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1. Cochlear promontory anatomy relevant to development of subendosteal and transpromontory electrodes using 192‐section ultra‐high resolution temporal bone CT imaging

Author

John P. Marinelli, Neil S. Patel, Christine M. Lohse, John I. Lane, and Matthew L. Carlson

Subjects
cochlear anatomy, cochlear implantation, cochleostomy, endosteal electrode, temporal bone imaging, Otorhinolaryngology, RF1-547, Surgery, RD1-811
Abstract

Abstract Objective To characterize normative adult ranges for cochlear promontory thickness relevant to the development of subendosteal and transpromontory electrodes to rehabilitate various neurotologic disorders. Patients Adults (≥18 years). Intervention In vivo radiologic assessment using a 192‐slice CT scanner (Force‐192; Siemens Healthcare) with ultrahigh‐resolution scan mode combined and iterative reconstruction. Main Outcome Measure Cochlear promontory thickness. Results Among 48 included patients (96 ears), the mean (SD) age was 56 (18) years (range 25–94) and included 25 (52%) women. Of that 12 patients (25%) had osteopenia (n = 6) or osteoporosis (n = 6). The mean (SD) body mass index was 28 (5) kg/m2. The mean (SD) promontory thickness for the 96 temporal bones under study was 1.22 (0.24) mm (range 0.55–1.85). There was not a statistically significant association between age and promontory thickness (correlation coefficient .08; p = .44). Promontory thickness was significantly greater for men than women (mean 1.28 vs. 1.17 mm; p = .03) and increased with increasing body mass index (correlation coefficient .30; p = .004). Last, promontory thickness was significantly less for patients with osteopenia or osteoporosis compared with those without these conditions (mean 1.09 vs. 1.27 mm; p = .002). Conclusions Cochlear promontory thickness can vary by almost 1.5 mm across patients and is significantly associated with patient sex, body mass index, and comorbid osteopenia/osteoporosis. Subendosteal and transpromontory electrode placement techniques must account for this degree of variability. Level of Evidence IV

Published
2022
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2. Coronal Heating as Determined by the Solar Flare Frequency Distribution Obtained by Aggregating Case Studies

