cerebrospinal fluid (CSF) leaks, encephaloceles, and superior semicircular canal dehiscence (SSCD). This study compares postoperative outcomes of MFCs with and without LD use. Methods  A retrospective cohort study of adults over the age of 18 years presenting for the repair of nonneoplastic CSF leak, encephalocele, or SSCD via MFC from 2009 to 2021 was conducted. The main exposure of interest was the placement of an LD. The primary outcome was the presence of postoperative complications (acute/delayed neurologic deficit, meningitis, intracranial hemorrhage, and stroke). Secondary outcomes included operating room (OR) time, length of stay, recurrence, and need for reoperation. Results  In total, 172 patients were included, 96 of whom received an LD and 76 who did not. Patients not receiving an LD were more likely to receive intraoperative mannitol ( n  = 24, 31.6% vs. n  = 16, 16.7%, p  = 0.02). On univariate logistic regression, LD placement did not influence overall postoperative complications (OR: 0.38, 95% confidence interval [CI]: 0.05-2.02, p  = 0.28), CSF leak recurrence (OR: 0.75, 95% CI: 0.25-2.29, p  = 0.61), or need for reoperation (OR: 1.47, 95% CI: 0.48-4.96, p  = 0.51). While OR time was shorter for patients not receiving LD (349 ± 71 vs. 372 ± 85 minutes), this difference was not statistically significant ( p  = 0.07). Conclusion  No difference in postoperative outcomes was observed in patients who had an intraoperative LD placed compared to those without LD. Operative times were increased in the LD cohort, but this difference was not statistically significant. Given the similar outcomes, we conclude that LD is not necessary to facilitate safe MCF for nonneoplastic skull base pathologies., Competing Interests: Conflict of Interest None declared., (Thieme. All rights reserved.)

Objective: Compare incidence of sigmoid sinus wall abnormalities (SSWAs) and other radiographic abnormalities in patients with pulsatile tinnitus (PT) versus controls., Study Design: Retrospective case-control., Setting: Tertiary referral center., Patients: Adults with PT and high-resolution computed tomography imaging were compared with adults undergoing cochlear implant workup including high-resolution computed tomography imaging., Main Outcome Measures: Incidence of SSWA in PT cohort (n = 141) compared with control (n = 149, n = 298 ears). Secondary outcome measures included differences in demographics and in other radiographic abnormalities between cohorts., Results: Patients with PT had a higher incidence of SSWA (34% versus 9%, p < 0.001) and superior canal dehiscence (23% versus 12%, p = 0.017) than controls. Spearman product component correlations demonstrated that ipsilateral PT was weakly associated with SSWA ( r = 0.354, p < 0.001). When SSWA was present in the PT cohort (n = 48 patients, n = 59 ears), in 31 cases (64.6%), the SSWA correlated with PT laterality (e.g., left SSWA, left PT); in 12 (25.0%), SSWA partially correlated with PT laterality (e.g., bilateral SSWA, right PT); and in 5 (10.4%), the SSWA did not correlate with PT laterality (e.g., right SSWA, left PT)., Conclusions: For our patients with both PT and SSWA, the SSWA is likely a contributing factor in approximately 65% of cases. For a third of patients with PT and concomitant SSWA, the association between the two is either not causative or not solely causative. Surgeons counseling patients with PT and SSWA may be optimistic overall regarding sigmoid resurfacing procedures but must appreciate the possibility of treatment failure, likely because of untreated comorbid conditions., Competing Interests: Conflicts of interest: D.S.H. is a consultant for Advanced Bionics Corp., Cochlear Corp., MED-EL GmbH, Stryker, Synthes, Grace Medical, and Oticon., (Copyright © 2023, Otology & Neurotology, Inc.)

