Faculty Bibliography

Oral medicine is the dental specialty dedicated to the oral health care of medically complex patients and the diagnosis and management of medically related diseases, disorders, and conditions affecting the oral and maxillofacial region. Like other dental and medical specialties, oral medicine patient care is often impacted by challenges such as limited manpower, time, or resources. Artificial intelligence (AI) tools seek to supersede these challenges by automating human tasks and ushering greater efficiency and productivity. For direct patient care in oral medicine, AI has applications in risk prediction modeling, diagnosis establishment, treatment decision-making, and prognosis and outcomes prediction modeling.

Oral medicine is the dental specialty dedicated to the oral health of medically complex patients and the diagnosis and management of medically-related diseases, disorders, and conditions affecting the oral and maxillofacial region. In addition to direct patient care, Oral Medicine specialists often engage in indirect patient care activities such as patient education and practice administration and/or academic activities such as student education and research. Artificial intelligence (AI) tools have been increasingly studied to facilitate these domains and contribute to more positive outcomes for practitioners, patients, and students alike. A review of the literature on these AI applications in Oral Medicine and related medical and dental fields provides an understanding of their current advantages and limitations.

Facial nerve palsy is a debilitating condition with substantial physical and psychosocial impacts. Facial reanimation encompasses surgical reconstructive procedures aimed at restoring the functions of the facial nerve to improve function and quality of life in patients with facial palsy. This educational review outlines the essential principles for interpreting imaging studies for facial reanimation including fundamental anatomy, technical descriptions and imaging appearances of common reconstructive procedures, and key findings that should be included when reporting studies for patients being considered for facial reanimation. The information provided in this review equips radiologists to contribute effectively to a multidisciplinary team necessary for the treatment of patients with facial nerve palsy.

OBJECTIVES/HYPOTHESIS/OBJECTIVE:This study sought to characterize the attitudes of performers regarding factors commonly believed to influence the voice. The primary goal was to describe the vocal health habits of singers to provide a framework for clinical counseling and a potential schema for future investigation. Secondary objectives included examining changes in these attitudes over time and identifying differences between professional and amateur vocalists. STUDY DESIGN/METHODS:Prospective, longitudinal analysis. METHODS:A longitudinal assessment was performed across ten years at two time points (2013 and 2023) to investigate potential changes in attitudes and practices over time. Participants were recruited by word of mouth and social media. RESULTS:One hundred nine participants completed the 2013 survey, approximately half of whom were professional vocalists (52.3% professionals vs 47.7% amateurs), defined by those who either considered themselves a professional performer or had at some point obtained their primary source of income from singing or performing. The 2023 cohort included 155 participants who completed the survey, 61.3% of whom were classified as professional vocalists, with the remaining 38.7% classified as amateurs. In both the 2013 and 2023 cohorts, professional vocalists were more likely than amateurs to report factors that affected their voice. Using 2013 survey results, five vocal habits showed statistically significant differences in how amateurs and professionals judged their effects: warming up for 20-60 minutes prior to singing, decongestants, holding breath, cough drops (menthol), and one glass of wine. Using 2023 survey results, eight vocal habits showed statistically significant differences in how amateurs and professionals judged their effects: belting, cough drops (menthol), decongestants, holding breath, menthol spray, spicy foods, steroids, and Throat Coat. CONCLUSION/CONCLUSIONS:This study provides a rich characterization of factors vocalists report as influencing vocal health to varying degrees. Singers' beliefs about vocal health practices at times diverged from available scientific evidence.

OBJECTIVE/UNASSIGNED:Cochlear implant (CI) speech processors have undergone technological advancements. Therefore, patients upgrade speech processors when new features are available or when their previous device becomes broken and is no longer serviceable. This study aimed to identify factors that impact the time to a speech processor upgrade and to evaluate patient experiences with upgrading and following upgrade. METHODS/UNASSIGNED:In this retrospective cohort study, 46 CI surgeries at a single tertiary care center in 2017 and that subsequently received a speech processor upgrade were included. Data on patient demographics, hearing loss history, CI manufacturer, insurance type and status, and configuration were collected. Time to first upgrade, reasons for upgrade, patient-reported satisfaction, and speech perception scores were analyzed. RESULTS/UNASSIGNED:The mean time to a speech processor upgrade was 5.13 years after implantation. The most common reason for an upgrade was the device being over five years old, followed by the device being out of warranty. 45.7% of patients expressed satisfaction with speech processor upgrade, while 8.7% were not satisfied. There were no statistically significant associations between the time to upgrade and demographic factors such as age, sex, insurance type, or CI manufacturer. Following the upgrade, there were no significant changes in speech perception scores. CONCLUSION/UNASSIGNED:Speech processor upgrades at this center align with when insurance companies typically deem upgrades medically necessary. Demographic factors, insurance, and device manufacturer did not significantly influence time to upgrade. While objective speech perception measures did not significantly improve, many patients reported subjective satisfaction with the upgrade.

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.

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.