Author

James Paul Mason, Alexandra Werth, Colin G. West, Allison Youngblood, Donald L. Woodraska, Courtney L. Peck, Arvind J. Aradhya, Yijian Cai, David Chaparro, James W. Erikson, Koushik Ganesan, T. R. Geerdts, Thi D Hoang, Thomas M. Horning, Yan Jin, Haixin Liu, Noah Lordi, Zheng Luo, Thanmay S. Menon, Josephine C. Meyer, Emma E Nelson, Kristin A. Oliver, Jorge L Ramirez Ortiz, Andrew Osborne, Alyx Patterson, Nick Pellatz, John Pitten, Nanako Shitara, Daniel Steckhahn, Aseem Visal, Hongda Wang, Chaoran Wang, Evan Wickenden, John Wilson, Mengyu Wu, Nikolay Yegovtsev, Ingrid H Zimmermann, James Holland Aaron, Jumana T. Abdullah, Jonathan M. Abrams, Riley Abrashoff, Andres B. Acevedo, Iker Acha, Daniela M. Meza Acosta, Megan M. Adam, Dante Q. Adams, Kalvyn N Adams, Elena R Adams, Zainab A. Akbar, Ushmi H. Akruwala, Adel Al-Ghazwi, Batool H. Alabbas, Areej A. Alawadhi, Yazeed A. Alharbi, Mohammed S. Alahmed, Mohammed A. Albakr, Yusef J. Albalushi, Jonathan Albaum, Ahmed Aldhamen, Nolan Ales, Mohammad Alesmail, Abdulelah Alhabeeb, Dania Alhamli, Isehaq Alhuseini, Suhail Alkaabi, Tameem Alkhezzi, Mohamed Alkubaisi, Nasser Allanqawi, Martin Allsbrook, Yousef A. Almohsen, Justin Thomas Almquist, Teeb Alnaji, Yousef A Alnasrallah, Nicholas Alonzi, Meshal Alosaimi, Emeen Alqabani, Mohammad Alrubaie, Reema A. Alsinan, Ava L. Altenbern, Abdullah Altokhais, Saleh A. Alyami, Federico Ameijenda, Hamzi Amer, Meggan Amos, Hunter J. Anderson, Carter Andrew, Jesse C Andringa, Abigail Angwin, Gabreece Van Anne, Andrew Aramians, Camila Villamil Arango, Jack. W. Archibald, Brian A. Arias-Robles, Maryam Aryan, Kevin Ash, Justin Astalos, N. S. Atchley-Rivers, Dakota N. Augenstein, Bryce W. Austin, Abhinav Avula, Matthew C. Aycock, Abdulrahman A. Baflah, Sahana Balaji, Brian Balajonda, Leo M Balcer, James O. Baldwin, David J Banda, Titus Bard, Abby Barmore, Grant M. Barnes, Logan D. W. Barnhart, Kevin M. Barone, Jessica L. Bartman, Claire Bassel, Catalina S Bastias, Batchimeg Bat-Ulzii, Jasleen Batra, Lexi Battist, Joshua Bay, Simone Beach, Sara Beard, Quinn I Beato, Ryan Beattie, Thomas Beatty, Tristan De La Beaujardiere, Jacob N. Beauprez, M. G. Beck, Lily Beck, Simone E. Becker, Braden Behr, Timothy A. Behrer, Joshua Beijer, Brennan J. Belei, Annelene L. Belknap, Aislyn Bell, Caden Bence, Evan Benke, Naomi Berhanu, Zachary D. Berriman-Rozen, Chrisanna Bertuccio, Owen A. Berv, Blaine B. Biediger, Samuel J Biehle, Brennen Billig, Jacob Billingsley, Jayce A. Billman, Connor J. Biron, Gabrielle E. Bisacca, Cassidy A. Blake, Guillermo Blandon, Olivia Blevins, Ethan Blouin, Michal Bodzianowski, Taylor A. Boeyink, Matthew Bondar, Lauren Bone, Alberto Espinosa De Los Monteros Bonilla, William T Borelli, Luke R. Borgerding, Troy Bowen, Christine Boyer, Aidan Boyer, Aidan P. Boyle, Tom Boyne, Donovan Branch, Ariana E. Brecl, David J. Brennan, Alexander J Brimhall, Jennifer L. Brockman, Sarah Brookins, Gabriel T. Brown, Cameron L. Brown, Ryan Brown, Jordi Brownlow, Grant Brumage-Heller, Preston J. Brumley, Samuel Bryan, A. Brzostowicz, Maryam Buhamad, Gigi Bullard-Connor, J. R. Ramirez Bunsow, Annemarie C. Burns, John J. Burritt, Nicholas David Burton, Taylor Burton, Celeste Busch, Dylan R. Butler, B. W. Buxton, Malena C. Toups, Carter C. Cabbage, Breonna Cage, Jackson R. Cahn, Andrew J Campbell, Braden P. Canales, Alejandro R. Cancio, Luke Carey, Emma L. Carillion, Michael Andrew Carpender, Emily Carpenter, Shivank Chadda, Paige Chambers, Jasey Chanders, Olivia M. Chandler, Ethan C. Chang, Mitchell G. Chapman, Logan T. Chapman, S. Chavali, Luis Chavez, Kevin Chen, Lily Chen, Sam Chen, Judy Chen, Jenisha Chhetri, Bradyn Chiles, Kayla M. Chizmar, Katherine E Christiansen, Nicholas A. Cisne, Alexis Cisneros, David B. Clark, Evelyn Clarke, Peter C Clarkson, Alexis R. Clausi, Brooke Cochran, Ryan W. Coe, Aislinn Coleman-Plante, Jake R. Colleran, Zachary Colleran, Curran Collier, Nathaniel A. Collins, Sarah Collins, Jack C. Collins, Michael Colozzi, Aurora Colter, Rebecca A. Cone, Thomas C. Conroy, Reese Conti, Charles J. Contizano, Destiny J. Cool, Nicholas M. Cooper, Jessica S Corbitt, Jonas Courtney, Olivia Courtney, Corben L. Cox, Wilmsen B. Craig, Joshua B. Creany, Anastasia Crews, K. A. Crocker, A. J. Croteau, Christian J. Crow, Zoe Cruse, Avril Cruz, Tyler L. Curnow, Hayden Current, Riley T. Curry, Libby Cutler, Aidan St. Cyr, Frederick M. Dabberdt, Johnston Daboub, Olivia Damgaard, Swagatam Das, Emma A. B. Davis, Elyse Debarros, Sean Deel, Megan E. Delasantos, Tianyue Deng, Zachary Derwin, Om Desai, Kai Dewey, John S. Dias, Kenzie A. Dice, R. Dick, Cyrus A. Dicken, Henry Dietrick, Alexis M. Dinser, Alyssa M. Dixon, Thomas J. Dixon, Helen C. Do, Chris H Doan, Connor Doane, Joshua Dodrill, Timothy Doermer, Lizbeth Montoya Dominguez, J. Dominguez, Emerson N. Domke, Caroline R. Doran, Jackson A. Dorr, Philip Dorricott, Danielle C. Dresdner, Michael Driscoll, Kailer H. Driscoll, Sheridan J. Duncan, Christian Dunlap, Gabrielle M. Dunn, Tien Q. Duong, Tomi Oshima Dupeyron, Peter Dvorak, Andrew East, Andrew N. East, Bree Edwards, Lauren Ehrlich, Sara I. Elbashir, Rasce Engelhardt, Jacob Engelstad, Colin England, Andrew Enrich, Abbey Erickson, Benjamin Erickson, Nathan Evans, Calvin A Ewing, Elizabeth A. Eyeson, Ian Faber, Avery M. Fails, John T Fauntleroy, Kevin Fell, Zitian Feng, Logan D. Fenwick, Nikita Feoktistov, Ryann Fife, John Alfred D. Figueirinhas, Jean-Paul Fisch, Emmalee Fischer, Jules Fischer-White, Aidan F. Fitton, Alexander Fix, Lydia Flackett, Fernando Flores, Aidan Floyd, Leonardo Del Foco, Adeduni Folarin, Aidan E. Forbes, Elise Fortino, Benjamin