Publications by authors named "Vincent Lin"

110 Publications

Pain Management Following Otological Surgery: A Prospective Study of Different Strategies.

Laryngoscope 2021 Sep 8. Epub 2021 Sep 8.

Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.

Objectives: The aim of this study was to prospectively assess pain and associated analgesic consumption after otological surgery comparing two prescription patterns.

Study Design: A prospective nonrandomized consecutive cohort study.

Methods: 125 adult patients undergoing ambulatory otologic surgery-cochlear implantation and endaural middle ear surgery, were assigned (according to surgeon's preference) and prospectively studied in two arms: 1) acetaminophen 500 mg + ibuprofen 400 mg; 2) acetaminophen 500 mg + codeine 30 mg. Pain levels, medication dose, disposal patterns of opioids, and suspected side effects were evaluated.

Results: All patients reported mild to moderate pain. There was a statistically significant reduction of pain from day to day, which was on average 0.26 lower than the day before. Sufficient pain control could be achieved with both drug regimens with no significant difference in pain levels. Only 50% of patients who were prescribed opioids used them. Additionally, the median tablet intake was 3 tablets while 10 to 20 tablets were prescribed. The majority of patients (97%) did not dispose of these drugs safely.

Conclusion: Adequate analgesia was achieved in both arms of this study. Pain control following otologic surgery with a combination of acetaminophen and nonsteroidal anti-inflammatory drugs is recommended unless contraindications or chronic opioid use are present. If opioids such as codeine (30 mg) are prescribed, the amount should be reduced as low as possible, such as five tablets, based on our studied population.

Level Of Evidence: Level 3-a prospective nonrandomized consecutive cohort study Laryngoscope, 2021.
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http://dx.doi.org/10.1002/lary.29845DOI Listing
September 2021

Glasgow Benefit Inventory in Cochlear Implantation: A Reliable Though Ancillary Quality of Life Metric.

Otol Neurotol 2021 Aug 4. Epub 2021 Aug 4.

Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada Department of Otolaryngology, Head & Neck Surgery, Stanford University Hospital and Clinics, Stanford, California Department of Otolaryngology - Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts.

Objective: The Glasgow Benefit Inventory (GBI) is a health-related quality of life instrument used to detect changes in health status following otolaryngologic interventions. Despite its use in cochlear implant literature, assessment of utility, reliability, and validity of GBI in an adult cochlear implants (CI) patient population has yet to be performed.

Study Design: Retrospective case series.

Setting: Academic, tertiary referral center.

Patients: Postlingually deafened, adult CI patients with at least 1 year of device use.

Interventions: Five hundred fifty-two patients were administered GBI questionnaires at least 1 year following CI activation during follow-up visits.

Main Outcome Measures: GBI total and subscale scoring were compared to either the Hearing Handicap Inventory for Adults or Hearing Handicap Inventory for the Elderly. Moreover, a factor analysis and Cronbach's alpha were performed to determine GBI validity and internal reliability, respectively.

Results: The average overall GBI score was 38.6 ± 21.7. This was weakly correlated to the reduction in Hearing Handicap Inventory for Adults/Hearing Handicap Inventory for the Elderly (τb = 0.282, p < 0.05). High factor loading with minimal cross-loading was noted on a three-factor solution, which emulated the original GBI development. Internal reliability was acceptable for the general benefit (α = 0.913) and social support subclasses (α = 0.706), whereas physical health's was low (α = 0.643).

Conclusions: Although GBI possesses adequate convergent and discriminant validity with acceptable reliability, its routine use to capture CI-specific health-related changes should not supersede validated CI-specific QoL instruments.
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http://dx.doi.org/10.1097/MAO.0000000000003292DOI Listing
August 2021

Local magnetic delivery of adeno-associated virus AAV2(quad Y-F)-mediated BDNF gene therapy restores hearing after noise injury.

Mol Ther 2021 Jul 21. Epub 2021 Jul 21.

Biological Sciences Platform, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; Department of Otolaryngology Head & Neck Surgery, Faculty of Medicine, University of Toronto, ON M5S 1A1, Canada. Electronic address:

Moderate noise exposure may cause acute loss of cochlear synapses without affecting the cochlear hair cells and hearing threshold; thus, it remains "hidden" to standard clinical tests. This cochlear synaptopathy is one of the main pathologies of noise-induced hearing loss (NIHL). There is no effective treatment for NIHL, mainly because of the lack of a proper drug-delivery technique. We hypothesized that local magnetic delivery of gene therapy into the inner ear could be beneficial for NIHL. In this study, we used superparamagnetic iron oxide nanoparticles (SPIONs) and a recombinant adeno-associated virus (AAV) vector (AAV2(quad Y-F)) to deliver brain-derived neurotrophic factor (BDNF) gene therapy into the rat inner ear via minimally invasive magnetic targeting. We found that the magnetic targeting effectively accumulates and distributes the SPION-tagged AAV2(quad Y-F)-BDNF vector into the inner ear. We also found that AAV2(quad Y-F) efficiently transfects cochlear hair cells and enhances BDNF gene expression. Enhanced BDNF gene expression substantially recovers noise-induced BDNF gene downregulation, auditory brainstem response (ABR) wave I amplitude reduction, and synapse loss. These results suggest that magnetic targeting of AAV2(quad Y-F)-mediated BDNF gene therapy could reverse cochlear synaptopathy after NIHL.
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http://dx.doi.org/10.1016/j.ymthe.2021.07.013DOI Listing
July 2021

Cortical alpha oscillations in cochlear implant users reflect subjective listening effort during speech-in-noise perception.

PLoS One 2021 9;16(7):e0254162. Epub 2021 Jul 9.

Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada.

Listening to speech in noise is effortful for individuals with hearing loss, even if they have received a hearing prosthesis such as a hearing aid or cochlear implant (CI). At present, little is known about the neural functions that support listening effort. One form of neural activity that has been suggested to reflect listening effort is the power of 8-12 Hz (alpha) oscillations measured by electroencephalography (EEG). Alpha power in two cortical regions has been associated with effortful listening-left inferior frontal gyrus (IFG), and parietal cortex-but these relationships have not been examined in the same listeners. Further, there are few studies available investigating neural correlates of effort in the individuals with cochlear implants. Here we tested 16 CI users in a novel effort-focused speech-in-noise listening paradigm, and confirm a relationship between alpha power and self-reported effort ratings in parietal regions, but not left IFG. The parietal relationship was not linear but quadratic, with alpha power comparatively lower when effort ratings were at the top and bottom of the effort scale, and higher when effort ratings were in the middle of the scale. Results are discussed in terms of cognitive systems that are engaged in difficult listening situations, and the implication for clinical translation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0254162PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270138PMC
July 2021

Quality Indicators for the Diagnosis and Management of Menière's Disease.

