Georgia Quality Improvement Programs Multi-Institutional Collection of Postoperative Opioid Data Using ACS-NSQIP Abstraction.

Background: Excessive postoperative opioid prescribing contributes to opioid misuse throughout the US. The Georgia Quality Improvement Program (GQIP) is a collaboration of ACS-NSQIP participating hospitals. GQIP aimed to develop a multi-institutional opioid data collection platform as well as understand our current opioid-sparing strategy (OSS) usage and postoperative opioid prescribing patterns.

Effect of Number of Electrodes Used to Elicit Electrical Stapedius Reflex Thresholds in Cochlear Implants.

Introduction: When mapping cochlear implant (CI) patients with limited reporting abilities, the lowest electrical stimulus level that produces a stapedial reflex (i.e., the electrical stapedius reflex threshold [eSRT]) can be measured to estimate the upper bound of stimulation on individual or a subset of CI electrodes.

Changes in Wide-band Tympanometry Absorbance Following Cochlear Implantation.

Objective: Determine if changes in middle ear absorbance measured with wide-band tympanometry (WBT) occur following hearing-preservation cochlear implantation (CI). Such measures may provide insight into the mechanisms of acoustic hearing loss postimplantation.

Study Design: Clinical capsule report.

Effect of Probe-Tone Frequency on Ipsilateral and Contralateral Electrical Stapedius Reflex Measurement in Children With Cochlear Implants.

Objectives: The upper loudness limit of electrical stimulation in cochlear implant patients is sometimes set using electrically elicited stapedius reflex thresholds (eSRTs), especially in children for whom reporting skills may be limited. In unilateral cochlear implant patients, eSRT levels are measured typically in the contralateral unimplanted ear because the ability to measure eSRTs in the implanted ear is likely to be limited due to the cochlear implant surgery and consequential changes in middle ear dynamics. This practice is particularly limiting in the case of fitting bilaterally implanted pediatric cases because there is no unimplanted ear option to choose for eSRT measurement.

Pure-Tone Masking Patterns for Monopolar and Phantom Electrical Stimulation in Cochlear Implants.

Objectives: Monopolar stimulation of the most apical electrode produces the lowest pitch sensation in cochlear implants clinically. A phantom electrode that uses out-of-phase electrical stimulation between the most apical and the neighboring basal electrode can produce a lower pitch sensation than that associated with the most apical electrode. However, because of the absence of contacts beyond the apical tip of the array, the ability to assess the spread of electrical excitation associated with phantom stimulation is limited in the typical cochlear implant subject with no residual hearing.

Optimizations for the Electrically-Evoked Stapedial Reflex Threshold Measurement in Cochlear Implant Recipients.

Objective: The electrically-evoked stapedial reflex threshold (eSRT) has proven to be useful in setting upper stimulation levels of cochlear implant recipients. However, the literature suggests that the reflex can be difficult to observe in a significant percentage of the population. The primary goal of this investigation was to assess the difference in eSRT levels obtained with alternative acoustic admittance probe tone frequencies.

Factors affecting open-set word recognition in adults with cochlear implants.

Objective: A great deal of variability exists in the speech-recognition abilities of postlingually deaf adult cochlear implant (CI) recipients. A number of previous studies have shown that duration of deafness is a primary factor affecting CI outcomes; however, there is little agreement regarding other factors that may affect performance. The objective of the present study was to determine the source of variability in CI outcomes by examining three main factors, biographic/audiologic information, electrode position within the cochlea, and cognitive abilities in a group of newly implanted CI recipients.

Detection of intracochlear damage during cochlear implant electrode insertion using extracochlear measurements in the gerbil.

Objectives/hypothesis: An intraoperative monitoring algorithm during cochlear implant electrode insertion could be used to detect trauma and guide electrode placement relative to surviving hair cells. The aim of this report was to assess the feasibility of using extracochlear recording sites to monitor acoustically evoked responses from surviving hair cells and neural elements during implantation in an animal model.

Study Design: Animal experiments.

Novel CO2 laser robotic controller outperforms experienced laser operators in tasks of accuracy and performance repeatability.

Objectives/hypothesis: To introduce a novel method of combining robotics and the CO(2) laser micromanipulator to provide excellent precision and performance repeatability designed for surgical applications.

Study Design: Pilot feasibility study.

Methods: We developed a portable robotic controller that appends to a standard CO(2) laser micromanipulator.

Optimizing the perception of soft speech and speech in noise with the Advanced Bionics cochlear implant system.

Objective: This study aimed to provide guidelines to optimize perception of soft speech and speech in noise for Advanced Bionics cochlear implant (CI) users.