L. Fougere, Alexandra A. Fowler, Margaret Fox, James M. French, Katherine V. French, Florian G. Frick, Calvin R. Fuchs, Bethany E. S. Fuhrman, Sebastian Furney, Moutamen Gabir, Gabriela Galarraga, Skylar Gale, Keala C. Gapin, A. J. Garscadden, Rachel Gasser, Lily Gayou, Emily E. Gearhart, Jane Geisman, Julianne R. Geneser, Sl Genne, Julia G Gentile, Eleanor Gentry, Jacob D. George, Nathaniel James Georgiades, Phillip Gerhardstein, Clint Gersabeck, Bandar Abu Ghaith, Dorsa Ghiassi, B. C. Giebner, Dalton Gilmartin, Connor B. Gilpatrick, Michael Gjini, Olivia Golden, Nathan T. Golding, C. A. Goldsberry, Angel R. Gomez, Angel A. Gomez, Sean Gopalakrishnan, Mariam Gopalani, Nicholas Gotlib, Alaina S. Graham, Michael J Gray, Alannah H. Gregory, Joshua A. Gregory, Kristyn Grell, Justus Griego, Nicholas F. Griffin, Kyle J. Griffin, Matt Guerrero, Nicole Gunderson, Mutian Guo, E. R. Gustavsson, Grace K. Hach, L. N. Haile, Jessica Haines, Jack J. Mc Hale, Ryder Buchanan Hales, Mark S. Haley, Jacqueline L. Hall, Sean R. Hamilton, Soonhee Han, Tyler Hand, Luke C. Hanley, Connor M Hansen, Joshua A. Hansen, Jonathan Hansson, Tony Yunfei Hao, Nicholas Haratsaris, Isabelle Hardie, Dillon F. Hardwick, Cameron T. Hares, Logan Swous Harris, Coyle M. Harris, Omer Hart, Kyle Hashiro, Elsie Hattendorf, Calder Haubrich, Elijah Hawat, Griffin A. Hayrynen, Danielle A. Heintz, Tim Hellweg, Angel Hernandez, Emanuel Herrera, Robert N. Herrington, Tim Herwig, Troy M. Hesse, Quinn Hiatt, Lea Pearl Hibbard, Imari R. Hicks, Andrew J. Hicks, Nigel Highhouse, Annalise K. Hildebrand, Paula Hill, Hallie Hill, Evan Hintsa, Anna E. Hirschmann, Travis Hitt, Ella Ho, Isabelle J. Hoff, Alex Hoffman, Blake A. Hogen, Linda Horne, Timothy J Houck, Noah H. Howell, E. M. Hrudka, J. Hu, Jianyang Huang, Chenqi Huang, Shancheng Huang, Zachary A. Hudson, Nathan C. Hudson, Tyler J. Huebsch, Owen Hull, Samuel C Hunter, Troy Husted, Abigail P. Hutabarat, Leslie Huynh, Antonio E. Samour Ii, Yolande Idoine, Julia A. Ingram, Taro Iovan, Samuel A. Isert, Antonio Salcido-Alcontar Jr, Thomas Jacobsen, Alan A Jaimes, Connor Jameson, J. R. Jarriel, Sam Jarvis, Josh Jenkins, Alexander V. Jensen, Jacob Jeong, Luke A. Jeseritz, Trevor Jesse, Soo Yeun Ji, Yufan Jiang, Owen Johnson, Matthew Johnson, Sawyer Johnson, Julia Johnston, Braedon Y. Johnston, Olivia M. Jones, M. R. Jones, Tara Jourabchi, Tony A. House Jr., Parker Juels, Sabrina J. H. T. Kainz, Emily Kaiser, Nicolas Ian Kallemeyn, Madison H. Kalmus, Etash Kalra, Margaret Kamenetskiy, Jeerakit Kanokthippayakun, Shaun D. Kapla, Brennan J. Karsh, Caden J. Keating, Morgan A. Kelley, Michael P. Kelley, Nicholas Kelly, James Kelly, Teagan Kelly, Christopher M Kelly, Kellen Kennedy, Cayla J. Kennedy, Forrest Kennedy, Abigail Kennedy, Liana Kerr-Layton, Marilyn Ketterer, Ibraheem A. Khan, Usman Khan, Sapriya Khanal, Jack L. Kiechlin, Dominic Killian, Kevin Kim, Brian T. Kim, Matthew M. Kim, Jake Kim, Aspen Kimlicko, Isabel M Kipp, Hunter B. Kirkpatrick, Natalie Kissner, Emily R. Kite, Olivia R. Kleinhaus, Philip Whiting Knott, Will Koch, Greta Koenig, Emily Koke, Thomas Kokes, Yash S. Kothamdi, Zack Krajnak, Zoe M. Kresek, Dylan Kriegman, Jake E. Kritzberg, Davis J. Krueger, Bartlomiej Kubiak, Kirsten Kuehl, Chrisanne Kuester, Nicolas A. Kuiper, Aman Priyadarshi Kumar, Connor Kuybus, Daniel Kwiatkowski, Quintin Y. Lafemina, Kevin Lacjak, Kyle Lahmers, Antonia Lam, Kalin Landrey, Maxwell B. Lantz, Zachary Larter, Benjamin P. Lau, Megan Lauzon, Rian Lawlor, Tyler Learned, E. C. Lee, Junwon Lee, Adrianna J. Lee, Justin Lee, Alexis Ying-Shan Lee, Christian J Lee, Nathaniel F. Lee, Linzhi Leiker, Dylan Lengerich, Cecilia Leoni, Adrienne R. Lezak, David Y. Li, Isaac Li, Ryan Z. Liao, Bridget Linders, Morgan I Linger, Katherine B. Linnane, Sam Lippincott, Barrett Lister, Shelby D Litton, Nianzi Liu, Steven Y. Liu, Timothy W. Logan, Nathan Londres, Mia C. Lonergan, Emily Lookhoff, N. E. Loomis, Christian Lopez, Justin Loring, Jeffrey Lucca, Dax Lukianow, Nathan M. Cheang, William Macdonald, Claire A. Madonna, Kasey O. Madsen, Tiffany E. Maksimuk, Macguire Mallory, Ryan A. Malone, Blake Maly, Xander R. Manzanares, Aimee S. Maravi, Serafima M. Marcus, Nasreen Marikar, Josie A. Marquez, Mathew J. Marquez, Lauren Marsh, Toni Marsh, Logan S. Martin, Alexa M. Martinez, Jose R. Martinez, Hazelia K. Martinez, Cara Martyr, Mirna Masri, Giorgio Matessi, Adam Izz Khan Mohd Reduan Mathavan, Randi M. Mathieson, Kabir P. Mathur, Graham Mauer, Victoria A. Mayer, Liam Mazzotta, Glen S. Mccammon, Rowan Mcconvey, Tyler Mccormick, Andrew Mccoy, Kelleen Mcentee, Meaghan V. Mcgarvey, Riley M. Mcgill, James K. Mcintyre, Finbar K. Mckemey, Zane Mcmorris, Jesse J. Mcmullan, Ella Mcquaid, Caden Mcvey, Kyle Mccurry, Mateo M. Medellin, Melissa Medialdea, Amar Mehidic, Stella Meillon, Jonah B. Meiselman-Ashen, Sarah Mellett, Dominic Menassa, Citlali Mendez, Patricia Mendoza-Anselmi, Riley Menke, Sarah Mesgina, William J. Mewhirter, Ethan Meyer, Aya M. Miften, Ethan J. Miles, Andrew Miller, Joshua B. Miller, Emily B. Millican, Sarah J. Millican, Dylan P. Mills, Josh Minimo, Jay H. Misener, Alexander J. Mitchell, Alexander Z. Mizzi, Luis Molina-Saenz, Tyler S Moll, Hayden Moll, Maximus Montano, Michael Montoya, Eli Monyek, Jacqueline Rodriguez Mora, Gavin Morales, Genaro Morales, Annalise M. Morelock, Cora Morency, Angel J. Moreno, Remy Morgan, Alexander P. Moss, Brandon A. Muckenthaler, Alexander Mueller, Owen T. Mulcahy, Aria T. Mundy, Alexis A. Muniz, Maxwell J. Murphy, Madalyn C. Murphy, Ryan C. Murphy, Tyler Murrel, Andrew J. Musgrave, Michael S. Myer, Kshmya Nandu, Elena