Objective: To evaluate safety of monopolar electrosurgery (MES) in patients with cochlear implants (CIs) by reporting outcomes of a series of patients who underwent MES after CI., Study Design: Retrospective case series., Setting: Tertiary referral center., Patients: Patients with indwelling CI subsequently undergoing surgery with operative note specifically detailing MES use., Main Outcome Measures: Adverse outcomes in post-operative audiology/otolaryngology documentation; speech recognition scores., Results: Thirty-five patients (10 with bilateral CI) experienced 63 unique MES exposure events, 85.7% below and 14.3% above the clavicle. No adverse events or decreased performance due to MES use were reported for any patient. Pre- and immediate postoperative speech recognition scores were not significantly different for patients using either consonant-nucleus-consonant (CNC; n = 23, 68%-66%, p = 0.80) or AzBio (n = 15, 82%-88%, p = 0.60). For individual CNC performance, 21 (91%) patients demonstrated stability, 1 improved >15%, and 1 declined >15%, although this patient had become a non-user due to magnet issues and, after resolution of these issues, exceeded baseline pre-operative score. For individual AzBio performance, 12 (80%) patients demonstrated stability, 3 improved >15%, and none declined >15%., Conclusions: No adverse events resulted from MES use in CI patients. Given the increased prevalence and expansion of indications for CIs, and widespread utility of MES, we suggest clarification and improved guidance from device manufacturers regarding safety and use of MES for patients with these devices. We hope that data regarding electrosurgery exposure events will better inform clinician decision-making with regards to relative benefits and risks for MES use for CI patients., Level of Evidence: 4 Laryngoscope, 133:933-937, 2023., (© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: To characterize the incidence of sigmoid sinus occlusion (SSO) following translabyrinthine (TL) surgery for posterior fossa tumor resection and determine the association with cerebrospinal fluid (CSF) leak., Study Design: Retrospective case series., Setting: Tertiary referral center., Methods: Patients undergoing TL surgery for vestibular schwannoma from 2012 to 2020 were included. Demographic data, medical history, preoperative tumor length and volume, and postoperative complications including CSF leak were recorded. Neuroradiology review of postoperative magnetic resonance imaging was used to determine the presence or absence of flow through the sigmoid sinus., Results: Of 205 patients undergoing TL, 21 (10.2%) experienced CSF leak postoperatively. Overall 56 (27%) demonstrated SSO on immediate postoperative magnetic resonance imaging. CSF leaks were more likely in those with SSO (19.6%) than those without SSO (6.7%; odds ratio, 3.54 [95% CI, 1.25-10.17]). Tumor volume and body mass index were not significantly associated with CSF leak. In total, 105 (51%) patients had some degree of sigmoid sinus thrombosis, but nonocclusive thrombosis was not associated with CSF leak., Conclusion: SSO after TL approaches is common and appears to be significantly associated with postoperative CSF leak development. Minimizing manipulation of the sigmoid sinus during TL surgery and compression after surgery may have a role in preventing CSF leak., (© 2022 American Academy of Otolaryngology-Head and Neck Surgery Foundation.)

