Cameron C. Wick

Sudden sensorineural hearing loss (SSNHL) is defined as a decline in hearing of at least 30 dB over three sequential frequencies that occurs within 72 hours. It represents a relative otologic emergency because early treatment favors better outcomes. The etiologies for SSNHL are diverse and subjective symptoms may vary. A specific etiology is only found in 29% of patients, however when identified it can have significant impact on treatment and counseling. Workup to rule-out retrocochlear pathology is necessary even if hearing recovers. Understanding SSNHL’s pathophysiology, differential diagnosis, workup, and treatment options are necessary for timely management and patient counseling.

Objective: To assess intracochlear electrocochleography (ECochG) for estimating cochlear implant (CI) performance for lateral wall and perimodiolar electrode arrays. Study Design: Prospective cohort study. Setting: Tertiary referral center. Methods: From December 2021 to June 2024, ECochG was measured intraoperatively using the Active Insertion Monitoring (AIM) system by Advanced Bionics. After insertion, multifrequency tone bursts were delivered via a sound tube from 250 Hz to 2 kHz at 95 to 105 dB HL with recordings at each internal electrode. Using spectral analysis, the maximal amplitude (MA) response electrode was identified by frequency and summed into a single value of total response (MA‐ECochG‐TR). Postoperative CI performance was routinely monitored. Results: Of 57 participants with ECochG recordings, 43 completed 6‐month testing. Of these, 23 were perimodiolar (Mid‐Scala [MS]), and 20 were lateral wall (SlimJ [SJ]). MA‐ECochG‐TR had a moderately strong positive correlation to 6‐month consonant‐nucleus‐consonant (CNC) word scores for MS cases ( r = 0.73, 95% CI [0.46‐0.88], P < .001), but showed no significant correlation for SJ cases ( r = 0.04, 95% CI [−0.41 to 0.47], P = .87). For the 13 SJ recipients without electroacoustic stimulation (EAS), there was a moderate, non‐significant positive correlation between MA‐ECochG‐TR and 6‐month CNC ( r = 0.44, 95% CI [−0.14 to 0.80], P = .13). Conclusion: MA‐ECochG‐TR independently estimates performance for perimodiolar arrays. Intracochlear ECochG is less predictive for lateral wall arrays; this may be due to confounding from EAS (though this was not statistically significant) or from signal degradation with a larger electrode‐modiolar distance.

Objective: To assess the relationship between quality of life and speech perception outcomes in older adult cochlear implant (CI) recipients. Study Design: Retrospective review and cross-sectional survey study. Setting: Tertiary care center. Patients: Traditional CI recipients 65 years and older implanted between 2015 and 1Implant Quality of Life (CIQOL-35) survey completed within 1 year of most recent speech perception testing. Main Outcome Measures: AzBio in quiet and +10 dB SNR in the binaural everyday listening condition; CIQOL-35 responses. Results: A total of 156 patients completed the survey within 1 year of most recent speech perception testing. Their demographics, otologic history, comorbidity index, and cognitive screen were collected alongside pre- and postoperative speech perception outcomes. Median age at implantation was 76.3 years (range, 65.0–97.2), and median age at CIQOL-35 was 78.0 years (range, 66.1–100.6). The mean CIQOL-Global was 48.3 (SD, 9.8), with scores across domains ranging from 34.9 (SD, 14.0) (Listening Effort) to 63.4 (SD, 19.3) (Social). Bivariate analysis showed that CIQOL-Global had positive correlations with AzBio quiet ( ρ = 0.413 [95% CI, 0.22–0.58]) and AzBio +10 dB SNR ( r = 0.537 [95% CI, 0.37–0.65]). Significance and strength of correlation remained true after controlling for age, cognitive screen, and duration of hearing loss using multivariable regression on 56 participants with complete data (standardized beta = 0.55). This model explained 38% of the CIQOL-35 global score variability ( R ² = 0.378). Conclusions: AzBio +10 dB SNR performance is positively correlated with CIQOL-35, but much of the variability in QOL remains unexplained.