Otol Neurotol 2021 Sep;42(8):e1084-e1092

Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto.

Objective: Menière's disease (MD) is a clinical disorder that often provides challenges in diagnosis and management. High-quality evidence to guide care providers is sparse, which can result in significant practice variations. Quality indicators (QIs) are one method that can be used to standardize and measure accepted care practices to improve healthcare quality and patient outcomes. Here, we developed practical, high-yield QIs that serve to measure and inform the quality of care provided to patients with MD.

Study Design: Modified RAND Corporation University of California, Los Angeles appropriateness methodology for QI development.

Setting: Multicenter nine-member expert panel.

Patients: NA.

Interventions: NA.

Main Outcome Measure: Final QIs deemed appropriate measures of quality care with agreement by the expert panel.

Results: Twenty-seven candidate indicators were identified after literature review. After the first round of evaluations, the panel agreed on three candidate indicators as appropriate QIs. A subsequent expert panel meeting provided a platform to discuss disagreements. Two agreed-upon QIs were revised during this discussion before final evaluations. The expert panel ultimately agreed upon five QIs as appropriate measures of high-quality care after completing final evaluations and reviewing updated literature. The five quality indicators measure audiometric documentation, minimization of electrocochleography, use of intratympanic dexamethasone, use of intratympanic gentamycin, and rate of labyrinthectomy/vestibular neurectomy in refractory MD patient.

Conclusions: This study proposes five QIs that cover key aspects of care for MD, such as accurate diagnosis and management options including initial destructive therapies. These QIs can serve multiple purposes, the most important of which is to galvanize quality improvement initiatives.
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http://dx.doi.org/10.1097/MAO.0000000000003206DOI Listing
September 2021

Is otologic surgery contributing to the opioid epidemic?

J Otolaryngol Head Neck Surg 2021 Jun 22;50(1):38. Epub 2021 Jun 22.

Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.

Background: The opioid epidemic is a significant public health crisis challenging the lives of North Americans. Interestingly, this problem does not exist to the same extent in Europe. Surgeons play a significant role in prescribing opioids, especially in the context of post-operative pain management. The aim of this study was to compare the post-surgical prescribing patterns of otologists comparing Canada and Austria.

Methods: An online questionnaire was sent to 33 Canadian and 32 Austrian surgeons, who perform otologic surgery on a regular basis. Surgeons were asked to answer some questions about their background as well as typical prescribing patterns for postoperative pain medication for different ear surgeries (cochlear implant, stapedotomy, tympanoplasty). In addition, surgeons were asked about the typical use of local anesthetics for pain control at the end of a procedure. Otologists gave an estimate how confident they were that their therapy and prescriptions provide sufficient pain control to their patients.

Results: Analysis of the returned questionnaires showed that opioids are more commonly prescribed in Canada than in Austria. Nonsteroidal anti-inflammatory drugs are used for postoperative pain more regularly after ear surgery in Austria, as opposed to Canada. Some of the prescribed drugs by European otologists are not available in North America. The use of local anesthetics at the end of surgery is not common in Austria. Surgeons´ confidence that the prescribed pain medication was sufficient to control postoperative symptoms was higher in the group not prescribing opioids than in the group that did routinely prescribe opioids.

Conclusion: Prescribing patterns differ substantially between the two evaluated countries. This data suggests an opportunity to reduce opioid prescriptions after otologic surgeries. Studies to evaluate pain after these operations as well as efficacy of analgesics following ear surgery are an important next step.
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http://dx.doi.org/10.1186/s40463-021-00521-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220669PMC
June 2021

Neural correlates of visual stimulus encoding and verbal working memory differ between cochlear implant users and normal-hearing controls.

Eur J Neurosci 2021 08 9;54(3):5016-5037. Epub 2021 Jul 9.

Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada.

A common concern for individuals with severe-to-profound hearing loss fitted with cochlear implants (CIs) is difficulty following conversations in noisy environments. Recent work has suggested that these difficulties are related to individual differences in brain function, including verbal working memory and the degree of cross-modal reorganization of auditory areas for visual processing. However, the neural basis for these relationships is not fully understood. Here, we investigated neural correlates of visual verbal working memory and sensory plasticity in 14 CI users and age-matched normal-hearing (NH) controls. While we recorded the high-density electroencephalogram (EEG), participants completed a modified Sternberg visual working memory task where sets of letters and numbers were presented visually and then recalled at a later time. Results suggested that CI users had comparable behavioural working memory performance compared with NH. However, CI users had more pronounced neural activity during visual stimulus encoding, including stronger visual-evoked activity in auditory and visual cortices, larger modulations of neural oscillations and increased frontotemporal connectivity. In contrast, during memory retention of the characters, CI users had descriptively weaker neural oscillations and significantly lower frontotemporal connectivity. We interpret the differences in neural correlates of visual stimulus processing in CI users through the lens of cross-modal and intramodal plasticity.
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http://dx.doi.org/10.1111/ejn.15365DOI Listing
August 2021

A 3D Fiber-Hydrogel Based Non-Viral Gene Delivery Platform Reveals that microRNAs Promote Axon Regeneration and Enhance Functional Recovery Following Spinal Cord Injury.

Adv Sci (Weinh) 2021 08 29;8(15):e2100805. Epub 2021 May 29.

School of Chemical and Biomedical Engineering, Nanyang Technological University, 62 Nanyang Drive, Singapore, 637459, Singapore.

