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Purpose and Technological Feasibility • In the ABR waveform, WI reflects activity in the 8th cranial nerve while WV reflects activity in the upper brainstem. The amplitude ratio between WI and WV is emerging as an important metric for auditory function. • In the electrically evoked ABR (eABR), eWI cannot be measured because of artifact associated with cochlear implant (CI) stimulation. The electrical eWI /eWV ratio therefore cannot be measured in a single test as the WI /WV ratio can for an acoustically evoked ABR. • For MED-EL Corporation CIs, the electrically evoked compound action potential (eCAP), equivalent to eWI, is measured with the Auditory nerve Response Telemetry (ART) test. The ART uses sequences of ‘masker’ and ‘probe’ biphasic pulses to extract an eCAP (see Fig. 1). Note that the ART also generates an external trigger.

Mount Diablo Coalfield was the largest producer of coal in California from the 1860s to 1906. The now-depleted coalfield is located on the northeast limb of the Mount Diablo anticline. The mineable coal seams occur in the Middle Eocene Domengine Formation, which is predominantly composed of quartz-rich sandstone with several thin coal seams. As many as 26 mine operations were established to mine the coal, and it has been estimated that the total production exceeded 4 million tons. The coal fueled the industrial growth of the major cities of northern California. The mines closed at the turn of the nineteenth century as competition from better coals from Washington Territory and overseas entered the market. After coal mining was abandoned, sand operations were established in the early and mid-twentieth century to mine the silica-rich sandstone. The extraction methods used for sand were underground room-and-pillar mining and surface open-pit mining. The high-quality sand was used widely in the production of pottery and glass, and in foundries. Previous studies have interpreted the environment of deposition of these quartz-rich sandstone and coal deposits as barrier island with tidal channels or delta, tidal shelf, and marsh complexes along a north-south–trending shoreline. However, the excellent exposures in the sand mines display abundant evidence for their deposition in a fluvial/estuarine system. Their regional distribution indicates that they were deposited in a northeast-southwest–trending incised-valley system formed by fluvial incision during a lowstand. The incised valley was filled with fluvial and estuarine deposits made up of quartz-rich sand brought in by streams that flowed westward from the Sierra Nevada.

Legacy advocacy organizations face growing competition from digitally native organizations. Interviews with leaders and staff of both types of organizations reveal that legacy NGOs with professiona...

This project reviews the current contracting storage method for contracts and supporting documentation of contracts in the United States Air Force (USAF) and Department of Defense Education Activity (DODEA). The project explores the history of cloud computing within the government as well as the commercial marketplace. An in-depth analysis of current contracting systems within USAF and DODEA is completed, which shows that our current generation of contracting systems hinders the standard contracting professional’s ability to retrieve data from other government entities. The paper further explores what is currently state of the art within the commercial realm in document generation and storage. This approach gives an accurate picture of where the government is currently lacking in its ability to share information internally. This paper results in four separate recommendations for the reader to consider. The recommendation that is most effective in terms of technical capabilities and cost constraints is for the government to continue down its current path of system development. While continuing this development, the government should consider expanded accessibility and compatibility of these systems. Civilian, Department of the Air Force Civilian, DoD Education Activity Approved for public release. Distribution is unlimited.

Purpose To examine how patients self-administer ear drops, ascertain their perceived difficulty in performing the task and determine if they are able to deliver the correct dosage. Materials and methods This is a prospective cohort study performed in an otology outpatient clinic with twenty-one subjects with a condition requiring ototopical antibiotics. The number of ear drops applied as well as skills performed during ear drop application was measured. Patient reported difficulty and confidence in application of ear drops data was also obtained. Results The mean number of drops applied was 2.91 ± 2.1 (target = 3 drops) with a large variance in drop application, range of 0.6 to 9.2 drops. If “correct dosage” is considered 85–115% of the intended dose, then almost half of patients, 47.6%, underdosed with 23.8% that over dosed. Patients reported that the average difficulty in applying drops to themselves was 3.6 (1 being easy and 10 being difficult). Patients reported a high confidence level in applying the correct dose of ear drops of 6.7 (1 being not confident and 10 being very confident). Conclusions In our study of 21 patients self-administering ear drops, only 28.6% of patients were able to correctly apply the appropriate treatment dose, with almost half of patients underdosing. Questionnaire data indicated that most patients were unaware they were administering an incorrect dose. Inaccurate administration of ear drops could be problematic and lead to longer durations of symptoms, false treatment failures, and increased costs.

