Effects of a Straw Phonation Protocol on Acoustic Measures of an SATB Chorus Singing Two Contrasting Renaissance Works

Publication date: Available online 14 February 2017
Source:Journal of Voice
Author(s): Jeremy N. Manternach, Chad Clark, James F. Daugherty
BackgroundResearchers have found that semi-occluded vocal tract (SOVT) exercises may increase vocal economy by reducing phonation threshold pressure and effort while increasing or maintaining consistent acoustic output. This research has focused solely on individual singers. Much singing instruction, however, takes place in choral settings. Choral singers may use different resonance strategies or unconsciously adjust their singing based on the ability to hear their own sound in relation to others. Results of studies with individual singers, then, may not be directly applicable to choral settings.ObjectiveThe purpose of this investigation was to measure the effect of an SOVT protocol (ie, straw phonation) on acoustic changes of conglomerate, choral sound.Study DesignThis is a quasi-experimental, one-group, pretest-posttest design.MethodsParticipants in this study constituted an intact SATB choir (soprano, alto, tenor, and bass) (N = 15 singers) who performed from memory two unaccompanied pieces of varied tempos from memory, participated in a 4-minute straw phonation protocol with a small stirring straw, and then sang each piece a second time.ResultsThe long-term average spectrum results indicated small, statistically significant increases in spectral energy for both pieces in the 0–10 kHz (.32 and .20 dB Sound Pressure Level) and 2–4 kHz regions (.46 and .25 dB SPL).ConclusionThese results, although not likely audible to average hearing humans, seem consistent with the assertion that singers enjoy vocal benefits with consistent or increased vocal output. SOVT exercises, therefore, may be useful as a time-efficient way to evoke more efficient and economical singing during choral warm-up and voice building procedures.



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Executive Function in Preschoolers with Primary Language Impairment

Purpose

The purpose of this study was to evaluate whether preschoolers with primary language impairment (PLI) show deficits in executive function (EF) compared with their peers with typical development (TD) when inhibition, updating, and mental-set shifting are examined using both linguistically based and visually based tasks.

Method

Twenty-two 4- and 5-year-old preschoolers with PLI and 30 preschoolers with TD completed 2 sets of computerized EF tasks: 3 that were linguistically based and 3 that were visually based. This permitted us to test the hypothesis that poor performance on EF tasks in preschoolers with PLI results from impaired language rather than impaired EF.

Results

The PLI group scored significantly lower than the TD group on linguistically and visually based updating tasks and mental-set shifting tasks. The PLI and TD groups did not differ significantly for accuracy or response time on linguistically and visually based inhibition tasks.

Conclusion

Results suggest that preschool-age children with PLI have domain-general EF deficits in updating and mental-set shifting but not inhibition deficits, as measured by our tasks.

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Autism and Bilingualism: A Qualitative Interview Study of Parents' Perspectives and Experiences

Purpose

Research into how bilingual parents of children with autism spectrum disorder (ASD) make choices about their children's language environment is scarce. This study aimed to explore this issue, focusing on understanding how bilingual parents of children with ASD may make different language exposure choices compared with bilingual parents of children without ASD.

Method

Semistructured qualitative interviews were conducted with 17 bilingual parents with a child with ASD and 18 bilingual parents with a typically developing (TD) child.

Results

Thematic analysis revealed that, in contrast to parents of TD children, parents with a child with ASD expressed concerns that a bilingual environment would cause confusion for their child and exacerbate language delays. This was particularly common for parents of children with lower verbal ability. Parents also identified potential benefits of bilingualism, particularly in terms of maintaining a close and affectionate bond with their child.

Conclusions

Parents of children with ASD have concerns about bilingualism not present for parents of TD children, and these concerns are greater for parents of children with lower verbal ability. Future research in this area should take into account factors such as parent–child bonds as well as communication and language development.

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Speaking Tongues Are Actively Braced

Purpose

Bracing of the tongue against opposing vocal-tract surfaces such as the teeth or palate has long been discussed in the context of biomechanical, somatosensory, and aeroacoustic aspects of tongue movement. However, previous studies have tended to describe bracing only in terms of contact (rather than mechanical support), and only in limited phonetic contexts, supporting a widespread view of bracing as an occasional state, peculiar to specific sounds or sound combinations.

Method

The present study tests the pervasiveness and effortfulness of tongue bracing in continuous English speech passages using electropalatography and 3-D biomechanical simulations.

Results

The tongue remains in continuous contact with the upper molars during speech, with only rare exceptions. Use of the term bracing (rather than merely contact) is supported here by biomechanical simulations showing that lateral bracing is an active posture requiring dedicated muscle activation; further, loss of lateral contact for onset /l/ allophones is found to be consistently accompanied by contact of the tongue blade against the anterior palate. In the rare instances where direct evidence for contact is lacking (only in a minority of low vowel and postvocalic /l/ tokens), additional biomechanical simulations show that lateral contact is maintained against pharyngeal structures dorsal to the teeth.

Conclusion

Taken together, these results indicate that tongue bracing is both pervasive and active in running speech and essential in understanding tongue movement control.

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Executive Function in Preschoolers with Primary Language Impairment

Purpose

The purpose of this study was to evaluate whether preschoolers with primary language impairment (PLI) show deficits in executive function (EF) compared with their peers with typical development (TD) when inhibition, updating, and mental-set shifting are examined using both linguistically based and visually based tasks.

Method

Twenty-two 4- and 5-year-old preschoolers with PLI and 30 preschoolers with TD completed 2 sets of computerized EF tasks: 3 that were linguistically based and 3 that were visually based. This permitted us to test the hypothesis that poor performance on EF tasks in preschoolers with PLI results from impaired language rather than impaired EF.

Results

The PLI group scored significantly lower than the TD group on linguistically and visually based updating tasks and mental-set shifting tasks. The PLI and TD groups did not differ significantly for accuracy or response time on linguistically and visually based inhibition tasks.

Conclusion

Results suggest that preschool-age children with PLI have domain-general EF deficits in updating and mental-set shifting but not inhibition deficits, as measured by our tasks.

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Autism and Bilingualism: A Qualitative Interview Study of Parents' Perspectives and Experiences

Purpose

Research into how bilingual parents of children with autism spectrum disorder (ASD) make choices about their children's language environment is scarce. This study aimed to explore this issue, focusing on understanding how bilingual parents of children with ASD may make different language exposure choices compared with bilingual parents of children without ASD.

Method

Semistructured qualitative interviews were conducted with 17 bilingual parents with a child with ASD and 18 bilingual parents with a typically developing (TD) child.

Results

Thematic analysis revealed that, in contrast to parents of TD children, parents with a child with ASD expressed concerns that a bilingual environment would cause confusion for their child and exacerbate language delays. This was particularly common for parents of children with lower verbal ability. Parents also identified potential benefits of bilingualism, particularly in terms of maintaining a close and affectionate bond with their child.