Current treatment approaches toward spinal cord injuries (SCI) have mainly focused on overcoming the inhibitory microenvironment that surrounds lesion sites. Unfortunately, the mere modulation of the cell/tissue microenvironment is often insufficient to achieve desired functional recovery. Therefore, stimulating the intrinsic growth ability of injured neurons becomes crucial. MicroRNAs (miRs) play significant roles during axon regeneration by regulating local protein synthesis at growth cones. However, one challenge of using miRs to treat SCI is the lack of efficient delivery approaches. Here, a 3D fiber-hydrogel scaffold is introduced which can be directly implanted into a spinal cord transected rat. This 3D scaffold consists of aligned electrospun fibers which provide topographical cues to direct axon regeneration, and collagen matrix which enables a sustained delivery of miRs. Correspondingly, treatment with Axon miRs (i.e., a cocktail of miR-132/miR-222/miR-431) significantly enhances axon regeneration. Moreover, administration of Axon miRs along with anti-inflammatory drug, methylprednisolone, synergistically enhances functional recovery. Additionally, this combined treatment also decreases the expression of pro-inflammatory genes and enhance gene expressions related to extracellular matrix deposition. Finally, increased Axon miRs dosage with methylprednisolone, significantly promotes functional recovery and remyelination. Altogether, scaffold-mediated Axon miR treatment with methylprednisolone is a promising therapeutic approach for SCI.
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http://dx.doi.org/10.1002/advs.202100805DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8336488PMC
August 2021

Quality Indicators for the Diagnosis and Management of Sudden Sensorineural Hearing Loss.

Otol Neurotol 2021 Sep;42(8):e991-e1000

Department of Otolaryngology-Head and Neck Surgery, University of Toronto.

Objective: Sudden sensorineural hearing loss (SSNHL) is an ideal entity for quality indicator (QI) development, providing treatment challenges resulting in variable or substandard care. The American Academy of Otolaryngology-Head and Neck Surgery recently updated their SSNHL guidelines. With SSNHL demonstrating a large burden of illness, this study sought to leverage the updated guidelines and develop QIs that support quality improvement initiatives at an individual, institutional, and systems level.

Methods: Candidate indicators (CIs) were extracted from high-quality SSNHL guidelines that were evaluated using the Appraisal of Guidelines for Research and Evaluation II tool. Each CI and its supporting evidence were summarized and reviewed by a nine-member expert panel based on validity, reliability, and feasibility of measurement. Final QIs were selected from CIs using the modified RAND Corporation-University of California, Los Angeles appropriateness methodology.

Results: Fifteen CIs were identified after literature review. After the first round of evaluations, the panel agreed on 11 candidate indicators as appropriate QIs with 2 additional CIs suggested for consideration. An expert panel meeting provided a platform to discuss areas of disagreement before final evaluations. The expert panel subsequently agreed upon 11 final QIs as appropriate measures of high-quality care for SSNHL.

Conclusion: The 11 proposed QIs from this study are supported by evidence and expert consensus, facilitating measurement across a wide breadth of quality domains. With the recently updated SSNHL guidelines, and a greater focus on quality improvement opportunities, these QIs may be used by healthcare providers for targeted quality improvement initiatives.
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http://dx.doi.org/10.1097/MAO.0000000000003205DOI Listing
September 2021

Patient Perspectives on Removing Adult Tonsillectomy and Septoplasty from the Government Health Insurance Plan in a Publicly Funded Health Care System.

Inquiry 2021 Jan-Dec;58:469580211005193

Department of Otolaryngology-Head & Neck Surgery, Michael Garron Hospital, The Toronto East Health Network, University of Toronto, Toronto, ON, Canada.

In several publicly funded health care systems, including Ontario, Canada, adult tonsillectomies and septoplasties have been suggested to be removed or "delisted" from the government health insurance plan. Thus, the objective of this study was to explore patient perspectives regarding out of pocket (OOP) payment for these procedures. An anonymous survey was administered to patients consented to undergo a tonsillectomy or septoplasty at a community otolaryngology-head and neck surgery (OHNS) practice. The survey asked patients if they would pay the projected cost for their surgery OOP and the maximum amount of time they would wait for their surgery. The survey also contained questions on socioeconomic status and disease severity. Seventy-one patients were included. Overall, 21% of patients were willing to pay OOP for their surgery. Forty-nine percent of patients reported that the maximum amount of time they would be willing to wait for their surgery was 2 to 6 months. There was no significant correlation found between any of the demographic variables or disease severity and willingness to pay OOP for these surgeries. In this study, a small percentage of patients who met the clinical indications for a tonsillectomy or a septoplasty would pay for their surgery in the event that it was not covered by the government health insurance plan. These surgeries are common operations and delisting them could potentially decrease the provision of these services and have a significant impact on Canadian OHNS practices.
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http://dx.doi.org/10.1177/00469580211005193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8058792PMC
April 2021

Management of sudden sensorineural hearing loss among primary care physicians in Canada: a survey study.

J Otolaryngol Head Neck Surg 2021 Apr 1;50(1):22. Epub 2021 Apr 1.

Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.

Background: Sudden Sensorineural Hearing Loss (SSNHL) is a medical emergency requiring immediate attention as delayed treatment can lead to permanent and devastating consequences. Primary care physicians are likely the first to be presented with SSNHL and therefore have the crucial role of recognizing it and initiating timely and appropriate management. The aim of this study was to gain insight into the current knowledge and practice trends pertaining to the diagnosis and management of SSNHL among family physicians in Canada.

Methods: An 18-question survey targeting Canadian family physicians was marketed through two, physician-only discussion groups on the social media platform Facebook. Responses were collected between August 1st and December 22nd 2019 then aggregated and quantified.

Results: 52 family physicians submitted responses. 94.2% (n = 49) reported that in their practice, unilateral SSNHL warrants urgent referral to otolaryngology and 84.6% (n = 44) reported that unilateral sudden-onset hearing loss warrants urgent referral for audiological testing. 73.1% of participants (n = 38) reported that they would attempt to differentiate between conductive and sensorineural hearing loss if presented with unilateral, acute or sudden-onset hearing loss. 61.5% (n = 32) would rely on tuning fork tests to inform management decisions, as compared to 94.2% (n = 49) relying on case history and 88.5% (n = 46) on otoscopy. 76.9% (n = 40) would prescribe corticosteroids if presented with confirmed, unilateral SSNHL.

Conclusion: The majority of family physicians in the study would make appropriate referral and treatment decisions in the management of SSNHL, understanding it is a medical emergency. Tuning fork tests are under-utilized for informing management decisions compared to other means of differentiating conductive and sensorineural hearing loss. Further research is needed to understand why some family physicians do not prescribe corticosteroids for treatment of SSNHL, which may then identify any gaps in knowledge or inform improvements in clinical protocol.
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http://dx.doi.org/10.1186/s40463-021-00498-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8015047PMC
April 2021

Noise in Otolaryngology - Head and Neck Surgery operating rooms: a systematic review.