OBJECTIVES/HYPOTHESIS Speech recognition with a cochlear implant (CI) tends to be better for younger adults than older adults. However, older adults may take longer to reach asymptotic performance than younger adults. The present study aimed to characterize speech recognition as a function of age at implantation and listening experience for adult CI users. STUDY DESIGN Retrospective review. METHODS A retrospective review identified 352 adult CI recipients (387 ears) with at least 5 years of device listening experience. Speech recognition, as measured with consonant-nucleus-consonant (CNC) words in quiet and AzBio sentences in a 10-talker noise masker (10 dB signal-to-noise ratio), was reviewed at 1, 5, and 10 years postactivation. RESULTS Speech recognition was better in younger listeners, and performance was stable or continued to improve through 10 years of CI listening experience. There was no indication of differences in acclimatization as a function of age at implantation. For the better performing CI recipients, an effect of age at implantation was more apparent for sentence recognition in noise than for word recognition in quiet. CONCLUSIONS Adult CI recipients across the age range examined here experience speech recognition benefit with a CI. However, older adults perform more poorly than young adults for speech recognition in quiet and noise, with similar age effects through 5 to 10 years of listening experience. LEVEL OF EVIDENCE 3 Laryngoscope, 131:2106-2111, 2021.

OBJECTIVE: High rates of partial insertion have been reported for cochlear implant (CI) recipients of long lateral wall electrode arrays, presumably caused by resistance encountered during insertion due to cochlear morphology. With recent advances in long-electrode array design, we sought to investigate 1) the incidence of complete insertions among patients implanted with 31.5 mm flexible arrays and 2) whether complete insertion is limited by cochlear duct length (CDL). STUDY DESIGN: Retrospective review. SETTING: Tertiary referral center. METHODS: Fifty-one adult CI recipients implanted with 31.5 mm flexible lateral wall arrays underwent postoperative computed tomography to determine the rate of complete insertion, defined as all contacts being intracochlear. CDL and angular insertion depth (AID) were compared between complete and partial insertion cohorts. RESULTS: The majority of cases had a complete insertion (96.1%, n=49). Among the complete insertion cohort, the median CDL was 33.6 mm (range: 30.3–37.9 mm), and median AID was 641° (range: 533–751°). Two cases of partial insertion had relatively short CDL (31.8 mm and 32.3 mm) and shallow AID (542° and 575°). Relatively shallow AID for the two cases of partial insertion fail to support the idea that CDL alone prevents a complete insertion. CONCLUSION: Complete insertion of a 31.5 mm flexible array is feasible in most cases and does not appear to be limited by the range of CDL observed in this cohort. Future studies are needed to estimate other variations in cochlear morphology that could predict resistance and failure to achieve complete insertion with long arrays.

OBJECTIVES The objectives were to characterize the effects of wearing face coverings on: 1) acoustic speech cues, and 2) speech recognition of patients with hearing loss who listen with a cochlear implant. METHODS A prospective cohort study was performed in a tertiary referral center between July and September 2020. A female talker recorded sentences in three conditions: no face covering, N95 mask, and N95 mask plus a face shield. Spectral differences were analyzed between speech produced in each condition. The speech recognition in each condition for twenty-three adult patients with at least 6 months of cochlear implant use was assessed. RESULTS Spectral analysis demonstrated preferential attenuation of high-frequency speech information with the N95 mask plus face shield condition compared to the other conditions. Speech recognition did not differ significantly between the uncovered (median 90% [IQR 89%-94%]) and N95 mask conditions (91% [IQR 86%-94%]; P = .253); however, speech recognition was significantly worse in the N95 mask plus face shield condition (64% [IQR 48%-75%]) compared to the uncovered (P

