Publications by authors named "Matthew L Bush"

53 Publications

Association of Subjective Hearing Loss and Apolipoprotein E ε4 Allele on Alzheimer's Disease Neurodegeneration.

Otol Neurotol 2021 01;42(1):e15-e21

Department of Otolaryngology-Head and Neck Surgery, University of Kentucky College of Medicine.

Objective: Hearing loss (HL) and apolipoprotein E ε4 (ApoE4) allele are both dementia risk factors. No research has investigated the association of these variables regarding dementia, specifically Alzheimer's disease. Our goal was to evaluate HL and ApoE4 allele positivity toward degree of Alzheimer's neurodegeneration.

Study Design: Retrospective.

Setting: Academic.

Patients: Alzheimer's neuropathology obtained from brain tissue databank. Documented demographics, subjective hearing status, cognition, and ApoE4. Subjects divided into four groups based on hearing status and ApoE4 positivity.

Main Outcome Measures: Differences in cognition (clinical dementia rating, mini mental state examination (MMSE), geriatric depression score) and Alzheimer's neuropathology staging (Braak, CERAD) between groups.

Results: Two-hundred and fifty-nine subjects. No significant difference between groups, with regard to hearing status or ApoE4 positivity, in premorbid cognition, including scores for clinical dementia rating and MMSE (p = 0.2332). HL subjects had less severe neuropathology, as compared with normal hearing subjects. For example, high grade Braak stage was present in 27.1 and 51.0% of HL and normal hearing subjects, respectively (p = 0.0263). This finding was in context of equivocal clinical cognition between groups. ApoE4+ individuals had more severe neurodegeneration; for example, 65.7 and 33.5% with high grade Braak stage for ApoE4+ and ApoE4- subjects, respectively (p < 0.0001).

Conclusion: Subjective HL subjects had less severe neuropathology with no difference in cognition, suggesting an additive effect of HL to cognitive burden of Alzheimer's neuropathology. HL appeared to increase cognitive burden, but wasn't manifested by greater neurodegeneration. This is clinically relevant in that treating HL could slow Alzheimer's disease progression.
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http://dx.doi.org/10.1097/MAO.0000000000002855DOI Listing
January 2021

Does Adherence to Early Infant Hearing Detection and Intervention Guidelines Positively Impact Pediatric Speech Outcomes?

Laryngoscope 2020 Aug 4. Epub 2020 Aug 4.

Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, U.S.A.

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http://dx.doi.org/10.1002/lary.28994DOI Listing
August 2020

A Position Paper on Systematic and Meta-analysis Reviews.

Otol Neurotol 2020 08;41(7):879-882

Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky.

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http://dx.doi.org/10.1097/MAO.0000000000002737DOI Listing
August 2020

Opioid Prescribing Patterns and Usage Following Cochlear Implantation.

Otol Neurotol 2020 08;41(7):922-928

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

Objective: To evaluate opioid prescribing patterns following cochlear implantation (CI) and assess factors associated with recurrent opioid use.

Study Design: Retrospective cohort study.

Setting: National pharmaceutical database recording opioid fulfillment (Truven Health Marketscan Commercial Claims and Encounters and Medicare Claims and Encounters database) PARTICIPANTS:: CI recipients who filled opioid prescriptions between January 2011 and December 2016. All patients had no previous opioid prescriptions filled 60 days before implantation and filled at least one opioid prescription within 1 week after surgery. Cohort 1 filled only one prescription and cohort 2 filled more than one prescription in the 12 months following CI. Univariate/multivariate analysis was performed to assess for associations with recurrent opioid use.

Main Outcome Measure(s): Opioid prescription details and recurrent opioid use.

Results: The study included 98 patients (cohort 1 = 57, cohort 2 (recurrent opioid use) = 41). Hydrocodone 5 mg was most frequently used. The average duration opioids were prescribed was 5.49 days with an average quantity of tablets of 36.1. Recurrent opioid use in cohort 2 was associated with both total morphine milligram equivalents (MME) prescribed/day in the first postoperative week (OR = 1.03, p = 0.01) and use of stronger MME opioids (OR = 7.20, p = 0.05).

Conclusion: Prescribing patterns following CI can influence recurrent opioid use in patients. Each additional tablet of hydrocodone 5 mg beyond 8 tablets/d or oxycodone 5 mg beyond 5.33 tablets/d, increases the likelihood of recurrent opioid use by 15 or 22.5%, respectively. Limiting opioids prescribed per day to no more than 40 MME could lower the likelihood of patients becoming recurrent opioid users postoperatively.
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http://dx.doi.org/10.1097/MAO.0000000000002674DOI Listing
August 2020

Factors Influencing Aberrant Facial Nerve Stimulation Following Cochlear Implantation: A Systematic Review and Meta-analysis.

Otol Neurotol 2020 09;41(8):1050-1059

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

Objective: The purpose of this study was to systematically evaluate the literature to evaluate the rate of and associated factors with aberrant facial nerve stimulation (AFNS) following cochlear implantation. Additionally, management strategies for AFNS were assessed.

Data Sources: A systematic search was performed in PubMed, Cochrane Database of Systematic Reviews, and Web of Science to identify peer reviewed research.

Study Selection: Eligible studies were those containing peer-reviewed research in English addressing AFNS following cochlear implantation. Studies with paired data were included in the meta-analysis.