J Otolaryngol Head Neck Surg 2021 Feb 11;50(1). Epub 2021 Feb 11.

Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.

Objective: Noise in operating rooms (OR) can have negative effects on both patients and surgical care workers. Noise can also impact surgical performance, team communication, and patient outcomes. Such implications of noise have been studied in orthopedics, neurosurgery, and urology. High noise levels have also been demonstrated in Otolaryngology-Head and Neck Surgery (OHNS) procedures. Despite this, no previous study has amalgamated the data on noise across all OHNS ORs to determine how much noise is present during OHNS surgeries. This study aims to review all the literature on noise associated with OHNS ORs and procedures.

Methods: Ovid Medline, EMBASE Classic, Pubmed, SCOPUS and Cochrane databases were searched following PRISMA guidelines. Data was collected on noise measurement location and surgery type. Descriptive results and statistical analysis were completed using Stata.

Results: This search identified 2914 articles. Final inclusion consisted of 22 studies. The majority of articles analyzed noise level exposures during mastoid surgery (18/22, 82%). The maximum noise level across all OHNS ORs and OHNS cadaver studies were 95.5 a-weighted decibels (dBA) and 106.6 c-weighted decibels (dBC), respectively (P = 0.2068). The mean noise level across all studies was significantly higher in OHNS cadaver labs (96.9 dBA) compared to OHNS ORs (70.1 dBA) (P = 0.0038). When analyzed together, the mean noise levels were 84.9 dBA.

Conclusions: This systematic review demonstrates that noise exposure in OHNS surgery exceeds safety thresholds. Further research is needed to understand how noise may affect team communication, surgical performance and patient outcomes in OHNS ORs.
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http://dx.doi.org/10.1186/s40463-020-00487-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879658PMC
February 2021

Corrigendum to "The Effect of Cochlear Size on Cochlear Implantation Outcomes".

Biomed Res Int 2020 1;2020:6407456. Epub 2020 Oct 1.

Sunnybrook Health Sciences Centre, Toronto, Canada M4N 3M5.

[This corrects the article DOI: 10.1155/2019/5849871.].
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http://dx.doi.org/10.1155/2020/6407456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7556065PMC
October 2020

Pharmacologic and surgical therapies for patients with Meniere's disease: A systematic review and network meta-analysis.

PLoS One 2020 1;15(9):e0237523. Epub 2020 Sep 1.

Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada.

Background: Meniere's disease (MD) is a chronic condition of the inner ear consisting of symptoms that include vertigo attacks, fluctuating sensorineural hearing loss, tinnitus and aural fullness. Despite availability of various interventions, there is uncertainty surrounding their relative efficacy, thus making it difficult to select the appropriate treatments for MD. The objective of this systematic review was to assess the relative effects of the available pharmacologic and surgical interventions in patients with MD with regard to vertigo and other key patient outcomes based on data from randomized clinical trials (RCTs).

Methods: Our published protocol registered with PROSPERO (CRD42019119129) provides details on eligibility criteria and methods. We searched various databases including MEDLINE, Embase and the Cochrane Library from inception to December 10th, 2018. Screening at citation and full-text levels and risk of bias assessment were performed by two independent reviewers in duplicate, with discrepancies resolved by consensus or third-party adjudication. Bayesian network meta-analyses (NMA) were performed for hearing change and vertigo control outcomes, along with pairwise meta-analyses for these and additional outcomes.

Results: We identified 2,889 unique citations, that yielded 23 relevant publications describing 18 unique RCTs (n = 1,231 patients). Overall, risk-of bias appraisal suggested the evidence base to be at unclear or high risk of bias. Amongst pharmacologics, we constructed treatment networks of five intervention groups that included placebo, intratympanic (IT) gentamicin, oral high-dose betahistine, IT steroid and IT steroid plus high-dose betahistine for NMAs of hearing change (improvement or deterioration) and complete vertigo control. IT steroid plus high-dose betahistine was associated with the largest difference in hearing improvement compared to placebo, followed by high-dose betahistine and IT steroid (though 95% credible intervals failed to rule out the possibility of no difference), while IT gentamicin was worse than IT steroid. The NMA of complete vertigo control suggested IT gentamicin was associated with the highest probability of achieving better complete vertigo control compared to placebo, followed by IT steroid plus high-dose betahistine. Only two studies related to surgical interventions were found, and data suggested no statistically significant difference in hearing changes between endolymphatic duct blockage (EDB) versus endolymphatic sac decompression (ESD), and ESD with or without steroid injection. One trial reported that 96.5% of patients in EDB group compared to 37.5% of the patients in ESD group achieved complete vertigo control 24 months after surgery (p = 0.002).

Conclusion: To achieve both hearing preservation and vertigo control, the best treatment option among the pharmacologic interventions compared may be IT steroid plus high-dose betahistine, considering that IT gentamicin may have good performance to control vertigo but may be detrimental to hearing preservation with high cumulative dosage and short interval between injections. However, IT steroid plus high-dose betahistine has not been compared in head-to-head trials against other interventions except for IT steroid alone in one trial, thus future trials that compare it with other interventions will help establish comparative effectiveness with direct evidence.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237523PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7462264PMC
October 2020

AutoAudio: Deep Learning for Automatic Audiogram Interpretation.

J Med Syst 2020 Aug 7;44(9):163. Epub 2020 Aug 7.

Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, Canada.

Hearing loss is the leading human sensory system loss, and one of the leading causes for years lived with disability with significant effects on quality of life, social isolation, and overall health. Coupled with a forecast of increased hearing loss burden worldwide, national and international health organizations have urgently recommended that access to hearing evaluation be expanded to meet demand. The objective of this study was to develop 'AutoAudio' - a novel deep learning proof-of-concept model that accurately and quickly interprets diagnostic audiograms. Adult audiogram reports representing normal, conductive, mixed and sensorineural morphologies were used to train different neural network architectures. Image augmentation techniques were used to increase the training image set size. Classification accuracy on a separate test set was used to assess model performance. The architecture with the highest out-of-training set accuracy was ResNet-101 at 97.5%. Neural network training time varied between 2 to 7 h depending on the depth of the neural network architecture. Each neural network architecture produced misclassifications that arose from failures of the model to correctly label the audiogram with the appropriate hearing loss type. The most commonly misclassified hearing loss type were mixed losses. Re-engineering the process of hearing testing with a machine learning innovation may help enhance access to the growing worldwide population that is expected to require audiologist services. Our results suggest that deep learning may be a transformative technology that enables automatic and accurate audiogram interpretation.
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http://dx.doi.org/10.1007/s10916-020-01627-1DOI Listing
August 2020

Otolaryngology needs among an adult homeless population: a prospective study.