Title: Facial Paralysis in Skull Base Osteomyelitis - Comparison of Surgical and Nonsurgical Management., Objective: To compare outcomes of surgical and nonsurgical management in cases of facial paresis secondary to skull base osteomyelitis., Methods: A 14 patients presenting with skull base osteomyelitis complicated by facial nerve paresis at a single tertiary referral center from 2009 to 2019 were retrospectively reviewed. Patients were treated with medical therapy with or without surgical intervention, consisting of mastoidectomy and debridement with or without facial nerve decompression. House-Brackmann (HB) Grade was the main outcome measure., Results: A 14 patients (average age 68 years, range 58-82 years, 71% male) were analyzed, with 5 undergoing facial nerve decompression (36%), 5 undergoing mastoidectomy without facial nerve decompression (36%), and 4 undergoing medical management alone (28%). Of the 4 patients who underwent medical therapy alone, none experienced significant improvement in facial function. Of the 5 patients who underwent facial nerve decompression, 3 patients experienced improved facial function. Of the 5 patients who underwent mastoidectomy without decompression, 4 experienced improved facial function. There was no clear link between the severity of infection and the severity of facial paresis. When comparing HB score changes before and after treatment across groups, there was no statistically significant difference seen (p = 0.47)., Conclusions: Mastoidectomy and debridement with or without facial nerve decompression may improve facial nerve outcomes when compared to isolated medical management, although differences were not of statistical significance. The best facial nerve recoveries occurred in patients undergoing surgery within 14 days of the onset of paralysis., Level of Evidence: 4 - Case Series Laryngoscope, 133:179-183, 2023., (© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: Precurved cochlear implant (CI) electrode arrays have demonstrated superior audiometric outcomes compared with straight electrodes in a handful of studies. However, previous comparisons have often failed to account for preoperative hearing and age. This study compares hearing outcomes for precurved and straight electrodes by a single manufacturer while controlling for these and other factors in a large cohort., Study Design: Retrospective cohort study., Setting: Tertiary academic medical center., Patients: Two hundred thirty-one adult CI recipients between 2015 and 2021 with cochlear (Sydney, Australia) 522/622 (straight) or 532/632 (precurved) electrode arrays., Interventions: Postactivation speech recognition and audiometric testing., Main Outcome Measures: Speech recognition testing (consonant-nucleus-consonant word [CNCw] and AzBio) was collected at 6 and 12 months postactivation. Hearing preservation was characterized by a low-frequency pure-tone average shift, or the change between preoperative and postoperative low-frequency pure-tone average., Results: Two hundred thirty-one patients (253 ears) with 6-month and/or 12-month CNCw or AzBio testing were included. One hundred forty-nine (59%) and 104 (41%) ears were implanted with straight and precurved electrode arrays, respectively. Average age at implantation was 70 years (interquartile range [IQR], 58-77 y). There was no significant difference in mean age between groups. CNCw scores were significantly different ( p = 0.001) between straight (51%; IQR, 36-67%) and precurved arrays (64%; IQR, 48-72%). AzBio scores were not significantly different ( p = 0.081) between straight (72%; IQR, 51-87%) and precurved arrays (81%; IQR, 57-90%). Controlling for age, race, sex, preoperative hearing, and follow-up time, precurved electrode arrays performed significantly better on CNCw (b = 10.0; 95% confidence interval, 4.2-16.0; p < 0.001) and AzBio (b = 8.9; 95% confidence interval, 1.8-16.0;, p = 0.014) testing. Hearing preservation was not different between electrodes on adjusted models., Conclusion: During the study period, patients undergoing placement of precurved electrode arrays had significantly higher CNC and AzBio scores than patients receiving straight electrodes, even after controlling for age, preoperative hearing, and follow-up time., Professional Practice Gap and Educational Need: Understanding the difference in audiometric outcomes between precurved and straight electrode arrays will help to guide electrode selection., Learning Objective: To understand differences in speech recognition scores postoperatively by electrode array type (precurved versus straight)., Desired Result: To demonstrate a difference in hearing performance postoperatively by electrode type., Level of Evidence: III., Indicate Irb or Iacuc: Approved by the Institutional IRB (090155)., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2022, Otology & Neurotology, Inc.)