R. Napoletano, Abdulaziz Naqi, Anoothi Narayan, Liebe Nasser, Brenna K Neeland, Molly Nehring, Maya Li Nelson, Lena P. Nguyen, Lena Nguyen, Leonardo Nguyen, Valerie A. Nguyen, Khoa D Nguyen, Kelso Norden, Cooper Norris, Dario Nuñez, Rosemary O. Nussbaum, Cian O’Sullivan, Ian O’Neill, S. H. Oakes, Anand Odbayar, Caleb Ogle, Sean Oishi-Holder, Nicholas Olguin, Nathaniel P. Olson, Jason Ong, Elena N. Opp, Dan Orbidan, Ryan Oros, Althea E. Ort, Matthew Osborn, Austin Osogwin, Grant Otto, Jessica Oudakker, Igor Overchuk, Hannah M. Padgette, Jacqueline Padilla, Mallory Palizzi, Madeleine L. Palmgren, Adler Palos, Luke J. Pan, Nathan L. Parker, Sasha R. Parker, Evan J. Parkinson, Anish Parulekar, Paige J. Pastor, Kajal Patel, Akhil Patel, Neil S. Patel, Samuel Patti, Catherine Patton, Genevieve K. Payne, Matthew P. Payne, Harrison M. Pearl, Charles B. Beck Von Peccoz, Alexander J. Pedersen, Lily M. Pelster, Munisettha E. Peou, J. S. Perez, Freddy Perez, Anneliese Pesce, Audrey J. Petersen, B. Peterson, Romeo S. L. Petric, Joshua Pettine, Ethan J. Phalen, Alexander V. Pham, Denise M. Phan, Callie C Pherigo, Lance Phillips, Justin Phillips, Krista Phommatha, Alex Pietras, Tawanchai P. Pine, Sedique Pitsuean-Meier, Andrew M. Pixley, Will Plantz, William C. Plummer, Kaitlyn E. Plutt, Audrey E. Plzak, Kyle Pohle, Hyden Polikoff, Matthew Pollard, Madelyn Polly, Trevor J. Porter, David Price, Nicholas K. Price, Gale H. Prinster, Henry Austin Propper, Josh Quarderer, Megan S. Quinn, Oliver Quinonez, Devon Quispe, Cameron Ragsdale, Anna L. Rahn, M. Rakhmonova, Anoush K Ralapanawe, Nidhi Ramachandra, Nathaniel Ramirez, Ariana C. Ramirez, Sacha Ramirez, Parker Randolph, Anurag Ranjan, Frederick C Rankin, Sarah Grace Rapaport, Nicholas O Ratajczyk, Mia G. V. Ray, Brian D. Reagan, John C. Recchia, Brooklyn J. Reddy, Joseph Reed, Charlie Reed, Justin Reeves, Eileen N. Reh, Ferin J. Von Reich, Andrea B. Reyna, Alexander Reynolds, Hope Reynolds, Matthew Rippel, Guillermo A. Rivas, Anna Linnea Rives, Amanda M. Robert, Samuel M. Robertson, Maeve Rodgers, Stewart Rojec, Andres C. Romero, Ryan Rosasco, Beth Rossman, Michael Rotter, Tyndall Rounsefell, Charlotte Rouse, Allie C. Routledge, Marc G. Roy, Zoe A. Roy, Ryan Ruger, Kendall Ruggles-Delgado, Ian C. Rule, Madigan Rumley, Brenton M. Runyon, Collin Ruprecht, Bowman Russell, Sloan Russell, Diana Ryder, David Saeb, J. Salazar, Violeta Salazar, Maxwell Saldi, Jose A. Salgado, Adam D. Salindeho, Ethan S. Sanchez, Gustavo Sanchez-Sanchez, Darian Sarfaraz, Sucheta Sarkar, Ginn A. Sato, Carl Savage, Marcus T. Schaller, Benjamin T. Scheck, Jared A. W. Schlenker, Matthew J Schofer, Stephanie H. Schubert, Courtney Schultze, Grace K Schumacher, Kasper Seglem, Lauren Serio, Octave Seux, Hannan Shahba, Callie D. Shannahan, Shajesh Sharma, Nathan Shaver, Timothy Shaw, Arlee K. Shelby, Emma Shelby, Grace Shelchuk, Tucker Sheldrake, Daniel P. Sherry, Kyle Z. Shi, Amanda M. Shields, Kyungeun Shin, Michael C. Shockley, Dominick Shoha, Jadon Shortman, Mitchell Shuttleworth, Lisa Sibrell, Molly G. Sickler, Nathan Siles, H. K. Silvester, Conor Simmons, Dylan M. Simone, Anna Simone, Savi Singh, Maya A. Singh, Madeline Sinkovic, Leo Sipowicz, Chris Sjoroos, Ryan Slocum, Colin Slyne, Korben Smart, Alexandra N. Smith, Kelly Smith, Corey Smith, Elena K. Smith, Samantha M. Smith, Percy Smith, Trevor J Smith, G. L. Snyder, Daniel A. Soby, Arman S. Sohail, William J. Solorio, Lincoln Solt, Caitlin Soon, Ava A Spangler, Benjamin C. Spicer, Ashish Srivastava, Emily Stamos, Peter Starbuck, Ethan K. Stark, Travis Starling, Caitlyn Staudenmier, Sheen L. Steinbarth, Christopher H. Steinsberger, Tyler Stepaniak, Ellie N. Steward, Trey Stewart, T. C. Stewart, Cooper N. Stratmeyer, Grant L. Stratton, Jordin L. Stribling, S. A Sulaiman, Brandon J Sullivan, M. E. Sundell, Sohan N. Sur, Rohan Suri, Jason R. Swartz, Joshua D. Sweeney, Konner Syed, Emi Szabo, Philip Szeremeta, Michael-Tan D. Ta, Nolan C. Tanguma, Kyle Taulman, Nicole Taylor, Eleanor Taylor, Liam C. Taylor, K. E. Tayman, Yesica Tellez, Richard Terrile, Corey D Tesdahl, Quinn N. Thielmann, Gerig Thoman, Daniel Thomas, Jeffrey J. Thomas, William N. Thompson, Noah R. Thornally, Darien P. Tobin, Kelly Ton, Nathaniel J. Toon, Kevin Tran, Bryn Tran, Maedee Trank-Greene, Emily D. Trautwein, Robert B. Traxler, Judah Tressler, Tyson R. Trofino, Thomas Troisi, Benjamin L. Trunko, Joshua K. Truong, Julia Tucker, Thomas D Umbricht, C. H. Uphoff, Zachary T. Upthegrove, Shreenija Vadayar, Whitney Valencia, Mia M. Vallery, Eleanor Vanetten, John D. Vann, Ilian Varela, Alexandr Vassilyev, Nicholas J. Vaver, Anjali A. Velamala, Evan Vendetti, Nancy Ortiz Venegas, Aditya V. Vepa, Marcus T. Vess, Jenna S. Veta, Andrew Victory, Jessica Vinson, Connor Maklain Vogel, Michaela Wagoner, Steven P. Wallace, Logan Wallace, Caroline Waller, Jiawei Wang, Keenan Warble, N. R. D. Ward-Chene, James Adam Watson, Robert J. Weber, Aidan B. Wegner, Anthony A Weigand, Amanda M. Weiner, Ayana West, Ethan Benjamin Wexler, Nicola H. Wheeler, Jamison R. White, Zachary White, Oliver S. White, Lloyd C. Whittall, Isaac Wilcove, Blake C. Wilkinson, John S. Willard, Abigail K. Williams, Sajan Williams, Orion K. Wilson, Evan M. Wilson, Timothy R. Wilson, Connor B. Wilson, Briahn Witkoff, Aubrey M. Wolfe, Jackson R. Wolle, Travis M. Wood, Aiden L. Woodard, Katelynn Wootten, Catherine Xiao, Jianing Yang, Zhanchao Yang, Trenton J. Young, Isabel Young, Thomas Zenner, Jiaqi Zhang, Tianwei Zhao, Tiannie Zhao, Noah Y. Zhao, Chongrui Zhou, Josh J Ziebold, Lucas J. Ziegler, James C. Zygmunt, Jinhua Zhang, and H. J. Lewandowski

