Faculty Bibliography

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.

Hearing loss is a highly prevalent disease state affecting almost 1 in 5 individuals globally. Growing research shows that untreated or undertreated hearing loss carries significant long-term sequelae, including increased risk of social isolation, depression, and cognitive decline, among other ramifications. Limited awareness and common misperceptions among the general US adult population and primary care providers contribute to low rates of referral to hearing specialty clinics and underutilization of hearing aids, cochlear implants, and other rehabilitative devices. Comprised of diverse membership, the Hearing Health Collaborative (HHC) was formed in May 2021 to identify and overcome challenges impacting good health care practices and public policy on hearing care in connection with healthy aging. This editorial documents a recent outcome of the HHC derived from a structured A3 process. Specifically, initiative 2, a proposal to develop a simple, clinically anchored staging system primarily for use by frontline providers and patients, is presented. Unlike other common disorders that harbor long-term health sequelae, a corresponding pragmatic clinical staging system-leveraging precedent disease staging convention, based on clinically meaningful outcomes and prognosis for acquired hearing loss-does not exist. The development of this staging system will potentially allow for improved communication across providers and patients, facilitate referral pathways, and ultimately enable patient access to timely and appropriate care.

OBJECTIVE:NF2-related schwannomatosis (NF2-SWN) is an autosomal dominant genetic disorder characterized by the development of schwannomas, meningiomas, and spinal ependymomas. Treatment with bevacizumab, a monoclonal antibody against VEGF, has been shown to result in decreased vestibular schwannoma size and hearing improvement in ~50% of NF2-SWN patients. It is unknown whether the same degree of benefit is seen in younger patients compared with older patients. The objective of this study is to determine the association between age and bevacizumab treatment outcomes in NF2-SWN. STUDY DESIGN/METHODS:Retrospective cohort study. SETTING/METHODS:Tertiary referral center. PATIENTS/METHODS:Thirty-seven patients with NF2-SWN. INTERVENTIONS/METHODS:Bevacizumab. MAIN OUTCOME MEASURES/METHODS:Change in tumor size of 20% or more. RESULTS:This study includes 37 patients with NF2-SWN who were treated with bevacizumab at our institution between 2014 and 2024. They were divided into 2 groups: 22 adults over the age of 25 (26 to 71 y) and 15 adolescent and young adult (AYA) patients under the age of 25 (12 to 24 y). The median treatment duration was 2.1 years. A significantly higher proportion of AYA schwannomas (37.5%, n=9) exhibited radiographic tumor progression during the treatment period compared with those of the older patient group (11.9%, n=5) (P=0.026), despite similar pre-treatment growth rates. There was no significant difference in the proportion of older and younger patients with hearing decline, improvement, or stability (P>0.05). CONCLUSIONS:AYA patients were significantly more likely to exhibit progression of tumor growth during bevacizumab treatment compared with older patients, though no significant differences were detected in hearing outcomes.

OBJECTIVE:To characterize patient outcomes after primary stereotactic radiosurgery (SRS) for the management of sporadic facial nerve schwannoma. STUDY DESIGN/METHODS:Retrospective cohort study. SETTING/METHODS:Six tertiary referral centers across the United States and United Kingdom. PATIENTS/METHODS:Adults undergoing SRS from 2000 through 2023 for sporadic facial nerve schwannoma along any segment of the facial nerve were included. Patients with NF2-related schwannomatosis were excluded. INTERVENTION/METHODS:Stereotactic radiosurgery. MAIN OUTCOME MEASURE/METHODS:Long-term tumor control. RESULTS:Among 60 patients meeting inclusion, the median age at SRS was 52 years (IQR: 41 to 64) with a median tumor size of 19.5 mm (IQR: 14.7 to 22.8). Tumors commonly involved the internal auditory canal (73%), cisternal (49%), geniculate/labyrinthine (47%), and tympanic segments (22%). Two patients experienced SRS failure and underwent salvage treatment; salvage-free survival rates (95% CI; number still at risk) at 1, 3, 5, and 10 years after SRS were 100% (100 to 100; 55), 100% (100 to 100; 36), 100% (100 to 100; 18), and 87% (72 to 100; 9), respectively. Among 31 (52%) patients with House-Brackmann (HB) grade I facial function at presentation, only 6 demonstrated worse facial function at a median of 3.2 years (IQR: 1.7 to 6.6) after SRS. Of 18 patients with serviceable hearing (AAO-HNS class A/B) at SRS, 13 maintained serviceable hearing at a median of 1.0 years (IQR: 0.5 to 4.9) of post-SRS audiometric follow-up. CONCLUSIONS:Durable tumor control after primary SRS for sporadic facial nerve schwannoma is achieved in most patients. Among those with HB grade I facial function at presentation, treatment with SRS harbors limited additional risk of facial paresis beyond observation alone.