Erin Williams

Introduction: Despite strong evidence for vestibular rehabilitation therapy (VRT), the proportion of referred patients who actually attend remains poorly characterized. This study quantified the VRT referral-to-attendance gap in a South Florida cohort and evaluated whether sociodemographic and insurance-related factors were associated with treatment uptake and clinical outcomes measured by the Dizziness Handicap Index (DHI) and Functional Gait Assessment (FGA). Methods: We conducted a retrospective chart review of 243 adults aged 18–80 (observed range 25–79) who were recommended VRT at the University of Miami Ear Institute between 2012 and 2022. Demographic information (age, sex, race, ethnicity, insurance status), vestibular diagnoses, and outcome measures were extracted. Functional outcomes were assessed with baseline and follow-up DHI and FGA scores. Neighborhood-level socioeconomic status was characterized using the Area Deprivation Index (ADI). Disparities in VRT attendance and outcomes were evaluated using Chi-square tests, Firth’s penalized logistic regression, and analysis of covariance. Results: Of 243 patients referred for VRT, only 41% ( n = 99) attended therapy, revealing a 59% referral-to-attendance gap, with a median of 7 visits (IQR 3–15) among attenders. No demographic, socioeconomic, insurance, or time variables were significantly associated with VRT attendance in unadjusted or multivariable analyses (all p > 0.05). In exploratory analyses limited to 25 patients with paired DHI data, DHI scores decreased by 15.2 points (95% CI −24.5 to −5.9; p = 0.002), though notably this did not exceed the 18-point minimum clinically important difference (MCID). Neighborhood deprivation (ADI) and insurance category were associated with DHI responder status. No medium-deprivation or publicly insured patients achieved the MCID, though no high-deprivation patients had paired data. Conclusion: No measured sociodemographic or clinical variable explained non-attendance, suggesting that structural or logistical barriers may be the primary drivers of this gap. Neighborhood deprivation and insurance category were associated with clinically meaningful DHI improvement in exploratory analyses, but these findings are constrained by a small, racially homogeneous analytic sample and require confirmation in larger prospective studies with standardized outcome collection.

Objective(s): Vestibular rehabilitation therapy (VRT) is an efficient treatment for dizziness and vertigo, but its accessibility remains limited. This study evaluates the feasibility and performance of a machine vision‐based automated alternative—the Automated Vestibular Rehabilitation System (AVRS)—as a more accessible approach to delivering VRT. Methods: Forty age‐ and sex‐matched adults without balance disorders or recent head injury completed one standard VRT exercise, X1, in seated and standing positions using the AVRS, which tracked real‐time head and eye movements. Gain, the ratio of eye to head velocity near the neutral head position, was calculated using median values and interquartile ranges. Test‐retest reliability (TRTR) was assessed in a subset of 20 participants using intraclass correlation coefficients (ICCs) with 95% confidence intervals. Results: All participants successfully completed the AVRS‐guided vestibular exercises. The n = 20 person test‐retest reliability subset returned after 27 ± 9 days. Mean VOR gain approximated the expected physiologic norms (~−1.0) across sessions irrespective of frequency (Session 1: −0.98 ± 0.04; Session 2: −0.99 ± 0.03). Overall reliability between sessions was moderate (ICC (3, 1): 0.59 [95% CI: 0.37–0.75], p < 0.001). Conclusion: The AVRS demonstrated moderate reliability and accurate VOR gain measurement in healthy adults, supporting its potential as a scalable, accessible tool for VRT delivery, with normative data to guide therapeutic progression in clinical populations. Level of Evidence: 4.