Conclusions

Parents of children with ASD have concerns about bilingualism not present for parents of TD children, and these concerns are greater for parents of children with lower verbal ability. Future research in this area should take into account factors such as parent–child bonds as well as communication and language development.

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Speaking Tongues Are Actively Braced

Purpose

Bracing of the tongue against opposing vocal-tract surfaces such as the teeth or palate has long been discussed in the context of biomechanical, somatosensory, and aeroacoustic aspects of tongue movement. However, previous studies have tended to describe bracing only in terms of contact (rather than mechanical support), and only in limited phonetic contexts, supporting a widespread view of bracing as an occasional state, peculiar to specific sounds or sound combinations.

Method

The present study tests the pervasiveness and effortfulness of tongue bracing in continuous English speech passages using electropalatography and 3-D biomechanical simulations.

Results

The tongue remains in continuous contact with the upper molars during speech, with only rare exceptions. Use of the term bracing (rather than merely contact) is supported here by biomechanical simulations showing that lateral bracing is an active posture requiring dedicated muscle activation; further, loss of lateral contact for onset /l/ allophones is found to be consistently accompanied by contact of the tongue blade against the anterior palate. In the rare instances where direct evidence for contact is lacking (only in a minority of low vowel and postvocalic /l/ tokens), additional biomechanical simulations show that lateral contact is maintained against pharyngeal structures dorsal to the teeth.

Conclusion

Taken together, these results indicate that tongue bracing is both pervasive and active in running speech and essential in understanding tongue movement control.

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Executive Function in Preschoolers with Primary Language Impairment

Purpose

The purpose of this study was to evaluate whether preschoolers with primary language impairment (PLI) show deficits in executive function (EF) compared with their peers with typical development (TD) when inhibition, updating, and mental-set shifting are examined using both linguistically based and visually based tasks.

Method

Twenty-two 4- and 5-year-old preschoolers with PLI and 30 preschoolers with TD completed 2 sets of computerized EF tasks: 3 that were linguistically based and 3 that were visually based. This permitted us to test the hypothesis that poor performance on EF tasks in preschoolers with PLI results from impaired language rather than impaired EF.

Results

The PLI group scored significantly lower than the TD group on linguistically and visually based updating tasks and mental-set shifting tasks. The PLI and TD groups did not differ significantly for accuracy or response time on linguistically and visually based inhibition tasks.

Conclusion

Results suggest that preschool-age children with PLI have domain-general EF deficits in updating and mental-set shifting but not inhibition deficits, as measured by our tasks.

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Autism and Bilingualism: A Qualitative Interview Study of Parents' Perspectives and Experiences

Purpose

Research into how bilingual parents of children with autism spectrum disorder (ASD) make choices about their children's language environment is scarce. This study aimed to explore this issue, focusing on understanding how bilingual parents of children with ASD may make different language exposure choices compared with bilingual parents of children without ASD.

Method

Semistructured qualitative interviews were conducted with 17 bilingual parents with a child with ASD and 18 bilingual parents with a typically developing (TD) child.

Results

Thematic analysis revealed that, in contrast to parents of TD children, parents with a child with ASD expressed concerns that a bilingual environment would cause confusion for their child and exacerbate language delays. This was particularly common for parents of children with lower verbal ability. Parents also identified potential benefits of bilingualism, particularly in terms of maintaining a close and affectionate bond with their child.

Conclusions

Parents of children with ASD have concerns about bilingualism not present for parents of TD children, and these concerns are greater for parents of children with lower verbal ability. Future research in this area should take into account factors such as parent–child bonds as well as communication and language development.

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Speaking Tongues Are Actively Braced

Purpose

Bracing of the tongue against opposing vocal-tract surfaces such as the teeth or palate has long been discussed in the context of biomechanical, somatosensory, and aeroacoustic aspects of tongue movement. However, previous studies have tended to describe bracing only in terms of contact (rather than mechanical support), and only in limited phonetic contexts, supporting a widespread view of bracing as an occasional state, peculiar to specific sounds or sound combinations.

Method

The present study tests the pervasiveness and effortfulness of tongue bracing in continuous English speech passages using electropalatography and 3-D biomechanical simulations.

Results

The tongue remains in continuous contact with the upper molars during speech, with only rare exceptions. Use of the term bracing (rather than merely contact) is supported here by biomechanical simulations showing that lateral bracing is an active posture requiring dedicated muscle activation; further, loss of lateral contact for onset /l/ allophones is found to be consistently accompanied by contact of the tongue blade against the anterior palate. In the rare instances where direct evidence for contact is lacking (only in a minority of low vowel and postvocalic /l/ tokens), additional biomechanical simulations show that lateral contact is maintained against pharyngeal structures dorsal to the teeth.

Conclusion

Taken together, these results indicate that tongue bracing is both pervasive and active in running speech and essential in understanding tongue movement control.

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Speech-in-noise perception in musicians: a review

Publication date: Available online 14 February 2017
Source:Hearing Research
Author(s): Emily B.J. Coffey, Nicolette Mogilever, Robert J. Zatorre
The ability to understand speech in the presence of competing sound sources is an important neuroscience question in terms of how the nervous system solves this computational problem. It is also a critical clinical problem that disproportionally affects the elderly, children with language-related learning disorders, and those with hearing loss. Recent evidence that musicians have an advantage on this multifaceted skill has led to the suggestion that musical training might be used to improve or delay the decline of speech-in-noise (SIN) function. However, enhancements have not been universally reported, nor have the relative contributions of different bottom-up versus top-down processes, and their relation to preexisting factors been disentangled. This information that would be helpful to establish whether there is a real effect of experience, what exactly is its nature, and how future training-based interventions might target the most relevant components of cognitive processes. These questions are complicated by important differences in study design and uneven coverage of neuroimaging modality. In this review, we aim to systematize recent results from studies that have specifically looked at musician-related differences in SIN by their study design properties, to summarize the findings, and to identify knowledge gaps for future work.



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Endoscopic Management of Middle Ear Paragangliomas: A Case Series

Objective: To investigate the efficacy and safety of endoscopic middle ear paraganglioma (glomus tympanicum) resection. Study Design: Case series with chart review. Setting: Multi-institutional tertiary university medical centers. Patients: Adult patients with middle ear paragangliomas treated via a transcanal endoscopic approach from 1/2012 to 11/2015. Intervention: All tumors were initially approached via a transcanal endoscopic technique. An operating microscope was used only if the tumor could not be adequately visualized or resected with endoscopic techniques alone. Main Outcome Measures: The main outcome was completeness of tumor resection via the endoscopic technique. Secondary measures were resolution of pulsatile tinnitus, audiometric outcomes, surgical duration, and surgical complications. Results: Endoscopic resection was attempted on 14 middle ear paragangliomas. Thirteen patients (93%) were women with a mean age of 61.6 years. The mean tumor size was 6.2 mm (SD, 3.3). Eleven cases (79%) had complete resection via an exclusive endoscopic approach. The mean surgical duration was 108.1 minutes (SD, 55.6). One case required use of an operating microscope via a transcanal route and two cases required postauricular incisions with mastoidectomy. There were no significant postoperative complications. Two patients (14%) had tympanic membrane perforations repaired intraoperatively without residual perforation on follow-up. All patients had normal postoperative facial nerve function. Pulsatile tinnitus resolved after surgery in all 13 patients who presented with this symptom preoperatively. The mean pure-tone average improved by 5.9 dB (SD, 4.6) after surgery. Conclusions: Endoscopic management of middle ear paraganglioma is safe, feasible, and effective.

