Faculty Bibliography

INTRODUCTION/BACKGROUND:With expanded candidacy, cochlear implantation candidates increasingly present with residual acoustic hearing. The level and stability of residual hearing is particularly relevant when considering electro-acoustic stimulation (EAS). While adult data suggest relative stability, the natural history of residual hearing in children-who often have distinct and potentially progressive etiologies-remains poorly defined. METHODS:We conducted a retrospective cohort study of pediatric (<18 years) and adult patients who underwent unilateral cochlear implantation. Inclusion required contralateral (non-implanted) low-frequency pure-tone average (LF-PTA; 250-500 Hz) ≤85 dB HL and interaural difference ≤15 dB HL. One-year changes in LF-PTA, mid-frequency PTA (MF-PTA; 750-2000 Hz), and PTA (500-4000 Hz) were compared using Mann-Whitney U tests. The proportion with clinically meaningful decline (≥15 dB HL) was compared using Fisher's exact test. Longitudinal trajectories were assessed descriptively. RESULTS:Mean one-year LF-PTA, MF-PTA, and PTA changes between children and adults were not statistically different. However, clinically meaningful LF-PTA decline (≥15 dB) occurred more frequently in children (5/24; 20.83%) than adults (2/46; 4.34%) (p = 0.04). Longitudinal trajectories demonstrated substantial inter-individual variability without a consistent pattern of progressive loss. Etiology-specific trends showed relative stability in birth-related hearing loss, whereas ototoxic, genetic, and enlarged vestibular aqueduct etiologies demonstrated greater decline. CONCLUSIONS:Residual low-frequency hearing in children is generally stable but more variable, with a higher rate of clinically significant decline than in adults one year post-implant. These findings suggest underlying disease progression contributes to hearing changes and should inform counseling and EAS candidacy.

OBJECTIVES/UNASSIGNED:To better understand the implications of tumor size on auditory brainstem implant (ABI) categories of auditory performance (CAP) score to facilitate more precise patient counselling. DESIGN/UNASSIGNED:Single-center retrospective chart review. SETTING/UNASSIGNED:Tertiary referral center. PARTICIPANTS/UNASSIGNED:Patients > 18 years old with neurofibromatosis type 2 who underwent ABI placement between the years 2009 and 2023 were included. Patients with prior surgical resection were excluded to reduce the potential of previous cochlear nucleus trauma confounding results. MAIN OUTCOME MEASURES/UNASSIGNED:Ipsilateral tumor volume was measured from the preoperative MRI, and the primary endpoint was the 1-year CAP score. RESULTS/UNASSIGNED: = 0.010). CONCLUSION/UNASSIGNED:Increased tumor size has a negative correlation with ultimate ABI performance. There were patients in this study with larger tumor sizes who still benefited from ABI placement. While larger tumor size should not be a contraindication for ABI placement, understanding the role tumor size can have on performance variation can serve to improve tumor management strategies and preoperative counselling.

