Faculty Bibliography

A novel psychophysical method was developed for assessing spatial resolution in cochlear implants. Spectrally flat and spectrally peaked pulse train stimuli were generated by interleaving pulses on 11 electrodes. Spectrally flat stimuli used loudness-balanced currents and the spectrally peaked stimuli had a single spatial ripple with the current of the middle electrode raised to create a peak while the currents on two electrodes equally spaced at variable distance from the peak electrode were reduced to create valleys. The currents on peak and valley electrodes were adjusted to balance the overall loudness with the spectrally flat stimulus, while keeping the currents on flanking electrodes fixed. The psychometric functions obtained from percent correct discrimination of peaked and flat stimuli versus the distance between peak and valley electrodes were used to quantify spatial resolution for each of the eight subjects. The ability to resolve the spatial ripple correlated strongly with current level difference limens measured on the peak electrode. The results were consistent with a hypothesis that a factor other than spread of excitation (such as neural response variance) might underlie much of the variability in spatial resolution. Resolution ability was not correlated with phoneme recognition in quiet or sentence recognition in quiet and background noise, consistent with a hypothesis that implantees rely on cues other than fine spectral detail to identify speech, perhaps because this detail is poorly accessible or unreliable.

This study investigated which acoustic cues within the speech signal are responsible for bimodal speech perception benefit. Seven cochlear implant (CI) users with usable residual hearing at low frequencies in the non-implanted ear participated. Sentence tests were performed in near-quiet (some noise on the CI side to reduce scores from ceiling) and in a modulated noise background, with the implant alone and with the addition, in the hearing ear, of one of four types of acoustic signals derived from the same sentences: (1) a complex tone modulated by the fundamental frequency (F0) and amplitude envelope contours; (2) a pure tone modulated by the F0 and amplitude contours; (3) a noise-vocoded signal; (4) unprocessed speech. The modulated tones provided F0 information without spectral shape information, whilst the vocoded signal presented spectral shape information without F0 information. For the group as a whole, only the unprocessed speech condition provided significant benefit over implant-alone scores, in both near-quiet and noise. This suggests that, on average, F0 or spectral cues in isolation provided limited benefit for these subjects in the tested listening conditions, and that the significant benefit observed in the full-signal condition was derived from implantees' use of a combination of these cues.

PURPOSE: National guidelines recommend patients with cancer of reproductive age be informed of their risk for infertility resulting from cancer treatment. Despite existing technologies to preserve fertility, many patients report not receiving timely information about fertility risk, and oncology providers report multiple barriers to discussing or referring patients on this topic. METHODS: Nine cancer centers have been recognized as Fertile Hope Centers of Excellence, a designation awarded to cancer centers with an institutionalized approach to addressing fertility issues. Individual semistructured interviews were conducted with each of these centers to identify strengths of and challenges to their approaches. RESULTS: All institutions had procedures for the provision of topical professional and patient education and for notification of patients. Notification methods varied widely, from use of customized consent forms to highly automated electronic alerts for providers. Referral routines and enactment of institutional policies also differed. Key components of successful programs emerged, including the value of internal champions, affiliation with complementary programs, and resource sharing. CONCLUSION: The programs described provide examples of systems that can be assembled in different types of clinical settings, depending on the availability of resources and infrastructure. As institutions develop programs, metrics to evaluate notification systems, in particular, as well as the supportive program components, should be used so identification of best practices can continue. Widespread adoption of programs that incorporate the baseline elements identified will not only comply with national guidelines but also address patients' reproductive needs and fundamentally affect future quality of life.

PURPOSE: The negative attitudes of patients with cancer regarding clinical trials are an important contributor to low participation rates. This study evaluated whether a brief psychoeducational intervention was effective in improving patients' attitudes as well as their knowledge, self-efficacy for decision making, receptivity to receiving more information, and general willingness to participate in clinical trials. PATIENTS AND METHODS: A total of 472 adults with cancer who had not been asked previously to participate in a clinical trial were randomly assigned to receive printed educational information about clinical trials or a psychoeducational intervention that provided similar information and also addressed misperceptions and concerns about clinical trials. The primary (attitudes) and secondary outcomes (knowledge, self-efficacy, receptivity, and willingness) were assessed via patient self-report before random assignment and 7 to 28 days later. RESULTS: Patients who received the psychoeducational intervention showed more positive attitudes toward clinical trials (P = .016) and greater willingness to participate (P = .011) at follow-up than patients who received printed educational information. Evidence of an indirect effect of intervention assignment on willingness to participate (estimated at 0.168; 95% CI, 0.088 to 0.248) suggested that the benefits of psychoeducation on willingness to participate were explained by the positive impact of psychoeducation on attitudes toward clinical trials. CONCLUSION: A brief psychoeducational intervention can improve the attitudes of patients with cancer toward clinical trials and thereby increase their willingness to participate in clinical trials. Findings support conducting additional research to evaluate effects of this intervention on quality of decision making and rates of participation among patients asked to enroll onto therapeutic clinical trials.