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Sound Localization in Patients With Congenital Unilateral Conductive Hearing Loss With a Transcutaneous Bone Conduction Implant

Objective: There is no consensus regarding the benefit of implantable hearing aids in congenital unilateral conductive hearing loss (UCHL). This study aimed to measure sound source localization performance in patients with congenital UCHL and contralateral normal hearing who received a new bone conduction implant. Study Design: Evaluation of within-subject performance differences for sound source localization in a horizontal plane. Setting: Tertiary referral center. Patients: Five patients with atresia of the external auditory canal and contralateral normal hearing implanted with transcutaneous bone conduction implant at the Medical University of Vienna were tested. Intervention: Activated/deactivated implant. Main Outcome Measure: Sound source localization test; localization performance quantified using the root mean square (RMS) error. Results: Sound source localization ability was highly variable among individual subjects, with RMS errors ranging from 21 to 40 degrees. Horizontal plane localization performance in aided conditions showed statistically significant improvement compared with the unaided conditions, with RMS errors ranging from 17 to 27 degrees. The mean RMS error decreased by a factor of 0.71 (p 

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American Neurotology Society Preliminary Program

No abstract available

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What Can Long-Term Attendance at Programming Appointments Tell Us About Pediatric Cochlear Implant Recipients?

Objective: This study sought to understand factors linked to long-term engagement with available post-implant “mapping” review services for individuals who received cochlear implants (CI)(s) as children. Study Design: Demographics, communication outcomes, and appointment attendance records from an unselected group of 400 participants who received CI(s) between 1985 and 2009 were analyzed. Results: After 5 years post-implant, 85.75% (n = 343) of participants attended the clinic for “mapping” appointments between March 2011 and March 2014, but 14.25% (n = 57) had not attended “mapping” for more than 3 years before March 2014. Findings showed that participants who did attend routine follow-up “mapping” appointments received their first implants at a significantly younger age (mean, 3.73 yr; standard deviation [SD], 3.39) and demonstrated better receptive language performance (mean standard score, 72; SD, 21.2) and better speech perception scores (mean open-set words, 54.1%; SD, 24.4; phonemes, 77.5%; SD, 15.8) suggesting they derived greater benefit from the technology than participants who did not attend (mean age at implant, 6.38 yr; SD, 4.85; mean receptive language standard score, 58.6; SD, 25.6; mean open-set-words, 34.5%; SD, 24.5; phonemes, 62.7.4%; SD, 23.4). Conclusions: The present study identified a profile of pediatric CI recipients who continue to attend follow-up review appointments after 5 years of device experience. Individuals who were non-attenders tended to include part-time and non-users of the technology. This could be due to a range of factors including the use of past speech processor technology (at first 12 months after switch-on), less overall benefit, and the presence of additional special needs.

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Cochlear Nerve Deficiency and Brain Abnormalities in Pediatric Patients

Hypothesis: To investigate the intracranial abnormalities present in children with cochlear nerve deficiency (CND), including abnormalities of other cranial nerves, and to describe their auditory abilities. Background: The prevalence of CND has increased with the development of high resolution magnetic resonance imaging (MRI). There are varying degrees of CND from true aplasia to hypoplasia. The etiology of CND remains unclear and it may be associated with intracranial abnormalities in some instances. CND needs to be identified as early as possible to ensure prompt and adequate management of hearing loss since hearing aids and cochlear implants may not be an option. Methods: A retrospective chart review of 56 ears of pediatric patients with CND was conducted between August 2006 and November 2014 at a tertiary care pediatric hospital. Results: 27.6% of children had cochlear abnormalities and 48.9.8% had concomitant vestibular anomalies. Five patients had absent or abnormal facial nerves and two patients had aplastic bilateral olfactory nerves. In the 27 ears with an absent nerve that were functionally tested, eight (29.6%) had partial hearing which indicates the presence of an extremely small nerve whose size is below the limits of spatial resolution of the MRI. Conclusion: MRI is becoming the initial imaging choice for children with sensorineural hearing loss to identify CND and other brain anomalies. Concomitant vestibular and cochlear abnormalities were observed in respectively half and one-third of the pediatric patients with CND. The incidence of vestibular malformation suggests that balance testing should be recommended for most if not all CND patients.

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Performance Plateau in Prelingually and Postlingually Deafened Adult Cochlear Implant Recipients

Objective: To characterize the performance plateau after unilateral cochlear implantation (CI) in prelingually and postlingually deafened adults and to compare their relative progress. Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: Prelingually and postlingually deaf adults who received a unilateral CI and completed a minimum of 2 years of follow-up at our center. Intervention: Unilateral CI. Main Outcome Measures: : Standard speech perception testing (consonant-nucleus-consonant [CNC] monosyllabic word test and hearing in noise test [HINT] or AzBio sentence test) were performed preoperatively and 3 and 12 months postoperatively, and annually thereafter. Results: In postlingually deaf patients (n = 102), there was a significant improvement in word scores for 3 years postimplantation (p 

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Multifactor Influences of Shared Decision-Making in Acoustic Neuroma Treatment

Objective: To identify factors associated with treatment modality selection in acoustic neuromas. Study Design: Prospective observational study. Setting: Tertiary care neurotology clinic. Patients: Data were prospectively collected from patients initially presenting to a tertiary care neurotology clinic between 2013 and 2016. Patients who did not have magnetic resonance imaging (MRI), demographic, psychometric, or audiometric data were excluded from analysis. Intervention: Demographic information, clinical symptoms, tumor characteristics, and psychometric data were collected to determine factors associated with undergoing acoustic neuroma surgical resection using univariate and multiple logistic regression analysis. Main Outcome Measure: The decision to pursue acoustic neuroma surgical resection versus active surveillance. Results: A total of 216 patients with acoustic neuroma (mean age 55 years, 58% women) were included. Ninety eight patients (45.4%) pursued surgical resection, 118 patients (54.6%) pursued active surveillance. Surgical treatment was significantly associated with patient age less than 65, higher grade tumors, growing tumors, larger volume tumors, lower word discrimination scores, Class D hearing, headache, and vertigo as presenting symptoms, higher number of total symptoms, and higher headache severity scores (p 