OBJECTIVES/OBJECTIVE:There is increased recognition of the importance of hearing ability in social connectedness and healthy aging. Hearing loss is common among Veterans, and hearing rehabilitation is prioritized within the Veterans Administration (VA). Despite the attention to hearing care in the VA, limited data on cochlear implant (CI) utilization raises concern about whether this transformative and accessible treatment is reaching Veterans who could be helped with communication to improve their quality of life. The overall hypothesis is that Veterans with severe hearing loss, despite having unique rehabilitative needs, are not consistently treated as a distinct population. In this article, we identify patterns associated with specific management strategies for Veterans with severe hearing loss and describe the utilization of CIs in the VA as an evidence-based strategy when hearing aids provide limited benefit. DESIGN/METHODS:We investigated rehabilitation strategies used for Veterans with severe hearing loss. We defined a population-based cohort of 213,285 United States Veterans with newly diagnosed bilateral severe or worse hearing loss from January 1, 2006, to December 31, 2023. Severe hearing loss was defined as having a 4-frequency pure tone average (0.5, 1, 2, and 4 kHz) ≥70 dB HL in both ears. Speech perception abilities were also collected. We related hearing rehabilitation treatment of Veterans to factors hypothesized to impact care, including audiologic results, sociodemographic characteristics, comorbidities, and geography. Main outcomes included the receipt of CI and the cumulative incidence of CI. We used a competing risks framework to determine the factors associated with CI receipt. RESULTS:Of the 213,285 Veterans with bilateral severe or poorer hearing loss (mean age [SD], 80.3 [9.7]), 202,949 (95.2%) were fit with hearing aids, 5335 (2.5%) had a CI procedure, and 5001 (2.3%) had no evidence of receiving hearing rehabilitation. The 5- and 10-yr cumulative incidence (95% confidence interval) of receipt of CI was 1.9% (1.8 to 2.0%) and 2.9% (2.8 to 3.0%), respectively (death treated as a competing risk). In competing risks regression, age, race and ethnicity, VA priority group, word recognition score (WRS), hearing loss severity, the year hearing loss was first identified, and a greater number of comorbidities were all significantly associated with the receipt of CI. Patient age, word recognition score, and hearing loss severity were found to be the most important predictors of CI receipt based on concordance loss. CONCLUSIONS:Most Veterans with severe hearing loss and poor speech understanding, who are likely to be audiologic candidates for CIs, are treated with hearing aids, whereas relatively few receive CIs. The treatment approach may be driven by several different factors specific to the Veteran, site of care, and VA policies. A multifaceted strategy and care delivery may be required to improve evidence-based care for those with severe hearing loss.

OBJECTIVES/UNASSIGNED:To develop and study a novel means of imaging auditory brainstem implant (ABI) paddle placement utilizing postoperative MRI images to determine correlation between ABI performance and ideal paddle placement properties. DESIGN/UNASSIGNED:Single-center retrospective review and image analysis. SETTING/UNASSIGNED:Tertiary referral center. PARTICIPANTS/UNASSIGNED:Patients >18 years old who received an ABI from 2009 to 2023 and had subsequent MRI and auditory performance testing completed. MAIN OUTCOME MEASURES/UNASSIGNED:ABI paddle angulation and insertion depth measure, in addition to categories of auditory performance (CAP) score. RESULTS/UNASSIGNED: = 0.049) once patients with large tumor burden were excluded. Insertion depth and axial angulation showed a negative correlation, in which higher insertion depth was associated with a decrease in axial angulation value, although not statistically significant. CONCLUSION/UNASSIGNED:We present a novel means of measuring ABI paddle placement utilizing MRI to improve the objectivity of paddle placements assessments. Multicenter collaboration to increase the number of patients studied with this new measurement scheme will be required before stronger measurement associations can be determined.

BACKGROUND:Age-related hearing loss is highly prevalent, underrecognized, and consequently, undertreated. Hearing loss can have a substantial negative impact on communication and biopsychosocial health. We hypothesize that offering validated hearing assessments and a point-of-care counseling program in an older, underserved population will be more accessible and acceptable than the traditional pathway for audiology care, particularly in marginalized communities. METHODS:This convergent mixed methods feasibility study will assess the implementation of a hearing program embedded in a quality improvement initiative within the Geriatric Clinic of New York City Health and Hospital's Bellevue Hospital Center and the feasibility of recruiting for a future efficacy trial to test the intervention. Adult patients ≥ 60 years who are proficient in English or Spanish and not currently using hearing rehabilitation are eligible for initial screening. Hearing level, including individual ear severity, is identified using a validated tablet-based measure of pure tone audiometry and a self-report measure of hearing disability. We define hearing loss subjectively based on a score of 8 or greater on the Hearing Handicap Inventory-Screen (HHI-S) or using a four-frequency pure tone average > 25 dB hearing level in the better ear, representing at least a mild hearing loss. Patients who are determined to have measurable hearing loss and provide informed consent will be invited to participate in a pilot study and randomized to one of two approaches: (1) a counseling on alternative rehabilitation strategies intervention arm or (2) usual care with referral to the audiology pathway. Primary feasibility outcomes include recruitment and retention rates, intervention adherence, acceptability, and the ability to collect outcome measurements. We will also explore changes in HHI-S scores over 3 months and assess subsequent audiology service utilization in both groups. In addition to the quantitative data, we will include key participant interviews with staff and patients to assess feasibility from participant attitudes. DISCUSSION/CONCLUSIONS:This study will provide insights into the feasibility of offering hearing screening/assessments and counseling in primary care and its potential to improve access to hearing care for underserved older adults. Findings will inform the design of future trials evaluating the impact of primary care-based tailored hearing interventions on patient health and quality of life. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov NCT05943509, Trial registration date: July 13, 2023, Protocol Version: 1.