Objective Cochlear nerve preserving translabyrinthine vestibular schwannoma (VS) resection enables concurrent cochlear implantation. Implantation in patients with VS raises important concerns including the ability to undergo postoperative magnetic resonance imaging (MRI) monitoring of residual tumor growth or tumor recurrence, specifically with a retained magnet. We aim to assess the feasibility of MRI monitoring and the impact on image quality with retained cochlear implant (CI) magnets. Methods Retrospective review of post-operative head MRI scans in CI recipients with a retained CI magnet, after cochlear nerve preserving translabyrinthine excision of VS. The ability to visualize the ipsilateral and contralateral internal auditory canal (IAC) and cerebellopontine angle (CPA) were assessed. Results A total of eight surveillance head MRI were performed in six patients. In one case, in which the receiver was positioned lower, the view of the ipsilateral IAC and CPA was distorted. In all other cases, the views of both the ipsilateral and contralateral IAC and CPA were overall unimpaired. Discussion Imaging artifact only very rarely impedes adequate visualization of the ipsilateral IAC or CPA in CI recipients. In anticipation of the need for further IAC and CPA imaging, it would be advisable to place the receiver in an exaggerated superior-posterior position to further decrease obscuring artifact. Thus, serial monitoring of VS tumors can be performed safely with preservation of image quality with a retained receiver magnet. Conclusions When placing the CI receiver-stimulator farther posterior-superiorly, excellent visualization of the IAC and CPA can be accomplished without significantly impairing the image quality.

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.

BACKGROUND Theoretical disadvantages are associated with the use of heat-crimped piston prostheses in stapedotomy. Loose crimping could result in prosthesis displacement or slippage. Alternatively, overly tight crimping may cause trauma to the incus with resultant necrosis. OBJECTIVES 1) Analyze outcomes of patients undergoing stapedotomy with heat-activated piston-style prostheses, and 2) compare outcomes between prostheses made by different manufacturers. STUDY DESIGN Retrospective. SETTING Vanderbilt Medical Center. PATIENTS AND METHODS Cases undergoing stapedotomy between 2005 and 2016 were reviewed. Audiometric assessments were recorded in accordance with American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines. Patients who lacked audiometric follow-up before 6 months or after 1 year were excluded. INTERVENTION(S) Diagnostic, therapeutic, and rehabilitative. MAIN OUTCOME MEASURE(S) Postoperative air-bone gap (ABG) and achievement of an ABG is less than or equal to 10 dB. RESULTS Three hundred fifty-eight patients met inclusion criteria. At short-term follow-up (

Evaluate outcomes following primary endoscopic stapes surgery.Retrospective case series.Two tertiary otologic centers.Eighty-one ears with surgically confirmed stapes fixation.Total endoscopic stapedotomy or stapedectomy.Surgical and audiologic outcomes.Eighty-one subjects were included (60% women) with a median age of 47.6 years (range, 19.1-73.6 yr). Etiologies of hearing loss included otosclerosis (96.3%), stapedial ankylosis (2.5%), and congenital stapes fixation (1.2%). The median follow-up was 5.3 months (range, 1.2-50.4 mo). 74.1% required scutum removal, and the chorda tympani nerve was sacrificed in 7.4%. Two techniques were used: 51.9% underwent stapedectomy and 48.1% underwent stapedotomy (with use of laser, drill, or both in 74.4, 20.5, and 5.1% of cases, respectively). The median air-bone gap (ABG) improved from 31.3 dB preoperatively to 6.25 dB postoperatively at last follow-up (p 0.0001). The ABG closed to less than 15 dB in 96.3% of patients and less than 10 dB in 84%. There were no instances of postoperative sensorineural hearing loss (defined as15 dB change from baseline) or facial nerve injury. Postoperatively, 29.6% of patients reported dysgeusia, of which 8.3% was persistent at last follow-up. Postoperative disequilibrium was reported in 17.3% of cases, with 100% resolution at last follow-up. Comparison of the stapedotomy and stapedectomy groups revealed no significant differences in audiologic or surgical outcomes.Endoscopic stapedotomy and stapedectomy are effective techniques to manage stapes fixation resulting in a median postoperative ABG of 6.25 dB and ABG closure to within 10 dB in 84% of patients.