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Automatic Cochlear Duct Length Estimation for Selection of Cochlear Implant Electrode Arrays

Hypothesis: Cochlear duct length (CDL) can be automatically measured for custom selection of cochlear implant (CI) electrode arrays. Background: CI electrode array selection can be influenced by measuring the CDL, which is estimated based on the length of the line that connects the round window and the lateral wall of the cochlea when passing through the modiolus. CDL measurement remains time consuming and inter-observer variability has not been studied. Methods: We evaluate an automatic approach to directly measure the two-turn (2T) CDL using existing algorithms for localizing cochlear anatomy in computed tomography (CT). Pre-op CT images of 309 ears were evaluated. Two fellowship-trained neurotologists manually and independently measured CDL. Inter-observer variability between measurements across expert and automatic observers is assessed. Inter-observer differences for choice of electrode type are also investigated. Results: Manual measurement of CDL by experts tends to underestimate cochlea size and has high inter-observer variability, with mean absolute differences between expert CDL estimations of 1.15 mm. Our results show that this can lead to a large number of cochleae for which a different electrode array type would be selected by different observers, depending on the specific threshold value of CDL used to decide between array type. Conclusion: Choosing the best CI electrode array is an important task for optimizing hearing outcomes. Manual cochleae length measurements are user-dependent, and errors impact upon the CI electrode array choice for certain patients. Measuring cochlea length automatically is less time consuming and generates more repeatable results. Our automatic approach could make use of CDL for patient-customized treatment more clinically adoptable.

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Facial Nerve Meningioma: A Cause of Pediatric Facial Weakness

Objective: To present an unusual case of a temporal bone meningioma with intrafascicular spread throughout the temporal facial nerve from cerebellopontine angle (CPA) to stylomastoid foramen. Patient: Four-year-old female with progressive facial weakness and normal hearing. Main Outcome Measure: Clinical, radiological, and histopathological findings of temporal bone meningiomas. Results: A patient presented with progressive facial weakness and normal hearing. Imaging demonstrated a mass within the left internal auditory canal radiologically consistent with a schwannoma. Asymmetric enlargement with enhancement of the left facial nerve from CPA to the stylomastoid foramen suggested facial schwannoma. At surgery, gross tumor was noted in the internal auditory canal, the fallopian canal seemed expanded and the facial nerve was enlarged and had an irregular contour. Resection of the facial nerve from the CPA to just proximal to its exit at the stylomastoid foramen was necessary to achieve negative margins. Cable grafting was performed. The histopathologic diagnosis was transitional meningioma with intraneural growth throughout the length of the resected facial nerve segment. Conclusion: Meningiomas involving the temporal bone are exceedingly rare. We report a rare case of a child presenting with progressive facial weakness due to a presumed facial schwannoma spreading along the facial nerve throughout its intratemporal course that at surgery was found to be an intrafascicular CN VII meningioma.

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Analysis and Management of Complications in a Cohort of 1,065 Minimally Invasive Cochlear Implantations

Objectives: To analyze complications associated with minimally invasive cochlear implantation by comparing data from different centers, to discuss major reasons for complications, and to refine implantation techniques to decrease them. Patients: Patients who underwent cochlear implantation at our center by the same surgeon (the corresponding author of this article) from March 2006 to March 2015 were enrolled. Intervention: First, a retrospective analysis of the complications associated with minimally invasive cochlear implantation at our center was performed. Second, published reports from other centers that describe complications were reviewed. Differences between complications in our cohort and other studies were evaluated. Main Outcome Measure: Strategies for reducing complications were assessed and modifications in surgical protocol proposed accordingly. Results: In total, 1,014 patients underwent 1,065 cochlear implantations. There were 28 complications (7 major, 21 minor) and only 2 reimplantations for the entire cohort, with no case of severe infection, flap necrosis, or device extrusion. The major complications were electrode misplacement, magnet displacement, implant failure secondary to trauma, and temporary cerebrospinal fluid leakage. The rates of major complications in our cohort were very low (0.6%) compared with those in the literature. Conclusion: Preoperative surgical planning based on individual patient anatomy and employment of soft surgical techniques can minimize surgical complications.

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Oculographic, Clinical Test of Sensory Integration and Balance and Computerized Dynamic Posturography Findings in Patients With Psoriatic Arthritis

Objective: To assess the frequency and characteristics of the oculographic findings and the usefulness of the clinical test of sensory integration and balance (CTSIB) for the evaluation of balance in patients with psoriatic arthritis (PsA) by comparing this test with the computerized dynamic posturography (CDP). Study Design: A series of consecutive patients that fulfilled the Moll and Wright criteria for PsA and matched controls were studied. Setting: The study was performed at the Otolaryngology Division of a tertiary reference center. Intervention: Vestibular evaluation including CTSIB followed by CDP was performed to all patients and age, sex, and ethnically frequency-matched controls. Main Outcome Measure: Patterns of CTSIB and CDP (gold standard) were assessed and compared. Patients: Sixty PsA patients (63.3% women) and 60 matched controls. Results: PsA patients had higher frequency of abnormal oculocephalic response (13.3%) and abnormal caloric test (26.7%) than controls (0% in both cases) (p = 0.006 and p 

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Light-Driven Contact Hearing Aid for Broad-Spectrum Amplification: Safety and Effectiveness Pivotal Study

Objective: Demonstrate safety and effectiveness of the light-driven contact hearing aid to support FDA clearance. Study Design: A single-arm, open-label investigational-device clinical trial. Setting: Two private-practice and one hospital-based ENT clinics. Patients: Forty-three subjects (86 ears) with mild-to-severe bilateral sensorineural hearing impairment. Intervention: Bilateral amplification delivered via a light-driven contact hearing aid comprising a Tympanic Lens (Lens) with a customized platform to directly drive the umbo and a behind-the-ear sound processor (Processor) that encodes sound into light pulses to wirelessly deliver signal and power to the Lens. Main Outcome Measures: The primary safety endpoint was a determination of “no change” (PTA4 

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Book Review

No abstract available

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Subdural Hematoma: A Rare Adverse Complication From Bone-Anchored Hearing Aid Placement

Objective: Bone-anchored hearing aids (BAHA) are bone conduction hearing aids commonly implantated by Ear, Nose, and Throat surgeons. We present the first documented case of a subdural hematoma secondary to primary fixation of a BAHA. Patient: We present a 65-year-old male patient undergoing a left sided BAHA for bilateral chronic ear infections and difficulty wearing conventional hearing aids. The procedure was uneventful, however, the patient developed a postoperative large acute left temporoparietal intracerebral hematoma associated with an ipsilateral acute subdural hematoma. This required emergency transfer to the local tertiary neurosurgical center for a left decompressive craniotomy and evacuation of the hematoma. Results: The patient required a prolonged stay on an intensive care unit and was eventually discharged to the community for on-going neurological rehabilitation. Conclusion: This is a rare and devastating complication BAHA surgery. Otologist, general ENT surgeons, and neurosurgeons should be aware of this life-threatening complication of BAHA surgery.

