Publications by authors named "Anil K Lalwani"

167 Publications

Is Cochlear Implantation Effective for Auditory Rehabilitation Following Vestibular Schwannoma Treatment?

Laryngoscope 2021 Aug 20. Epub 2021 Aug 20.

Department of Otolaryngology/Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, U.S.A.

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http://dx.doi.org/10.1002/lary.29836DOI Listing
August 2021

Integrating community health workers into a community hearing health collaborative to understand the social determinants of health in children with hearing loss.

Disabil Health J 2021 Aug 13:101181. Epub 2021 Aug 13.

Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, 180 Fort Washington Avenue, New York, NY, 10032, USA. Electronic address:

Background: Children with hearing loss (HL) require coordination of care to navigate medical and social services. Strong evidence supports the role of community health workers (CHWs) to identify and address social barriers.

Objective: The goal of this study was to evaluate the impact of integrating CHWs into the medical teams of children with HL and identify the social needs associated with their caregivers at a large urban hospital center.

Methods: A retrospective chart review was conducted for 30 children with HL whose caregivers enrolled in a CHW program between August 1, 2017 and December 31, 2019. Baseline demographic data were collected, including social circumstances such as food and housing insecurity, status of social security supplemental income (SSI), and need for referral to early intervention (EI) or preschool/school services. Caregivers were assessed for confidence in self-management; baseline distress level was measured via a distress thermometer.

Results: Of the 30 charts reviewed, 93% demonstrated social needs including food insecurity (24%) and educational service needs (45%). Eighty-seven percent of caregivers reported a sense of control over the child's condition, yet 73% reported a stress level of four or greater on the distress thermometer scale. At 3 months follow-up, 70% of patients completed referrals; a significant number of patients had obtained hearing aids and cochlear implants compared to baseline (p = 0.017).

Conclusions: Caregivers of children with HL face multiple social obstacles, including difficulties connecting to educational and financial resources. CHWs are instrumental in identifying social needs and connecting caregivers to services.
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http://dx.doi.org/10.1016/j.dhjo.2021.101181DOI Listing
August 2021

Chronic Obstructive Pulmonary Disease is a Risk Factor for Sensorineural Hearing Loss: A US Population Study.

Otol Neurotol 2021 Aug 13. Epub 2021 Aug 13.

Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center Graham Headache Center at the Brigham and Women's Faulkner Hospital and Department of Neurology at the Mass General Hospital, Harvard University, Boston, Massachusetts Department of Mechanical Engineering, The Fu Foundation School of Engineering and Applied Science, Columbia University, New York, New York.

Objectives: The goal of this study is to determine if chronic obstructive pulmonary disease (COPD) is associated with sensorineural hearing loss (SNHL) in a national database.

Study Design: Cross-sectional study.

Setting: National sample of the United States population.

Patients: Adults with audiometric and spirometry data from the National Health and Nutrition Examination Study (NHANES) database.

Interventions: None.

Methods: A total of 2,464 adults with spirometry and audiometry data from the NHANES database (2009-2012) were studied. Outcome measures included hearing, measured by high-frequency pure tone average (HFPTA; 3, 4, 6, 8 kHz) and low-frequency pure tone average (LFPTA; .5, 1, 2 kHz) frequencies. SNHL was defined as a HFPTA or LFPTA threshold more than 25 decibels (dB) in the better ear. Multivariable regression analyses explored the association between hearing loss and COPD.

Results: The prevalence of COPD was 19.8% in individuals with SNHL in the better ear and 4.7% in individuals with normal hearing (p < 0.001). Presence of COPD was associated with elevated hearing thresholds (worse hearing) at each individual frequency. The presence of COPD was independently associated with a 3.29 dB (95% CI: 1.48, 5.09) increase in HFPTA (p < 0.001), and 2.32 dB (1.13, 3.50) increase in LFPTA (p < 0.001) after controlling for medical, social, and environmental covariates. The presence of COPD was independently associated with a 1.85-fold (1.12, 3.06) increased odds of isolated low-frequency SNHL (p = 0.017).

Conclusions: COPD was independently associated with sensorineural hearing loss after controlling for multiple confounding factors. These results contribute to the evidence that COPD and pulmonary dysfunction can be comorbid with hearing decline.
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http://dx.doi.org/10.1097/MAO.0000000000003317DOI Listing
August 2021

Impact of Systemic versus Intratympanic Dexamethasone Administration on the Perilymph Proteome.

J Proteome Res 2021 08 22;20(8):4001-4009. Epub 2021 Jul 22.

Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York 10032, United States.