J Otolaryngol Head Neck Surg 2020 Jul 9;49(1):47. Epub 2020 Jul 9.

Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, Canada.

Background: Homeless individuals frequently experience poor access to healthcare, delayed clinical presentation, and higher disease burden. Providing subspecialty otolaryngology care to this population can be challenging. We previously reported on the prevalence of hearing impairment in Toronto's homeless community. As a secondary objective of this study, we sought to define otolaryngology specific need for this population.

Methods: One hundred adult homeless individuals were recruited across ten homeless shelters in Toronto, Canada using a stratified random sampling technique. An audiometric evaluation and head and neck physical examination were performed by an audiologist and otolaryngology resident, respectively. Basic demographic and clinical information was captured through verbal administration of a survey. Descriptive statistics were used to estimate frequency of otolaryngology specific diseases for this population.

Results: Of the 132 individuals who were initially approached to participant, 100 (76%) agreed. There were 64 males, with median age of 46 years (IQR 37-58 years). The median life duration of homelessness was 24 months (IQR 6-72 months). Participants had a wide range of medical comorbidities, with the most common being current tobacco smoking (67%), depression (36%), alcohol abuse (32%), and other substance abuse (32%). There were 22 patients with otolaryngology needs as demonstrated by one or more abnormal findings on head and neck examination. The most common finding was nasal fracture with significant nasal obstruction (6%). Eleven patients required referral to a staff otolaryngologist based on concerning or suspicious findings, including two head and neck masses, 6 were later seen in follow-up.

Conclusion: There were substantial otolaryngology needs amongst a homeless population within a universal healthcare system. Future research should focus on further elucidating head and neck related issues in this population and expanding the role of the otolaryngologist in providing care to homeless individuals.
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http://dx.doi.org/10.1186/s40463-020-00445-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7346481PMC
July 2020

Machine learning for pattern detection in cochlear implant FDA adverse event reports.

Cochlear Implants Int 2020 11 5;21(6):313-322. Epub 2020 Jul 5.

Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, Ontario.

Medical device performance and safety databases can be analyzed for patterns and novel opportunities for improving patient safety and/or device design. The objective of this analysis was to use supervised machine learning to explore patterns in reported adverse events involving cochlear implants. Adverse event reports for the top three CI manufacturers were acquired for the analysis. Four supervised machine learning algorithms were used to predict which adverse event description pattern corresponded with a specific cochlear implant manufacturer and adverse event type. U.S. government public database. Adult and pediatric cochlear patients. Surgical placement of a cochlear implant. Classification prediction accuracy (% correct predictions). Most adverse events involved patient injury ( = 16,736), followed by device malfunction ( = 10,760), and death ( = 16). The random forest, linear SVC, naïve Bayes and logistic algorithms were able to predict the specific CI manufacturer based on the adverse event narrative with an average accuracy of 74.8%, 86.0%, 88.5% and 88.6%, respectively. Using supervised machine learning algorithms, our classification models were able to predict the CI manufacturer and event type with high accuracy based on patterns in adverse event text descriptions.
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http://dx.doi.org/10.1080/14670100.2020.1784569DOI Listing
November 2020

Comparing Efficacy, Safety, and Preinfusion Period of Axicabtagene Ciloleucel versus Tisagenlecleucel in Relapsed/Refractory Large B Cell Lymphoma.

Biol Blood Marrow Transplant 2020 09 17;26(9):1581-1588. Epub 2020 Jun 17.

Moffitt Cancer Center, Tampa, Florida.

Axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) are autologous anti-CD19 chimeric antigen receptor T (CAR T) cell therapies for the treatment of patients with relapsed/refractory large B cell lymphoma (RR-LBCL). Both can induce durable responses; however, cross-trial comparisons are difficult due to differences in study design. In this study, the registration trials of axi-cel and tisa-cel were compared using a matching adjusted indirect comparison (MAIC). A MAIC was performed to adjust for differences in patient characteristics between trials. The estimates for the ZUMA-1 (axi-cel) trial were adjusted using patient-level data to match the study population in JULIET (tisa-cel) for key variables: International Prognostic Index), Eastern Cooperative Oncology Group score, stage, refractoriness or relapsed disease, double/triple hit status, cell of origin, and number of prior lines of therapy. The endpoints analyzed were response, overall survival (OS), and adverse events. After adjusting for differences in patient characteristics between trials, axi-cel was associated with a greater objective response rate (relative risk [RR]=1.61; 95% confidence interval [CI], 1.29 to 2.01) and complete response (RR = 1.62; 95% CI, 1.16 to 2.27) than tisa-cel among patients who underwent infusion. The OS from infusion onward comparing axi-cel to tisa-cel had a hazard ratio of 0.51 (95% CI, 0.31 to 0.83). The indirect comparison showed a higher rate of grade 1 to 2 cytokine release syndrome (CRS) in ZUMA-1 compared with JULIET (RR = 2.03; 95% CI, 1.55 to 2.65) and similar rates of grade ≥3 CRS and neurologic events. In the absence of a direct head-to-head study, the MAIC statistical technique suggests axi-cel may have superior efficacy but a greater risk of grade 1 to 2 CRS. Future real-world studies can further inform the relative efficacy and safety of CAR T therapies in RR-LBCL.
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http://dx.doi.org/10.1016/j.bbmt.2020.06.008DOI Listing
September 2020

Predicting Postoperative Cochlear Implant Performance Using Supervised Machine Learning.

Otol Neurotol 2020 09;41(8):e1013-e1023

Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, Ontario, Canada.

Objectives: To predict postoperative cochlear implant performance with heterogeneous text and numerical variables using supervised machine learning techniques.

Study Design: A supervised machine learning approach comprising neural networks and decision tree-based ensemble algorithms were used to predict 1-year postoperative cochlear implant performance based on retrospective data.

Setting: Tertiary referral center.

Patients: One thousand six hundred four adults who received one cochlear implant from 1989 to 2019. Two hundred eighty two text and numerical objective demographic, audiometric, and patient-reported outcome survey instrument variables were included.