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Plasmacytoma of the Temporal Bone, a Great Imitator: Report of Seven Cases and Comprehensive Review of the Literature

Objectives: To describe the clinical presentation, radiological features, and outcome of patients with plasmacytoma of the temporal bone. Methods: Multicenter retrospective case series of all patients diagnosed with plasmacytoma of the temporal bone between 1990 and 2015. Comprehensive literature review of all previously published cases. Results: A total of seven patients (average age, 57.3 yr; 57% women) met inclusion criteria. Three (43%) had a known history of multiple myeloma (MM). The most common symptoms at presentation included otalgia, headache, and dizziness (43%, each). Five (71%) presented with a vascular appearing middle ear mass visible on otoscopy. Four of these patients did not have an established history of MM and were referred with presumptive diagnoses of paraganglioma or endolymphatic sac tumor (ELST). The average maximum tumor diameter was 3.7 cm (median, 3.5 cm; range, 0.9–6.6 cm) and the most commonly involved temporal bone subsites were the middle ear and mastoid (71% each). MM was ultimately diagnosed in six cases (86%). In addition to the new cases presented herein, 18 previously published reports were analyzed. In the 25 aggregate cases, 44% of cases were associated with MM, and the mastoid (72%) and middle ear (53%) were the most commonly involved temporal bone subsites. Conclusion: Plasmacytoma of the temporal bone is rare, and the clinical presentation can closely mimic that of other primary temporal bone tumors. In patients with an established history of MM, it is imperative to have a high index of suspicion for temporal bone plasmacytoma, even when radiological features suggest an alternate diagnosis.

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Skin Necrosis After Implantation With the BAHA Attract: A Case Report and Review of the Literature

Objective: The bone-anchored hearing aid (BAHA) Attract is a transcutaneous bone conduction hearing aid that uses magnetic coupling to enable sound conduction. We report the first case of skin necrosis associated with the BAHA Attract and perform a literature review of soft tissue complications related to the device. Patient: A single patient who was found to develop skin necrosis 2 weeks after being fitted for the BAHA Attract speech processor. Intervention: After the patient developed skin necrosis from the device, she was advised to immediately discontinue use of the Attract to allow complete wound healing, upon which the Attract was successfully converted to a percutaneous BAHA. Main Outcome and Results: We monitored for the development of skin complications from the BAHA Attract. The patient's immediate postoperative course was unremarkable and she was fitted with a speech processor of M5 magnet strength at 1 month postoperatively. After 1 week of use, she reported discomfort and was advised to downgrade to an M4 magnet; however, she continued to use the M5 and the following week was found to have developed skin necrosis around the device. Conclusion: Despite the infrequency of skin necrosis related to the BAHA Attract, it must be considered in counseling and managing candidates for the device.

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Outcomes of the Suture “Pull-Through” Technique for Repair of Lateral Skull Base CSF Fistula and Encephaloceles

Objective: Describe the safety profile and surgical outcomes of a combined transmastoid-middle cranial fossa suture “pull-through” technique for repair of lateral skull base defects. Study Design: Retrospective. Setting: Tertiary care hospital. Patients: Patients undergoing surgery for cerebrospinal fluid (CSF) fistula and/or encephalocele. Intervention: Combined transmastoid and middle fossa approach using suture pull-through technique. Main Outcome Measures: The primary outcome measures of interest were recurrence of CSF fistula or encephalocele, and postoperative air-bone gap. Results: Twenty-six patients were included; mean age at surgery was 60 ± 14 years and 65% of patients were female. The majority of defects involved both the tegmen mastoideum and tympani (69%); multiple defects were present in 11 patients. Small craniotomy (2 × 3 cm) was performed and defects were repaired using composite grafts constructed with fascia, bone, and/or cartilage, and dural substitute affixed with suture. The suture tail was left long and passed from the middle fossa through the defect into the mastoid. At average follow-up of 8.3 months, no patients of recurrent CSF leak were noted. Significant improvements in both mean pure-tone average and air-bone gap were noted for the entire cohort (p = 0.04 and p = 0.02, respectively). Conclusion: A combined transmastoid-middle cranial fossa for the repair of lateral skull base CSF fistula and encephaloceles using the suture “pull-through” technique is efficacious and the complication profile is favorable. This method facilitates reliable placement of a composite graft in the center of lateral skull base defects through a small craniotomy that minimizes temporal lobe retraction.

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Analysis of Factors Affecting the Outcomes of In-hospitalized Vestibular Rehabilitation in Patients With Intractable Dizziness

Objective: To analyze somatic and psychological factors affecting the outcomes of in-hospital vestibular rehabilitation in patients with intractable dizziness. Materials and Methods: The study involved 138 patients with persistent dizziness caused by peripheral vestibular dysfunction. They were hospitalized and taught to conduct a vestibular rehabilitation program for 30 minutes by themselves three times a day over 5 days. They were then instructed to continue performing the program every day after discharge. Several questionnaires were conducted immediately before, and 1 month after, the treatment. For example, the dizziness handicap inventory (DHI), the somatosensory catastrophizing scale (SSCS), and indexes of depression and anxiety. Posturography was also performed. The main outcome was the difference between the DHI scores before and after rehabilitation. Body sway was objectively evaluated using static posturography. Results: The vestibular rehabilitation significantly improved the DHI score, the SSCS score, depression, and anxiety. Multivariate analysis indicated that the improvement in the DHI score was poorer in patients who showed high SSCS score before intervention. A higher prevalue of the DHI was associated with greater improvements in this perceived handicap after the rehabilitation. Small body sway pre-rehabilitation was related to positive effects on the DHI score in patients with a high prevalue of the DHI. Conclusion: The vestibular rehabilitation contributed to the improvement of perceived handicap due to dizziness, catastrophization of bodily sensation, and emotional distress. Patients who catastrophized their bodily sensations before vestibular rehabilitation saw smaller improvements in perceived handicap due to dizziness.