Data Extraction: Three investigators independently reviewed all articles and extracted data. Bias was assessed using the National Institutes of Health Study Quality Assessment Tool.

Data Synthesis: Thirty-seven articles were included, representing 5,694 patients. The overall reported AFNS rate was 5.6% (range, 0.68-43%). Array type demonstrated a significant association with AFNS with lateral wall electrodes having a higher odds ratio than perimodiolar electrodes (odds ratio [OR] = 3.92, 95% confidence interval [CI] 1.46-10.47, p = 0.01). CI recipients with otosclerosis were also more likely to experience AFNS compared with non-otosclerosis pathology (OR = 13.73, 95% CI 3.57-52.78, p < 0.01). Patients with cochlear malformations had an overall AFNS rate of 28% (range, 5.3-43%) and those with otosclerosis had an overall rate of 26% (range, 6.25-75%). Reprogramming with or without electrode deactivation was successful for AFNS elimination. Four patients of 3,015 required explantation.

Conclusion: Array type and underlying cochlear pathology are associated with AFNS and implant reprogramming is an overall successful management strategy. Further research is needed to elucidate mechanism of AFNS and develop management strategies that limit impact on hearing outcomes.
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http://dx.doi.org/10.1097/MAO.0000000000002693DOI Listing
September 2020

Trends in Opioid Usage Following Tympanoplasty and Mastoidectomy.

Otol Neurotol 2020 09;41(8):e1035-e1040

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

Objective: Evaluate opioid prescribing patterns following tympanoplasty/mastoidectomy and assess factors associated to recurrent opioid use.

Study Design: Retrospective cohort study.

Setting: National pharmaceutical database recording opioid fulfillment (Truven Health Marketscan Commercial Claims/Encounters and Medicare Claims/Encounters database).

Participants: Patients who 1) underwent tympanoplasty and/or mastoidectomy, 2) filled postoperative opioid prescriptions between 2011 and 2016, and 3) had no opioid prescriptions filled 60 days before surgery. Cohort 1 filled only one prescription and cohort 2 filled more than one prescription in the 12 months following surgery. Univariate/multivariate analysis was performed to assess for associations with recurrent opioid use.

Main Outcome Measure(s): Opioid prescription details and recurrent opioid use.

Results: The study included 398 patients (cohort 1 = 233, cohort 2 [recurrent opioid user] = 165). Hydrocodone 5 mg was most frequently used. The average duration opioids were prescribed was 5.8 days with an average quantity of tablets of 36.51. Recurrent opioid use in cohort 2 was associated with total morphine milligram equivalents prescribed/d in the first postoperative week (odds ratio [OR] = 1.02, p < 0.001), post-op chronic pain disorder (OR = 2.00, p = 0.04), post-op substance abuse (OR = 2.12, p = 0.05), and post-op anxiety (OR = 1.96, p = 0.02).

Conclusion: Recurrent opioid use following tympanoplasty/mastoidectomy is associated with the amount prescribed per day but not opioid type or duration of treatment. Postoperative diagnoses such as chronic pain disorder, substance abuse, or anxiety could be predictive of or coexistent with recurrent opioid use. Limiting opioids prescribed per day and use of anti-inflammatory medications could decrease the risk of recurrent opioid use.
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http://dx.doi.org/10.1097/MAO.0000000000002709DOI Listing
September 2020

Clinical Practice Guideline: Ménière's Disease Executive Summary.

Otolaryngol Head Neck Surg 2020 04;162(4):415-434

American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA.

Objective: Ménière's disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many, and approaches typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies.

Purpose: The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.
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http://dx.doi.org/10.1177/0194599820909439DOI Listing
April 2020

Clinical Practice Guideline: Ménière's Disease.

Otolaryngol Head Neck Surg 2020 04;162(2_suppl):S1-S55

American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA.

Objective: Ménière's disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid (endolymph) volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Conventional imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many and typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies.

Purpose: The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.
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http://dx.doi.org/10.1177/0194599820909438DOI Listing
April 2020

Neuropathological Findings of Dementia Associated With Subjective Hearing Loss.

Otol Neurotol 2019 10;40(9):e883-e893

Department of Otolaryngology-Head and Neck Surgery, University of Kentucky College of Medicine.

Objective: The relationship between hearing loss and cognitive decline is of great importance with growing evidence of hearing loss as an independent modifiable risk factor for dementia. Our goal was to evaluate for differences in dementia neuropathology between subjective normal hearing and hearing loss subjects, as well as subjects who wore hearing aids.

Study Design: Retrospective database.

Setting: Tertiary academic center.

Patients: Brain tissue analyzed from our Center on Aging. Demographics, subjective hearing status, hearing aid use, cognitive status, and dementia neuropathology documented.

Interventions: Dementia neuropathology analyzed in brains of normal hearing and hearing loss subjects.

Main Outcome Measures: Differences in dementia neuropathology between hearing groups. Groups were compared using logistic regression and analysis of covariance (ANCOVA).

Results: Two-hundred and seventy-three subjects were included, 189 normal hearing and 84 subjective hearing loss subjects. No significant difference demonstrated in Alzheimer's disease neuropathology (p > 0.05) or pathologic stage (p = 0.2471). No significant difference observed in neuropathology of other major dementia types, specifically, presence of Lewy bodies (p > 0.05), Lewy body disease pathologic stage (p = 0.9778), or presence of micro-infarcts, macro-infarcts, or arteriosclerosis (p > 0.05). Hearing aid-wearing subjects had a lower prevalence of clinical dementia (39.1% versus 57.9%; p = 0.0208) with no significant difference in dementia neuropathology (p > 0.05).