Objective To describe the incidence and clinical course of patients who develop delayed facial nerve paralysis (DFNP) after surgical resection of vestibular schwannoma. Setting Tertiary skull base center. Methods Retrospective chart review. Results Two hundred and forty six consecutive patients, who underwent surgical resection for vestibular schwannoma at a single center between 2010 and 2015, were analyzed. Of these patients, 22 (8.9%) developed DFNP, defined here as deterioration of function by at least 2 House–Brackmann (HB) grades within 30 days in patients with immediate postoperative HB ≤ 3. The mean age of DFNP patients was 47.2 years (range: 17–67) and 16 (73%) were female. The mean tumor size in greatest dimension was 2.1 cm (range: 0.7–3.5 cm). At the conclusion of each case, the facial nerve stimulated at the brainstem. Mean immediate postoperative facial nerve function was HB 1.8 (range: 1–3). Average facial nerve function at the 3-week-postoperative visit was 4.4 (range: 2–6). In 1-year, 8 patients (36%) recovered HB 1 function, 10 patients (46%) recovered to HB 2, and 2 patients (9%) were HB 3. The remaining 2 patients did not recover function and were HB 6 at last follow-up. Initial postoperative facial nerve function (HB 1 or HB 2) was associated with improved recovery to normal (HB 1) function (p = 0.018). Conclusion A majority of patients that develop delayed paralysis will recover excellent facial nerve function. Patients should be counseled; however, a small percentage of patients will not recover function long-term, despite having a previously functioning and anatomically intact nerve.

OBJECTIVE To report short (∼4 mo) and long-term (>12 mo) audiometric outcomes following ossiculoplasty using a titanium clip partial ossicular reconstruction prosthesis. METHODS Case series at a single tertiary referral center reviewing 130 pediatric and adult patients with conductive hearing loss (CHL) secondary to chronic otitis media (n = 121, 93%) or traumatic ossicular disruption (n = 9, 7%) who underwent partial ossiculoplasty from January 2005 to December 2015 with the CliP prosthesis. RESULTS At both short and long-term follow-up, postoperative air-bone gap (ABG) was significantly improved (18 dB HL, IQ range 13-26, p

To evaluate the use of porcine small intestinal submucosal grafts for tympanic membrane repair.Adult and pediatric patients with tympanic membrane perforations with and without chronic otitits media, and perforations after removal of cholesteatoma.Endoscopic or microscopic tympanic membrane repair using porcine small intestinal submucosal grafts (Biodesign).Perforation closure, bone and air pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS) were recorded as outcome measures.Thirty-seven patients were included with a mean age of 25.4 years (range, 6-75), 57% men. Twenty-six cases (70%) were performed endoscopically and 34 (92%) had concomitant cartilage grafting. Three patients (8%) had postoperative pinpoint (1% surface area) perforation, and two patients (5%) had postoperative perforation, with an overall success rate of 86.5%. The mean improvement in air-bone gap was 7.6 dB and (p = 0.006). There were no statistically significant differences in closure rates when comparing primary versus revision cases, endoscopic versus microscopic cases, size of perforation, cholesteatoma, concomitant mastoidectomy, age, tobacco exposure, or comorbid diabetes mellitus. Patients with concomitant cartilage graft were more likely to be successful when compared with those without cartilage graft (p = 0.04).Porcine small intestinal submucosal grafts are effective in the repair of the tympanic membrane. These grafts are an excellent choice in total endoscopic cases as it avoids incisions necessary for allograft harvest.