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Pilot Study Evaluating the Impact of Otology Surgery Videos on Otolaryngology Resident Education

Objectives: Use of videos as educational tools is not a novel concept; however, there is a paucity of high-quality video resources available to otolaryngology trainees. We hypothesized that residents would deem surgical-videos using a multimedia-style format more valuable as preparatory tools. Aims of this study: 1) develop portfolio of otology/neurotology videos overviewing key steps, anatomy, and pearls by a senior surgeon; 2) have residents rate the effectiveness of the videos as a preoperative tool. Study Design: Prospective study. Methods: A video-library of procedures at (https://www.youtube.com/user/cisurgeon ) was formatted via time-stamping to coincide expert level narration with closed captioning, critical procedural steps, relevant instrumentation, radiographic pictures, orientation cues, and anatomical highlights. Otolaryngology trainees of postgraduate years 2 through 5 (n = 13) watched a minimum of three videos and completed an assessment addressing: current resource identification/usefulness comparison, self-efficacy, impact on preparation time, and prioritization of resources. Results: The videos rated as highly useful compared with current resources (p = 0.002) and capable of promoting self-efficacy. Residents reported moderate-high prioritization of our multi-media formatted resource (scores >6) among their current preoperative regimen. Conclusion: The varied videos were rated highly in terms of usefulness, promoting self-efficacy and as a high-priority for a resident's surgical preparation. Multimedia-formatted training videos should be further explored for this generation of electronic-learners. Future studies with a larger cohort, objective approaches, and multidisciplinary involvement are needed to determine the full impact of this education medium on surgical-training.

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Compensatory Saccades Are Associated With Physical Performance in Older Adults: Data From the Baltimore Longitudinal Study of Aging

Objective: To determine whether compensatory saccade metrics observed in the video head impulse test, specifically saccade amplitude and latency, predict physical performance. Study Design: Cross-sectional analysis of the Baltimore Longitudinal Study of Aging, a prospective cohort study. Setting: National Institute on Aging Intramural Research Program Clinical Research Unit in Baltimore, Maryland. Patients: Community-dwelling older adults. Intervention(s): Video head impulse testing was performed, and compensatory saccades and horizontal vestibulo-ocular reflex (VOR) gain were measured. Physical performance was assessed using the Short Physical Performance Battery (SPPB), which included the feet side-by-side, semitandem, tandem, and single-leg stance; repeated chair stands; and usual gait speed measurements. Main Outcome Measure(s): Compensatory saccade amplitude and latency, VOR gain, and SPPB performance. Results: In 183 participants who underwent vestibular and SPPB testing (mean age 71.8 yr; 53% females), both higher mean saccade amplitude (odds ratio [OR] =1.62, p = 0.010) and shorter mean saccade latency (OR = 0.88, p = 0.004) were associated with a higher odds of failing the tandem stand task. In contrast, VOR gain was not associated with any physical performance measure. Conclusion: We observed in a cohort of healthy older adults that compensatory saccade amplitude and latency were associated with tandem stance performance. Compensatory saccade metrics may provide insights into capturing the impact of vestibular loss on physical function in older adults.

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Speech-in-noise perception in musicians: a review

Publication date: Available online 14 February 2017
Source:Hearing Research
Author(s): Emily B.J. Coffey, Nicolette Mogilever, Robert J. Zatorre
The ability to understand speech in the presence of competing sound sources is an important neuroscience question in terms of how the nervous system solves this computational problem. It is also a critical clinical problem that disproportionally affects the elderly, children with language-related learning disorders, and those with hearing loss. Recent evidence that musicians have an advantage on this multifaceted skill has led to the suggestion that musical training might be used to improve or delay the decline of speech-in-noise (SIN) function. However, enhancements have not been universally reported, nor have the relative contributions of different bottom-up versus top-down processes, and their relation to preexisting factors been disentangled. This information that would be helpful to establish whether there is a real effect of experience, what exactly is its nature, and how future training-based interventions might target the most relevant components of cognitive processes. These questions are complicated by important differences in study design and uneven coverage of neuroimaging modality. In this review, we aim to systematize recent results from studies that have specifically looked at musician-related differences in SIN by their study design properties, to summarize the findings, and to identify knowledge gaps for future work.



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Prevalence of minimal hearing loss in South Korea

by Ji Eun Choi, Jungmin Ahn, Hyun Woo Park, Sun-Young Baek, Seonwoo Kim, Il Joon Moon

This study evaluated the prevalence of minimal hearing loss (MHL) in South Korea based on the 2010 to 2012 Korea National Health and Nutrition Examination Survey. A total of 16,630 representative individuals (older than 12 years) who completed ear examinations and structured questionnaires were analyzed. Only participants who had normal tympanic membranes were included. MHL was categorized into the following three groups: 1) unilateral sensorineural hearing loss (USHL, pure-tone average (PTA) ≥ 15 dB in the affected ear), 2) bilateral sensorineural hearing loss (BSHL, 15 dB ≤ PTA 25 dB in either ear). To evaluate clinical symptoms, subjective hearing status, tinnitus, and quality of life of each MHL group were compared to those of normal-hearing listeners. The use of hearing aids (HAs) was also investigated in the MHL population. The prevalence of normal hearing and MHL were 58.4% and 37.4%, respectively. In univariate analyses, the prevalence of MHL increased with age. It was significantly increased in males. Regarding clinical symptoms, 13.0% and 92.1% of participants with MHL reported difficulties with hearing and annoying tinnitus, respectively. In multivariate analyses, these proportions were significantly higher in the MHL groups than in normal-hearing listeners. Participants with MHL also showed significantly lower Euro Qol-5D index scores than did normal-hearing listeners. Regarding hearing rehabilitation, among minimally hearing impaired participants with subjective hearing loss, only 0.47% of individuals used HAs. Our results reveal that MHL is common in South Korea. It is associated with significant subjective hearing loss, tinnitus, and poor quality of life. Therefore, clinicians need to pay attention to this special group and provide proper counselling and rehabilitative management.

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Desynchronisation of auditory steady-state responses related to changes in interaural phase differences: an objective measure of binaural hearing

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Desynchronisation of auditory steady-state responses related to changes in interaural phase differences: an objective measure of binaural hearing

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Desynchronisation of auditory steady-state responses related to changes in interaural phase differences: an objective measure of binaural hearing

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Microsurgical Outcomes After Gross Total Resection on Vestibular Schwannoma in the Elderly :A Matched Cohort Study.

Microsurgical Outcomes After Gross Total Resection on Vestibular Schwannoma in the Elderly :A Matched Cohort Study.

World Neurosurg. 2017 Feb 09;:

Authors: Jiang N, Wang Z, Chen W, Xie Y, Peng Z, Yuan J, Wanggou S, Su Y, Li X, Yuan X

Abstract
OBJECTIVES: To compare and analyze the differences in clinical manifestations and surgical outcomes after gross total resection (GTR) for vestibular schwannoma (VS) between elderly and younger patients.
METHODS: We conducted a retrospective study of 40 elderly (≥65 years) and 40 younger (< 65 years) patients, and matched operation dates and tumor size in the 2 groups were matched. All 80 patients underwent microsurgical resection though the sigmoid approach, by the same surgeon (Professor Xianrui Yuan, M.D. Ph.D.). We then summarized clinical manifestations, image data, peri-operative complications, tumor recurrence, and functional outcomes, and assessed the differences between the 2 groups.
RESULTS: The mean follow-up time was 52.64 months. Elderly patients had a poorer preoperative American Society of Anesthesiology(ASA) physical status scores than younger patients (62.5% VS 30%, P=0.004), and were more likely to have balance disorders (72.5% VS 25%, P<0.01), without other preoperative differences. Both groups of patients achieved GTR. The incidence of infection was slightly but not significantly higher in elderly patients (P>0.05). There were also no significant differences in peri-operative complications, recurrence rate, facial nerve function, hearing level, or Karnofsky Performance Status Scale (KPS) scores between younger and older patients.
CONCLUSIONS: The elderly tend to suffer from poorer health (ASA score) and poor balance before the operation. However, elderly patients did not experience more complications, worse nerve function or worse quality of life in the perioperative or follow-up times. We concluded that GTR of VSs, even large or giant ones, is a safe and effective option for the elderly patients.

