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Objectives/hypothesis To measure and report noise exposure at urban music venues and assess the risk of noise-induced hearing loss by comparing these measures to the National Institute of Occupations Safety and Health (NIOSH) guidelines. Study design Observational study. Methods A commercially available smartphone and external calibrated microphone were used to measure sound levels at urban music venues. The maximum sound level, equivalent continuous sound level, and statistical noise levels (L10, L50, L75, L90) were recorded. Results The average equivalent continuous sound level was 112.0 (±4.9) dBA, and the average maximum sound level was 127.0 (±3.2) dBA. The L90 average (sound levels at or above this loudness for 90% of measured exposure time) was 101.1 (±5.5) dBA, and the L10 average was 115.2 (±5.0) dBA. Based off of NIOSH guidelines, noise exposure duration at the L10 average should not exceed 28 seconds, and those at the L90 average should not exceed 12 minutes. Conclusions Smartphone applications using external calibrated microphones can provide useful sound measurements. Data show that randomly sampled music venues may have noise levels that place patrons without hearing protection at risk for noise-induced hearing loss with prolonged exposure. Level of evidence NA Laryngoscope, 131:25-27, 2021.

Objectives 1) Examine angular insertion depths (AID) and scalar location of Med-El (GmbH Innsbruck, Austria) electrodes; and 2) determine the relationship between AID and audiologic outcomes controlling for scalar position. Study Design Retrospective review. Methods Postlingually deafened adults undergoing cochlear implantation with Flex 24, Flex 28, and Standard electrode arrays (Med-El) were identified. Patients with preoperative and postoperative computed tomography scans were included so that electrode location and AID could be determined. Outcome measures were 1) speech perception in the cochlear implant (CI)-only condition, and 2) short-term hearing preservation. Results Forty-eight implants were included; all electrodes (48 of 48) were positioned entirely within the scala tympani. The median AID was 408° (interquartile [IQ] range 373°–449°) for Flex 24, 575° (IQ range 465°–584°) for Flex 28, and 584° (IQ range 368°–643°) for Standard electrodes (Med-El). The mean postoperative CNC score was 43.7% ± 21.9. A positive correlation was observed between greater AID and better CNC performance (r = 0.48, P < 0.001). Excluding patients with postoperative residual hearing, a strong correlation between AID and CNC persisted (r = 0.57, P < 0.001). In patients with preoperative residual hearing, mean low-frequency pure-tone average (PTA) shift was 27 dB ± 14. A correlation between AID and low-frequency PTA shift at activation was noted (r = 0.41, P = 0.04). Conclusion Favorable rates of scala tympani insertion (100%) were observed. In the CI-only condition, a direct correlation between greater AID and CNC score was noted regardless of postoperative hearing status. Deeper insertions were, however, associated with worse short-term hearing preservation. When patients without postoperative residual hearing were analyzed independently, the relationship between greater insertion depth and better performance was strengthened. Level of Evidence 4. Laryngoscope, 127:2352–2357, 2017

Design and validate a laryngeal surgical simulator to teach phonomicrosurgical techniques.Device development and prospective validation.Tertiary medical center.A novel laryngeal fixation device and custom laryngoscope were produced for use with ex vivo porcine larynx specimens. Vocal fold lesions such as nodules and keratotic lesions were simulated with silicone injections and epithelial markings. A prospective validation using postsimulation surveys, global rating scales, and procedure-specific checklists was performed with a group of 15 medical students, otolaryngology residents, fellows, and attending laryngologists. Three procedures were performed: vocal fold augmentation, excision of a simulated vocal fold nodule, and excision of a simulated vocal fold keratosis.Participants overwhelmingly agreed that the simulator provided a realistic dissection experience that taught skills that would transfer to real operating scenarios. Expert performance was statistically superior to novice performance for excision of simulated vocal fold nodules and keratotic lesions, while no difference was observed for injection laryngoplasty.The ability to learn and rehearse surgical procedures in a safe environment is invaluable, particularly for delicate and highly technical phonomicrosurgical operations. We have developed a high-fidelity laryngeal surgical simulator complete with pathological lesions such as nodules and keratoses to teach these procedures. A prospective study demonstrated validity of our global rating scale and checklist assessments for vocal fold nodule and keratosis excision procedures, allowing them to be confidently incorporated into phonomicrosurgical training programs for surgeons of all levels of expertise.