Endoscopic ear surgery (EES) is an emerging technique requiring single-handed dissection with limited depth perception. Current options for EES simulation and training are limited. Herein, we introduce a versatile, low-cost surgical skills trainer that aims to improve the fine motor control necessary for EES.Prospective validation study.Surgical simulation laboratory.Seven subjects ranging in experience from medical students ("Novices") to experienced ear surgeons ("Experts") participated in the validation study. Experts (n = 3) were defined as performing10 EES cases per year.The skills trainer was constructed from a 3" diameter polyvinyl chloride pipe cap modified with two ports for instrument passage. A wooden platform was placed inside at an appropriate working distance for ear surgery. Eight interchangeable skills modules were fabricated on wooden squares (3 cm × 3 cm) using materials such as #19 wire brads, 1.6 mm glass beads, and 26-gauge jewelry wire. The material cost of this reusable model was $15. Subjects completed each skills module in triplicate, followed by a Likert-based survey.Expert performance was superior to novices in 100% (8/8) of skills modules, i.e., threading beads on a wire (43 versus 127 s, p 0.001) and placing a simulated prosthesis (13 versus 68 s, p = 0.01). Most participants (86%) agreed the trainer orientation was accurate and all participants (100%) were satisfied with the experience.This low-cost modular task trainer may help fill a void in otologic training by allowing efficient, deliberate practice of validated exercises designed to improve fine motor control with EES instrumentation.

Sliding and tread brake heating are known to alter microstructures and properties and show causal relationships with shelling and spalling. Temperature can also affect the performance of wheels in other ways: rolling contact forces depend on the size of the contact patch, which is affected by the elastic modulus, which in turn is affected by the tread temperature. Temperature differences from the rim to the remaining portion of the wheel may cause distortions, which may result in unfavorable contact between the wheel and the rail. Cold temperatures affect the fracture toughness and, in the presence of water, may cause wedging, which will accelerate the shelling process. Oxidation within a crack can also cause wedging, resulting in the propagation of thermal cracks. Changes in the residual stress due to brake heating can also affect shakedown. This study considers the many ways of how temperature can affect the performance of the railroad wheel of a freight car. Most of the author’s observations relate to the freight car service in North America and may not be applicable to other types of service in other parts of the world.

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

RA is a chronic systemic inflammatory disease that primarily affects the small joints of the hands and feet, and results in a mean reduction in life expectancy of 3–10 years. RA is a multigene disorder with a substantial genetic component and a heritability estimate of 60%. Large-scale Genome-Wide Association Studies (GWAS) and meta-analyses have revealed common disease-associated variants in the population that may contribute cumulatively to RA pathogenesis. This review identifies the most significant genetic variants associated with RA susceptibility to date, with particular focus on the contribution of the HLA class II genes across different ethnic groups. Also discussed are the potential applications of pharmacogenomics to RA management by identifying polymorphisms associated with variation in treatment response or toxicity. The use of genetic variants to guide treatment strategy has the potential to not only reduce National Health Service costs, but also drastically improve patient experience and quality of life.

International relations (IR) scholars have recognized the importance of technology in enabling nongovernmental organizations (NGOs) to build transnational networks and enhance their influence. However, IR scholars have typically focused on elite networks across NGOs, states, and international organizations. This article considers how digital technologies generate new types of networked power between NGOs and their members. Digital tools allow for fast feedback from supporters, rapid surges in mobilization, and more decentralized campaigns. Importantly, in the digital era, NGOs must decide not only which digital platforms to use, but also whether to devolve decision-making to their supporters. Two questions arise: First, do NGO staff or supporters primarily define and produce advocacy content? Second, is the goal of digital activism to broaden or intensify participation? Answers to these questions generate four digital strategies: proselytizing, testing, conversing, and facilitating. These strategies change advocacy practices, but only facilitating strategies open up new forms of networked power based on supporter-to-supporter connections. Digital strategies have profound ramifications for individual organizations, the nature of the advocacy sector, and its power in relation to states, corporations, and other nonstate actors. Digital adoption patterns shape how NGOs choose campaigns, how they legitimate their claims, and what strategies they rely on.