Conclusion: Subjective hearing loss was not found to be associated with significantly different dementia neuropathology, which counters hypotheses on hearing loss causing permanent neurodegeneration and cognitive decline. Hearing aid users were found to have a lower prevalence of dementia for similar levels of neurodegeneration, suggesting a potential neuroprotective effect of hearing aids.
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http://dx.doi.org/10.1097/MAO.0000000000002381DOI Listing
October 2019

Outpatient healthcare access and utilization for neonatal abstinence syndrome children: A systematic review.

J Clin Transl Sci 2019 Aug 29;4(5):389-397. Epub 2019 Aug 29.

Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, KY, USA.

Objective: The objective of this study was to systematically assess the literature regarding postnatal healthcare utilization and barriers/facilitators of healthcare in neonatal abstinence syndrome (NAS) children.

Methods: A systematic search was performed in PubMed, Cochrane Database of Systematic Reviews, PsychINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science to identify peer-reviewed research. Eligible studies were peer-reviewed articles reporting on broad aspects of primary and specialty healthcare utilization and access in NAS children. Three investigators independently reviewed all articles and extracted data. Study bias was assessed using the Newcastle-Ottawa Assessment Scale and the National Institute of Health Study Quality Assessment Tool.

Results: This review identified 14 articles that met criteria. NAS children have poorer outpatient appointment adherence and have a higher rate of being lost to follow-up. These children have overall poorer health indicated by a significantly higher risk of ER visits, hospital readmission, and early childhood mortality compared with non-NAS infants. Intensive multidisciplinary support provided through outpatient weaning programs facilitates healthcare utilization and could serve as a model that could be applied to other healthcare fields to improve the health among this population.

Conclusions: This review investigated the difficulties in accessing outpatient care as well as the utilization of such care for NAS infants. NAS infants tend to have decreased access to and utilization of outpatient healthcare following hospital birth discharge. Outpatient weaning programs have proven to be effective; however, these programs require intensive resources and care coordination that has yet to be implemented into other healthcare areas for NAS children.
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http://dx.doi.org/10.1017/cts.2019.407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7681131PMC
August 2019

Rural Adult Perspectives on Impact of Hearing Loss and Barriers to Care.

J Community Health 2019 08;44(4):668-674

School of Public Health, University of California Berkeley, Berkeley, CA, USA.

Adult hearing loss has a significant impact on communication and quality of life. In spite of effective methods of diagnosis and treatment, many rural adults face significant barriers and delays in accessing care. The purpose of this study is to characterize the impact of hearing loss and the barriers for hearing healthcare in rural adults. Using stratified purposeful sampling, the study design involved semi-structured phone interviews with adults in the Appalachian region of Kentucky between 2016 and 2017 to describe perceived susceptibility to hearing loss; knowledge of hearing loss; cues leading to help-seeking; barriers limited access to care; benefits of seeking help; and self-rated confidence in seeking treatment. Thematic qualitative analysis was performed to identify recurring content themes. Forty adults participated in the study. Participants reported susceptibility to noise induced hearing loss with infrequent hearing protection use. Participants described concern with hearing loss-related communication barriers that could affect compliance with medical care, employment performance, personal safety, and relationship communication. Rural adult expressed willingness to seek hearing healthcare but reported a lack of providers in rural areas. The cost and the lack of insurance coverage for hearing aids were the most clearly articulated obstacles influencing access to care. Hearing loss has a significant impact on adults in rural areas. A lack of providers and the overwhelming cost of treatment are barriers to care. Further research is needed to identify novel methods to support rural adults seeking affordable hearing healthcare.
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http://dx.doi.org/10.1007/s10900-019-00656-3DOI Listing
August 2019

Audiology Telemedicine Evaluations: Potential Expanded Applications.

Otolaryngol Head Neck Surg 2019 07 5;161(1):63-66. Epub 2019 Mar 5.

1 Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA.

There is underutilization of cochlear implants with delays in implantation linked to distance from implant centers. Telemedicine could connect cochlear implant specialists with patients in rural locations. We piloted telemedicine cochlear implant testing in a small study, largely composed of normal-hearing volunteers to trial this new application of teleaudiology technology. Thirteen subjects (8 with normal hearing and 5 with hearing loss ranging from mild to profound) underwent a traditional cochlear implant evaluation in person and then via telemedicine technology. Routine audiometry, word recognition testing, and Arizona Biological Test (AzBio) and consonant-nucleus-consonant (CNC) testing were performed. Mean (SD) percent difference in AzBio between in-person and remote testing was 1.7% (2.06%). Pure tone average (PTA), speech reception threshold (SRT), and word recognition were similar between methods. CNC testing showed a mean (SD) difference of 6.8% (10.2%) between methods. Testing conditions were acceptable to audiologists and subjects. Further study to validate this method in cochlear implant candidates and a larger population is warranted.
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http://dx.doi.org/10.1177/0194599819835541DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602851PMC
July 2019

Management of Hearing Loss Through Telemedicine.

JAMA Otolaryngol Head Neck Surg 2019 03;145(3):204-205

Kentucky TeleCare, University of Kentucky Medical Center, Lexington.