Design: Three programs differing in T-levels were created for ten subjects. Using the T-level setting that provided the lowest FM-tone, sound-field threshold levels for each subject, three additional programs were created with input dynamic range (IDR) settings of 50, 65 and 80 dB.

Consensus panel on a cochlear coordinate system applicable in histologic, physiologic, and radiologic studies of the human cochlea.

Hypothesis: An objective cochlear framework, for evaluation of the cochlear anatomy and description of the position of an implanted cochlear implant electrode, would allow the direct comparison of measures performed within the various subdisciplines involved in cochlear implant research.

Background: Research on the human cochlear anatomy in relation to tonotopy and cochlear implantation is conducted by specialists from numerous disciplines such as histologists, surgeons, physicists, engineers, audiologists, and radiologists. To allow accurate comparisons between and combinations of previous and forthcoming scientific and clinical studies, cochlear structures and electrode positions must be specified in a consistent manner.

Role of electrode placement as a contributor to variability in cochlear implant outcomes.

Hypothesis: Suboptimal cochlear implant (CI) electrode array placement may reduce presentation of coded information to the central nervous system and, consequently, limit speech recognition.

Background: Generally, mean speech reception scores for CI recipients are similar across different CI systems, yet large outcome variation is observed among recipients implanted with the same device. These observations suggest significant recipient-dependent factors influence speech reception performance.

Use of computed tomography scans for cochlear implants.

While 3-dimensional (3D) imaging by computed tomography has long been desirable for research and treatment of cochlear-implant patients, technical challenges have limited its wide application. Recent developments in scanner hardware and image processing techniques now allow image quality improvements that make clinical applications feasible. Validation experiments were performed to characterize a new methodology and its imaging performance.

In vivo estimates of the position of advanced bionics electrode arrays in the human cochlea.

Objectives: A new technique for determining the position of each electrode in the cochlea is described and applied to spiral computed tomography data from 15 patients implanted with Advanced Bionics HiFocus I, Ij, or Helix arrays.

Methods: ANALYZE imaging software was used to register 3-dimensional image volumes from patients' preoperative and postoperative scans and from a single body donor whose unimplanted ears were scanned clinically, with micro computed tomography and with orthogonal-plane fluorescence optical sectioning (OPFOS) microscopy. By use of this registration, we compared the atlas of OPFOS images of soft tissue within the body donor's cochlea with the bone and fluid/ tissue boundary available in patient scan data to choose the midmodiolar axis position and judge the electrode position in the scala tympani or scala vestibuli, including the distance to the medial and lateral scalar walls.

An electric frequency-to-place map for a cochlear implant patient with hearing in the nonimplanted ear.

The aim of this study was to relate the pitch of high-rate electrical stimulation delivered to individual cochlear implant electrodes to electrode insertion depth and insertion angle. The patient (CH1) was able to provide pitch matches between electric and acoustic stimulation because he had auditory thresholds in his nonimplanted ear ranging between 30 and 60 dB HL over the range, 250 Hz to 8 kHz. Electrode depth and insertion angle were measured from high-resolution computed tomography (CT) scans of the patient's temporal bones.

Minimization of cochlear implant stimulus artifact in cortical auditory evoked potentials.

Objective: To compare two methods of minimizing cochlear implant artifact in cortical auditory evoked potential (CAEP) recordings.

Methods: Two experiments were conducted. In the first, we assessed the use of independent component analysis (ICA) as a pre-processing filter.

A prospective randomized trial comparing intraoperative 5-fluorouracil vs mitomycin C in primary trabeculectomy.

Purpose: To compare the safety and efficacy of intraoperative 5-fluorouracil (5-FU) or Intraoperative mitomycin C (MMC) in eyes undergoing primary trabeculectomy.

Design: Prospective double-masked randomized clinical trial.

Methods: One hundred fifteen eyes of 103 patients with uncontrolled intraocular pressure (IOP) despite maximally tolerated medical therapy or laser were prospectively randomized in a double-masked fashion to one of two treatment groups in a single institution setting.

Experience with optical trocar in performing laparoscopic procedures.

We report on the results of laparoscopic procedures in 1187 patients with use of the OPTIVIEW Optical Surgical Obturator, a device that permits visually guided trocar entry without insufflation. Most of these procedures (78%) involved hiatal hernia repairs, and 51% of our patients had a history of previous abdominal procedures. Visualization and pneumoperitoneum were successfully achieved in all patients, including those who had previously undergone multiple upper-midline abdominal procedures.