PMID: 28192265 [PubMed - as supplied by publisher]

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Microsurgical Outcomes After Gross Total Resection on Vestibular Schwannoma in the Elderly :A Matched Cohort Study.

Microsurgical Outcomes After Gross Total Resection on Vestibular Schwannoma in the Elderly :A Matched Cohort Study.

World Neurosurg. 2017 Feb 09;:

Authors: Jiang N, Wang Z, Chen W, Xie Y, Peng Z, Yuan J, Wanggou S, Su Y, Li X, Yuan X

Abstract
OBJECTIVES: To compare and analyze the differences in clinical manifestations and surgical outcomes after gross total resection (GTR) for vestibular schwannoma (VS) between elderly and younger patients.
METHODS: We conducted a retrospective study of 40 elderly (≥65 years) and 40 younger (< 65 years) patients, and matched operation dates and tumor size in the 2 groups were matched. All 80 patients underwent microsurgical resection though the sigmoid approach, by the same surgeon (Professor Xianrui Yuan, M.D. Ph.D.). We then summarized clinical manifestations, image data, peri-operative complications, tumor recurrence, and functional outcomes, and assessed the differences between the 2 groups.
RESULTS: The mean follow-up time was 52.64 months. Elderly patients had a poorer preoperative American Society of Anesthesiology(ASA) physical status scores than younger patients (62.5% VS 30%, P=0.004), and were more likely to have balance disorders (72.5% VS 25%, P<0.01), without other preoperative differences. Both groups of patients achieved GTR. The incidence of infection was slightly but not significantly higher in elderly patients (P>0.05). There were also no significant differences in peri-operative complications, recurrence rate, facial nerve function, hearing level, or Karnofsky Performance Status Scale (KPS) scores between younger and older patients.
CONCLUSIONS: The elderly tend to suffer from poorer health (ASA score) and poor balance before the operation. However, elderly patients did not experience more complications, worse nerve function or worse quality of life in the perioperative or follow-up times. We concluded that GTR of VSs, even large or giant ones, is a safe and effective option for the elderly patients.

PMID: 28192265 [PubMed - as supplied by publisher]

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Gait ground reaction force characteristics in deaf and hearing children

Publication date: Available online 14 February 2017
Source:Gait & Posture
Author(s): Amir Ali Jafarnezhadgero, Mahdi Majlesi, Elaheh Azadian
The link between gait parameters and hearing loss is not well understood. The objective of this study was to investigate the effects of the gait ground reaction forces, their time to peak, vertical loading rate, impulses and free moment during gait in deaf and hearing children. Thirty male children were equally divided into a healthy group and a group with hearing loss problems (Deaf group). Ground reaction forces were analyzed during barefoot walking. MANOVA test was used for between group comparisons. The significance level was set at p<0.05 for all analyses. Hearing loss was associated with increased propulsion lateral-medial ground reaction force (p=0.031), its time to peak (p=0.008), and lateral- medial impulse (p=0.018). Similar vertical reaction forces were observed in both groups (p>0.05). Positive peak of free moments in the healthy group was significantly greater than that in the deaf group (p=0.004). In conclusion, the results reveal that gait ground reaction force components in deaf children may have clinical values for rehabilitation of these subjects.



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Gait ground reaction force characteristics in deaf and hearing children

Publication date: Available online 14 February 2017
Source:Gait & Posture
Author(s): Amir Ali Jafarnezhadgero, Mahdi Majlesi, Elaheh Azadian
The link between gait parameters and hearing loss is not well understood. The objective of this study was to investigate the effects of the gait ground reaction forces, their time to peak, vertical loading rate, impulses and free moment during gait in deaf and hearing children. Thirty male children were equally divided into a healthy group and a group with hearing loss problems (Deaf group). Ground reaction forces were analyzed during barefoot walking. MANOVA test was used for between group comparisons. The significance level was set at p<0.05 for all analyses. Hearing loss was associated with increased propulsion lateral-medial ground reaction force (p=0.031), its time to peak (p=0.008), and lateral- medial impulse (p=0.018). Similar vertical reaction forces were observed in both groups (p>0.05). Positive peak of free moments in the healthy group was significantly greater than that in the deaf group (p=0.004). In conclusion, the results reveal that gait ground reaction force components in deaf children may have clinical values for rehabilitation of these subjects.



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Gait ground reaction force characteristics in deaf and hearing children

Publication date: Available online 14 February 2017
Source:Gait & Posture
Author(s): Amir Ali Jafarnezhadgero, Mahdi Majlesi, Elaheh Azadian
The link between gait parameters and hearing loss is not well understood. The objective of this study was to investigate the effects of the gait ground reaction forces, their time to peak, vertical loading rate, impulses and free moment during gait in deaf and hearing children. Thirty male children were equally divided into a healthy group and a group with hearing loss problems (Deaf group). Ground reaction forces were analyzed during barefoot walking. MANOVA test was used for between group comparisons. The significance level was set at p<0.05 for all analyses. Hearing loss was associated with increased propulsion lateral-medial ground reaction force (p=0.031), its time to peak (p=0.008), and lateral- medial impulse (p=0.018). Similar vertical reaction forces were observed in both groups (p>0.05). Positive peak of free moments in the healthy group was significantly greater than that in the deaf group (p=0.004). In conclusion, the results reveal that gait ground reaction force components in deaf children may have clinical values for rehabilitation of these subjects.



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Vestibular (dys)function in children with sensorineural hearing loss: a systematic review

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Vestibular (dys)function in children with sensorineural hearing loss: a systematic review

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Vestibular (dys)function in children with sensorineural hearing loss: a systematic review

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A Meta-Analysis on the Diagnostic Performance of Non-Echoplanar Diffusion-Weighted Imaging in Detecting Middle Ear Cholesteatoma: 10 Years on.