Glucocorticoids are the first-line treatment for sensorineural hearing loss, but little is known about the mechanism of their protective effect or the impact of route of administration. The recent development of hollow microneedles enables safe and reliable sampling of perilymph for proteomic analysis. Using these microneedles, we investigate the effect of intratympanic (IT) versus intraperitoneal (IP) dexamethasone administration on guinea pig perilymph proteome. Guinea pigs were treated with IT dexamethasone ( = 6), IP dexamethasone ( = 8), or untreated for control ( = 8) 6 h prior to aspiration. The round window membrane (RWM) was accessed via a postauricular approach, and hollow microneedles were used to perforate the RWM and aspirate 1 μL of perilymph. Perilymph samples were analyzed by liquid chromatography-mass spectrometry-based label-free quantitative proteomics. Mass spectrometry raw data files have been deposited in an international public repository (MassIVE proteomics repository at https://massive.ucsd.edu/) under data set # MSV000086887. In the 22 samples of perilymph analyzed, 632 proteins were detected, including the inner ear protein cochlin, a perilymph marker. Of these, 14 proteins were modulated by IP, and three proteins were modulated by IT dexamethasone. In both IP and IT dexamethasone groups, VGF nerve growth factor inducible was significantly upregulated compared to control. The remaining adjusted proteins modulate neurons, inflammation, or protein synthesis. Proteome analysis facilitated by the use of hollow microneedles shows that route of dexamethasone administration impacts changes seen in perilymph proteome. Compared to IT administration, the IP route was associated with greater changes in protein expression, including proteins involved in neuroprotection, inflammatory pathway, and protein synthesis. Our findings show that microneedles can mediate safe and effective intracochlear sampling and hold promise for inner ear diagnostics.
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http://dx.doi.org/10.1021/acs.jproteome.1c00322DOI Listing
August 2021

SUDDEN SENSORINEURAL HEARING LOSS AND COVID-19: AN EVOLVING DISCUSSION.

Otol Neurotol 2021 08;42(7):e968-e969

Department of Otolaryngology-Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center and Columbia University Vagelos College of Physicians and Surgeons.

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http://dx.doi.org/10.1097/MAO.0000000000003233DOI Listing
August 2021

Novel Web-Based Music Re-Engineering Software for Enhancement of Music Enjoyment Among Cochlear Implantees.

Otol Neurotol 2021 Oct;42(9):1347-1354

Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center.

Objectives: Cochlear implant (CI) listeners experience diminished music perception and enjoyment from a variety of patient-related and implant-related factors. We investigate the hypothesis that patient-directed music re-engineering may enhance music enjoyment with CI.

Study Design: Prospective cohort study.

Setting: Academic cochlear implant center.

Subjects And Methods: A multidisciplinary team of neurotologists, audiologists, and a sound/audio engineer collaborated with a web developer to create a music re-engineering application. Experienced adult CI listeners rated original excerpts from five major genres of music on enjoyment using a visual analog scale (VAS). Subjects were then allowed to re-engineer the original by adjusting treble frequencies, bass frequencies, percussion emphasis, and reverberation and again rated on enjoyment.

Results: Total of 46 subjects, with a mean age of 57.6 years (SD = 16; range, 18-90) participated in the study. User-mixed audio was rated higher across all measures of enjoyment than original recordings (mean difference +0.92; p < 0.05, CI [0.22, 1.62]), an effect that was seen across all genres except for country music. Subjects preferred louder bass frequencies (mean difference +7.1 dB; p < 0.01, CI [2.15, 24.3]) and more reverberation (mean difference +6.6 ms; p < 0.01, CI [2.85, 10.7]). Re-engineered music increased enjoyment in 57%, and 79% reported an interest in being able to mix music of their own choosing.

Conclusion: User-directed music re-engineering increases music enjoyment for CI listeners. The cochlear implantee preferred heightened bass, reverberation, and treble across musical genres. These findings support the implementation of patient-directed music re-engineering to enhance music enjoyment with technology that is readily available today.
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http://dx.doi.org/10.1097/MAO.0000000000003262DOI Listing
October 2021

A Novel 3D-Printed Head Holder for Guinea Pig Ear Surgery.

Otol Neurotol 2021 Oct;42(9):e1197-e1202

Department of Otolaryngology - Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons.

Background: Otologic surgery in guinea pig requires head immobilization for microscopic manipulation. Existing commercially available stereotaxic frames are expensive and impede access to the ear as they rely on ear bars or mouthpieces to secure the head.

Method: Prototype head holders were designed using the Solidworks 2019 software and 3D-printed using Formlabs Form 2 Printers with photopolymer resin. The head holder consists of a C-shaped brace with adjustable radial inserts of 1/4-20 UNC standard screws with cone point tips providing head fixation for animals of various sizes. The C-shaped brace is attached to a rod that can be secured to a commercially available micromanipulator. The head holder design was tested during in vivo guinea pig experiments where their head motion with (n = 22) and without the head holder (n = 2) was evaluated visually through a stereotaxic microscope at 24× magnification during surgery.