Objective: Cochlear implant (CI) electrode array tip fold‐overs occur at an increased rate with perimodiolar electrode arrays, necessitating removal and re‐insertion. The degree to which an intra‐operative correction of tip fold‐over affects CI performance and hearing preservation has not been previously reported.Study Design: Retrospective chart review of CI recipients receiving a slim perimodiolar electrode array from 2016 to 2023.Setting: Tertiary referral center.Methods: Low‐frequency pure tone average (LFPTA) was defined as the average of thresholds at 125, 250, and 500 Hz. We defined hearing preservation candidacy as LFPTA < 60 dB HL preoperatively, and successful hearing preservation was defined as LFPTA < 80 dB HL at activation. Consonant‐nucleus‐consonant (CNC) word recognition and AzBio scores in quiet and in +10 dB signal‐to‐noise ratio (SNR) were collected preoperatively, and at 3‐ and 6‐months postoperatively.Results: From 663 implants, 35 (5.3%) experienced tip fold‐over that was identified and corrected intra‐operatively. There was no significant difference in 3‐month CNC scores between those with fold‐overs (44.9%, SD 20.9%) and those without (46.2%, SD 21.0%; P = .98). Similarly, there was no difference in AzBio in quiet (53.1%, SD 21.7% vs 60.8%, SD 28.0%; P = .26) or in AzBio +10 dB SNR (19.1%, SD 23.7% vs 31.5%, SD 27.2%; P = .60). Of 19 hearing preservation candidates that experienced tip fold‐over, 6 (31.6%) had preserved hearing at activation compared to 31 of 59 candidates (52.5%; P = .11) without fold‐over.Conclusion: While tip fold‐over remains a clinical concern, speech performance does not appear to be negatively affected if the fold‐over is identified and corrected.

Objective: To investigate management practices and outcomes in a retrospective cohort of patients who have sustained temporal bone gunshot wounds (TBGSW). Study Design: Retrospective chart review. Setting: Five participating hospitals. Patients: Twenty-two patients met inclusion criteria: experienced a TBGSW, survived ≥30 days following the injury, and were evaluated and managed by a neurotologist between 2019 and 2023. Interventions: No specific interventions were performed for the purposes of this study. Main Outcome Measure(s): Characteristics, evaluation, management, and outcomes of TBGSW survivors. Results: Patients were found to have a mean age of 33 ± 18 years and were predominantly male (18/22, 81.8%). Majority of patients (17/22, 77.3%) had mastoid injury. Most patients (14/22, 63.6%) had some evidence for vascular injury, most frequently the internal carotid artery (9/22, 40.9%). Almost three-quarters (17/22, 77.3%) of patients had clinical exam findings of facial nerve injury, which was the most common indication for surgery. Otologic surgery was performed in 72.7% (16/22), with delayed adverse events most commonly including cholesteatoma and external auditory canal stenosis. Though evidence for hearing impairment was clinically present in at least 15 of 22 patients (68.2%), hearing rehabilitation was pursued in only two patients. Conclusion: With increasing numbers of TBGSW survivors, there is a growing need for practicing neurotologists to be familiar with the wide spectrum of injury patterns and possible complications to inform clinical management in these patients. Early neurotologic assessment and follow-up beyond the acute period is crucial to minimize morbidity in this high-risk cohort.

