Otolaryngology - Research Publications

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    Hybrid optogenetic and electrical stimulation for greater spatial resolution and temporal fidelity of cochlear activation
    Thompson, AC ; Wise, AK ; Hart, WL ; Needham, K ; Fallon, JB ; Gunewardene, N ; Stoddart, PR ; Richardson, RT (IOP PUBLISHING LTD, 2020-10-01)
    OBJECTIVE: Compared to electrical stimulation, optogenetic stimulation has the potential to improve the spatial precision of neural activation in neuroprostheses, but it requires intense light and has relatively poor temporal kinetics. We tested the effect of hybrid stimulation, which is the combination of subthreshold optical and electrical stimuli, on spectral and temporal fidelity in the cochlea by recording multiunit activity in the inferior colliculus of channelrhodopsin (H134R variant) transgenic mice. APPROACH: Pulsed light or biphasic electrical pulses were delivered to cochlear spiral ganglion neurons of acutely deafened mice, either as individual stimuli or as hybrid stimuli for which the timing of the electrical pulse had a varied delay relative to the start of the optical pulse. Response thresholds, spread of activation and entrainment data were obtained from multi-unit recordings from the auditory midbrain. MAIN RESULTS: Facilitation occurred when subthreshold electrical stimuli were applied at the end of, or up to 3.75 ms after subthreshold optical pulses. The spread of activation resulting from hybrid stimulation was significantly narrower than electrical-only and optical-only stimulation (p < 0.01), measured at equivalent suprathreshold levels of loudness that are relevant to cochlear implant users. Furthermore, temporal fidelity, measured as maximum following rates to 300 ms pulse trains bursts up to 240 Hz, was 2.4-fold greater than optical-only stimulation (p < 0.05). SIGNIFICANCE: By significantly improving spectral resolution of electrical- and optical-only stimulation and the temporal fidelity of optical-only stimulation, hybrid stimulation has the potential to increase the number of perceptually independent stimulating channels in a cochlear implant.
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    Tissue Characterization Using Synchrotron Radiation at 0.7 THz to 10.0 THz with Extended ATR Apparatus Techniques
    Vilagosh, Z ; Appadoo, D ; Foroughimehr, N ; Shams, R ; Sly, D ; Juodkazis, S ; Ivanova, E ; Wood, AW (MDPI, 2022-11-01)
    The attenuated total reflection (ATR) apparatus, with an added partial reflection/partial transmission mode, was used to demonstrate a novel way of characterizing water-based substances at 0.7 to 10.0 THz at the Australian Synchrotron THz-far infrared beamline. The technique utilized a diamond-crystal-equipped ATR to track temperature-dependent changes in reflectance. A "crossover flare" feature in the spectral scan was noted, which appeared to be a characteristic of water and water-dominated compounds. A "quiet zone" feature was also seen, where no temperature-dependent variation in reflectance exists. The variation in these spectral features can be used as a signature for the presence of bound and bulk water. The method can also potentially identify the presence of fats and oils in a biological specimen. The technique requires minimal sample preparation and is non-destructive. The presented method has the promise to provide a novel, real-time, low-preparation, analytical method for investigating biological material, which offers avenues for rapid medical diagnosis and industrial analysis.
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    Electrocochleography triggered intervention successfully preserves residual hearing during cochlear implantation: Results of a randomised clinical trial
    Bester, C ; Collins, A ; Razmovski, T ; Weder, S ; Briggs, RJ ; Wei, B ; Zakaria, AF ; Gerard, J-M ; Mitchell-Innes, A ; Tykocinski, M ; Kennedy, R ; Iseli, C ; Dahm, M ; Ellul, S ; O'Leary, S (ELSEVIER, 2022-11-29)
    BACKGROUND: Preservation of natural hearing during cochlear implantation is associated with improved speech outcomes, however more than half of implant recipients lose this hearing. Real-time electrophysiological monitoring of cochlear output during implantation, made possible by recording electrocochleography using the electrodes on the cochlear implant, has shown promise in predicting hearing preservation. Sudden drops in the amplitude of the cochlear microphonic (CM) have been shown to predict more severe hearing losses. Here, we report on a randomized clinical trial investigating whether immediate surgical intervention triggered by these drops can save residual hearing. METHODS: A single-blinded placebo-controlled trial of surgical intervention triggered when CM amplitude dropped by at least 30% of a prior maximum amplitude during cochlear implantation. Intraoperative electrocochleography was recorded in 60 adults implanted with Cochlear Ltd's Thin Straight Electrode, half randomly assigned to a control group and half to an interventional group. The surgical intervention was to withdraw the electrode in ½-mm steps to recover CM amplitude. The primary outcome was hearing preservation 3 months following implantation, with secondary outcomes of speech-in-noise reception thresholds by group or CM outcome, and depth of implantation. RESULTS: Sixty patients were recruited; neither pre-operative audiometry nor speech reception thresholds were significantly different between groups. Post-operatively, hearing preservation was significantly better in the interventional group. This was the case in absolute difference (median of 30 dB for control, 20 dB for interventional, χ² = 6.2, p = .013), as well as for relative difference (medians of 66% for the control, 31% for the interventional, χ² = 5.9, p = .015). Speech-in-noise reception thresholds were significantly better in patients with no CM drop at any point during insertion compared with patients with a CM drop; however, those with successfully recovered CMs after an initial drop were not significantly different (median gain required for speech reception score of 50% above noise of 6.9 dB for no drop, 8.6 for recovered CM, and 9.8 for CM drop, χ² = 6.8, p = .032). Angular insertion depth was not significantly different between control and interventional groups. CONCLUSIONS: This is the first demonstration that surgical intervention in response to intraoperative hearing monitoring can save residual hearing during cochlear implantation.