Results: The head holder design was easy to use and allowed for both nose cone administration of anesthesia and access to the ear for intraoperative auditory testing and manipulation. Functionally, the head holder successfully minimized head movement. Furthermore, harvested round window membranes evaluated at 72 hours following surgery showed precise perforations with the use of head holder.

Conclusion: The novel 3D-printed head holder enables simultaneous access for nose cone administration of anesthesia and surgical manipulation of the ear and brain. Moreover, it provides a modular, intuitive, and economical alternative to commercial stereotaxic devices for minimizing head motion during small animal surgery.
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http://dx.doi.org/10.1097/MAO.0000000000003255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8448908PMC
October 2021

Does Stereotactic Radiosurgery Worsen Vestibular Symptoms In Patients With Vestibular Schwannoma?

Laryngoscope 2021 Jun 3. Epub 2021 Jun 3.

Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A.

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http://dx.doi.org/10.1002/lary.29670DOI Listing
June 2021

Simulation assisted design for microneedle manufacturing: Computational modeling of two-photon templated electrodeposition.

J Manuf Process 2021 Jun 16;66:211-219. Epub 2021 Apr 16.

Department of Chemical Engineering, Columbia University, New York, NY, 10027, USA.

Fully metallic micrometer-scale 3D architectures can be fabricated via a hybrid additive methodology combining multi-photon lithography with electrochemical deposition of metals. The methodology - referred to as two-photon templated electrodeposition (2PTE) - has significant design freedom that enables the creation of complicated, traditionally difficult-to-make, high aspect ratio metallic structures such as microneedles. These complicated geometries, combined with their fully metallic nature, can enable precision surgical applications such as inner ear drug delivery or fluid sampling. However, the process involves electrochemical deposition of metals into complicated 3D lithography patterns thicker than 500 μm. This causes potential and chemical gradients to develop within the 3D template, creating limitations to what can be designed. These limitations can be explored, understood, and overcome via numerical modeling. Herein we introduce a numerical model as a design tool that can predict growth for manufacturing complicated 3D metallic geometries. The model is successful in predicting the geometric result of 2PTE, and enables extraction of insights about geometric constraints through exploration of its mechanics.
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http://dx.doi.org/10.1016/j.jmapro.2021.04.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128138PMC
June 2021

Is Betahistine Effective in the Treatment of Ménière's Disease?

Laryngoscope 2021 Mar 23. Epub 2021 Mar 23.

Department of Otolaryngology/Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.

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http://dx.doi.org/10.1002/lary.29535DOI Listing
March 2021

In Response to Is Bilateral Cochlear Implantation Cost-Effective Compared to Unilateral Cochlear Implantation?

Laryngoscope 2021 05 26;131(5):E1700. Epub 2021 Feb 26.

Department of Otolaryngology- Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A.

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http://dx.doi.org/10.1002/lary.29467DOI Listing
May 2021

Inner Ear Gene Delivery: Vectors and Routes.

Hearing Balance Commun 2020 25;18(4):278-285. Epub 2020 Aug 25.

Department of Otolaryngology -- Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, NY.

Objectives: Current treatments for hearing loss offer some functional improvements in hearing, but do not restore normal hearing. The aim of this review is to highlight recent advances in viral and non-viral vectors for gene therapy and to discuss approaches for overcoming barriers inherent to inner ear delivery of gene products.

Data Sources: The databases used were Medline, EMBASE, Web of Science, and Google Scholar. Search terms were [("cochlea*" or "inner ear" or "transtympanic" or "intratympanic" or "intracochlear" or "hair cells" or "spiral ganglia" or "Organ of Corti") and ("gene therapy" or "gene delivery")]. The references section of resulting articles was also used to identify relevant studies.

Results: Both viral and non-viral vectors play important roles in advancing gene delivery to the inner ear. The round window membrane is one significant barrier to gene delivery that intratympanic delivery methods attempt to overcome through diffusion and intracochlear delivery methods bypass completely.

Conclusions: Gene therapy for hearing loss is a promising treatment for restoring hearing function by addressing innate defects. Recent technological advances in inner ear drug delivery techniques pose exciting opportunities for progress in gene therapy.
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http://dx.doi.org/10.1080/21695717.2020.1807261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888570PMC
August 2020

Radiologic Assessment of the Sinonasal Tract, Nasopharynx and Mastoid Cavity in Patients with SARS-Cov-2 Infection Presenting with Acute Neurological Symptoms.

Ann Otol Rhinol Laryngol 2021 Feb 11:3489421995070. Epub 2021 Feb 11.

Department of Otolaryngology-Head and Neck Surgery, Division of Otology, Neurotology, & Skull Base Surgery, Columbia University Irving Medical Center, New York, NY, USA.