Background: Few case reports have described primary central nervous system lymphoma (PCNSL) presenting as a cerebellopontine angle (CPA) lesion in HIV-positive patients. We describe a rare presentation of rapidly progressing PCNSL of the CPA/internal auditory canal (IAC) as labyrinthitis with initial negative MRI in an HIV-positive patient., Case: A 58-year-old male with well-controlled HIV presented with sudden left sensorineural hearing loss, tinnitus, and imbalance. Vestibular testing suggested an uncompensated left peripheral vestibular weakness. MRI demonstrated facial and cochleovestibular nerve enhancement within the CPA and IAC. The presumptive diagnosis of labyrinthitis was made. Two months later, he presented to his infectious disease provider with left facial weakness and disequilibrium and was treated for presumed Bell's palsy. One month later, he presented with left corneal reflex dysfunction, decreased visual acuity, diplopia, and worsening ataxia. Repeat MRI demonstrated a new 3.6 cm lesion of the left CPA/IAC with vasogenic edema. Despite location, the mass lacked the brainstem compression characteristic of other extra-axial CPA masses such as vestibular schwannoma. Flow cytometry and cytology from cerebrospinal fluid was consistent with primary central nervous system large B-cell lymphoma., Conclusions: We present a unique case of rapidly progressing PCNSL of the CPA/IAC in an HIV-positive patient, presenting initially as labyrinthitis with negative MRI followed by development of multiple cranial neuropathies and 3-month repeat MRI demonstrating a large CPA mass. In HIV-positive patients with a similar initial presentation, PCNSL should considered early in the diagnostic evaluation with close clinical monitoring and a low threshold for repeat imaging., Competing Interests: D.S.H. is a consultant for Advanced Bionics Corp., Cochlear Corp., MED-EL GmbH, Stryker, Synthes, Grace Medical, and Oticon, all which are not relevant to this research. D.S.H. holds the position of Senior Editor for Otology & Neurotology Open and has been recused from reviewing or making decisions for the article. The remaining author discloses no conflicts of interest., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of Otology & Neurotology, Inc.)

Objective: To report speech outcomes after cochlear implantation (CI) for asymmetric hearing loss (AHL) and assess the influence of contralateral hearing., Study Design: Retrospective review., Setting: Tertiary referral center., Patients: One hundred eighty-eight adults (mean age, 70 yr) undergoing CI for AHL from 2015 to 2020. Candidacy included pure-tone average (PTA) at least 70 dB hearing level and AzBio in quiet 60% or less in the implanted ear and AzBio in quiet greater than 40% in the contralateral ear., Main Outcome Measures: PTA; Consonant-Nucleus-Consonant (CNC) word, AzBio sentences scores; Speech, Spatial, and Qualities of Hearing Scale (SSQ)., Results: Mean preoperative PTA and AzBio in the implanted and contralateral ears were 85.2 and 68.1 dB hearing level and 24.7% and 69.2%, respectively. Mean CNC in the implanted ear increased from 18.3% preoperatively to 44.4% ( p < 0.0001) at 6 months and 49.3% ( p < 0.0001) at 12 months. Mean AzBio in the implanted ear improved from 24.7% preoperatively to 60.3% ( p < 0.0001) at 6 months and 64.3% ( p < 0.0001) at 12 months. Patients demonstrated significant improvement in all SSQ domains at 6 and 12 months. When comparing patients with preoperative contralateral AzBio greater than 60% versus 41% to 60%, no significant differences existed in postoperative CNC scores (6-mo: 47% versus 41%, p = 0.276; 12-mo: 51% versus 47%, p = 0.543). There were no significant differences in 6-month ( p = 0.936) or 12-month ( p = 0.792) CNC scores between patients with AHL (contralateral ear AzBio >40%) and 169 unilateral CI patients meeting the traditional Medicare criteria (contralateral ear AzBio ≤40%)., Conclusion: CI recipients with AHL derive significant speech improvements, supporting individual ear consideration for CI candidacy and patient benefit outside of current Medicare criteria., Competing Interests: K.O.T. has served as an advisory board member for GlaxoSmithKline. D.S.H. is a consultant for Advanced Bionics, Cochlear Americas, MED-EL GmbH, Stryker, Synthes, Grace Medical, and Oticon. R.G. is a consultant for Advanced Bionics, Akouos, and Cochlear Americas; is on the clinical advisory board for Frequency Therapeutics; and is on the Board of Directors for the American Auditory Society. The other authors disclose no conflicts of interest., (Copyright © 2022, Otology & Neurotology, Inc.)

