Economic, Environmental, and Social Value of Virtual Care in Otolaryngology: Sustainability in Quality Improvement Framework.

Objective: Apply the Sustainability in Quality Improvement framework to virtual care for Otolaryngology-Head and Neck Surgery (OHNS) patients to understand the economic, environmental, and social impacts.

Methods: This project consisted of retrospective analysis of anonymized data from all appointments that took place in three academic ambulatory OHNS clinics (pediatrics, head and neck, and otology/neurotology) from fiscal years of 2021 to 2023. Data were obtained from our institution's Virtual Care Dashboard.

Intratympanic corticosteroids for sudden sensorineural hearing loss.

Background: Idiopathic sudden sensorineural hearing loss (ISSNHL) is common, and defined as a sudden decrease in sensorineural hearing sensitivity of unknown aetiology. Systemic corticosteroids are widely used, however their value remains unclear. Intratympanic injections of corticosteroids have become increasingly common in the treatment of ISSNHL.

Suitable Electrode Choice for Robotic-Assisted Cochlear Implant Surgery: A Systematic Literature Review of Manual Electrode Insertion Adverse Events.

Background And Objective: The cochlear implant (CI) electrode insertion process is a key step in CI surgery. One of the aims of advances in robotic-assisted CI surgery (RACIS) is to realize better cochlear structure preservation and to precisely control insertion. The aim of this literature review is to gain insight into electrode selection for RACIS by acquiring a thorough knowledge of electrode insertion and related complications from classic CI surgery involving a manual electrode insertion process.

A pathogenic deletion in Forkhead Box L1 (FOXL1) identifies the first otosclerosis (OTSC) gene.

Otosclerosis is a bone disorder of the otic capsule and common form of late-onset hearing impairment. Considered a complex disease, little is known about its pathogenesis. Over the past 20 years, ten autosomal dominant loci (OTSC1-10) have been mapped but no genes identified.

Quality Indicators for the Diagnosis and Management of Menière's Disease.

Objective: Menière'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.

Comprehensive metrics for evaluating surgical microscope use during tympanostomy tube placement.

Purpose: Learning to use a surgical microscope is a fundamental step in otolaryngology training; however, there is currently no objective method to teach or assess this skill. Tympanostomy tube placement is a common otologic procedure that requires skilled use of a surgical microscope. This study was designed to (1) implement metrics capable of evaluating microscope use and (2) establish construct validity.

Quality Indicators for the Diagnosis and Management of Sudden Sensorineural Hearing Loss.

Objective: Sudden sensorineural hearing loss (SSNHL) is an ideal entity for quality indicator (QI) development, providing treatment challenges resulting in variable or substandard care. The American Academy of Otolaryngology-Head and Neck Surgery recently updated their SSNHL guidelines. With SSNHL demonstrating a large burden of illness, this study sought to leverage the updated guidelines and develop QIs that support quality improvement initiatives at an individual, institutional, and systems level.

Two-phase survey on the frequency of use and safety of MRI for hearing implant recipients.

Purpose: Magnetic resonance imaging (MRI) is often used to visualize and diagnose soft tissues. Hearing implant (HI) recipients are likely to require at least one MRI scan during their lifetime. However, the MRI scanner can interact with the implant magnet, resulting in complications for the HI recipient.

The reliability of hearing implants: report on the type and incidence of cochlear implant failures.

This study presents the data collected through a database on the type and incidence of cochlear implant device failures and major complications and quantifies the risk of failures across time based on the Association for the Advancement of Medical Instrumentation (AAMI) CI86:2017 standard. Information on reliability of MED-EL cochlear implants was collected from the MED-EL complaint database between 2003 and2013. Explants were categorized and device reliability was calculated according to the AAMI CI86:2017 standard principles.

Active Transcutaneous Bone Conduction Implant: Audiometric Outcomes Following a Novel Middle Fossa Approach With Self-Drilling Screws.

Objective: To present surgical and audiometric outcomes of patients implanted with an active transcutaneous bone conduction implant following the novel middle fossa surgical approach with self-drilling screws.

Study Design: Retrospective review.

Setting: Tertiary care center.

Audiological outcome measures with the BONEBRIDGE transcutaneous bone conduction hearing implant: impact of noise, reverberation and signal processing features.

To assess the performance of an active transcutaneous implantable-bone conduction device (TI-BCD), and to evaluate the benefit of device digital signal processing (DSP) features in challenging listening environments. Participants were tested at 1- and 3-month post-activation of the TI-BCD. At each session, aided and unaided phoneme perception was assessed using the Ling-6 test.

Effects of Bimodal and Bilateral Cochlear Implant Use on a Nonauditory Working Memory Task: Reading Span Tests Over 2 Years Following Cochlear Implantation.

Purpose A growing body of evidence indicates that treatment of hearing loss by provision of hearing aids leads to improvements in auditory and visual working memory. The purpose of this study was to assess whether similar working memory benefits are observed following provision of cochlear implants (CIs). Method Fifteen adults with postlingually acquired severe bilateral sensorineural hearing loss completed the prospective longitudinal study.

Otology/Neurotology recommendations - Choosing Wisely campaign.