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http://dx.doi.org/10.1001/jamaoto.2018.3885DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6620156PMC
March 2019

Assessment and Treatment of Behavioral Disorders in Children with Hearing Loss: A Systematic Review.

Otolaryngol Head Neck Surg 2019 01 11;160(1):36-48. Epub 2018 Sep 11.

2 Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA.

Objective: There is evidence that children who are deaf and hard of hearing (DHH) have a higher incidence of behavioral disorders. Assessment of behavioral health in this population is often complicated by language developmental delays, which may result in unrecognized and untreated behavioral problems. The purpose of this study is to assess the association of behavioral disorders among children who are DHH and to explore behavioral interventions for children in this population.

Data Sources: PubMed, CINALH, PsychINFO, and Web of Science.

Review Methods: Search terms included the following: problem behavior, child behavior disorders/diagnosis, child behavior disorders/psychology coupled with hearing loss, cochlear implants, hearing aids, or deafness. Studies from the last 30 years (1985-2016) were included. The articles were reviewed independently by 3 reviewers.

Results: Thirty-six articles met criteria. There was an association between internalizing behaviors and hearing loss among children, which may persist after cochlear implantation. These problems may be more pronounced for children with additional disabilities. Conduct and hyperactivity disorders as well as emotional and executive function problems among children who are DHH may be related to poor language development. There was limited evidence regarding interventions to address the behavioral disorders of DHH children.

Conclusions: There is a significant body of evidence demonstrating behavioral problems among DHH children but a lack of clear understanding of the mechanisms involved. There is limited evidence on interventions to address the behavioral problems of DHH children. Future research is warranted to mitigate the long-term effects of disruptive behavior among these children.
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http://dx.doi.org/10.1177/0194599818797598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441325PMC
January 2019

Travel distance: Impact on stage of presentation and treatment choices in head and neck cancer.

Am J Otolaryngol 2018 Sep - Oct;39(5):575-581. Epub 2018 Jun 28.

Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, KY, United States of America. Electronic address:

Objectives: The objective was to examine the impact of travel distance on stage of presentation and treatment choices in head and neck squamous cell carcinoma in the rural setting.

Methods: 6029 cases diagnosed from 2002 to 2011 were obtained from the state cancer registry. Travel time was calculated to the nearest academic medical centers, otolaryngologist, and radiation treatment facilities. Multivariate logistic regression was used to examine the association of travel time with stage of presentation as well as the likelihood of appropriate therapy after adjustment for other demographic variables.

Results: Patients in the highest quartile for travel distance to academic centers were 33% more likely to present with early stage disease (p = 0.02), and 42% more likely to receive appropriate surgical therapy for oral cavity cancer. Patients were 70% more likely to receive appropriate surgery if they were farthest from the nearest radiation center (p = 0.03). Proximity to otolaryngology care was not significant.

Conclusion: Increased travel distance to academic medical centers is associated with increased likelihood of proper therapy for surgically treated tumors of the head and neck. Impact on these findings on improvements in access to care is discussed.
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http://dx.doi.org/10.1016/j.amjoto.2018.06.020DOI Listing
January 2019

The Natural History and Rehabilitative Outcomes of Hearing Loss in Congenital Cytomegalovirus: A Systematic Review.

Otol Neurotol 2018 08;39(7):854-864

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

Objective: The purpose of this study was to examine the literature regarding the natural history and rehabilitative outcomes of sensorineural hearing loss from congenital cytomegalovirus infections.

Data Sources And Study Eligibility Criteria: A systematic search was performed in PubMed, PsychINFO, CINAHL, and Web of Science to identify peer-reviewed research. Eligible studies were those containing original peer-reviewed research in English addressing either the natural history or rehabilitative outcomes of sensorineural hearing loss (SNHL) in congenital cytomegalovirus (cCMV).

Study Appraisal And Synthesis Methods: Two investigators independently reviewed all articles and extracted data. Bias was assessed using the Cochrane Collaboration's tool and the Newcastle-Ottawa Assessment Scale.

Results: Thirty-six articles were reviewed. Universal screening identifies 0.2 to 1% of newborns with cCMV infection. SNHL ranged from 8 to 32% of infants and was more prevalent in symptomatic versus asymptomatic cases. Nine to 68% of hearing loss occurs in a late or delayed fashion. In 7 to 71% of cases hearing loss is progressive. Cochlear implantation (CI) is a viable option for patients with cCMV associated hearing loss and leads to improvements in hearing and language. There is limited literature comparing rehabilitation outcomes in cCMV and non-cCMV CI recipients.

Conclusion: Late onset and progressive hearing loss is seen in children who develop hearing loss from cCMV. Frequent audiologic follow-up is necessary considering the natural history of cCMV hearing loss. Universal screening should be pursued due to the number of asymptomatic children, at birth, who develop late onset/delayed hearing loss. CI is an effective means of improving speech and language in this population.
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http://dx.doi.org/10.1097/MAO.0000000000001861DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6041170PMC
August 2018

Physical Therapists Forward Deployed on Aircraft Carriers: A Retrospective Look at a Decade of Service.

Mil Med 2018 11;183(11-12):e377-e382

Naval Medicine Training Center, Bldg 903, 2931 Harney Rd, Fort Sam Houston, TX.

Introduction: Navy physical therapists (PTs) have been a part of ship's company aboard Aircraft Carriers since 2002 due to musculoskeletal injuries being the number one cause of lost duty time and disability. This article describes a decade of physical therapy services provided aboard aircraft carriers.