Subjects
Solar physics, Solar flares, Astrostatistics distributions, Astrophysics, QB460-466
Abstract

Flare frequency distributions represent a key approach to addressing one of the largest problems in solar and stellar physics: determining the mechanism that counterintuitively heats coronae to temperatures that are orders of magnitude hotter than the corresponding photospheres. It is widely accepted that the magnetic field is responsible for the heating, but there are two competing mechanisms that could explain it: nanoflares or Alfvén waves. To date, neither can be directly observed. Nanoflares are, by definition, extremely small, but their aggregate energy release could represent a substantial heating mechanism, presuming they are sufficiently abundant. One way to test this presumption is via the flare frequency distribution, which describes how often flares of various energies occur. If the slope of the power law fitting the flare frequency distribution is above a critical threshold, α = 2 as established in prior literature, then there should be a sufficient abundance of nanoflares to explain coronal heating. We performed >600 case studies of solar flares, made possible by an unprecedented number of data analysts via three semesters of an undergraduate physics laboratory course. This allowed us to include two crucial, but nontrivial, analysis methods: preflare baseline subtraction and computation of the flare energy, which requires determining flare start and stop times. We aggregated the results of these analyses into a statistical study to determine that α = 1.63 ± 0.03. This is below the critical threshold, suggesting that Alfvén waves are an important driver of coronal heating.