Objective: To characterize the influence of expanding indications on the profile of adults undergoing cochlear implantation (CI) at a high-volume CI center., Study Design: Retrospective review., Setting: Tertiary referral center., Patients: 774 adults undergoing CI evaluation from August 2015 to August 2020., Main Outcome Measures: Demographics; audiometry; speech recognition; speech, spatial, and qualities of hearing scale (SSQ-12)., Results: Of 745 (96.3%) patients qualifying for implantation, 642 (86.6%) pursued surgery. Median age at evaluation was 69 years; 56.3% were men; 88.2% were Caucasian. Median distance to our center was 95 miles. The majority (51.8%) had public insurance (Medicare, Medicaid), followed by private (47.8%) and military (0.4%). Mean PTA, CNC, and AzBio in quiet and noise for the ear to be implanted were 85.2 dB HL, 15.0%, and 19.2% and 3.5%, respectively. Hybrid/EAS criteria were met by 138 (18.5%) CI candidates, and 436 (77.0%) unilateral CI recipients had aidable contralateral hearing for bimodal hearing configurations. Younger age (odds ratio [OR], 0.96; 95% confidence interval, 0.93-0.99) and non-Caucasian race (OR, 6.95; 95% confidence interval, 3.22-14.98) predicted candidacy. Likelihood of surgery increased for Caucasian (OR, 8.08; 95% confidence interval, 4.85-13.47) and married (OR, 2.28; 95% confidence interval, 1.50-3.47) patients and decreased for those with public insurance (OR, 0.45; 95% confidence interval, 0.29-0.69). A lower SSQ-12 score predicted both candidacy and surgery., Conclusion: Despite expansions in criteria, speech understanding remained extremely low at CI evaluation. Younger age and non-Caucasian race predicted candidacy, and Caucasian, married patients with private insurance and lower SSQ scores were more likely to pursue surgery., Competing Interests: Conflicts of Interest: K.O.T. has served as an advisory board member for GlaxoSmithKline. D.S.H. is a consultant for Advanced Bionics, Cochlear Americas, MED-EL GmbH, Stryker, Synthes, Grace Medical, and Oticon. R.G. is a consultant for Advanced Bionics, Akouos, and Cochlear Americas, is on the clinical advisory board for Frequency Therapeutics, and is on the Board of Directors for the American Auditory Society. The remaining authors disclose no conflicts of interest., (Copyright © 2022, Otology & Neurotology, Inc.)

Objective: To evaluate the impact of otolaryngology programs' social media on residency candidates in the 2020 to 2021 application cycle., Methods: An anonymous survey was distributed via Otomatch, Headmirror, and word of mouth to otolaryngology residency applicants in the 2021 Match. Survey items included demographics, social media usage, and impact of programs' social media on applicant perception and ranking. Descriptive statistics were performed, and responses based on demographic variables were compared using Fisher's exact and Mann-Whitney U tests., Results: Of 64 included respondents, nearly all (61/64, 95%) used Facebook, Instagram, and/or Twitter for personal and/or professional purposes. Applicants (59/64, 92%) most commonly researched otolaryngology residency programs on Instagram (55/59, 93%) and Twitter (36/59, 61%), with younger ( P  = .023) and female ( P  = .043) applicants being more likely to engage with programs on Instagram. Program accounts were most helpful in showcasing program culture (50/59, 85%) and highlighting its location (34/59, 58%). Nearly one third (19/59, 32%) reported that social media impacted their rank list. Age, gender, reapplication, home program status, or time taken off before and/or during medical school did not significantly influence social media's usefulness in the application cycle., Conclusion: Social media platforms like Instagram and Twitter are frequently used by applicants to assess otolaryngology residency programs. Programs' social media accounts effectively demonstrate program culture and affect applicants' rank lists. As social media usage continues to rise in the medical community, these findings can help otolaryngology residency programs craft a beneficial online presence that aids in recruitment, networking, and education.