BACKGROUND:Age-related hearing loss is common and a particularly prevalent disability among Veterans. In response, comprehensive hearing services are available within the Veterans Affairs (VA) integrated healthcare system. Severe hearing loss may pose distinct communication challenges inadequately addressed by hearing aids, but data suggest severe hearing loss is often not treated differently. We sought to identify barriers and facilitators to evidence-based and individualized management of severe hearing loss from the perspectives of VA clinicians and Veterans. METHODS:We used purposeful sampling to conduct remote semi-structured video interviews with 33 current VA clinicians encompassing multiple disciplines and 39 Veterans with severe hearing loss over approximately an 18 month period (May 2022 to December 2023). We analyzed qualitative data using content thematic analysis. Coding categories were summarized within each participant; then across all participants to yield clinician-specific and Veteran themes. RESULTS:In the sample of 33 VA clinicians (20 audiologists, 9 otolaryngologists and 4 primary care clinicians), the overarching theme of qualitative data is that hearing loss is undertreated in the Veteran population. Across clinician groups, the qualitative data revealed multi-level factors (system-, clinician-, and patient-level) that influence the delivery of hearing care and management for Veterans with severe hearing loss. Interviews revealed that efficient access and collaborative care facilitate evidence-based practice. Among Veterans, inadequately managed hearing loss impacts quality of life; lack of knowledge and misconceptions about hearing care options and system-level barriers influence Veterans' perceptions of their hearing care and management. CONCLUSION/CONCLUSIONS:Although hearing care is available to Veterans, multi-level factors influence the delivery of hearing care and management for Veterans with severe hearing loss. Greater attention both in primary and specialty care is needed to ensure tailored treatments are available to Veterans with severe hearing loss across the integrated VA health care system.

OBJECTIVE:We sought to apply a previously developed transimpedance (TIM) heatmap pattern classification scheme in patients with no known risk factors for cochlear anomalies, in addition to patients implanted in the revision setting, to better understand the incidence of pattern variants, and potential clinical implications. STUDY DESIGN/METHODS:Single-center retrospective review. SETTING/METHODS:Tertiary referral centre. PATIENTS/METHODS:Patients older than 6 months of age who underwent cochlear implantation between June 2020 and June 2024 with normal gross cochlear anatomy and no concern for fibrosis that had intraoperative TIM testing completed. Patients undergoing revision implantation were also included as a separate cohort. INTERVENTION/METHODS:None. MAIN OUTCOME MEASURES/METHODS:The number of patients with normal and variant TIM patterns was evaluated for each cohort. TIM patterns were subsequently compared with the electrode position found on intraoperative x-ray. RESULTS:There were 321 ears that underwent implantation and subsequent intraoperative TIM assessment meeting inclusion criteria. Of these, 310 (96.6%) were in the primary surgery setting, and 11 (3.4%) were in the revision surgical setting. In the primary surgical setting, 86.4% (n=268) of the implants demonstrated a normal TIM heatmap. Compared with the primary surgical setting, where only 45.5% (n=5) of revision surgery TIM heatmaps were interpreted as normal. One patient in the revision setting had a newly identified "double X" pattern corresponding to a normal electrode position on x-ray. CONCLUSIONS:There is a decreased incidence of previously developed TIM heatmap pattern variants in CI recipients with normal gross cochlear anatomy.