Background: Acute neurological sequela in patients with COVID-19 infection include acute thromboembolic infarcts related to cytokine storm and post infectious immune activation resulting in a prothrombotic state. Radiologic imaging studies of the sinonasal tract and mastoid cavity in patients with COVID-19 infection are sparse and limited to case series. In this report, we investigate the radiologic involvement of nasal cavity, nasopharynx, paranasal sinuses, and mastoid cavity in patients with SARS-CoV-2 infection who presented with acute neurological symptoms.

Methods: Retrospective review of medical records and neuroradiologic imaging in patients diagnosed with acute COVID-19 infection who presented with acute neurological symptoms to assess radiologic prevalence of sinus and mastoid disease and its correlation to upper respiratory tract symptoms.

Results: Of the 55 patients, 23 (42%) had partial sinus opacification, with no evidence for complete sinus opacification. The ethmoid sinus was the most commonly affected (16/55 or 29%). An air fluid level was noted in 6/55 (11%) patients, most commonly in the maxillary sinus. Olfactory recess and mastoid opacification were uncommon. There was no evidence of bony destruction in any of the studies, Cough, nasal congestion, rhinorrhea, and sore throat were not significantly associated with any radiological findings.

Conclusion: In patients who present with acute neurological symptoms, COVID-19 infection is characterized by limited and mild mucosal disease within the sinuses, nasopharynx and mastoid cavity.

Level Of Evidence: 4.
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http://dx.doi.org/10.1177/0003489421995070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879045PMC
February 2021

SARS-COV-2 transmission rate is low when following a COVID+ patient in the operating room.

Langenbecks Arch Surg 2021 Mar 6;406(2):401-404. Epub 2021 Feb 6.

Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian Hospital, Columbia University Irving Medical Center, Columbia Vagelos College of Physicians and Surgeons, 180 Fort Washington Avenue, Harkness 8, New York, NY, 10032, USA.

Purpose: Acquiring SARS-CoV-2 infection for uninfected patients undergoing surgical procedures following a COVID positive (COVID+) patient is of significant concern, both for patients seeking medical care in hospital settings and for management of surgical services during pandemic times.

Methods: Using data identifying all COVID+ surgical patients during the initial pandemic peak in New York City (March 15 to May 15, 2020), we analyzed the rate of postoperative symptomatic SARS-CoV-2 infection in COVID negative (COVID-) patients undergoing surgery in the same operating room within 48 h, thus determining nosocomial symptomatic infection rate attributable to COVID operating room exposure.

Results: Five COVID- patients directly followed a COVID+ patient, while 19 patients were exposed to COVID+ operating rooms within 24 h. By 48 h, 21 additional patients were exposed. No exposed patients acquired symptomatic SARS-CoV-2 infection postoperatively.

Conclusion: With implementation of infection prevention and control procedures in the operating room under local pandemic conditions, our findings suggest that the risk of acquiring SARS-CoV-2 infection, when following a COVID+ patient in the same operating room, is very low.
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http://dx.doi.org/10.1007/s00423-021-02085-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7864797PMC
March 2021

COVID-19 survivorship: How otolaryngologist-head and neck surgeons can restore quality of life after critical illness.

Am J Otolaryngol 2021 May-Jun;42(3):102917. Epub 2021 Jan 9.

Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical Center, Ann Arbor, MI, United States; Global Tracheostomy Collaborative, Raleigh, NC, United States. Electronic address:

Mortality from COVID-19 has obscured a subtler crisis - the swelling ranks of COVID-19 survivors. After critical illness, patients often suffer post-intensive care syndrome (PICS), which encompasses physical, cognitive, and/or mental health impairments that are often long-lasting barriers to resuming a meaningful life. Some deficits after COVID-19 critical illness will require otolaryngologic expertise for years after hospital discharge. There are roles for all subspecialties in preventing, diagnosing, or treating sequelae of COVID-19. Otolaryngologist leadership in multidisciplinary efforts ensures coordinated care. Timely tracheostomy, when indicated, may shorten the course of intensive care unit stay and thereby potentially reduce the impairments associated with PICS. Otolaryngologists can provide expertise in olfactory disorders; thrombotic sequelae of hearing loss and vertigo; and laryngotracheal injuries that impair speech, voice, swallowing, communication, and breathing. In the aftermath of severe COVID-19, otolaryngologists are poised to lead efforts in early identification and intervention for impairments affecting patients' quality of life.
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http://dx.doi.org/10.1016/j.amjoto.2021.102917DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833311PMC
May 2021

Jugular Bulb Anomalies Involving the Internal Auditory Canal: A Case Series.

Ann Otol Rhinol Laryngol 2021 Aug 29;130(8):970-975. Epub 2021 Jan 29.

Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center, New York, NY, USA.

Objective: Jugular bulb abnormalities (JBA) such as high riding jugular bulb and jugular bulb diverticulum can extend or erode into the middle and inner ear. In this report, we report on a series of 6 patients with jugular bulb anomalies involving the internal auditory canal (IAC).

Methods: A retrospective case series.

Results: Six females, ages 6 to 63 presenting with myriad of otologic symptoms including hearing loss, tinnitus, balance disturbance, fullness, and otalgia were discovered to have JB eroding into IAC. Computerized tomography, but not Magnetic Resonance Imaging, was able to identify IAC erosion by a significantly enlarged JB.

Conclusion: A significantly enlarged JB eroding into the IAC maybe congenital or acquired. It can present with a variety of common otologic symptoms. Long term follow-up is needed to determine the natural history of JB anomalies involving the IAC and need for intervention.
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http://dx.doi.org/10.1177/0003489421990153DOI Listing
August 2021

Hearing Loss Is Associated with Increased Variability in Double Support Period in the Elderly.

Sensors (Basel) 2021 Jan 4;21(1). Epub 2021 Jan 4.

Division of Otology, Neurotology, and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA.

Hearing loss is a disabling condition that increases with age and has been linked to difficulties in walking and increased risk of falls. The purpose of this study is to investigate changes in gait parameters associated with hearing loss in a group of older adults aged 60 or greater. Custom-engineered footwear was used to collect spatiotemporal gait data in an outpatient clinical setting. Multivariable linear regression was used to determine the relationship between spatiotemporal gait parameters and high and low frequency hearing thresholds of the poorer hearing ear, the left ear, and the right ear, respectively, adjusting for age, sex, race/ethnicity, and the Dizziness Handicap Inventory-Screening version score. Worsening high and low frequency hearing thresholds were associated with increased variability in double support period. Effects persisted after adjusting for the effects of age and perceived vestibular disability and were greater for increases in hearing thresholds for the right ear compared to the left ear. These findings illustrate the importance of auditory feedback for balance and coordination and may suggest a right ear advantage for the influence of auditory feedback on gait.
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http://dx.doi.org/10.3390/s21010278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7795333PMC
January 2021

Do Hearing Aids Help Prevent Cognitive Decline?

Laryngoscope 2021 Oct 4;131(10):2166-2168. Epub 2021 Jan 4.

Department of Otolaryngology Head and Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center and Columbia University Vagelos College of Physicians and Surgeons, New York, New York, U.S.A.

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http://dx.doi.org/10.1002/lary.29365DOI Listing
October 2021

Novel 3D-printed hollow microneedles facilitate safe, reliable, and informative sampling of perilymph from guinea pigs.

Hear Res 2021 02 2;400:108141. Epub 2020 Dec 2.

Department of Otolaryngology - Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, 180 Fort Washington Avenue, Harkness Pavilion, 8th Floor, New York, NY 10032, United States; Department of Mechanical Engineering, Columbia University, New York, NY, United States. Electronic address:

Background: Inner ear diagnostics is limited by the inability to atraumatically obtain samples of inner ear fluid. The round window membrane (RWM) is an attractive portal for accessing perilymph samples as it has been shown to heal within one week after the introduction of microperforations. A 1 µL volume of perilymph is adequate for proteome analysis, yet the total volume of perilymph within the scala tympani of the guinea pig is limited to less than 5 µL. This study investigates the safety and reliability of a novel hollow microneedle device to aspirate perilymph samples adequate for proteomic analysis.

Methods: The guinea pig RWM was accessed via a postauricular surgical approach. 3D-printed hollow microneedles with an outer diameter of 100 µm and an inner diameter of 35 µm were used to perforate the RWM and aspirate 1 µL of perilymph. Two perilymph samples were analyzed by liquid chromatography-mass spectrometry-based quantitative proteomics as part of a preliminary study. Hearing was assessed before and after aspiration using compound action potential (CAP) and distortion product otoacoustic emissions (DPOAE). RWMs were harvested 72 h after aspiration and evaluated for healing using confocal microscopy.

Results: There was no permanent damage to hearing at 72 h after perforation as assessed by CAP (n = 7) and DPOAE (n = 8), and all perforations healed completely within 72 h (n = 8). In the two samples of perilymph analyzed, 620 proteins were detected, including the inner ear protein cochlin, widely recognized as a perilymph marker.

Conclusion: Hollow microneedles can facilitate aspiration of perilymph across the RWM at a quality and volume adequate for proteomic analysis without causing permanent anatomic or physiologic dysfunction. Microneedles can mediate safe and effective intracochlear sampling and show great promise for inner ear diagnostics.
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http://dx.doi.org/10.1016/j.heares.2020.108141DOI Listing
February 2021

Bilateral Sudden Sensorineural Hearing Loss and Intralabyrinthine Hemorrhage in a Patient With COVID-19.