Materials And Methods: A retrospective survey was conducted to evaluate the types of services provided, volume of workload, value of services provided, and impact of PTs on operational readiness for personnel aboard Naval aircraft carriers. Thirty-four reports documenting workload from PTs stationed onboard aircraft carriers were collected during the first decade of permanent PT assignment to aircraft carriers.

Results: This report quantifies a 10-yr period of physical therapy services (PT and PT Technician) in providing musculoskeletal care within the carrier strike group and adds to existing literature demonstrating a high demand for musculoskeletal care in operational platforms. A collective total of 144,211 encounters were reported during the 10-yr period. The number of initial evaluations performed by the PT averaged 1,448 per assigned tour. The average number of follow-up appointments performed by the PT per tour was 1,440. The average number of treatment appointments per tour provided by the PT and PT technician combined was 1,888. The average number of visits per patient, including the initial evaluation, was 3.3. Sixty-five percent (65%) of the workload occurred while deployed or out to sea during training periods. It was estimated that 213 medical evacuations were averted over the 10-yr period. There were no reports of adverse events or quality of care reviews related to the care provided by the PT and/or PT technician. Access to early PT intervention aboard aircraft carriers was associated with a better utilization ratio (lower average number of visits per condition) than has been reported in prior studies and suggests an effective utilization of medical personnel resources.

Conclusions: The impact of Navy PTs serving afloat highlights the importance of sustaining these billets and indicates the potential benefit of additional billet establishment to support operational platforms with high volumes of musculoskeletal injury. Access to early PT intervention can prevent and rehabilitate injuries among operational forces, promote human performance optimization, increase readiness during war and peace time efforts, and accelerate rehabilitation from neuromusculoskeletal injuries. With the establishment of Electronic Health Records within all carrier medical groups a repeat study may provide additional detail related to musculoskeletal injuries to guide medical planners to staff sea-based operational platforms most effectively to care for the greatest source of battle and disease non-battle injuries and related disability in the military.
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http://dx.doi.org/10.1093/milmed/usy070DOI Listing
November 2018

Barriers to Rehabilitation Care in Pediatric Cochlear Implant Recipients.

Otol Neurotol 2018 06;39(5):e307-e313

Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky.

Objective: The purpose of this study was to assess barriers to rehabilitation care for pediatric cochlear implant (CI) recipients.

Study Design: Cross-sectional questionnaire study.

Setting: Tertiary medical center.

Patients: Parents of children who received a CI from October 1996 to June 2013.

Main Outcome Measure(s): Factors related to access to and barriers in audiology and speech therapy services, factors related to CI use, and performance with CI using the Parents' Evaluation of Aural/Oral Performance of Children (PEACH).

Results: Thirty-five parents participated in the study (21 rural residents and 14 urban residents). Distance was a significant barrier to audiology services for rural participants compared with urban participants (p = 0.01). Consistent CI use was complicated by mechanical complications or malfunction in 70% of rural children compared with 33% of urban children (p = 0.05). Only 10% of rural children were able to access speech therapy services at diagnosis compared with 42% of urban children (p = 0.04). Low socioeconomic (SES) status and Medicaid insurance were associated with a lack of local speech therapists and medical/mechanical CI complications. Higher parental educational attainment was associated with higher PEACH scores in quiet conditions compared with families with lower parental education (p = 0.04).

Conclusions: Rural children are often delayed in receipt of CI rehabilitation services. Multiple barriers including low SES, insurance type, and parental education can affect utilization of these services and may impact the recipient language development. Close follow-up and efforts to expand access to care are needed to maximize CI benefit.
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http://dx.doi.org/10.1097/MAO.0000000000001777DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5940514PMC
June 2018

Assessment of Behavioral Problems in Children With Hearing Loss.

Otol Neurotol 2017 12;38(10):1456-1462

*Department of Otolaryngology-Head and Neck Surgery †College of Medicine ‡Department of Biostatistics §College of Public Health ||Department of Health, Behavior, and Society, University of Kentucky, Lexington, Kentucky.

Objective: To compare the prevalence of disruptive behavior problems between preschool-aged children with hearing loss and normal hearing.

Study Design: Cross-sectional study.

Setting: Tertiary academic center.

Patients: Caregivers of children (2-5 yr old) with normal hearing (NH) (n = 39), hearing loss using hearing aid(s) (HA) (n = 29), or cochlear implant(s) (CI) (n = 21).

Intervention(s): Demographic information and a mental health history were obtained. Child behavior and language development were assessed.

Main Outcome Measure(s): The Young Child-Diagnostic Interview Schedule for Children-IV and the MacArthur-Bates Communication Development Inventory III.

Results: Distributions of race, socioeconomic status, insurance status, and parental home situation (single versus two parent family) were similar across all groups. Parents of children with hearing loss were significantly more likely to report behavior problems (HA = 41%, CI = 38%) than parents of NH children (10%; p = 0.002). Children with hearing loss were significantly more likely to meet diagnostic criteria for oppositional defiant disorder (HA = 48%, CI = 48%) than NH children (23%; p = 0.02). More NH children (8%) than hearing impaired children (0%) had accessed mental health services (p = 0.08). NH children were found to have more advanced language development than hearing-impaired children (p < 0.01), but controlling for Communication Development Inventory III percentiles, the observed behavioral differences remained.