The Choosing Wisely Canada Campaign aims to raise awareness amongst physicians and patients regarding unnecessary tests and treatment. The otology/neurotology subspecialty group within the Canadian Society of Otolaryngology - Head & Neck Society developed a list of five common otologic presentations to help physicians deliver high quality effective care: (1) Don't order specialized audiometric and vestibular testing to screen for peripheral vestibular disease, (2) Don't perform computed tomography or blood work in the evaluation of sudden sensorineural hearing loss, (3) Don't perform auditory brain responses (ABR) in patients with asymmetrical hearing loss, (4) Don't prescribe oral antibiotics as first line treatment for patients with painless otorrhea associated with tympanic membrane perforation or tympanostomy tube, and (5) Don't perform particle repositioning maneuvers without a clinical diagnosis of posterior canal benign paroxysmal positional vertigo.

Response to commentary on "the middle fossa approach with self-drilling screws: a novel technique for BONEBRIDGE implantation".

The aim of this letter is to respond to a commentary on a published article on the middle fossa approach to BONEBRIDGE implantation with self-drilling screws published by the senior authors.

The middle fossa approach with self-drilling screws: a novel technique for BONEBRIDGE implantation.

Background: Bone conduction implants can be used in the treatment of conductive or mixed hearing loss. The BONEBRIDGE bone conduction implant (BB-BCI) is an active, transcutaneous device. BB-BCI implantation can be performed through either the transmastoid or retrosigmoid approach with their respective limitations.

Cochlear implant failures and reimplantation: A 30-year analysis and literature review.

Objectives/hypothesis: The objectives of the study were to present an institutional experience with device failures and cochlear reimplantation rates over a 30-year period and to perform a detailed literature review.

Study Design: Retrospective institutional experience and literature review.

Methods: A review of cochlear implant failures over a period of 30 years, between January 1988 and March 2017, at a single institution was conducted.

Benign Paroxysmal Positional Vertigo.

Purpose of Chapter: This chapter discusses the recent progress made in understanding the pathophysiology, diagnosis, and treatment of benign paroxysmal positional vertigo (BPPV). Recent Findings: Recent evidence supports the canalolithiasis model as the pathophysiological mechanism and predominant subtype of BPPV. Scanning electron micrographs of extracted posterior semicircular canal contents show free-floating otoconia of utricular origin.

Benign paroxysmal positional vertigo.

Objectives: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular end-organ disease. This article aims to summarize research findings and key discoveries of BPPV. The pathophysiology, diagnosis, nonsurgical, and surgical management are discussed.

Stapedectomy Versus Stapedotomy.

Stapedectomy and stapedotomy represent the state-of-the-art surgical procedures in addressing the conductive hearing loss caused by otosclerosis. Their high rates of success and long-term stability have been demonstrated repeatedly in many studies. In comparing the short- and long-term results of the 2 procedures, it is evident that stapedotomy confers better hearing gain at high frequencies and lower complication rates.

Hearing preservation cochlear implantation in children: The HEARRING Group consensus and practice guide.

Objectives: To provide multidisciplinary cochlear implant teams with a current consensus statement to support hearing preservation cochlear implantation (HPCI) in children, including those children with symptomatic partial deafness (PD) where the intention is to use electric-acoustic stimulation (EAS). The main objectives are to provide guidelines on who is a candidate, how to assess these children and when to implant if Med-El Flex electrode arrays are chosen for implantation.

Methods: The HEARRING group reviewed the current evidence and practice regarding the management of children to be considered for HPCI surgery emphasizing the assessment needed prior to implantation in order to demonstrate the benefits in these children over time.

Intratympanic Dexamethasone in the Treatment of Ménière's Disease: A Comparison of Two Techniques.

Objective: To assess the efficacy and safety of two different intratympanic dexamethasone (IT Dex) injection protocols for intractable unilateral Ménière's disease.

Study Design: Prospective case series.

Setting: Tertiary neurotology clinic.

Intra- and Interobserver Variability of Cochlear Length Measurements in Clinical CT.

Hypothesis: The cochlear A-value measurement exhibits significant inter- and intraobserver variability, and its accuracy is dependent on the visualization method in clinical computed tomography (CT) images of the cochlea.

Background: An accurate estimate of the cochlear duct length (CDL) can be used to determine electrode choice, and frequency map the cochlea based on the Greenwood equation. Studies have described estimating the CDL using a single A-value measurement, however the observer variability has not been assessed.

Electrically evoked compound action potentials are different depending on the site of cochlear stimulation.

One of the many parameters that can affect cochlear implant (CI) users' performance is the site of presentation of electrical stimulation, from the CI, to the auditory nerve. Evoked compound action potential (ECAP) measurements are commonly used to verify nerve function by stimulating one electrode contact in the cochlea and recording the resulting action potentials on the other contacts of the electrode array. The present study aimed to determine if the ECAP amplitude differs between the apical, middle, and basal region of the cochlea, if double peak potentials were more likely in the apex than the basal region of the cochlea, and if there were differences in the ECAP threshold and recovery function across the cochlea.

Otoconia and otolithic membrane fragments within the posterior semicircular canal in benign paroxysmal positional vertigo.

Objectives/hypothesis: Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder with an incidence between 10.7 and 17.3 per 100,000 persons per year.