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    Dynamic optical clamp: A novel electrophysiology tool and a technique for closed-loop stimulation
    Hart, WL ; Needham, K ; Richardson, RT ; Stoddart, PR ; Kameneva, T (ELSEVIER SCI LTD, 2023-08)
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    Monitoring Cochlear Health With Intracochlear Electrocochleography During Cochlear Implantation: Findings From an International Clinical Investigation
    O'Leary, S ; Mylanus, E ; Venail, F ; Lenarz, T ; Birman, C ; Di Lella, F ; Roland Jr, JT ; Gantz, B ; Beynon, A ; Sicard, M ; Buechner, A ; Lai, WK ; Boccio, C ; Choudhury, B ; Tejani, VD ; Plant, K ; English, R ; Arts, R ; Bester, C (LIPPINCOTT WILLIAMS & WILKINS, 2023-03-01)
    OBJECTIVES: Electrocochleography (ECochG) is emerging as a tool for monitoring cochlear function during cochlear implant (CI) surgery. ECochG may be recorded directly from electrodes on the implant array intraoperatively. For low-frequency stimulation, its amplitude tends to rise or may plateau as the electrode is inserted. The aim of this study was to explore whether compromise of the ECochG signal, defined as a fall in its amplitude of 30% or more during insertion, whether transient or permanent, is associated with poorer postoperative acoustic hearing, and to examine how preoperative hearing levels may influence the ability to record ECochG. The specific hypotheses tested were threefold: (a) deterioration in the pure-tone average of low-frequency hearing at the first postoperative follow-up interval (follow-up visit 1 [FUV1], 4 to 6 weeks) will be associated with compromise of the cochlear microphonic (CM) amplitude during electrode insertion (primary hypothesis); (b) an association is observed at the second postoperative follow-up interval (FUV2, 3 months) (secondary hypothesis 1); and (c) the CM response will be recorded earlier during electrode array insertion when the preoperative high-frequency hearing is better (secondary hypothesis 2). DESIGN: International, multi-site prospective, observational, between groups design, targeting 41 adult participants in each of two groups, (compromised CM versus preserved CM). Adult CI candidates who were scheduled to receive a Cochlear Nucleus CI with a Slim Straight or a Slim Modiolar electrode array and had a preoperative audiometric low-frequency average thresholds of ≤80 dB HL at 500, 750, and 1000 Hz in the ear to be implanted, were recruited from eight international implant sites. Pure tone audiometry was measured preoperatively and at postoperative visits (FUV1 and follow-up visit 2 [FUV2]). ECochG was measured during and immediately after the implantation of the array. RESULTS: From a total of 78 enrolled individuals (80 ears), 77 participants (79 ears) underwent surgery. Due to protocol deviations, 18 ears (23%) were excluded. Of the 61 ears with ECochG responses, amplitudes were < 1 µV throughout implantation for 18 ears (23%) and deemed "unclear" for classification. EcochG responses >1 µV in 43 ears (55%) were stable throughout implantation for 8 ears and compromised in 35 ears. For the primary endpoint at FUV1, 7/41 ears (17%) with preserved CM had a median hearing loss of 12.6 dB versus 34/41 ears (83%) with compromised CM and a median hearing loss of 26.9 dB ( p < 0.014). In assessing the practicalities of measuring intraoperative ECochG, the presence of a measurable CM (>1 µV) during implantation was dependent on preoperative, low-frequency thresholds, particularly at the stimulus frequency (0.5 kHz). High-frequency, preoperative thresholds were also associated with a measurable CM > 1 µV during surgery. CONCLUSIONS: Our data shows that CM drops occurring during electrode insertion were correlated with significantly poorer hearing preservation postoperatively compared to CMs that remained stable throughout the electrode insertion. The practicality of measuring ECochG in a large cohort is discussed, regarding the suggested optimal preoperative low-frequency hearing levels ( < 80 dB HL) considered necessary to obtain a CM signal >1 µV.
