Faculty Bibliography

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>.

Speech production entails several processing steps that encode linguistic and articulatory structure, but whether these computations correspond to spatiotemporally discrete patterns of neural activity is unclear. To address this issue, we use electrocorticography to directly measure the brains of neurosurgical participants performing an interactive speech paradigm. We observe a broad range of cortical modulation profiles, and subsequent clustering analyses establish that responses comprised distinct classes associated with sensory perception, planning, motor execution, and task-related suppression. These activity classes are also localized to separate neural substrates, indicating their status as specialized networks. We then parse dynamics in the planning and motor networks using unsupervised dimensionality reduction, which reveals subnetworks that are sequentially active throughout preparation and articulation. These results therefore support and extend a localizationist model of speech production where cortical activity "flows" within and across discrete pathways during language use.

Despite the poor sound quality provided by cochlear implants (CIs), single-sided deaf (SSD) CI users prefer to listen to music with the acoustic hearing (AH) and CI ears together rather than with the AH ear alone. The source of this binaural benefit remains unclear. In the present study, sound quality ratings were collected in SSD CI users for music excerpts from different genres (pop, rock, and classical). A novel vocoder-to-the-CI (VCI) approach was used to control the spectral and temporal information delivered to the CI ear. Custom sine-wave vocoders were designed for each participant according to the frequency allocation in their clinical map. Sound quality ratings were collected with CI-only, AH-only, and CI+AH listening. CI+AH ratings were significantly higher than AH-only ratings when unprocessed stimuli or vocoded stimuli with spectro-temporal information were delivered to the CI ear. There were no significant differences among CI+AH ratings for the unprocessed stimuli, vocoded stimuli with spectro-temporal information, and vocoded stimuli with greatly reduced temporal cues, suggesting that the binaural benefit was largely driven by similar spectral information across ears. Effects of genre were minimal. CI+AH ratings for unprocessed music were significantly correlated with CI-only ratings (r = 0.57, p < 0.001), with the slope (0.97) suggesting that the binaural benefit was largely additive between the AH and CI ears. VCI appears to be a fruitful approach to control the spectral and temporal information delivered to the CI ear without directly manipulating CI users' clinical processors.

Developing populations of connected neurons often share spatial and/or temporal features that anticipate their assembly. A unifying spatiotemporal motif might link sensory, central, and motor populations that comprise an entire circuit. In the sensorimotor reflex circuit that stabilizes vertebrate gaze, central and motor partners are paired in time (birthdate) and space (dorso-ventral). To determine if birthdate and/or dorso-ventral organization could align the entire circuit, we measured the spatial and temporal development of the sensory circuit node: the vestibular ganglion neurons. We discovered that progressive dorsal-to-ventral organization closely predicts vestibular ganglion development, with additional organization along its functional (rostrocaudal) axis. With an acute optical lesion and calcium imaging paradigm, we found that this common temporal axis anticipated functional sensory-to-central partner matching. We propose a "first-come, first-served" model in which birthdate organizes and assembles the sensory, central, and motor populations that comprise the gaze stabilization circuit, a general strategy for poly-synaptic circuit assembly across embryonically-diverse neural populations.

OBJECTIVE/UNASSIGNED:Signaling was introduced to the otolaryngology match in 2021, with 5 signals allotted to applicants in 2021, 4 in 2022, 7 in 2023, and 25 in 2024. This study investigated the modifying effect of signaling volume on the relationship between away rotations and matching in otolaryngology from 2018 to 2024. STUDY DESIGN/UNASSIGNED:Cross-sectional. SETTING/UNASSIGNED:National survey of US medical students. METHODS/UNASSIGNED:We used the Texas Seeking Transparency in Application to Residency (STAR) survey responses of otolaryngology applicants from 2018 to 2024. Using multivariate logistic regression, we determined the odds of matching where away rotations were performed and how these odds varied across the pre-volume (2018-2020), low-volume (2021-2023), and high-volume (2024) signaling eras. RESULTS/UNASSIGNED: < .001). CONCLUSION/UNASSIGNED:The introduction of signaling and the recent increase in signal number are associated with decreased likelihood of matching at a program where an away rotation was performed compared to the pre-signaling era. LEVEL OF EVIDENCE/UNASSIGNED:V.

OBJECTIVE:With regulatory approval of HPV-specific immunotherapy for recurrent respiratory papillomatosis (RRP) and growing experience with systemic bevacizumab, a management algorithm incorporating these medical treatments is warranted. DATA SOURCES AND METHODS/METHODS:RRP Foundation (RRPF) Key Opinion Leaders offer a proposed management algorithm for adults with RRP considering published literature and commercial drug availability. RESULTS:Preventative HPV vaccination should be considered for all patients. Determination of HPV type and pulmonary imaging are important for contemporary RRP patient care and assist in decision making. Risks and benefits of papilloma debulking as needed versus medical management of RRP must be deliberated on a patient case-by-case basis. HPV-specific immunotherapy that induces an HPV-specific T cell response to target the underlying HPV infection that is the cause of RRP is safe, offers the possibility of durable disease control following a short treatment course and is the recommended first-line medical treatment for patients who wish to avoid the risks of repeat procedural management. Papilloma disease control with systemic bevacizumab, which carries defined risks and must be continued for clinical benefit is the recommended second-line medical treatment for patients who do not achieve a complete response with immunotherapy and wish to continue medical management. For patients who elect to be treated with debulking procedures as needed, use of locally-administered adjuvant should be considered. CONCLUSION/CONCLUSIONS:This proposed management algorithm from the RRPF serves as a contemporary resource and information guide for adult patients with RRP and their physicians considering treatment options.

OBJECTIVES/OBJECTIVE:Traditionally, disorders of the vocal fold (VF) mucosa and underlying musculature have been regarded as mutually exclusive entities. However, emerging evidence from other organ systems suggests mucosal and muscle compartments engage in reciprocal interactions with functional consequences. We hypothesized that similar crosstalk exists in the VF, whereby fibrotic mucosa influences adjacent muscle. To model this process, we stimulated human VF fibroblasts (HVOX) with TGF-β1, a central mediator of fibrosis, and examined the effects on rat VF myoblasts (rVF-Mbs), as well as reciprocal influences of rVF-Mbs on fibroblasts. METHODS:HVOX fibroblasts were stimulated with 10 ng/mL TGF-β1, and the effects on rVF-Mbs were assessed using conditioned media and co-culture. Myotube formation was evaluated by immunofluorescence, and nuclear localization of Smad2/3 was examined in conditioned media experiments. qRT-PCR quantified transcripts related to myogenic differentiation and Smad2/3 signaling. ALK4/5 inhibition was performed in co-culture to test TGF-β/Smad2/3-signaling pathway involvement. Reciprocal effects were examined by changes in fibrogenic gene expression in HVOX fibroblasts. RESULTS:Both conditioned media and co-culture suppressed myogenic differentiation in rVF-Mbs; increased inhibition was observed in co-culture, as indicated by reduced myotube formation, decreased Myh2 expression, and activation of Smad2/3 signaling. ALK4/5 inhibition abrogated these effects. Differentiating rVF-Mbs attenuated the fibrogenic phenotype of HVOX fibroblasts. CONCLUSIONS:Fibrotic VF mucosal cells can impair myogenic differentiation through TGF-β/Smad2/3-mediated fibroblast-myoblast crosstalk, and myogenic cells may exert reciprocal anti-fibrotic effects. These findings suggest mucosa-muscle interactions may contribute to VF pathology and highlight Smad2/3 as a potential therapeutic target. LEVEL OF EVIDENCE/METHODS:NA STUDY DESIGN: In vitro.