Outcome Measures: Outcomes for postoperative cochlear implant performance were discrete Hearing in Noise Test (HINT; %) performance and binned HINT performance classification ("High," "Mid," and "Low" performers). Algorithm performance was assessed using hold-out validation datasets and were compared using root mean square error (RMSE) in the units of the target variable and classification accuracy.

Results: The neural network 1-year HINT prediction RMSE and classification accuracy were 0.57 and 95.4%, respectively, with only numerical variable inputs. Using both text and numerical variables, neural networks predicted postoperative HINT with a RMSE of 25.0%, and classification accuracy of 73.3%. When applied to numerical variables only, the XGBoost algorithm produced a 1-year HINT score prediction performance RMSE of 25.3%. We identified over 20 influential variables including preoperative sentence-test performance, age at surgery, as well as specific tinnitus handicap inventory (THI), Short Form 36 (SF-36), and health utilities index (HUI) question responses as the highest influencers of postoperative HINT.

Conclusion: Our results suggest that supervised machine learning can predict postoperative cochlear implant performance and identify preoperative factors that significantly influence that performance. These algorithms can help improve the understanding of the diverse factors that impact functional performance from heterogeneous data sources.
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http://dx.doi.org/10.1097/MAO.0000000000002710DOI Listing
September 2020

Artificial Intelligence Applications in Otology: A State of the Art Review.

Otolaryngol Head Neck Surg 2020 Dec 9;163(6):1123-1133. Epub 2020 Jun 9.

Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada.

Objective: Recent advances in artificial intelligence (AI) are driving innovative new health care solutions. We aim to review the state of the art of AI in otology and provide a discussion of work underway, current limitations, and future directions.

Data Sources: Two comprehensive databases, MEDLINE and EMBASE, were mined using a directed search strategy to identify all articles that applied AI to otology.

Review Methods: An initial abstract and title screening was completed. Exclusion criteria included nonavailable abstract and full text, language, and nonrelevance. References of included studies and relevant review articles were cross-checked to identify additional studies.

Conclusion: The database search identified 1374 articles. Abstract and title screening resulted in full-text retrieval of 96 articles. A total of N = 38 articles were retained. Applications of AI technologies involved the optimization of hearing aid technology (n = 5; 13% of all articles), speech enhancement technologies (n = 4; 11%), diagnosis and management of vestibular disorders (n = 11; 29%), prediction of sensorineural hearing loss outcomes (n = 9; 24%), interpretation of automatic brainstem responses (n = 5; 13%), and imaging modalities and image-processing techniques (n = 4; 10%). Publication counts of the included articles from each decade demonstrated a marked increase in interest in AI in recent years.

Implications For Practice: This review highlights several applications of AI that otologists and otolaryngologists alike should be aware of given the possibility of implementation in mainstream clinical practice. Although there remain significant ethical and regulatory challenges, AI powered systems offer great potential to shape how healthcare systems of the future operate and clinicians are key stakeholders in this process.
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http://dx.doi.org/10.1177/0194599820931804DOI Listing
December 2020

Middle Ear and Temporal Bone Nonkeratinizing Squamous Cell Carcinomas With DEK-AFF2 Fusion: An Emerging Entity.

Am J Surg Pathol 2020 09;44(9):1244-1250

Laboratory Medicine Program, University Health Network.

Primary squamous cell carcinomas (SCCs) of the middle ear and temporal bone are rare and usually keratinizing by morphology. Nonkeratinizing, basaloid SCCs arising in this area are exceedingly rare, and, due to the anatomic proximity to the skull base, nasopharynx, and nasal sinuses, the differential diagnosis is broad. Most tumors with squamous differentiation arising in these subsites are either viral-induced (human papillomavirus/Epstein-Barr virus) or rarely may have specific molecular alterations (BRD4-NUT, EWSR1-FLI translocations). Occasional tumors are negative for these findings, and their pathogenesis is unknown. A recently discovered DEK-AFF2 fusion was clinically detected in a series of 2 cases known to the authors. This fusion has been previously reported in the literature in a patient with a base of skull tumor who was an exceptional responder to programmed cell death protein 1 inhibitor therapy. We examine here the histomorphologic and molecular findings of 2 additional cases of an emerging entity. Two male patients were identified. Each had a primary middle ear/temporal bone mass with locally advanced disease. The histology was reviewed, and immunohistochemistry was performed. RNA-based next-generation sequencing was performed for clinical detection of diagnostic or actionable fusions. Both patients had basaloid/nonkeratinizing tumors on biopsy. They were positive for markers of squamous differentiation (HMWK, CK5, and p40). By RNA sequencing, they demonstrated the presence of a DEK-AFF2 fusion and were negative for EWSR1 and NUT translocations. The DEK-AFF2 fusion may define a novel diagnostic category of middle ear and temporal bone nonkeratinizing/basaloid SCCs. This fusion also may represent a potential avenue for immunotherapy in these patients. Further studies are needed to fully explore whether this fusion defines a location-specific clinicopathologic entity.
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http://dx.doi.org/10.1097/PAS.0000000000001498DOI Listing
September 2020

Hearing loss and hearing needs in an adult homeless population: a prospective cross-sectional study.

CMAJ Open 2020 Jan-Mar;8(1):E199-E204. Epub 2020 Mar 16.

Department of Otolaryngology - Head and Neck Surgery (Noel, Mok, Wu, Eskander, Yao, Zirkle, Lin), University of Toronto; Institute of Health Policy, Management and Evaluation (Noel), Dalla Lana School of Public Health, University of Toronto; Department of Otolaryngology - Head & Neck Surgery (Eskander, Syrett, Lin), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (Hwang, Lee); Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Departments of Ophthalmology (Lichter), Audiology (Reekie, Smith) and Otolaryngology - Head & Neck Surgery (Zirkle, Lee), St. Michael's Hospital, Toronto, Ont.

Background: Given that hearing loss is associated with increased social isolation, reduced earning potential and neurocognitive disease, findings of uncorrected hearing loss in the homeless population have important policy implications. We sought to estimate the prevalence of hearing impairment in an adult homeless population.

Methods: We recruited adult (age ≥ 18 yr) homeless people across 10 homeless shelters in Toronto between April and June 2018 using a 2-stage sampling technique. Participants were interviewed by 1 interviewer using a modified survey that had been used in previous studies looking at other health needs in homeless populations. A comprehensive head and neck examination and audiometric evaluation were performed in each participant by an otolaryngologist and an audiologist. Descriptive statistics were estimated. Audiometric data were standardized directly for age and sex to facilitate direct comparisons with the general Canadian population.