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    Acoustic Analysis of Slag Foaming in the BOF
    Heenatimulla, J ; Brooks, GA ; Dunn, M ; Sly, D ; Snashall, R ; Leung, W (MDPI, 2022-07-01)
    The control of slag foam that is produced during the Basic Oxygen Furnace (BOF) process has been the subject of significant research. The behaviour of slag foams is complex. Hence, the control of slag foam in the dynamic process of the BOF is challenging. Acoustic analysis of the BOF is one of the most promising methods for the indirect measurement of slag foam height. This paper reviews different studies on the fundamental behaviour of acoustics in liquid foams and various acoustic studies related to determining the slag foam height during the BOF process. Studies on the BOF have been carried out using both cold water models and plant trials, where acoustic measurements taken directly from the process were analysed. These studies showed that the attenuation of sound through liquid foam was influenced mainly by factors such as viscosity, bubble size, and foam height. Current systems are said to be 70 to 87 per cent accurate in detecting and/or predicting slopping events in the BOF, though there is a lack of systematic data in the literature to fully quantify this accuracy. There have been various attempts to combine sound with vibration and image signals to improve the prediction of slopping events in BOFs. The review substantiates the lack of accuracy of the current systems in determining the slag foam height using acoustic analysis and the need to address fundamental questions about the behaviour of sound in dynamic foam, its reliance on different factors, and the relatability of comparing cold model data to industrial data.
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    Comparison of Quality of Life between Patients Undergoing Submental Endoscopic Thyroidectomy and Conventional Thyroidectomy: A Prospective Controlled Clinical Trial
    Piromchai, P (MDPI, 2022-08-01)
    The objectives of this study were to compare the surgical outcomes and quality of life between patients undergoing submental endoscopic thyroidectomy and those undergoing conventional thyroidectomy. The surgical outcomes and quality of life were recorded. Forty-eight patients were included in the study. Their ages ranged from 20 to 60 years. All patients underwent lobectomy, isthmectomy, or the combination of lobectomy and isthmectomy. Most histological diagnoses were benign (85.42%). The submental endoscopic thyroidectomy group showed better scores in the energy/fatigue, emotional wellbeing, and general health domains (p = 0.006, 0.041, and 0.004, respectively). There were no statistically significant differences in surgical outcomes between the submental endoscopic thyroidectomy and conventional thyroidectomy groups (p > 0.05). Submental endoscopic thyroidectomy is feasible, and permits a better quality of life in terms of the energy/fatigue, emotional wellbeing, and general health domains.
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    Automatic analysis of cochlear response using electrocochleography signals during cochlear implant surgery
    Wijewickrema, S ; Bester, C ; Gerard, J-M ; Collins, A ; O'Leary, S ; Buechner, A (PUBLIC LIBRARY SCIENCE, 2022-07-14)
    Cochlear implants (CIs) provide an opportunity for the hearing impaired to perceive sound through electrical stimulation of the hearing (cochlear) nerve. However, there is a high risk of losing a patient's natural hearing during CI surgery, which has been shown to reduce speech perception in noisy environments as well as music appreciation. This is a major barrier to the adoption of CIs by the hearing impaired. Electrocochleography (ECochG) has been used to detect intra-operative trauma that may lead to loss of natural hearing. There is early evidence that ECochG can enable early intervention to save natural hearing of the patient. However, detection of trauma by observing changes in the ECochG response is typically carried out by a human expert. Here, we discuss a method of automating the analysis of cochlear responses during CI surgery. We establish, using historical patient data, that the proposed method is highly accurate (∼94% and ∼95% for sensitivity and specificity respectively) when compared to a human expert. The automation of real-time cochlear response analysis is expected to improve the scalability of ECochG and improve patient safety.
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    Spironolactone Ameliorates Cochlear Implant Induced Endolymphatic Hydrops.
    Creber, NJ ; Eastwood, HT ; Hampson, AJ ; Lo, J ; Zhang, D ; Chambers, SA ; Bester, CW ; Thorne, PR ; O'Leary, SJ (Ovid Technologies (Wolters Kluwer Health), 2022-07-01)
    BACKGROUND: Endolymphatic hydrops (EH) has been observed in both animal and human cochleae following cochlear implant (CI) surgery. We tested whether EH could be eliminated by administration of mineralocorticoid steroid antagonist spironolactone and explored the electrophysiological consequences of this. METHODS: Sixty-four adult guinea pigs underwent cochlear implantation with a dummy electrode. Animals then survived either 2, 7, or 28 days. Auditory function was monitored by recording electrocochleography from the round window membrane preimplantation, and on the last day of the experiment. Spironolactone or control solution was added to animals' feed for 7 days (if they survived that long) beginning immediately prior to surgery. The presence of EH was determined using thin-sheet laser imaging microscopy. RESULTS: Treatment with spironolactone resulted in significant reduction in EH in the second cochlear turn 7 days postimplantation. In all animals, the compound action potential (CAP) threshold was elevated 2 days postimplantation, but for most frequencies had recovered substantially by 28 days. There was no treatment effect on CAP thresholds. SP/AP ratios were elevated at day 2. The amplitude growth of the CAP did not differ between test and control groups at any time after implantation. CONCLUSIONS: EH can be suppressed by antagonism of mineralocorticoid receptors in the week after cochlear implantation. Reduction in EH did not lead to any change in hearing, and there was no indication of synaptopathy signalled by reduced CAP amplitude at high sound intensities. We found no electrophysiological evidence that EH early after implantation impacts negatively upon preservation of residual hearing.