Published
2023
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4. Factors associated with hearing outcomes after a middle fossa approach in 131 consecutive patients with vestibular schwannomas

Author

Karol P, Budohoski, Robert C, Rennert, Steven A, Gordon, Amol, Raheja, Cameron, Brandon, J Curran, Henson, Mohammed A, Azab, Neil S, Patel, Michael, Karsy, Richard K, Gurgel, Clough, Shelton, and William T, Couldwell

Subjects
General Medicine
Abstract

OBJECTIVE The middle fossa approach is an effective option for the treatment of small (Koos grade I and II) vestibular schwannomas (VSs) when the goal is hearing preservation. The authors evaluated the rates of hearing preservation and examined the factors associated with improved hearing outcomes after the middle fossa approach for VSs. METHODS In this retrospective, single-center cohort study evaluating the clinical outcomes after resection of small VSs using the middle fossa approach, consecutive adult patients (> 18 years) who underwent surgery between January 2000 and December 2021 were included. Clinical and imaging characteristics were analyzed, including baseline hearing status, duration of surgery, anesthetic parameters, and imaging characteristics of the surgically treated tumors. RESULTS Among the 131 included patients, 102 had valid and discoverable pre- and postoperative audiology assessments. The mean follow-up was 26 months (range 1–180 months). There were 85 patients with serviceable hearing preoperatively, defined as American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) class A or B, of whom 78% retained class A or B hearing at the last follow-up. Binary logistic regression demonstrated that preoperative hearing AAO-HNS class (OR 0.19, 95% CI 0.05–0.77; p = 0.02), overlap between fundus and cochlea (OR 0.32, 95% CI 0.11–0.96; p = 0.04), and duration of anesthesia (OR 0.98, 95% CI 0.97–0.99; p = 0.03) were independent predictors of hearing outcomes. Additionally, 75% of patients with high diffusion-weighted imaging signal in the tumor (p = 0.009) and 67% of patients with the tumor originating at the modiolus of the cochlea (p = 0.004) had poor hearing outcomes. CONCLUSIONS The hearing preservation rates after microsurgical resection of small VSs using the middle fossa approach are high, with 78% of patients maintaining AAO-HNS class A or B hearing. Poor hearing status at baseline, longer duration of anesthesia, and large overlap between the fundus of the internal auditory canal and the cochlea were independently associated with unfavorable hearing outcomes. Imaging characteristics can be used to stratify patients’ risk of hearing loss.

Published
2022
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5. Cochlear Implantation in Patients With Known Cognitive Impairment: What Are the Benefits?

Author

Eric E, Babajanian, Erin C, Carmichael, Steven A, Gordon, Neil S, Patel, and Richard K, Gurgel

Subjects
Adult, Cochlear Implants, Treatment Outcome, Otorhinolaryngology, Hearing Loss, Sensorineural, Speech Perception, Humans, Cognitive Dysfunction, Neurology (clinical), Cochlear Implantation, Sensory Systems, Aged, Retrospective Studies
Abstract

To evaluate the outcomes of cochlear implantation (CI) in adults with preoperatively diagnosed cognitive impairment.Retrospective cohort study.Tertiary-care academic center.Adults undergoing CI with preexisting cognitive impairment.Cochlear implantation.1) Hearing improvement after CI; 2) morbidity and mortality associated with surgery.Eight patients met inclusion criteria with mean age 77.8 years (SD, 9.6 y) at time of implantation; 7 were included in subsequent analysis as one did not have speech recognition scores. Average preoperative MoCA cognitive score of 22.6 (SD, 3.9, ≤25 demonstrates cognitive impairment). Average follow-up was 29.0 months (SD, 33.3 mo). Two patients passed away at an average 58.0 months (SD, 31.1 mo) after surgery. Median preoperative pure tone average was 86.3 dB HL ( interquartile range 31.3 dB HL) compared with 33.8 dB HL (IQR 5.0 dB HL) postoperatively ( p =0.001). Median preoperative speech testing score (AzBio/HINT) was 21% (IQR, 24%) compared with 44% (IQR, 21%) postoperatively ( p =0.001). There were no observed surgical complications during the follow-up period.This study demonstrates that patients with cognitive impairment before CI can experience improved hearing, no increased risk of complications, and good longevity after CI. Further prospective studies are needed to further define the utility of CI in patients with impaired cognition.