Conclusion: Controlling for language development, children with hearing loss have higher prevalence of and impairment from disruptive behaviors than their NH peers. These children are less likely to receive appropriate behavioral interventions. Further research is warranted to investigate the impact of disruptive behaviors on speech and hearing rehabilitation. Methods to improve access to effective behavioral interventions in this population are needed.
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http://dx.doi.org/10.1097/MAO.0000000000001583DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685876PMC
December 2017

Promotion of early pediatric hearing detection through patient navigation: A randomized controlled clinical trial.

Laryngoscope 2017 11 20;127 Suppl 7:S1-S13. Epub 2017 Sep 20.

Department of Health, Behavior and Society, University of Kentucky College of Public Health, Lexington, Kentucky, U.S.A.

Objectives/hypothesis: To assess the efficacy of a patient navigator intervention to decrease nonadherence to obtain audiological testing following failed screening, compared to those receiving the standard of care.

Methods: Using a randomized controlled design, guardian-infant dyads, in which the infants had abnormal newborn hearing screening, were recruited within the first week after birth. All participants were referred for definitive audiological diagnostic testing. Dyads were randomized into a patient navigator study arm or standard of care arm. The primary outcome was the percentage of patients with follow-up nonadherence to obtain diagnostic testing. Secondary outcomes were parental knowledge of infant hearing testing recommendations and barriers in obtaining follow-up testing.

Results: Sixty-one dyads were enrolled in the study (patient navigator arm = 27, standard of care arm = 34). The percentage of participants nonadherent to diagnostic follow-up during the first 6 months after birth was significantly lower in the patient navigator arm compared with the standard of care arm (7.4% vs. 38.2%) (P = .005). The timing of initial follow-up was significantly lower in the navigator arm compared with the standard of care arm (67.9 days after birth vs. 105.9 days, P = .010). Patient navigation increased baseline knowledge regarding infant hearing loss diagnosis recommendations compared with the standard of care (P = .004).

Conclusions: Patient navigation decreases nonadherence rates following abnormal infant hearing screening and improves knowledge of follow-up recommendations. This intervention has the potential to improve the timeliness of delivery of infant hearing healthcare; future research is needed to assess the cost and feasibility of larger scale implementation.

Level Of Evidence: 1b. Laryngoscope, 127:S1-S13, 2017.
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http://dx.doi.org/10.1002/lary.26822DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5669046PMC
November 2017

Factors associated with patient no-show rates in an academic otolaryngology practice.

Laryngoscope 2018 03 16;128(3):626-631. Epub 2017 Aug 16.

Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky.

Objectives/hypothesis: Factors affecting access to healthcare is an expanding area of research. This study seeks to identify factors associated with no-show rates in an academic otolaryngology practice to improve clinical efficiency and patient access to care.

Study Design: Retrospective review.

Methods: A retrospective review of scheduled clinical appointments from February 1, 2015 to January 30, 2016 at a single academic otolaryngology department was performed. Statistical analysis was completed to examine the association of no-show rates with the following: otolaryngology subspecialty, clinic location (e.g., main campus vs. satellite), patient demographic factors, attending seniority, temporal factors, insurance types, rurality, and visit type.

Results: There was an overall no-show rate of 20% for 22,759 scheduled clinic visits. Satellite clinics had the highest no-show rates at 25% (P < .001). New patient visits had the highest no-show rate at 24% (P < .001). Among subspecialties, facial plastic surgery had the lowest no-show rate (12.6%), whereas Pediatrics had the highest (23%) (P < .001). No significant association between gender and no-show rates was observed (P = .29), but patients over 60 years old had the lowest no-show rate (12.7%, P < .0001). Patients with Medicaid (28%), Medicare (15.3%), and commercial insurance (12.9%) had significantly different overall no-show rates (P < .0001).

Conclusions: Increased clinic no-show rates are associated with satellite clinics, new patient visits, younger age, and insurance type. No-show rates varied among subspecialties. Further investigation is warranted to assess barriers to appointment compliance and to develop interventions to improve access to care.

Level Of Evidence: 4. Laryngoscope, 128:626-631, 2018.
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http://dx.doi.org/10.1002/lary.26816DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5814324PMC
March 2018

Disparities in access to pediatric hearing health care.

Curr Opin Otolaryngol Head Neck Surg 2017 Oct;25(5):359-364

Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA.

Purpose Of Review: There are significant disparities in care facing children with hearing loss. The objective of this review is to assess the current disparities in pediatric hearing healthcare delivery, describe the barriers of efficient and effective pediatric hearing health care, and explore the innovations to improve pediatric hearing healthcare delivery.

Recent Findings: Children with hearing loss from certain geographic regions or ethnic background are significantly delayed in diagnosis and treatment. Multiple patient characteristics (presentation of hearing loss), parental factors (insurance status, socioeconomic status, educational status, and travel distance to providers), and provider barriers (specialist shortage and primary care provider challenges) prevent the delivery of timely hearing health care. Advances, such as improved screening programs and the expansion of care through remote services, may help to ameliorate these disparities.

Summary: Timely identification and treatment of pediatric hearing loss is critical to prevent lifelong language complications. Children from vulnerable populations, such as rural residents, face significant disparities in care. Careful assessment of these barriers and implementation of culturally acceptable interventions are paramount to maximize communication outcomes of children with hearing loss.
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http://dx.doi.org/10.1097/MOO.0000000000000388DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5973811PMC
October 2017

In Response to Letter to the Editor Entitled, "The Role of Radiation in Tympanojugular Paragangliomas Needs to be Re-evaluated".