Results: Of the 132 people invited, 100 (75.8%) agreed to participate. The median age was 46 (interquartile range [IQR] 37-58) years. The median duration of homelessness was 24 (IQR 6-72) months. Although most participants (78) had some form of extended health care benefits through social assistance, only 22/78 (28%) were aware that hearing tests and hearing aids were covered through these programs. After direct standardization for age and sex, the proportions of participants with a speech-frequency and high-frequency hearing loss were 39.5% (95% confidence interval [CI] 30.4%-49.3%) and 51.9% (95% CI 42.2%-61.4%), respectively. Nineteen participants were hearing aid candidates, only 1 of whom owned functional hearing aids. Rates of speech-frequency hearing loss (39.5%, 95% CI 30.4%-49.3% v. 19.2%, 95% CI 16.9%-21.7%) and high-frequency hearing loss (51.9%, 95% CI 42.2%-61.4% v. 35.5%, 95% CI 33.1%-37.7%) were substantially higher than in the general Canadian population.

Interpretation: Our results suggest that homeless adults have a high prevalence of hearing impairment, even when living within a system of universal health insurance; awareness of health care benefits through social assistance programs was poor. Results from this study may prompt initiatives surrounding homeless outreach and health screening.
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http://dx.doi.org/10.9778/cmajo.20190220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082104PMC
February 2021

Mobile phone app Vs bucket test as a subjective visual vertical test: a validation study.

J Otolaryngol Head Neck Surg 2020 Feb 5;49(1). Epub 2020 Feb 5.

Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada.

Background: The SVV tests the ability of a person to perceive the gravitational vertical. A tilt in SVV indicates vestibular imbalance in the roll plane, and thus injuries to the utricle or its connecting nerves. A validated bedside method (et, al., 2009, 72(19):1689-1692, Neurol, Zwergal) is the bucket method, in which the subject estimates the true vertical by attempting to properly align a straight line visible on the bottom of a bucket that is rotated at random by the examiner. In our study, the subjects need to align the plumb line on the Visual Vertical iOS app to the vertical direction.

Methods: Measurements of the SVV were made in 22 healthy subjects (16 females and 6 males). Each subject conducted 10 iterations of bucket test and 10 iterations of iOS app test. The reliability and validity of the iOS app was analyzed by SPSS21.

Results: Cronbach's α for the plumb line method was 0.976, and the iOS app was 0.978. Statistical comparison of SVV values measured by the iOS app and the bucket method showed no significant difference in distribution (Mann Whitney U test U = 0.944).

Conclusion: The Visual Vertical iOS app is an effective and accessible substitute to the plumb line for the measurement of the validated bucket test.
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http://dx.doi.org/10.1186/s40463-020-0402-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001292PMC
February 2020

Pharmacologic and surgical therapies for patients with Meniere's disease: a protocol for a systematic review and meta-analysis.

Syst Rev 2019 12 30;8(1):341. Epub 2019 Dec 30.

Center for Practice Changing Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8 L6, Canada.

Background: Hearing loss is one of the leading causes of disability in Canada and worldwide, with more than one million Canadians enduring a hearing-related disability. Meniere's disease (MD) is a chronic condition of the inner ear, manifesting as a triad of disabling symptoms, including attacks of vertigo, fluctuating sensorineural hearing loss (SNHL), and tinnitus. Impacts on quality of life are severe, particularly with respect to restrictions in social participation and physical activity, fatigue, and reduced capacity to work. Anxiety and other psychological disorders may result from the restrictions imposed on life, the constant uncertainty of vertigo attacks, and fluctuating SNHL, with neuroses and depression affecting 40 to 60% of sufferers of intractable MD. There is a need to establish the benefits of previously studied interventions with greater certainty. The planned systematic review and meta-analyses/network meta-analyses (NMAs) will assess the relative effects of competing pharmacologic and surgical interventions for management of MD in adults.

Methods: An experienced medical information specialist in consultation with the review team will develop the electronic search strategies. We will search various databases including MEDLINE, Embase, and the Cochrane Library with no date or language restrictions for published literature, and key clinical trial registries for in-progress and completed trials. Screening of the literature will be performed by two reviewers independently using pre-specified eligibility criteria, and quality of the included studies will be assessed using the Cochrane Risk of Bias tool. We will resolve disagreements through consensus or third-party adjudication. When applicable, meta-analyses and NMAs will be pursued to compare interventions in terms of their effects on outcomes, including frequency and severity of vertigo, occurrence and intensity of tinnitus, changes in hearing and speech recognition, quality of life, and harms. Separate analyses exploring the effects of pharmacologic and surgical approaches will be performed.

Discussion: Our planned systematic review will provide informative evaluations of existing treatments for management of Meniere's disease. The findings will inform practitioners as to the relative benefits and harms of the existing competing interventions for MD, offer optimal clinical treatment strategies, identify evidence gaps, and determine promising therapies for evaluation in future trials.

Systematic Review Registration: PROSPERO CRD42019119129.
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http://dx.doi.org/10.1186/s13643-019-1195-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937806PMC
December 2019

Predicting Reduced Tinnitus Burden After Cochlear Implantation in Adults.

Otol Neurotol 2020 02;41(2):196-201

Department of Otolaryngology-Head & Neck Surgery.

Objective: Explore patient characteristics associated with tinnitus improvement after cochlear implantation.

Study Design: Retrospective cohort.

Setting: Tertiary referral.

Patients: Adults with bilateral severe-to-profound hearing loss and tinnitus.

Interventions: Unilateral cochlear implantation.

Results: From 1996 to 2018, 358 patients endorsed pre-implant tinnitus and had ascertainable tinnitus status at 1-year. Clinically significant improvement in Tinnitus Handicap Inventory (THI) (reduction by at least 7-points) was observed in 262 (73.2%) patients, of whom 155 (59.2%) reported complete resolution. Of the 24 characteristics explored, four were identified as independent predictors of improved tinnitus in logistic regression models. In a multivariable model including identified independent predictors, each 10-percentage point increase in baseline hearing in noise test was associated with an 14% reduction in odds of tinnitus resolution or clinically significant improvement (odds ratio [OR] 0.86, 95% confidence limits [CL] 0.77, 0.96) and preoperative use of a hearing aid in the contralateral ear was associated with a 72% reduction (OR 0.28; 95% CL 0.11, 0.73). Each 10-point increase in baseline Hearing Handicap Inventory for Adults (HHI) score was associated with a 28% increase in odds of tinnitus improvement (OR 1.28; 95% CL 1.07, 1.54). Higher baseline burden of tinnitus was associated with higher odds of tinnitus improvement (OR 1.21 per 10-point THI increase, 95% CL 1.04, 1.40).