Objective: To describe via a meta-analysis of the published literature, the performance of non-echo-planar diffusion weighted imaging (DWI) in detecting middle ear cholesteatoma. Methodology: A systematic review of the published literature was performed to identify original studies evaluating the diagnostic performance of non-echo-planar DWI in detecting middle ear cholesteatoma. Only studies with surgical correlation were included. A bi-variate meta-analysis and hierarchical summary receiver operating characteristic model was performed. Results: A total of 26 studies (1,152 patient episodes) were included. Pooled sensitivity and specificity of 0.91 (95% CI: 0.87-0.95) and 0.92 (95% CI: 0.86-0.96), respectively were obtained. Separate subgroup analysis performed for primary cholesteatoma, postoperative cholesteatoma, pediatric cases, and adult cases all showed high sensitivities (range, 0.86-0.93) and specificities (0.88-0.97). There was a statistically significant degree of heterogeneity in terms of sensitivity between all studies (I2 value 46%) and in the pediatric subgroup (I2 value 78%). There was no evidence of significant heterogeneity between the specificity measurements. Conclusions: Non-echo-planar DWI is highly sensitive and specific in detecting cholesteatoma. A large prospective multicentre randomized controlled study could validate the findings and evaluate the cost-effectiveness of DWI as an alternative for second-look surgery (control arm) in managing cases of postoperative cholesteatoma. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Clinical Significance of Arterial Stiffness and Metabolic Syndrome Scores in Vestibular Neuritis.

Objective: To investigate the clinical significance of cardiovascular factors, including arterial stiffness and metabolic syndrome scores, in the development of vestibular neuritis. Study Design: A prospective, case-control study. Setting: Tertiary referral center. Patients: Fifty-eight adult patients with vestibular neuritis (VN) and 58 age- and sex-matched controls were evaluated between January 2015 and January 2016. Intervention: Measurement of arterial stiffness. Main Outcome Measures: Arterial stiffness was assessed from brachial-ankle pulse wave velocity (baPWV), and cardiovascular markers including blood pressure, body mass index and lipid profiles, and metabolic syndrome scores were determined. The dizziness handicap inventory (DHI) and vestibular function tests, including the caloric test and video head impulse test were evaluated. The correlations between cardiovascular factors and clinical parameters of VN were assessed. Results: Blood pressure, baPWV, and metabolic syndrome scores were higher in the VN group than in the control group (p = 0.002, p = 0.001, and p = 0.001, respectively), whereas comorbidity, anthropometric characteristics, and lipid profiles did not differ significantly. baPWV and metabolic syndrome scores were not correlated with the clinical parameters of the DHI scores, canal paresis, and spontaneous nystagmus duration. In addition, cardiovascular factors did not associate with the vestibular compensation. Conclusions: Higher baPWV, representative of arterial stiffness, and higher metabolic syndrome scores, are associated with the development of VN. This supports the hypothesis of a vascular etiology of the disease. However, cardiovascular risk factors had limited value in predicting the clinical course of VN. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Development and Validation of the Cochlear Implant Surgical Competency Assessment Instrument.

Objective: We present a new instrument for evaluation of cochlear implant (CI) surgical skills and review its validation process. Methods: An instrument to assess CI surgical competency incorporated results of structured surveys of comprehensiveness sent to 30 international CI experts and US trainees. One-hundred evaluations of 28 residents, fellows, and practicing CI surgeons were completed. Surgical skills were evaluated by four experienced neurotologists (two raters per subject) using two temporal bones per subject. A training session was completed by 24 subjects between the first and second procedure. Comparison of two blinded rater's scores per subject provided information on interrater reliability. Correlation of competency scores with degree of training and with improvement after a training session provided information on construct validity. Results: High levels of interrater reliability were confirmed by using the intraclass correlation coefficient. Construct validity was demonstrated by correlation of higher performance scores with increasing years of training, board certification, and fellowship training. Construct validity is also supported by improvement in scores after a CI training session as well as by acceptability surveys. Discussion: Data indicate that this instrument is an objective, accurate, and dependable procedure-specific instrument for evaluating CI surgical competency. Conclusion: The cochlear implant surgical competency assessment (CI-SCA) can be used to establish CI surgical competency, identify surgical skills that require remediation and demonstrate progress during training. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Population Statistics Approach for Safety Assessment in Robotic Cochlear Implantation.

Hypothesis: Descriptive statistics with respect to patient anatomy and image guidance accuracy can be used to assess the effectiveness of any system for minimally invasive cochlear implantation, on both an individual patient and wider population level. Background: Minimally invasive cochlear implantation involves the drilling of a tunnel from the surface of the mastoid to cochlea, with the trajectory passing through the facial recess. The facial recess anatomy constrains the drilling path and places prohibitive accuracy requirements on the used system. Existing single thresholds are insufficient for assessing the effectiveness of these systems. Methods: A statistical model of the anatomical situation encountered during minimally invasive drilling of the mastoid for cochlear implantation was developed. A literature review was performed to determine the statistical distribution of facial recess width; these values were confirmed through facial recess measurements on computed tomography (CT) data. Based on the accuracy of a robotic system developed by the authors, the effect of variation of system accuracy, precision, and tunnel diameter examined with respect to the potential treatable portion of the population. Results: A facial recess diameter of 2.54 +/- 0.51 mm (n = 74) was determined from a review of existing literature; subsequent measurements on CT data revealed a facial recess diameter of 2.54 +/- 0.5 mm (n = 23). The developed model demonstrated the effects of varying accuracy on the treatable portion of the population. Conclusions: The presented model allows the assessment of the applicability of a system on a wider population scale beyond examining only the system's ability to reach an arbitrary threshold accuracy. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Efficacy of Bone-Anchored Hearing Aids in Single-Sided Deafness: A Systematic Review.

Objectives: Bone-anchored hearing aids (BAHAs) have been known to partially restore some of the functions lost in subjects with single-sided deafness (SSD). Our aims in this systemic review were to analyze the present capabilities of BAHAs in the context of SSD, and to evaluate the efficacy of BAHAs in improving speech recognition in noisy conditions, sound localization, and subjective outcomes. Design: A systematic search was undertaken until August 2015 by two independent reviewers, with disagreements resolved by consensus. Among 286 references, we analyzed 14 studies that used both subjective and objective indicators to assess the capabilities of a total of 296 patients in the unaided and aided situations. Results: Although there was "no benefit" of BAHA implantation for sound localization, BAHAs certainly improved subjects' speech discrimination in noisy circumstances. In the six studies that dealt with sound localization, no significant difference was found after the implantation. Twelve studies showed the benefits of BAHAs for speech discrimination in noise. Regarding subjective outcomes of using the prosthesis in patients with SSD (abbreviated profile of hearing aid benefit (APHAB) and the Glasgow hearing aid benefit profile (GHABP), etc.), we noticed an improvement in the quality of life. Conclusions: This systematic review has indicated that BAHAs may successfully rehabilitate patients with SSD by alleviating the hearing handicap to a certain degree, which could improve patients' quality of life. This report has presented additional evidence of effective auditory rehabilitation for SSD and will be helpful to clinicians counseling patients regarding treatment options for SSD. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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