Otol Neurotol 2017 08;38(7):1062

Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky University of Kentucky College of Medicine, Lexington, Kentucky Department of Radiation Medicine, University of Kentucky Medical Center, Lexington, Kentucky Department of Radiation Medicine, University of Kentucky Medical Center, Lexington, Kentucky.

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http://dx.doi.org/10.1097/MAO.0000000000001472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5515234PMC
August 2017

Adherence in the Cancer Care Setting: a Systematic Review of Patient Navigation to Traverse Barriers.

J Cancer Educ 2018 12;33(6):1222-1229

College of Medicine, University of Kentucky, Lexington, KY, USA.

Patient navigation is an evidence-based intervention involving trained healthcare workers who assist patients in assessing and mitigating personal and environmental factors to promote healthy behaviors. The purpose of this research is to systematically assess the efficacy of patient navigation and similar programs to improve diagnosis and treatment of diseases affecting medically underserved populations. A systematic review was performed by searching PubMed, MEDLINE, PsychINFO, and CINAHL to identify potential studies. Eligible studies were those containing original peer-reviewed research reports in English on patient navigation, community health workers, vulnerable and underserved populations, and healthcare disparity. Specific outcomes regarding patient navigator including the effect of the intervention on definitive diagnosis and effect on initiation of treatment were extracted from each study. The search produced 1428 articles, and 16 were included for review. All studies involved patient navigation in the field of oncology in underserved populations. Timing of initial contact with a patient navigator after diagnostic or screening testing is correlated to the effectiveness of the navigator intervention. The majority of the studies reported significantly shorter time intervals to diagnosis and to treatment with patient navigation. Patient navigation expedites oncologic diagnosis and treatment of patients in underserved populations. This intervention is more efficacious when utilized shortly after screening or diagnostic testing.
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http://dx.doi.org/10.1007/s13187-017-1235-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5711635PMC
December 2018

Rurality and determinants of hearing healthcare in adult hearing aid recipients.

Laryngoscope 2017 10 31;127(10):2362-2367. Epub 2017 Jan 31.

Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A.

Objective: The objective of this study was to compare the timing of hearing aid (HA) acquisition between adults in rural and urban communities. We hypothesized that time of acquisition of HA after onset of hearing loss is greater in rural adults compared with urban adults. Secondary objectives included assessment of socioeconomic/educational status and impact of hearing loss and hearing rehabilitation of urban and rural HA recipients.

Study Design: Cross-sectional questionnaire survey.

Methods: We assessed demographics, timing of HA fitting from onset of hearing loss, and impact of hearing impairment in 336 adult HA recipients (273 urban, 63 rural) from a tertiary referral center. Amplification benefit was assessed using the International Outcome Inventory for Hearing Aids (IOI).

Results: The time to HA acquisition was greater for rural participants compared to urban participants (19.1 vs. 25.7 years, P = 0.024) for those with untreated hearing loss for at least 8 years. Age at hearing loss onset was correlated with time to HA acquisition (P = -0.54, P < 0.001). Rural HA participants experienced longer commutes to hearing specialists (68 vs. 32 minutes, P < 0.001), were less likely to achieve a degree beyond high school (P < 0.001), and were more likely to possess Medicaid coverage (P = 0.012) compared to urban participants. Hearing impairment caused job performance difficulty in 60% of all participants.

Conclusion: Rural adults are at risk for delayed HA acquisition, which may be related to distance to hearing specialists. Further research is indicated to investigate barriers to care and expand access for vulnerable populations.

Level Of Evidence: 4. Laryngoscope, 127:2362-2367, 2017.
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http://dx.doi.org/10.1002/lary.26490DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537053PMC
October 2017

The Role of Telemedicine in Auditory Rehabilitation: A Systematic Review.

Otol Neurotol 2016 12;37(10):1466-1474

*Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky†Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Nairobi College of Medicine, Nairobi, Kenya.

Objective: The purpose of this study was to assess the feasibility and effectiveness of live telemedicine applications in hearing amplification and cochlear implantation.

Data Sources And Study Selection: A systematic search was performed in PubMed, MEDLINE, PsychINFO, CINALH, and Web of Science to identify peer-reviewed research. Inclusion criteria were titles containing words from the search terms 1) audiology, otolaryngology, and hearing impairment, 2) rehabilitative methods, and 3) telemedicine. Exclusion criteria were: 1) non-English articles, and 2) non-original research.

Data Extraction And Synthesis: Twelve eligible studies were identified. The studies employed a prospective design in nine of the articles and retrospective case series in three. The use of telemedicine for the provision of cochlear implant services was examined in eight of the articles and with hearing aids in four of the articles. The types of services include intraoperative cochlear implant telemetry; implant programming and assessment of electrode-specific measures and speech recognition after implantation. Hearing aid programming and remote gain assessments were also reported. Many studies assess patient and provider satisfaction along with encounter time comparison. The studies occurred from 2009 to 2014 and took place in seven countries.

Conclusions: This review examined the feasibility of remote telemedicine connection to provide in auditory rehabilitation services through hearing aids and cochlear implants. There are significant concerns regarding Internet bandwidth limitations for remote clinics. There is a paucity of research examining reimbursement and cost-effectiveness for services. Further prospective research investigating cost-effectiveness and bandwidth limitations is warranted to assess long-term sustainability of remote audiological rehabilitative service delivery.
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http://dx.doi.org/10.1097/MAO.0000000000001236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102772PMC
December 2016

Timing and Impact of Hearing Healthcare in Adult Cochlear Implant Recipients: A Rural-Urban Comparison.