Background/Objectives: Migraine is frequently comorbid with Meniere’s disease, which may complicate interpretation of inner ear imaging and clinical diagnosis. While endolymphatic hydrops has been studied in Meniere’s disease and vestibular migraine separately, comparative imaging data for Meniere’s disease patients with and without migraine remain limited. Methods: We retrospectively analyzed 78 patients with definite Meniere’s disease who underwent endolymphatic contrast-enhanced MRI (HYbriD of Reversed image of Positive endolymph signal and native image of positive perilymph signal; or “HYDROPS”). Patients were classified as Meniere’s disease only group (n = 56), or Meniere’s disease with migraine (n = 22). The degree of endolymphatic hydrops (negative, mild, or significant) was assessed separately in the inner ear, the cochlea, and the vestibule. Results: In Meniere’s disease group, the affected ear consistently showed higher rates of significant endolymphatic hydrops compared to the healthy ear across the inner ear, cochlea, and vestibule (p < 0.01). In contrast, Meniere’s disease with migraine group showed no significant interaural differences. Meniere’s disease with migraine group showed a significantly higher frequency of significant endolymphatic hydrops in the healthy cochlea (p < 0.01). Similar patterns were observed in the inner ear (p < 0.025) and vestibule (p = 0.05), although these differences did not reach statistical significance. Bilateral hydrops was significantly more frequent in Meniere’s disease with migraine group than in Meniere’s disease group among all regions investigated (p < 0.05). Conclusions: Meniere’s disease patients with migraine exhibit a distinct endolymphatic hydrops pattern, characterized by bilateral or symmetrical hydrops and involvement of the healthy ear. These findings suggest migraine-related mechanisms may contribute to endolymphatic hydrops, and bilateral endolymphatic hydrops on endolymphatic contrast-enhanced MRI in suspected Meniere’s disease cases should prompt consideration of comorbid migraine, in addition to bilateral Meniere’s disease or asymptomatic hydrops.

Background/Objectives: Single-sided deafness (SSD) treatment options include Contralateral Routing of Signal (CROS) or Bilateral Routing of Signal (BiCROS) systems, bone conduction devices, cochlear implants (CIs) and no intervention. Aligning treatment recommendations with patient motivations is fundamental for satisfaction and successful outcomes. At our institution, a structured telehealth consultation precedes formal testing and includes treatment motivation exploration and comprehensive review of all interventions. This study examined SSD treatment motivations and their association with pursuing cochlear implantation. Methods: Adults who completed a pre-treatment SSD telehealth consultation over a four-year period were identified. Charts were retrospectively reviewed for demographics, SSD characteristics, treatment motivations, treatment choice, and CI outcomes. Results: A total of 122 adults were evaluated. Mean age was 56.3 (±13.0) years, and 59.8% were male. Mean SSD duration was 10.8 (±15.8) years. The most common etiology was sudden sensorineural hearing loss. The top primary motivations were improving overall hearing (23.0%), restoring hearing to the deaf ear (22.1%), and improving hearing in noise (21.3%). Most patients (45.1%) opted for a hearing aid, CROS or BiCROS system; 38.5% chose CI; and 14.8% declined treatment. Only 57.4% of those who selected CI had the implant, primarily due to surgery avoidance (31.5%) and insurance limitations (10.5%). Motivation did not predict treatment choice or CI receipt. Among CI recipients (n = 27), those motivated by hearing restoration demonstrated poorer speech outcomes and datalogging. Conclusions: Improving overall hearing and restoring hearing to the deaf ear were the most common motivations for seeking SSD treatment. Adult CI recipients had similar motivations to those who chose non-surgical options.

Background: The computerized rotational head impulse test (crHIT) employs whole-body impulsive rotations like the angular motion used in the video head impulse test (vHIT) to assess the function of all semicircular canals (SCCs). Objective: This study utilized vertical crHIT and vHIT among healthy subjects to evaluate the effectiveness of these tools in assessing SCC function. Methods: Thirty-five individuals with no history of vestibular disorders or traumatic brain injury were enrolled in this study. Participants underwent vHIT (ICS Impulse Otometrics) and crHIT (Neuro-Otologic Testing Center, Spryson America, Inc.). Results: Mean VOR gain was significantly higher during crHIT compared to vHIT, except for the right horizontal SCC ( p < 0.01). Coefficient of variation (CV) for crHIT was smaller than that observed in vHIT across all 6 SCCs, with significant differences in all but the LA and RP SCCs. We also computed lower limits of normal (LLN) for each condition; up to 2.9% of crHIT values fell outside the acceptable LLN compared to up to 37% of vHIT gain values. Average reduced vestibular response (RVR) for crHIT was lower than that observed in vHIT among all semicircular canal pairs and demonstrated less variability for crHIT as compared to vHIT. Conclusions: Overall, these findings support the clinical utility of crHIT for comprehensive SCC function evaluation.