Published
2022
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6. Is There an Inherited Contribution to Risk for Sporadic Unilateral Vestibular Schwannoma? Evidence of Familial Clustering

Author

Richard K, Gurgel, William T, Couldwell, Neil S, Patel, and Lisa A, Cannon-Albright

Subjects
Otorhinolaryngology, Risk Factors, Humans, Cluster Analysis, Genetic Predisposition to Disease, Neuroma, Acoustic, Neurology (clinical), Sensory Systems, Pedigree
Abstract

Unlike the autosomal dominant inheritance of neurofibromatosis 2, there are no known inherited risk factors for sporadic, unilateral vestibular schwannoma (VS), which comprise most VS cases. The authors tested a hypothesis positing a genetic contribution to predisposition to these lesions by analyzing familial clustering of cases.Familial clustering of individuals with unilateral VS was analyzed in two independent genealogical resources with linked diagnosis data: the Veterans Health Administration Genealogy Resource and the Utah Population Database. Tests for excess relatedness, estimation of relative risks (RRs) in close and distant relatives, and identification of pedigrees with a significant excess of unilateral VS among descendants were performed.The average pairwise relatedness of the Veterans Health Administration Genealogy Resource VS cases significantly exceeded the expected relatedness ( p = 0.016), even when close relationships were ignored ( p = 0.002). RR for third- and fifth-degree relatives developing VS were significantly elevated (RR, 60.83; p = 0.0005; 95% confidence interval [CI], 7.37-219.73) and (RR, 11.88; p = 0.013; 95% CI, 1.44-42.90), respectively. No VS-affected first-, second-, or fourth-degree relatives were observed. In the Utah Population Database population, no first- or second-degree relatives with VS were observed. RR for fifth-degree relatives developing VS was significantly elevated (RR, 2.23; p = 0.009; 95% CI, 1.15-3.90).These results provide strong evidence for an inherited predisposition to sporadic, unilateral VS. This study exhibits the value of genealogical resources with linked medical data for examining hypotheses regarding inherited predisposition. The high-risk unilateral VS pedigrees identified in two independent resources provide a powerful means of pursuing predisposition gene identification.

Published
2022
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8. His-Purkinje Conduction System Pacing in Atrioventricular Block

Author

Angela Naperkowski, Dominik Beer, Neil S. Patel, Shaun Colburn, Faiz A. Subzposh, and Pugazhendhi Vijayaraman

Subjects
medicine.medical_specialty, His-Purkinje conduction, business.industry, medicine.disease, Pacemaker implantation, QRS complex, Internal medicine, Block (telecommunications), Left bundle branch, medicine, Cardiology, In patient, Electrical conduction system of the heart, business, Atrioventricular block
Abstract

Objectives This study aims to assess the safety and feasibility of achieving His-Purkinje conduction system pacing (HPCSP) in consecutive patients with atrioventricular block (AVB) and to describe the site of conduction block in patients with infranodal AVB. Background HPCSP has evolved as the preferred form of physiologic pacing. Left bundle branch area pacing (LBBAP) has emerged as an effective alternative to His bundle pacing (HBP). Methods Consecutive patients with AVB referred for pacemaker implantation were included in the study. HBP or LBBAP was attempted in all patients. Site of conduction block was identified as nodal or infranodal (intra-Hisian or infra-Hisian) AVB. Results HPCSP was attempted in 333 consecutive patients with AVB and was successful in 322 (97%) patients. HBP was achieved in 140 patients, LBBAP in 179 patients, and both in 3 patients. Site of conduction block was nodal in 55% and infranodal in 45% (intra-Hisian 89%; infra-Hisian 4%; indeterminate 7%). QRS duration at baseline was 111±27 versus 129±31 (P Conclusions HPCSP pacing was successfully performed in 97% of unselected patients with AVB irrespective of the site of conduction block. True infra-Hisian block (distal His-Purkinje conduction disease) is rare. HBP and LBBAP were complementary in achieving stable and low capture thresholds.

Published
2022
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9. The Impact of Cochlear Implantation: Cognitive Function, Quality of Life, and Frailty in Older Adults

Author

Eric E. Babajanian, Neil S. Patel, and Richard K. Gurgel

Subjects
cognition, Speech and Hearing, quality of life, otorhinolaryngologic diseases, cochlear implant, sense organs, Review Article, frailty
Abstract

This review examines the relationship between cochlear implantation and cognition and quality of life in older adults, as well as how frailty affects outcomes for older patients with cochlear implants. A growing body of evidence suggests that there is a strong association between hearing loss and cognitive impairment. Preliminary studies suggest that cochlear implantation in older adults may be protective against cognitive decline. While studies have observed a positive impact of cochlear implantation on quality of life, currently it is unclear what factors contribute the most to improved quality of life. Frailty, as a measurement of general health, likely plays a role in complication rates and quality-of-life outcomes after cochlear implantation, though larger prospective studies are required to further elucidate this relationship.