Otol Neurotol 2016 10;37(9):1320-4

*Department of Otolaryngology-Head and Neck Surgery†College of Medicine, University of Kentucky, Lexington, Kentucky.

Objective: The purpose of this study is to compare the timing and impact of hearing healthcare of rural and urban adults with severe hearing loss who use cochlear implants (CI).

Study Design: Cross-sectional questionnaire study.

Setting: Tertiary referral center.

Patients: Adult cochlear implant recipients.

Main Outcome Measures: Data collected included county of residence, socioeconomic information, impact of hearing loss on education/employment, and timing of hearing loss treatment. The benefits obtained from cochlear implantation were also evaluated.

Results: There were 91 participants (32 from urban counties, 26 from moderately rural counties, and 33 for extremely rural counties). Rural participants have a longer commute time to the CI center (p < 0.001), lower income (p < 0.001), and higher percentage of Medicaid coverage (p = 0.004). Compared with urban-metro participants, rural participants with gradually progressive hearing loss had a greater time interval from the onset of hearing loss to obtaining hearing aid amplification (10 yr versus 5 yr, p = 0.04). There was also a greater time interval from onset of hearing loss to the time of cochlear implantation in rural participants (p = 0.04). Reported job loss was higher in rural participants than in urban participants (p = 0.05). Both groups reported comparable benefit from cochlear implantation.

Conclusion: Rural CI recipients differ from urban residents in socioeconomic characteristics and may be delayed in timely treatment of hearing loss. Further efforts to expand access to hearing healthcare services may benefit rural adult patients.
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http://dx.doi.org/10.1097/MAO.0000000000001197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027983PMC
October 2016

Factors involved in access and utilization of adult hearing healthcare: A systematic review.

Laryngoscope 2017 05 22;127(5):1187-1194. Epub 2016 Aug 22.

Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A.

Objective/hypothesis: Hearing loss is a public health concern, yet hearing healthcare disparities exist and influence utilization of rehabilitation services. The objective of this review was to systematically analyze the published literature on motivators, barriers, and compliance factors affecting adult patient access and utilization of hearing rehabilitation healthcare.

Data Sources: Pubmed, PsychINFO, CINAHL, and Web of Science were searched for relevant articles. Eligible studies were those containing original, peer-reviewed research in English pertaining to factors affecting adult hearing healthcare access and utilization of hearing aids and cochlear implantation. The search encompassed 1990 to 2015.

Methods: Two investigators independently reviewed all articles and extracted data. Specific variables regarding access to care and compliance to recommended care were extracted from each study.

Results: Thirty articles were reviewed. The factors affecting access and utilization of hearing rehabilitation could be classified into motivators, barriers, and compliance in treatment or device use. The key motivators to seek care include degree of hearing loss, self-efficacy, family support, and self-recognition of hearing loss. The primary barriers to care were financial limitations, stigma of hearing devices, inconvenience, competing chronic health problems, and unrealistic expectations. Compliance is most affected by self-efficacy, education level, and engagement in the rehabilitation process.

Conclusion: Accessing hearing healthcare is complicated by multiple factors. Considering the current climate in healthcare policy and legislation toward improved access of care, a deeper understanding of motivators, barriers, and compliance factors can aid in delivery of effective and efficient hearing healthcare. Laryngoscope, 127:1187-1194, 2017.
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http://dx.doi.org/10.1002/lary.26234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5322257PMC
May 2017

Treatment Outcomes for Single Modality Management of Glomus Jugulare Tumors With Stereotactic Radiosurgery.

Otol Neurotol 2016 10;37(9):1406-10

*Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center †University of Kentucky College of Medicine ‡Department of Radiation Medicine, University of Kentucky Medical Center, Lexington, Kentucky.

Objectives: The objectives were to evaluate the audiological outcomes, response of symptoms, and response of tumor volume in patients with glomus jugulare tumors treated solely with single fraction gamma knife radiosurgery.

Study Design: Single institution retrospective review.

Setting: Academic, tertiary referral center.

Patients: The diagnosis code for glomus jugulare was used to identify patients. Only those who underwent gamma knife radiosurgery were included. Those previously treated with any modality were excluded. A total of 12 patients were included for the tumor response and symptom response data and 7 of those were included in the audiometric analysis.

Main Outcomes Measures: Audiometric data at most recent follow-up compared with presentation, subjective improvement in pulsatile tinnitus, and change in tumor volume at most recent follow-up compared with pretreatment.

Results: The average time to most recent follow-up was 27.6 months. There was no significant change in pure-tone average or word recognition. Pulsatile tinnitus completely resolved or improved in 80% of patients. Cranial neuropathies were stable or improved. A single patient experienced facial nerve paresis 2 years after treatment, which resolved with steroid treatment. Tumor control was 100% and the average change in tumor volume was a decrease of 37%.

Conclusion: Single modality gamma knife radiosurgery treatment of glomus jugulare tumors seems to be safe. Treatment results in decreased tumor volume and improved pulsatile tinnitus in most patients. There was no significant progression of hearing loss after treatment. Lower cranial nerve function remains stable in all patients.
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http://dx.doi.org/10.1097/MAO.0000000000001160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5025368PMC
October 2016