Objectives: The aims of this study were to compare pre- and post-operative word recognition scores (WRSs) for the adult Spanish-speaking population and to describe their cochlear implant (CI) performance trajectory. Methods: A retrospective chart review (n = 115) was completed for Spanish-speaking post-lingually deafened adults who underwent a traditional CI evaluation and subsequent surgery between 2018 and 2023. Pre- and post-CI (3, 6, 12-month) Spanish Bisyllable WRSs and CI datalogging (hours per day) were collected for 66 subjects who met inclusion. Patients were, on average, 61.4 years of age (SD = 14.9) at the time of their first CI, and all were Hispanic and White (100%). Results: The outcomes of the 66 subjects who met the inclusion criteria were analyzed. Spanish Bisyllable WRSs improved at all post-CI test intervals, though the mean change between intervals showed a decreasing trend over time, with a plateau in WRSs occurring by 6 months post-CI. Time was a significant predictor of increased post-CI WRSs at 6 months (p = 0.004) and 12 months (p < 0.001). Sex, the implanted ear, electrode type, CI manufacturer, and datalogging hours did not significantly predict Bisyllable WRSs. Conclusions: This study used the largest cohort dataset to date to describe pre-and post-CI WRSs for Spanish-speaking adults. The post-CI performance trajectory is similar in Spanish-speaking CI recipients compared to English-speaking cohorts. This study is fundamental in providing evidence-based outcomes for Spanish-speaking CI recipients and will assist clinicians with pre-CI counseling based on realistic expectations.

Objective: The effect of stress on vaccine-induced humoral immunity and therapeutic interventions to mitigate pandemic-related stress remain underexplored. Method: Participants in a longitudinal cohort study (n = 189) completed a validated measure, GAD-7, and 10-instrument stress measure to assess stress and anxiety after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Serum was collected to obtain SARS-CoV-2 antibody titer levels. Results: Participants experienced increased stress due to the SARS-CoV-2 pandemic with a positive correlation between GAD-7 scores and peak antibody titers overall; however, there was a negative association with scores commensurate with severe anxiety. Health care workers and younger participants were more significantly affected by anxiety. Conclusions: Mild anxiety levels may have immune-enhancing effects, whereas severe anxiety may cause antibody generation reduction. Mental health–focused interventions are imperative for younger adults and health care workers. Young adults may be more resilient to increased stress levels.

The objectives of this study were to (1) investigate the association between human blood type and COVID-19 in both inpatient and longitudinal populations and (2) identify the association between blood type and severity of COVID-19 via presence of cellular biomarkers of severe infection in hospitalized individuals at our institution in South Florida. This study consisted of (1) a single-center retrospective analysis of 669 out of 2741 COVID-19-positive, screened patients seen from 1 January 2020 until 31 March 2021 at the University of Miami Emergency Department (ED) who tested positive for COVID-19 and had a documented ABO blood type and (2) a longitudinal SARS-CoV-2 immunity study (“CITY”) at the University of Miami Miller School of Medicine, consisting of 185 survey participants. In an inpatient setting, blood type appeared to be associated with COVID-19 severity and mortality. Blood type O sustained less risk of COVID-19 mortality, and blood type O- demonstrated less risk of developing COVID-19 pneumonia. Inpatients with O- blood type exhibited less biomarkers of severe infection than did other blood types. In a longitudinal setting, there was no association found between blood type and SARS-CoV-2 infection.