Conclusions: Worse residual hearing and higher baseline hearing and tinnitus handicap are associated with higher odds of tinnitus improvement. Expectations of patients seeking reduced tinnitus burden following cochlear implantation should be managed by counselling regarding odds of tinnitus improvement compared to those with similar residual hearing and tinnitus burden.
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http://dx.doi.org/10.1097/MAO.0000000000002481DOI Listing
February 2020

Cone beam CT for perioperative imaging in hearing preservation Cochlear implantation - a human cadaveric study.

J Otolaryngol Head Neck Surg 2019 Nov 21;48(1):65. Epub 2019 Nov 21.

Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room M1, Toronto, 102, Canada.

Background: Knowledge of the cochlear implant array's precise position is important because of the correlation between electrode position and speech understanding. Several groups have provided recent image processing evidence to determine scalar translocation, angular insertion depth, and cochlear duct length (CDL); all of which are being used for patient-specific programming. Cone beam computed tomography (CBCT) is increasingly used in otology due to its superior resolution and low radiation dose. Our objectives are as followed: 1.Validate CBCT by measuring cochlear metrics, including basal turn diameter (A-value) and lateral wall cochlear duct length at different angular intervals and comparing it against microcomputed CT (uCT).2.Explore the relationship between measured lateral wall cochlear duct length at different angular intervals and insertion depth among 3 different length electrodes using CBCT.

Methods: The study was performed using fixed human cadaveric temporal bones in a tertiary academic centre. Ten temporal bones were subjected to the standard facial recess approach for cochlear implantation and imaged by CBCT followed by uCT. Measurements were performed on a three-dimensional reconstructed model of the cochlea. Sequential insertion of 3 electrodes (Med-El Flex24, 28 and Soft) was then performed in 5 bones and reimaged by CBCT. Statistical analysis was performed using Pearson's correlation.

Results: There was good agreement between CBCT and uCT for cochlear metrics, validating the precision of CBCT against the current gold standard uCT in imaging. The A-value recorded by both modalities showed a high degree of linear correlation and did not differ by more than 0.23 mm in absolute values. For the measurement of lateral wall CDL at various points along the cochlea, there was a good correlation between both modalities at 360 deg and 720 deg (r = 0.85, p < 0.01 and r = 0.79, p < 0.01). The Flex24 electrode displayed consistent insertion depth across different bones.

Conclusions: CBCT reliably performs cochlear metrics and measures electrode insertion depth. The low radiation dose, fast acquisition time, diminished metallic artifacts and portability of CBCT make it a valid option for imaging in cochlear implant surgery.
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http://dx.doi.org/10.1186/s40463-019-0388-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6873551PMC
November 2019

Otology/Neurotology recommendations - Choosing Wisely campaign.

J Otolaryngol Head Neck Surg 2019 Nov 8;48(1):60. Epub 2019 Nov 8.

Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Canada.

The Choosing Wisely Canada Campaign aims to raise awareness amongst physicians and patients regarding unnecessary tests and treatment. The otology/neurotology subspecialty group within the Canadian Society of Otolaryngology - Head & Neck Society developed a list of five common otologic presentations to help physicians deliver high quality effective care: (1) Don't order specialized audiometric and vestibular testing to screen for peripheral vestibular disease, (2) Don't perform computed tomography or blood work in the evaluation of sudden sensorineural hearing loss, (3) Don't perform auditory brain responses (ABR) in patients with asymmetrical hearing loss, (4) Don't prescribe oral antibiotics as first line treatment for patients with painless otorrhea associated with tympanic membrane perforation or tympanostomy tube, and (5) Don't perform particle repositioning maneuvers without a clinical diagnosis of posterior canal benign paroxysmal positional vertigo.
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http://dx.doi.org/10.1186/s40463-019-0381-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6839125PMC
November 2019

Machine Learning and Cochlear Implantation-A Structured Review of Opportunities and Challenges.

Otol Neurotol 2020 01;41(1):e36-e45

Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada.

Objective: The use of machine learning technology to automate intellectual processes and boost clinical process efficiency in medicine has exploded in the past 5 years. Machine learning excels in automating pattern recognition and in adapting learned representations to new settings. Moreover, machine learning techniques have the advantage of incorporating complexity and are free from many of the limitations of traditional deterministic approaches. Cochlear implants (CI) are a unique fit for machine learning techniques given the need for optimization of signal processing to fit complex environmental scenarios and individual patients' CI MAPping. However, there are many other opportunities where machine learning may assist in CI beyond signal processing. The objective of this review was to synthesize past applications of machine learning technologies for pediatric and adult CI and describe novel opportunities for research and development.

Data Sources: The PubMed/MEDLINE, EMBASE, Scopus, and ISI Web of Knowledge databases were mined using a directed search strategy to identify the nexus between CI and artificial intelligence/machine learning literature.

Study Selection: Non-English language articles, articles without an available abstract or full-text, and nonrelevant articles were manually appraised and excluded. Included articles were evaluated for specific machine learning methodologies, content, and application success.

Data Synthesis: The database search identified 298 articles. Two hundred fifty-nine articles (86.9%) were excluded based on the available abstract/full-text, language, and relevance. The remaining 39 articles were included in the review analysis. There was a marked increase in year-over-year publications from 2013 to 2018. Applications of machine learning technologies involved speech/signal processing optimization (17; 43.6% of articles), automated evoked potential measurement (6; 15.4%), postoperative performance/efficacy prediction (5; 12.8%), and surgical anatomy location prediction (3; 7.7%), and 2 (5.1%) in each of robotics, electrode placement performance, and biomaterials performance.

Conclusion: The relationship between CI and artificial intelligence is strengthening with a recent increase in publications reporting successful applications. Considerable effort has been directed toward augmenting signal processing and automating postoperative MAPping using machine learning algorithms. Other promising applications include augmenting CI surgery mechanics and personalized medicine approaches for boosting CI patient performance. Future opportunities include addressing scalability and the research and clinical communities' acceptance of machine learning algorithms as effective techniques.
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http://dx.doi.org/10.1097/MAO.0000000000002440DOI Listing
January 2020
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