OBJECTIVES: A preponderance of literature supports the safety of office-based flexible endoscopic procedures of the upper aerodigestive tract; however, until recently there were no data regarding hemodynamic stability during these procedures. A recent study showed intraprocedure changes in patients' hemodynamic parameters, raising the concern that perhaps patients should be monitored during these procedures. The aim of our study was to determine whether physiologically significant alterations in vital signs occur during office-based flexible endoscopic procedures. METHODS: We performed a retrospective review of 100 consecutive patients who underwent office-based flexible endoscopic procedures of the upper aerodigestive tract from July 2010 to October 2011. Baseline values and the maximal changes in systolic blood pressure, diastolic blood pressure, heart rate, and oxygen saturation were recorded and compared. RESULTS: One hundred consecutive patients were included in the study. Twenty-one patients (21%) had severe hypertension and 40 patients (40%) had tachycardia during the procedure. The mean change overall in systolic blood pressure was 26.2 mm Hg (p < 0.001), the mean change in diastolic blood pressure was 13.9 mm Hg (p < 0.001), the mean change in heart rate was 16.6 beats per minute (p < 0.001), and the mean change in oxygen saturation was 1.6% (p < 0.001). These changes were significant. On further breakdown into groups, patients over 50 years of age and patients who were undergoing esophageal or laser procedures had significant elevations in heart rate (p = 0.01 and p = 0.04, respectively). An elevation in diastolic blood pressure was also significant in patients who were undergoing esophageal or laser procedures (p = 0.04 for both). CONCLUSIONS: These data concur with those of the previous report that found potentially significant hemodynamic changes during office-based procedures. Although preliminary, our findings suggest that it may be wise to monitor vital signs in patients over 50 years of age and patients who are undergoing an esophageal or laser procedure who are at risk for complications that could arise from tachycardia and hypertension.

BACKGROUND: Saline irrigations are proving to be a valuable intervention in the treatment of chronic sinusitis. The use of surfactants is a well established additive to topical treatments known to reduce surface tension and may prove to be a simple, nonoperative intervention to improve intrasinus douching penetration. METHODS: Six 30-mL, flat-bottomed medicine cups with circular holes cut through the bottom center and varying in diameter from 1 to 6 mm were created with punch biopsies. Water, saline, saline/dye, and saline/dye/surfactant were compared for maximum holding pressure via these modeled ostia. Holding pressures also were determined for cups with septal mucosa fused to the bottom with holes ranging from 1 to 6 mm. In addition, analysis was carried out with blood and blood/surfactant. Finally, five thawed, fresh-frozen cadaver heads were evaluated before any sinus surgery with water/dye and water/dye/surfactant for intrasinus penetration. RESULTS: Surfactant significantly improved the ability of all solutions to penetrate ostia in both the plastic cup and fused septal mucosa model. All nonsurfactant-containing solutions were not statistically different from one another, nor did surfactant change the ostial penetration of blood. Surfactant significantly improved the ability of sinus irrigant to penetrate unoperated sinus cavities (3.12 vs 3.5, p = .021). CONCLUSIONS: The addition of surfactant to saline irrigation improves ostial penetration in undissected and undiseased cadavers. This has practical implications for unoperated patients seeking care for sinus-related symptoms in that we have now described a method for improving topical treatment of target sinus mucosa prior to surgical intervention.

OBJECTIVE: Laryngomalacia is best known as a self-resolving infantile disorder characterized by inspiratory stridor with occlusion of the larynx by collapse of arytenoid tissues due to Bernoulli forces. Adult laryngomalacia has been sporadically described in the literature. We identified a series of patients with aerodynamic supraglottic collapse mimicking laryngomalacia in our Otolaryngology clinic. STUDY DESIGN: Case series. METHODS/PATIENTS: A series of five patients from our Otolaryngology clinic with aerodynamic supraglottic collapse presented with complaints ranging from noisy breathing to dyspnea with exertion. Diagnosis was made using rest and exercise flexible laryngoscopy. RESULTS: Symptoms resolved in all patients who underwent traditional or modified supraglottoplasty. CONCLUSIONS: These patients, all with abnormal corniculate/cuneiform motion occluding the airway during forceful inspiration, reinforce the diagnostic role of rest and exercise flexible laryngoscopy in patients with dyspnea and stridor. These results may suggest that aerodynamic supraglottic collapse is an underdiagnosed clinical entity.