False positive reactive plasmin reagin (RPR) reactivity following a COVID-19 vaccine has been reported, and it is therefore conceivable that individuals who receive frequent coronavirus disease 2019 (COVID-19) vaccinations may exhibit durable RPR responses. Here, we sought to investigate the extent to which repeated mRNA COVID-19 vaccines can elicit chronic false RPR reactivity in a longitudinal cohort. Participants (n = 119) in an IRB-approved (#20201026), longitudinal SARS-CoV-2 cohort study were screened for RPR reactivity via manual RPR card assays. Samples with reactive results underwent additional testing, including follow-on RPR screening at additional timepoints, confirmatory fluorescent treponemal antibody (FTA-ABS) testing and anti-nuclear antibody (ANA) testing. Medical histories were collected. We observed (n = 2) screen-positive RPR results (1.7% [2/119]) following booster vaccination, for which two individuals exhibited chronic, vaccine-induced RPR reactivity for up to 9 months following booster vaccination. Both participants were ANA-negative. It is imperative for clinicians to be mindful of the potential immunologic interference of COVID-19 vaccines with standard infectious disease assays, including RPR testing. Detailed medical histories and clinical contexts, including recent vaccination, should be reviewed prior to proceeding with distressing and invasive workups.

Introduction: The objectives of this study were to (1) investigate the association between human blood type and COVID-19 infection in both inpatient and longitudinal populations at our institution in South Florida and (2) identify the association between blood type and severity of COVID-19 infection via presence of cellular biomarkers of severe infection in hospitalized individuals. Methods: This study consists of (1) a single-center retrospective analysis of 669 of 2,741 COVID-19 positive screened patients seen from January 1, 2020 until March 31, 2021 at the University of Miami Emergency Department (ED) who tested positive for COVID-19 infection and had a documented ABO blood type and (2) a longitudinal SARS-CoV-2 immunity study (“CITY”) at the University of Miami Miller School of Medicine consisting of 185 survey participants. COVID-19 outcome rates and 95% confidence intervals were calculated for each ABO blood type and Rh group using Chi-squared tests for categorical and ANOVA for continuous variables in the inpatient cohort and Chi-squared tests for the longitudinal cohort, all executed in R studio. Results: Our inpatient cohort had a mean age of 53.6 (± 17.9) years with 48% males and 52% females. When compared to patients with other blood types, those with O- demonstrated less risk of developing COVID-19 pneumonia (26.7% for O- vs. 69.2% for type A-, 56.5% for A+, 71.4% for AB+, 53.7% for B+, 51.5% for O+, p-value= 0.003 via Chi-squared test) and decreased mortality due to COVID-19 infection (17.0% mortality for O vs. 26.3% for A, 29.2% for B, p-value= 0.012 via Chi-squared test). Blood type O- demonstrated less elevated levels of LDH than did other blood types (p-value= 0.001, ANOVA) and a higher frequency of clinically accepted baseline levels of troponin (0.04 ng/mL) (p-value= 0.026, ANOVA) (Figure 1). Most of the longitudinal cohort was ABO blood grouping type O (47% (87/185)), with 33.5% type A, 14.1% B, and 5.4% AB. Most individuals were Rh positive (85.9%). There was no significant association found between COVID status (infection vs. non-infection) and ABO (Chi-squared test (3, N = 185) = 1.8, p = 0.6) or Rh (Chi-squared test (1, N = 185) = 0.16, p = 0.7) blood typing. Nearly all participants had been vaccinated (95.1% (176/185)), with a majority reporting primary vaccination with Pfizer (57.8% (107/185)), followed by Moderna (33% (61/185)), and Johnson & Johnson (4.3% (8/185)). 8 participants (4.3%) were unvaccinated. Conclusions: In an inpatient setting, blood type O sustained less risk of COVID-19 mortality and O- demonstrated less risk of developing COVID-19 pneumonia. In a longitudinal setting, there was no association found between blood type and COVID-19 severity. As the novelty of COVID-19 infection declines with time, further studies on risk-stratification by blood type are encouraged.