Otol Neurotol 2021 01;42(1):e10-e14

Department of Otolaryngology-Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center and Columbia University Vagelos College of Physicians and Surgeons, New York, New York.

Objective: To describe a case of bilateral sudden sensorineural hearing loss (SSNHL) and intralabyrinthine hemorrhage in a patient with COVID-19.

Study Design: Clinical capsule report.

Setting: Tertiary academic referral center.

Patient: An adult woman with bilateral SSNHL, aural fullness, and vertigo with documented SARS-CoV-2 infection (IgG serology testing).

Interventions: High-dose oral prednisone with taper, intratympanic dexamethasone.

Main Outcome Measures: Audiometric testing, MRI of the internal auditory canal with and without contrast.

Results: A patient presented with bilateral SSNHL, bilateral aural fullness, and vertigo. Serology testing performed several weeks after onset of symptoms was positive for IgG COVID-19 antibodies. MRI showed bilateral intralabyrinthine hemorrhage (left worse than right) and no tumor. The patient was treated with two courses of high-dose oral prednisone with taper and a left intratympanic dexamethasone injection, resulting in near-resolution of vestibular symptoms, a fluctuating sensorineural hearing loss in the right ear, and a severe to profound mixed hearing loss in the left ear.

Conclusions: COVID-19 may have otologic manifestations including sudden SSNHL, aural fullness, vertigo, and intralabyrinthine hemorrhage.
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http://dx.doi.org/10.1097/MAO.0000000000002860DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7737860PMC
January 2021

Low vitamin D status is associated with hearing loss in the elderly: a cross-sectional study.

Am J Clin Nutr 2021 02;113(2):456-466

Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.

Background: The elderly are at increased risk of both hearing loss (HL) and osteoporosis. Bone mineral density (BMD) has been putatively linked to HL. However, the roles of serum calcium concentrations and vitamin D status have yet to be elucidated.

Objectives: The purpose of this study was to examine the relation between vitamin D status, parathyroid hormone (PTH), total calcium, BMD, and HL in a nationally representative sample of elderly adults.

Methods: Using the NHANES (2005-2010), audiometry and BMD data of 1123 participants aged ≥70 y were analyzed in a cross-sectional manner. HL was defined as pure tone averages >25 dB HL at 500, 1000, and 2000 Hz (low frequency); 500, 1000, 2000, and 4000 Hz (speech frequency); and 3000, 4000, 6000, and 8000 Hz (high frequency) in either ear. Multivariable logistic regression was used to examine the relation between HL and total 25-hydroxyvitamin D [25(OH)D], PTH, total calcium, and BMD, adjusting for covariates.

Results: In multivariable analyses, total 25(OH)D < 20 ng/mL was found to be associated with greater odds of low-frequency HL (OR: 2.02; 95% CI: 1.28, 3.19) and speech-frequency HL (OR: 1.96; 95% CI: 1.12, 3.44). A 1-unit decrease in femoral neck BMD (OR: 4.55; 95% CI: 1.28, 16.67) and a 1-unit decrease in total spine BMD (OR: 6.25; 95% CI: 1.33, 33.33) were found to be associated with greater odds of low-frequency HL. Serum PTH and total calcium were not found to be associated with HL.

Conclusions: In the elderly, low vitamin D status was associated with low-frequency and speech-frequency HL. Low vitamin D status may be a potential risk factor for age-related HL.
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http://dx.doi.org/10.1093/ajcn/nqaa310DOI Listing
February 2021

Modeling Hearing Loss Progression and Asymmetry in the Older Old: A National Population-Based Study.

Laryngoscope 2021 04 8;131(4):879-884. Epub 2020 Nov 8.

Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.

Objective: The progression and asymmetry of age-related hearing loss has not been well characterized in those 80 years of age and older because public datasets mask upper extremes of age to protect anonymity. We aim to characterize the progression, severity, and asymmetry of hearing loss in those 80 years of age and older using a representative, national database.

Methods: Cross-sectional, multicentered U.S. epidemiologic analysis using the National Health and Nutrition Examination Survey (NHANES) 2005 to 2006, 2009 to 2010, and 2011 to 2012 cycles. Subjects included noninstitutionalized, civilian adults aged 80 years and older (n = 621). Federal security clearance was granted to access publicly restricted age data. Outcome measures included pure-tone average (PTA) air conduction thresholds and the 4-frequency PTA.

