Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P89

Oral Presentations

Age of Cochlear Implantation Predicts
Sound Quality Perception
Sarah Yui-Ting Bessen, MD (Presenter); Eric A. Eisen;
James E. Saunders, MD; Isabelle Magro
Objectives: Cochlear implant (CI) research has primarily
focused on speech understanding. This study aims to characterize the quality and enjoyment of sound by CI recipients and
to identify predictors of outcomes of cochlear implantation.
Methods: A cross-sectional study was conducted characterizing the enjoyment and quality of sound over time by CI
recipients using survey questions based on the Hearing Implant
Sound Quality Index (HISQUI19) with reference to the perception of voices, music, and meditative sounds. Surveys were
sent to all adult patients who received a CI at a tertiary care
hospital from 2000 to 2019. Survey responses were evaluated
in the context of patient characteristics using linear regression
models.
Results: Of the 339 surveys, 49 (14.5%) were returned with
complete data. CI recipients had a mean age of 61.7 ± 18.3
years with a mean of 7.9 ± 6.2 years since CI surgery. As
length of implantation increased, the quality of sound
improved (r = 0.3, P < .05), but there was no change in the
enjoyment. However, as age of implantation increased, the
quality (r = 0.4, P < .01) and enjoyment (r = 0.4, P < .01) of
sound worsened. There was also a negative correlation
between the age of implantation and the change in enjoyment
(r = 0.3, P < .05) and quality (r = 0.4, P < .05) over time.

Conclusions: As a whole, recipients who had CIs for a longer
period of time had improved quality of sound perception, but
not of enjoyment, suggesting a degree of adaptation. However,
CI recipients who were implanted at an older age reported
poorer sound quality and enjoyment as well as a worsening in
their sound quality and enjoyment perception over time, indicating that age-related changes influence outcomes of cochlear
implantation.
Assessing the Mechanics of Pathological
Middle Ears With Optical Coherence
Tomography
Dan MacDougall (Presenter); David P. Morris, MD; Josh
Farrell; Christine Morrison; Robert B. A. Adamson
Objectives: Optical coherence tomography (OCT) is a promising new tool for diagnosing middle ear disease owing to its
ability to deliver high-contrast, high-resolution 3-dimensional
imaging and measurement of ossicular mobility. In this study,
we examine how OCT can be used to understand the mechanics of pathological ears. OCT was used to obtain images and
vibrometry measurements in 6 middle ear cases.
Methods: Cases were imaged using an Audioptics Medical
Ossiview Middle Ear Imaging System. In each, images and
quantitative measurements of displacement of middle ear
structures in response to sound are presented along with
results from standard-of-care diagnostics.
Results: In the case of a patient with a significant air-bone
gap (ABG), normal tympanic membrane, and a history of
head trauma, OCT findings were consistent with partial dislocation of the incudostapedial joint and inconsistent with otosclerosis. In a case of an evident atelectatic segment but a very
small ABG, OCT revealed that the tympanic membrane was
transmitting sound directly to the incus and bypassing the
malleus. In the case of a patient with moderate conductive
hearing loss (CHL) and no recollection of previous middle ear
surgery, OCT found a silastic sheet in the middle ear acoustically coupled to the ossicles. In the case of a patient with moderate CHL who suffered middle ear injury during jaw surgery,
OCT demonstrated activation of the malleus despite its significant medialization and pointed to disarticulation of the
malleoincudal joint as the cause of the CHL.
Conclusions: OCT offers diagnostic information that is complementary to standard-of-care diagnostics. In some of the
described cases, OCT evidence contradicts the presumed diagnosis, indicating that OCT has adjunctive diagnostic value.
Association Between the Duration of
Hearing Loss and Hearing Outcomes in
Surgery for Otosclerosis
Alexander L. Luryi, MD (Presenter); Amy E. Schettino;
Dennis Bojrab, MD; Seilesh Babu, MD; Elias M.
Michaelides, MD; Christopher A. Schutt, MD
Objectives: Hearing loss due to otosclerosis is effectively
treated with surgery. The association between duration of
hearing loss and surgical outcomes is unknown.

Otology/Neurotology

temporal bones allow for preoperative planning and simulation
that can help mitigate these challenges.
Methods: The 3D simulation models were generated preoperatively for 3 patients aged 1, 5, and 21 years, undergoing
surgery respectively for cochlear implantation (CI) using an
electrode prone to tip-rollover, X-linked hearing loss (XLHL)
for sequential contralateral CI in which initial CI was
challenging, and petrous apex cholesteatoma involving internal auditory canal (IAC) and labyrinth. Patient-specific templates based on temporal bone imaging were created on a
Projet 5500X-E 3D printer using white soft resin for facial
nerve and translucent hard resin for bone structures. The cholesteatoma model required drilling for the approach, whereas
2 other approaches were established virtually before printing.
Results: Surgical planning and simulation by attending surgeon and trainees using 3D-printed patient-specific models
significantly altered surgical plans. The angle of CI insertion
and rotatory placement maneuvers were predetermined in the
laboratory, avoiding implant tip-rollover, IAC insertion, or
electrode damage. Surgical time was reduced by 85 minutes in
the XLHL case. Simulation also proved the feasibility of
endoscopic cholesteatoma resection sparing a translabyrinthine/transcochlear approach.
Conclusions: The 3D-printed models in neurotologic cases
demonstrated significant benefit in designing surgical
approaches, developing patient-specific techniques, and allowing for simulation that avoided potential or actual complications
encountered in previous surgery and reduced surgical time.

P89

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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