Transcanal endoscopic ear surgery (TEES) is being increasingly used in chronic ear disease for cholesteatoma removal and middle ear reconstruction, reducing the need for a postauricular incision and mastoidectomy. However, TEES is a challenging technique even for the most experienced otologist, requiring one-handed dissection using angled instrumentation. We have therefore developed a high-fidelity dissection model incorporating key aspects of TEES and cholesteatoma removal to facilitate the acquisition of these skills. Artificial cholesteatoma was implanted into middle ear spaces of a human temporal bone via a facial recess approach. A pilot study was conducted whereby surgeons endoscopically elevated a tympanomeatal flap with artificial bleeding and removed artificial cholesteatoma with angled instrumentation. Surgeons were uniformly satisfied with the experience and felt it would translate into improved performance in the operating room. This study suggests that the TEES dissection model could become an integral tool in the training of emerging TEES techniques.

A sample of 162six-month-old infants was selected from a larger sample of 346 infants on the basis of mothers' report of their infants' temperament and a laboratory assessment of temperament. Infants were classified as easily frustrated or less frustrated and observed in several types of interactions with their mothers in the laboratory. Mothers completed several measures that indicated their level of parenting stress, psychological functioning, and marital adjustment. Maternal behavior with infants was coded along the dimensions of sensitivity, intrusiveness, and physical stimulation. Results indicated that maternal intrusiveness was related to infant temperament and that maternal physical stimulation was predicted by an interaction of infant temperament and mothers' perceived parenting stress. Implications of these findings for mother- infant interaction and subsequent child adjustment are discussed. RESUMEN: Un grupo muestra de 162infantes de seis meses de nacidos fue seleccionado de una muestra aun mayor de 346 infantes, sobre la base de lo que las madres reportaron acerca del temperamento de sus infantes y una evaluacion de laboratorio del temperamento. A los infantes se les dividioentre los que se frustraban facilmente y los menos frustrados, y se les observoen varios tipos de interacciones con sus madres en el laboratorio. Las madres completaron varias encuestas que indicaron su nivel de tension en cuanto al proceso de crianza, el funcionamiento sicologico, asicomo la adaptacion marital. La conducta materna con los infantes fue codificada a lo largo de las dimensiones de susceptibilidad, entremetimiento, y estimulacion fisica. Los resultados indicaron que el entremetimiento materno estaba relacionado con el temperamento del infante; ademas, que una interaccion entre el temperamento del infante y la tension acerca de la crianza, tal como era percibida por la madre, predecian el nivel de estimulacion fisica de la madre. Se discuten las implicaciones de estos resultados en cuanto a la interaccion entre madre e infante y las subsecuentes adaptaciones del nino.

A study sample of 162 six-month-old children was selected from a larger sample of 346 infants on the basis of parents' report of their infants' temperament and a laboratory assessment of temperament. Infants were classified as easily frustrated and less easily frustrated and compared on a number of emotion regulation, physiology, and temperament measures. Results indicated that male and female infants were equally likely to be classified as frustrated and less easily frustrated; however, male infants were less able to regulate physiologically. Easily frustrated infants used different emotion regulation strategies and were observed to be less attentive and more active than less easily frustrated infants when observed in the laboratory. These infants were also characterized by their parents as more active, less attentive, and more distressed to novelty. Infants classified as easily frustrated were more reactive physiologically and less able to regulate physiological reactivity than their less easily frustrated counterparts. It is hypothesized that this cluster of characteristics may constitute a unique temperamental type that may have implications for other types of behavioral functioning. Limitations of the study are that observations are based on a single brief assessment of the infant, modest effect sizes were found, and the study is cross-sectional.

This paper reports the results of a 1980 survey of the teaching of hypnosis in U.S. dental schools. Responses were received from 60 dental schools. Information was obtained on hypnosis education in both the predoctoral and postdoctoral curriculums, including what is being taught, how hypnosis education is structured in the curriculum, who is teaching hypnosis, the number of students receiving hypnosis education, and attitudes and policies about hypnosis education. Results of this survey were compared to previous surveys by Parrish (1973) and Scott (1977, for the United Kingdom). The survey reveals a gradual increase in the number of U.S. dental schools teaching hypnosis.