Conventional problem solving is a time-honored and accepted methodology for solving many problems we encounter in our daily home and work lives. Thought processes can be linear (like a programmer) or non-linear and still use conventional problem solving skills. Conventional problem solving begins with a statement of the problem, accumulation of data, analysis of data and proposals of solutions to the problem, then testing of the hypotheses. Non-conventional problem solving often skips some of these steps, beginning with a statement of the problem and ending with possible solutions. The tools of conventional problem solving include “critical thinking”, Fool-proofing, “thinking outside the box” and Statistical techniques. Consider the first of our ancestors to figure out that harnessing fire would provide security from large predators, make food safer and easier to eat and make tools such as fire hardened tips on spears. Did all these inventions occur in one moment of genius, or did they take innumerable years to accomplish? Sometime in this process of non-conventional thinking our ancestors brought forth a new technology which ensured the survival of our species. So, how does non-conventional problem solving work? When current theory does not appear to work, then we look to the margins of our science to see if current theory continues to be ineffective. Most theories fail in the margins of the science. A classic example of conventional science failing in the margins is the general and special theory of relativity. Non-conventional problem solving offers greater opportunity for revolutionary rather than incremental, or evolutionary advancements to our science. Other examples are included in this paper. Two wheel related problems are also presented using non-conventional problem solving techniques to provide alternative solutions.

Objectives Healthy individuals have significant beat-to-beat variability in heart rate, and this variability decreases with mental stress. We aim to use heart rate variability (HRV) to objectively compare mental stress levels in otologic surgeons at rest and during key portions of procedures. Design Pilot study. Setting Operating room and laboratory. Participants Two neurotology fellows performed six mastoidectomy and facial nerve (FN) dissections in the operating room and six in a cadaver lab while continuous electrocardiograms were measured wirelessly. Five-minute samples were recorded during resting, preoperative, mastoidectomy, and FN dissection. Beat-to-beat time intervals were analyzed in time and frequency domains. The standard deviation of normal beat-to-beat intervals (SDNN) and the ratio of low frequency to high frequency power (LF/HF, measure of sympathetic tone) were calculated. Decreases in SDNN and increases in LF/HF indicate elevated mental stress. Results Mean resting SDNN was 43.9 ± 9.2 ms, not statistically different from preoperative SDNN (34.1 ± 8.2 ms, p = 0.13). SDNN decreased during mastoidectomy (29.4 ± 11.7 ms) and FN dissection (22.8 ± 3.1 ms), which was significant compared to preoperative values (p = 0.03). Intraoperative LF/HF increased for FN dissection (6.8 ± 2.6) compared to resting (2.2 ± 0.7, p = 0.004), indicating increased sympathetic tone. Mastoid and FN cadaveric procedures resulted in SDNN of 33.6 ± 3.8 and 32.9 ± 4.7 ms, respectively, not statistically different from preoperative values (p = 0.82 and p = 0.94, respectively). Cadaveric FN dissection did not result in increased LF/HF (2.4 ± 0.9) compared to resting (p = 0.94). Conclusions Decreased HRV and increased sympathetic tone were observed intraoperatively, indicating high levels of mental stress, particularly with FN dissection. Similar changes were not found during cadaveric dissections.

Objectives Review outcomes of lateral temporal bone resections for ear and temporal bone malignancy. Design, Setting, and Participants Retrospective review of all lateral temporal bone resections performed from 2008 to 2015 at a single tertiary care center. Main Outcome Measures Patient demographics, perioperative variables, overall survival, disease-free survival (DFS), and comparison of Kaplan–Meier curves. Results Overall, 56 patients were identified with a mean follow-up period of 2.3 ± 1.8 years. The predominant histopathologic diagnosis was squamous cell carcinoma (SCC, 54%), followed by salivary gland tumors (18%), and basal cell carcinoma (9%). Tumor stages were T1-T2 in 23%, T3-T4 in 73%, and two unknown primary lesions. Mean overall survival was 4.6 ± 0.4 years. Comparison of tumors with and without lymph node involvement or perineural invasion approached statistical significance for overall survival ( p = 0.07 and 0.06, respectively). DFS was 2.5 ± 0.3 years. Stratification by lymph node status had a statistically significant difference in DFS ( p = 0.03). Subgroup analysis of SCC patients did not reveal significant differences. Conclusions Based on our cohort, most patients with temporal bone malignancies present with advanced disease, making it difficult to achieve negative margins. Overall, lymph node status was the strongest predictor of survival in this group.