UNLABELLED:<p>Introduction: Cochlear implantation has demonstrated benefit for restoring hearing in patients with Ménière's disease. We sought to examine disease and management factors that may influence postoperative speech performance and vertigo control. METHODS:A single-center retrospective chart review between 2010 and 2023 of patients with Ménière's disease receiving a cochlear implant (CI). The primary outcome was 1-year postoperative word recognition score on Consonant-Nucleus-Consonant (CNC) testing. Postoperative vertigo control was assessed as a secondary outcome. Variables including concurrent labyrinthectomy, pre- and postoperative Ménière's disease symptoms and treatments, duration of deafness, and hearing loss laterality were analyzed. RESULTS:Twenty-five patients were identified over the study period. Of those, 9 (36%) also underwent labyrinthectomy; 6 (67%) were performed simultaneously with CI and 3 (33%) received a CI following surgical ablation. There was a statistically significant (p = 0.03) higher rate of bilateral Ménière's disease in the CI-only cohort (n = 9, 56%), compared to the cochlear implant and labyrinthectomy (CI + L) cohort (n = 1, 11%). There was also a higher rate of preoperative uncontrolled vertigo (n = 5, 56%) in the CI + L cohort compared to the CI-only cohort (n = 3, 20%), although this did not reach statistical significance (p = 0.08). The average pre- and postoperative CNC score for the CI + L cohort was 3.6 (SD 5.9) and 36.7 (SD 17.5), respectively, and 7.1 (SD 10.1) and 62.1 (SD 14.3) for the CI-only group. There was a statistically significant difference noted at most recent CNC follow-up testing (p = 0.01) between the CI + L and CI-only group. CONCLUSION/CONCLUSIONS:Patients with Ménière's disease meeting CI candidacy criteria may undergo CI safely and achieve speech performance benefit. A trend toward worse performance in patients who undergo concurrent labyrinthectomy with CI compared to CI alone was seen which warrants further study. </p>.

OBJECTIVE/UNASSIGNED:We sought to consolidate the anatomical findings from radiologic research and prior surgical literature to develop a stepwise surgical approach utilizing cadaveric specimens which can serve to improve the accuracy and scalability of surgical apical cochleostomies in the future. METHODS/UNASSIGNED:Cadaveric temporal bone dissections, with subsequent image documentation and distance measurements to confirm surgical accuracy. RESULTS/UNASSIGNED:All four temporal bones (100%) that were drilled utilizing the newly developed surgical approach had an accurately placed apical cochleostomy. No inadvertent entry into the middle turn of the cochlea occurred. There was no violation of the labyrinthine facial nerve, or carotid artery. CONCLUSIONS/UNASSIGNED:Preliminary findings are promising for the described steps to achieve a substantial improvement in apical cochleostomy accuracy, with reduced trauma compared to historically taught techniques.

OBJECTIVE:Music, like all forms of art, seeks to communicate emotional content to its audience. The signal provided by cochlear implants (CI) does not faithfully represent the psychophysical relationships inherent in music; however, it is unknown whether targeted musical emotions are conveyed through electric only stimulation with a cochlear implant. METHODS:Twenty musical excerpts for which there was concordance among normal hearing (NH) listeners as to the emotion conveyed: (1) happy, (2) sad, (3) scary, or (4) peaceful were presented to cochlear implant (CI) subjects (n = 20) and age-matched NH controls (n = 8) through a specifically designed iPad application. The musical clips were original recordings of western music from various musical genres but not widely familiar to participants. Subjects also completed a music background questionnaire. RESULTS:CI users identified the target emotion in only 57% of excerpts compared with NH listeners who correctly identified the target emotion in 76.9% of excerpts. Musical excerpts with the target emotion of happy were recognized in 84% of cases by CI users compared with 75% among NH controls while the remaining target emotions were much more difficult for CI users compared with NH raters. Length of CI experience, speech perception scores, and musical training or listening habits did not correlate with performance on this task. CONCLUSIONS:Current CI technology and processing strategies do not convey the range of emotions conveyed in music as recognized by normal hearing subjects. This difficulty may explain the reported lack of interest many patients have in music after CI despite a passion for music before onset of hearing loss. LEVEL OF EVIDENCE/METHODS:3 Laryngoscope, 135:2112-2119, 2025.