Results: Six hundred and twenty-one subjects were 80 years old or older (mean = 84.2 years, range = 80-104 years), representing 10,600,197 Americans. The average PTA was 38.9 dB (95% confidence interval [CI] = 37.8, 40.0). Hearing loss exhibited constant acceleration across the adult lifespan at a rate of 0.0052 dB/year (95% CI = 0.0049, 0.0055). This model predicted mean PTA within 2 dB of accuracy for most ages between 20 and 100 years. From age 80 years to approximately 100 years, the average PTA difference between the better and worse ear was 6.75 dB (95% CI = 5.8, 7.1). This asymmetry was relatively constant (i.e., nonsignificant linear regression coefficient of asymmetry over age = 0.07 [95% CI = -0.01, 0.2]).

Conclusion: Hearing loss steadily and predictably accelerates across the adult lifespan to at least age 100 years, becoming near universal. These population-level statistics will guide treatment and policy recommendations for hearing health in the older old.

Level Of Evidence: 3 Laryngoscope, 131:879-884, 2021.
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http://dx.doi.org/10.1002/lary.28971DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7990690PMC
April 2021

Risk of Acquiring Perioperative COVID-19 During the Initial Pandemic Peak: A Retrospective Cohort Study.

Ann Surg 2021 01;273(1):41-48

Columbia University Vagelos College of Physicians and Surgeons, New York, New York.

Objective: To determine the risk of acquiring perioperative COVID-19 infection in previously COVID-19 negative patients.

Summary Of Background Data: During the initial peak of the COVID-19 pandemic, there was significant concern of hospital acquired COVID-19 infections. Medical centers rapidly implemented systems to minimize perioperative transmission, including routine preoperative testing, patient isolation, and enhanced cleaning.

Methods: In this retrospective cohort study, medical records of all adult patients who underwent surgery at our quaternary, acute care hospital between March 15 and May 15, 2020 were reviewed. The risk of preoperatively negative patients developing symptomatic COVID-19 within 2-14 days postoperatively was determined. Surgical characteristics, outcomes, and complications were compared between those with and without acquired perioperative COVID-19 infection.

Results: Among 501 negative patients undergoing index surgeries, 9 (1.8%) developed symptomatic COVID-19 in the postoperative period; all occurred before implementation of routine preoperative testing [9/243, 3.7% vs 0/258, 0%, odds ratio (OR): 0.048, P = 0.036]. No patient who was polymerase-chain-reaction negative on the day of surgery (n = 170) developed postoperative infection. Perioperative infection was associated with preoperative diabetes (OR: 3.70, P = 0.042), cardiovascular disease (OR: 3.69, P = 0.043), angiotensin receptor blocker use (OR: 6.58, P = 0.004), and transplant surgery (OR: 11.00, P = 0.002), and multiple complications, readmission (OR: 5.50, P = 0.029) and death (OR: 12.81, P = 0.001).

Conclusions: During the initial peak of the COVID-19 pandemic, there was minimal risk of acquiring symptomatic perioperative COVID-19 infection, especially after the implementation of routine preoperative testing. However, perioperative COVID-19 infection was associated with poor postoperative outcome.
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http://dx.doi.org/10.1097/SLA.0000000000004586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7737880PMC
January 2021

Age-related differences in gait adaptations during overground walking with and without visual perturbations using a virtual reality headset.

Sci Rep 2020 09 21;10(1):15376. Epub 2020 Sep 21.

Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, 180 Fort Washington Avenue, Harkness Pavilion, 8th Floor, New York, NY, 10032, USA.

Older adults have difficulty adapting to new visual information, posing a challenge to maintain balance during walking. Virtual reality can be used to study gait adaptability in response to discordant sensorimotor stimulations. This study aimed to investigate age-related modifications and propensity for visuomotor adaptations due to continuous visual perturbations during overground walking in a virtual reality headset. Twenty old and twelve young subjects walked on an instrumented walkway in real and virtual environments while reacting to antero-posterior and medio-lateral oscillations of the visual field. Mean and variability of spatiotemporal gait parameters were calculated during the first and fifth minutes of walking. A 3-way mixed-design ANOVA was performed to determine the main and interaction effects of group, condition and time. Both groups modified gait similarly, but older adults walked with shorter and slower strides and did not reduce stride velocity or increase stride width variability during medio-lateral perturbations. This may be related to a more conservative and anticipatory strategy as well as a reduced perception of the optic flow. Over time, participants adapted similarly to the perturbations but only younger participants reduced their stride velocity variability. Results provide novel evidence of age- and context-dependent visuomotor adaptations in response to visual perturbations during overground walking and may help to establish new methods for early identification and remediation of gait deficits.
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http://dx.doi.org/10.1038/s41598-020-72408-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505838PMC
September 2020

Cochlear Implant Today…Pill Tomorrow.

Authors:
Anil K Lalwani

JAMA Otolaryngol Head Neck Surg 2020 10;146(10):954-955

Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York.