Objective: To explore whether deintensification of adjuvant therapy reduces ototoxicity among patients with human papillomavirus (HPV)‐related oropharyngeal squamous cell carcinoma (OPSCC).Study Design: Retrospective cohort study.Setting: Single academic center.Methods: The ototoxicity rate among adult patients with HPV‐related OPSCC enrolled in the Minimalist Trial (MINT), a prospective phase 2 trial of surgery followed by risk‐adjusted deintensified adjuvant therapy (42 Gy radiation given alone or with a single 100 mg/m² dose of cisplatin), was compared to that among a historical cohort treated with standard adjuvant therapy (60‐66 Gy radiation with up to three 100 mg/m² doses of cisplatin). Ototoxicity was defined as Common Terminology Criteria for Adverse Events v5.0 ≥ Grade 2. Mixed model analysis was performed to investigate the association between deintensified adjuvant therapy and treatment‐related hearing loss.Results: A total of 29 patients (58 ears) were analyzed in the MINT cohort, and 27 patients (54 ears) in the historical cohort. The ototoxicity rate was 5% (n = 3/58 ears) in the MINT cohort and 46% (n = 25/54 ears) in the historical cohort (difference, 41%; 95% confidence interval [CI] = 27%‐56%). Patients in the MINT cohort demonstrated a 95% decrease in risk of ototoxicity compared to those in the historical cohort (adjusted odds ratio: 0.05, 95% CI = 0.01‐0.31). Differences in estimated marginal mean threshold shifts were statistically and clinically significant at frequencies ≥ 3 kHz.Conclusion: The deintensified adjuvant therapy given in MINT led to less ototoxicity than standard adjuvant therapy among patients with HPV‐related OPSCC.

Objective: This study aimed 1) to measure the effect of cochlear implantation on health-related quality of life (HR-QOL) using the Cochlear Implant Quality of Life (CIQOL) questionnaire and 2) to determine audiologic, demographic, and non-CI/hearing-related QOL factors influencing the CIQOL. Study Design: Prospective observational study. Setting: Tertiary referral center. Patients and Interventions: Thirty-seven adult patients with sensorineural hearing loss undergoing cochlear implantation. Main Outcome Measure(s): CIQOL-global score preimplantation and 6 months postimplantation. Physical function score as measured by the short-form survey, audiologic, and demographic variables. Results: CIQOL showed significant improvement from preimplantation to 6 months postactivation with a mean difference of 14.9 points (95% confidence interval, 11.3 to 18.5, p < 0.0001). Improvement in CIQOL (ΔCIQOL) correlated linearly with age (r = −0.49, p = 0.001) and improvement in speech perception testing (r = 0.63, p < 0.0001). Multivariate modeling using age and change in consonant–vowel nucleus–consonant (CNC) score explained 46% of the variability measured by the ΔCIQOL-global score. Conclusions: Nearly all CI recipients achieve significant gains for all domains as measured by the CIQOL. However, younger patients and those with a greater improvement in speech perception performance (CNC) are more likely to achieve a greater CIQOL benefit. Results here suggest the importance of considering preoperative CIQOL and speech perception measures when evaluating predictors of HR-QOL.

Objective: To compare the indications and efficacy of endoscopic over‐under tympanoplasty versus endoscopic underlay tympanoplasty.Methods: Retrospective cohort study of patients undergoing type I endoscopic tympanoplasty via either an underlay or over‐under technique by a single surgeon from 2017 to 2021. Patients were excluded if they had a concurrent mastoidectomy, ossiculoplasty, or advanced cholesteatoma defined by involvement of multiple subsites. Patient demographics, perforation size and location, middle ear status, preoperative and postoperative audiograms, and perforation closure were reviewed. Middle ear status was represented using the Ossiculoplasty Outcome Parameter Score (OOPS). The primary outcome was perforation closure at most recent follow‐up and secondary outcomes were change in postoperative pure‐tone average (PTA) and air‐bone gap (ABG).Results: Of 48 patients, 27 underwent endoscopic underlay tympanoplasty and 21 underwent endoscopic over‐under tympanoplasty. Tragal cartilage‐perichondrium graft was used in 90% of procedures. Distribution of OOPS scores was not significantly different between groups. Over‐ under technique addressed significantly larger perforations (mean size of 54% vs. 31%, p < .001) and a higher rate of anterior extension (95% vs. 22%, p < .001) than underlay technique. Perforation closure rate was not different between groups (95% vs. 96%). Patients experienced significant improvement in PTA and ABG in both groups.Conclusion: The endoscopic over‐under tympanoplasty is comparable to endoscopic underlay tympanoplasty in terms of graft take and audiologic improvement. The over‐under technique is effective for repairing larger perforations or those with anterior extension.Level of evidence: IV