Published
2021

10. A Comprehensive Review of Thrombocytopenia With a Spotlight on Intensive Care Patients

Author

Ratnam K, Santoshi, Reema, Patel, Neil S, Patel, Varinder, Bansro, and Gurdeep, Chhabra

Subjects
General Engineering
Abstract

Thrombocytopenia is a common entity seen in ICU patients and is associated with increased morbidity such as bleeding and transfusions, and mortality in ICU patients. Various mechanisms such as decreased platelet production, sequestration, destruction, consumption, and sometimes a combination of these factors contribute to thrombocytopenia. An understanding of the mechanism is essential to diagnose the cause of thrombocytopenia and to help provide appropriate management. The management strategies are aimed at treating the underlying disorder, such as platelet transfusion to treat complications like bleeding. Several studies have aimed to provide the threshold for platelet transfusions in various clinical settings and recommend a conservative approach in the appropriate scenario. In this review, we discuss various pathophysiological mechanisms of thrombocytopenia and the diverse scenarios of thrombocytopenia encountered in the ICU setting to shed light on the varied thresholds for platelet transfusion, alternative agents to platelet transfusion, and future directions for the implementation of thromboelastography (TEG) in multiple clinical scenarios to assist in the administration of appropriate blood products to correct coagulopathy.

Published
2022
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11. Caregiver Quality of Life after Cochlear Implantation in Older Adults

Author

Richard K. Gurgel, Steven A. Gordon, Chelsea McCarty Allen, Morganne Murphy-Meyers, Alana Aylward, and Neil S. Patel

Subjects
Hearing aid, Multivariate statistics, medicine.medical_specialty, Multivariate analysis, Hearing loss, medicine.medical_treatment, Psychological intervention, Article, Quality of life, Cochlear implant, Surveys and Questionnaires, otorhinolaryngologic diseases, medicine, Humans, Aged, business.industry, Cochlear Implantation, Sensory Systems, Confidence interval, Cochlear Implants, Cross-Sectional Studies, Otorhinolaryngology, Caregivers, Physical therapy, Quality of Life, Speech Perception, Female, Neurology (clinical), medicine.symptom, business
Abstract

OBJECTIVE To evaluate factors affecting quality of life (QOL) in caregivers of older cochlear implant (CI) recipients. STUDY DESIGN Cross-sectional survey. SETTING Academic medical center. PATIENTS Adults over age 65 receiving CI between July 13, 2000 and April 3, 2019. INTERVENTIONS Cochlear implantation. MAIN OUTCOME MEASURES Linear regression models for caregiver QOL measured by Significant Other Scale for Hearing Disability (SOS-HEAR), with independent variables: caregiver role, patient gender, 11 factor modified frailty index (mFI), duration of hearing loss, hearing aid use, age at surgery, time since surgery, change in pure tone average (PTA), processor input type and Nijmegen Cochlear Implant Questionnaire (NCIQ). Correlations between SOS-HEAR and patient speech recognition scores. RESULTS Questionnaires were mailed to all 294 living CI recipients. Seventy-one caregivers completed the questionnaire. Only patient gender and mFi were significant predictors of caregiver QOL on both univariate (p ≤ 0.001, β= -20.26 [95% confidence interval -30.21, -10.3]; 0.005, -0.72 [-1.20, -0.23], respectively) and multivariate (p = 0.005, β = -20.09, -33.05 to -7.13; 0.003, -0.93 [-1.50, -0.37]) analysis, where caregivers of female patients with lower mFI (better health) had better QOL scores. Caregiver QOL was significantly associated with patient's change in PTA and self-reported QOL scores on univariate (p = 0.041, β = 0.52 [0.08, 0.96]; 0.024, -0.27 [-0.52, -0.02]) but not multivariate analysis. Time since CI was significant only on multivariate analysis (0.041, -0.17 [-0.33, -0.01]). Caregiver QOL did not correlate with patient speech recognition scores. CONCLUSIONS Higher QOL scores were found among caregivers of healthier, female CI recipients. Patient hearing measurements did not correspond with better caregiver QOL.

Published
2022

12. Disease recidivism after subtotal petrosectomy and ear canal closure

Author

Robert J, Macielak, Amanda J, Kull, Matthew L, Carlson, and Neil S, Patel

Subjects
Otorhinolaryngology
Abstract

To describe the presentation, diagnosis, and management of chronic otitis media recidivism after subtotal petrosectomy and ear canal closure (STP).Patients with temporal bone pathology detected during follow-up after STP were identified in the electronic medical record. Pertinent clinical details regarding surveillance plan, presentation, imaging findings, and revision surgery were collected and analyzed.A total of 10 patients were identified with recurrent or persistent pathology after STP. The median time to detection was 46 months (IQR 24-84). Five patients (50 %) had non-specific symptomatology, 4 patients (40 %) were completely asymptomatic, and 1 patient (10 %) was asymptomatic outside of two instances of mastoiditis with cochlear implant device infection treated with incision and drainage. One patient (10 %) was noted to have proptosis on examination, but no other patients had objective signs of disease at detection of disease recidivism. Nine (90 %) patients had pathology identified on preoperative imaging. All patients underwent revision surgery, with identification of cholesteatoma in 8 cases (80 %) and cholesterol granuloma in 2 cases (20 %). Extensive disease was noted in 6 patients (60 %), all of whom followed-up greater than 3 years from surgery. All patients tolerated revision surgery without complication.Recidivistic disease often remains clinically silent for extended periods of time after STP. Planned follow-up - with imaging or second look surgery - to facilitate early detection should be considered. Undetected disease recurrence or development may result in morbidity in a proportion of patients if surveillance is not performed.

Published
2023
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