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http://dx.doi.org/10.1001/jamaoto.2020.2285DOI Listing
October 2020

Sialadenitis: A Possible Early Manifestation of COVID-19.

Laryngoscope 2020 11 4;130(11):2595-2597. Epub 2020 Sep 4.

Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia University Irving Medical Center and Columbia University Vagelos College of Physicians and Surgeons, New York, New York, U.S.A.

Acute sialadenitis may be caused by viruses, including coronaviruses. Although there are anecdotal reports of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) salivary gland infections, there have been no well-documented cases of sialadenitis in patients with COVID-19 described in the literature. We report a case of parotitis and submandibular gland sialadenitis, as well as an isolated case of parotitis, in two patients with concurrent SARS-CoV-2 infections. Computed tomography imaging demonstrated parotid and submandibular gland enlargement with heterogenous enhancement and attenuation, consistent with sialadenitis. Medical management was sufficient for successful resolution of the acute sialadenitis. Laryngoscope, 130:2595-2597, 2020.
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http://dx.doi.org/10.1002/lary.29083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7461412PMC
November 2020

Dual-Motor-Task of Catching and Throwing a Ball During Overground Walking in Virtual Reality.

IEEE Trans Neural Syst Rehabil Eng 2020 07;28(7):1661-1667

Virtual Reality is a versatile platform to study human behavior in simulated environments and to develop interventions for functional rehabilitation. In this work, we designed a dual-task paradigm in a virtual environment where both tasks demand motor skills. Twenty-one healthy adults (mean age: 24.1 years) participated in this study. The experiment involved three conditions - normal overground walking, catch and throw a ball while standing, and catch and throw a ball while walking overground -all in the virtual environment. We investigated the dual-task gait characteristics and their correlations with outcomes from cognitive assessments. Results show that subjects walk conservatively with smaller stride lengths, larger stride widths and stride time while catching and throwing. However, they are able to throw the balls more accurately at the target and achieve higher scores. During the dual-task throw, we observed that the participants threw more balls during the stance phase of the gait when the foot was in the terminal stance and pre-swing region. During this region, the body has forward momentum. In addition, the changes in gait characteristics during dual-task throw correlate well with outcome measures in standardized cognitive tests. This study provides a new and engaging paradigm to analyze dual-motor-task cost in a virtual reality environment and it can be used as a basis to compare strategies adopted by different population groups with healthy young adults to execute coordinated motor tasks.
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http://dx.doi.org/10.1109/TNSRE.2020.2999352DOI Listing
July 2020

Prevalence and Severity of Hearing Loss in the Older Old Population.

JAMA Otolaryngol Head Neck Surg 2020 08;146(8):762-763

Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York.

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http://dx.doi.org/10.1001/jamaoto.2020.0900DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7317651PMC
August 2020

Drug delivery device for the inner ear: ultra-sharp fully metallic microneedles.

Drug Deliv Transl Res 2021 Feb;11(1):214-226

Department of Mechanical Engineering, Columbia University, 500 West 120th Street, New York, NY, 10027, USA.

Drug delivery into the inner ear is a significant challenge due to its inaccessibility as a fluid-filled cavity within the temporal bone of the skull. The round window membrane (RWM) is the only delivery portal from the middle ear to the inner ear that does not require perforation of bone. Recent advances in microneedle fabrication enable the RWM to be perforated safely with polymeric microneedles as a means to enhance the rate of drug delivery from the middle ear to the inner ear. However, the polymeric material is not biocompatible and also lacks the strength of other materials. Herein we describe the design and development of gold-coated metallic microneedles suitable for RWM perforation. When developing microneedle technology for drug delivery, we considered three important general attributes: (1) high strength and ductility material, (2) high accuracy and precision of fabrication, and (3) broad design freedom. We developed a hybrid additive manufacturing method using two-photon lithography and electrochemical deposition to fabricate ultra-sharp gold-coated copper microneedles with these attributes. We refer to the microneedle fabrication methodology as two-photon templated electrodeposition (2PTE). We demonstrate the use of these microneedles by inducing a perforation with a minimal degree of trauma in a guinea pig RWM while the microneedle itself remains undamaged. Thus, this microneedle has the potential literally of opening the RWM for enhanced drug delivery into the inner ear. Finally, the 2PTE methodology can be applied to many different classes of microneedles for other drug delivery purposes as well the fabrication of small scale structures and devices for non-medical applications. Graphical Abstract Fully metallic ultra-sharp microneedle mounted at end of a 24-gauge stainless steel blunt syringe needle tip: (left) Size of microneedle shown relative to date stamp on U.S. one-cent coin; (right) Perforation through guinea pig round window membrane introduced with microneedle.
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http://dx.doi.org/10.1007/s13346-020-00782-9DOI Listing
February 2021
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