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Objective: To investigate the relationship between ergonomic positions and electromyographic muscle activity during otologic drilling. Study Design: Cross‐over experimental trial. Setting: Tertiary Academic Medical Center. Methods: Surgeon participants were tasked with delicate eggshell drilling in 3 different seated positions: "neutral," "slouched," and "craned." Surface electromyography (sEMG) sensors recorded the amplitude and frequency of muscle activity. The joint analysis of spectrum and amplitude (JASA) method, which combines temporal trends in frequency and amplitude, was used to identify trials that exhibited patterns of fatigue. Results: The sEMG amplitude and frequency responses demonstrated wide temporal changes. In a majority of experiments, amplitude increased over the course of the experiment, while frequency remained more stable. On analysis of variance testing, only the mean frequency of the deltoid differed significantly between postures (P =.02). Under the JASA framework, external carpi radialis and upper trapezius experienced fatigue in nearly half of the trials regardless of position (47% vs 49%). The upper trapezius demonstrated fatigue during 46% and 69% of the "craned" and "slouched" trials, respectively, compared to just 31% of the "neutral" trials. Fewer attendings demonstrated upper trapezius fatigue compared to trainees (33% vs 62%). Female surgeons experienced fatigue in more trials than male counterparts (73% vs 25%). Conclusion: This study highlights a first step in quantifying the relationship between operating postures and muscle fatigue. Results suggest that specific muscle groups are more susceptible to fatigue; gender and experience may also impact muscle activity. [ABSTRACT FROM AUTHOR]

Objective: Music is a highly complex acoustic stimulus in both spectral and temporal contents. Accurate representation and delivery of high‐fidelity information are essential for music perception. However, it is unclear how well bone‐anchored hearing implants (BAHIs) transmit music. The study objective is to establish music perception performance baselines for BAHI users and normal hearing (NH) listeners and compare outcomes between the cohorts. Methods: A case‐controlled, cross‐sectional study was conducted among 18 BAHI users and 11 NH controls. Music perception was assessed via performance on seven major musical element tasks: pitch discrimination, melodic contour identification, rhythmic clocking, basic tempo discrimination, timbre identification, polyphonic pitch detection, and harmonic chord discrimination. Results: BAHI users performed comparably well on all music perception tasks with their device compared with the unilateral condition with their better‐hearing ear. BAHI performance was not statistically significantly different from NH listeners' performance. BAHI users performed just as well, if not better than NH listeners when using their control contralateral ear; there was no significant difference between the two groups except for the rhythmic timing (BAHI non‐implanted ear 69% [95% CI: 62%–75%], NH 56% [95% CI: 49%–63%], p = 0.02), and basic tempo tasks (BAHI non‐implanted ear 80% [95% CI: 65%–95%]; NH 75% [95% CI: 68%–82%, p = 0.03]). Conclusions: This study represents the first comprehensive study of basic music perception performance in BAHI users. Our results demonstrate that BAHI users perform as well with their implanted ear as with their contralateral better‐hearing ear and NH controls in the major elements of music perception. Level of Evidence: 3 Laryngoscope, 134:1381–1387, 2024 [ABSTRACT FROM AUTHOR]

Superior semicircular canal dehiscence (SCD) repair through the middle cranial fossa approach is typically performed on a patient in the supine position and the patient's head is turned to the contralateral side and secured with surgical pinions or supported on a headrest. However, traditional supine positioning method may place strain on the patient's neck, limit the surgeon's visualization of the dehiscence due to inadequate head rotation, and compromise the ergonomic positioning of the surgeon. Here, we present a novel positioning method for middle fossa SCD repair that allows for optimal head rotation in a semi‐supine position, requires less set‐up and patient manipulation than the park bench position, and does not require the use of surgical pins. Laryngoscope, 133:1218–1221, 2023 [ABSTRACT FROM AUTHOR]

SOX transcription factors have the capacity to modulate stem/progenitor cell proliferation and differentiation in a dose-dependent manner. SOX9 is expressed in the small intestine epithelial stem cell zone. Therefore, we hypothesized that differential levels of SOX9 may exist, influencing proliferation and/or differentiation of the small intestine epithelium. Sox9 expression levels in the small intestine were investigated using a Sox9 enhanced green fluorescent protein ([Sox9.sup.EGFP]) transgenic mouse. [Sox9.sup.EGFP] levels correlate with endogenous SOX9 levels, which are expressed at two steady-state levels, termed [Sox9.sup.EGFPLO] and [Sox9.sup.EGFPHI]. Crypt-based columnar cells are [Sox9.sup.EGFPLO] and demonstrate enriched expression of the stem cell marker, Lgr5. [Sox9.sup.EGFPHI] cells express chromogranin A and substance P but do not express Ki67 and neurogenin3, indicating that [Sox9.sup.EGFPHI] cells are postmitotic enteroendocrine cells. Overexpression of SOX9 in a crypt cell line stopped proliferation and induced morphological changes. These data support a bimodal role for SOX9 in the intestinal epithelium, where low SOX9 expression supports proliferative capacity, and high SOX9 expression suppresses proliferation. intestinal epithelial development; stem cell; progenitor cell

Objectives: To elucidate differences in demographic and clinical characteristics between patients with episodic and chronic dizziness. Methods: A cross-sectional, observational study of 217 adults referred for dizziness at 1 tertiary center was undertaken. Subjects were split into a chronic dizziness group (>15 dizzy days per month) and an episodic dizziness group (<15 dizzy days per month). Results: 217 adults (average age, 53.7 years; 56.7% female) participated. One-third (n = 74) met criteria for chronic dizziness. Dizziness handicap inventory (DHI) scores were significantly higher in those with chronic dizziness compared to those with episodic dizziness (53.9 vs 40.7; P <.001). Comorbid depression and anxiety were more prevalent in those with chronic dizziness (44.6% and 47.3% vs 37.8% and 35.7%, respectively; P >.05). Abnormal vestibular testing and abnormal imaging studies did not differ significantly between the 2 groups. Ménière's disease and BPPV were significantly more common among those with episodic dizziness, while the prevalence of vestibular migraine did not differ according to chronicity of symptoms. A multivariate regression that included age, sex, DHI, history of anxiety and/or depression, associated symptoms, and dizziness triggers was able to account for 15% of the variance in the chronicity of dizziness (pseudo- R 2 = 0.15; P <.001). Conclusions: Those who suffer from chronic dizziness have significantly higher DHI and high comorbid rates of depression and anxiety than those with episodic dizziness. Our findings show that factors other than diagnosis alone are important in the chronification of dizziness, an observation that could help improve on multimodal treatment options for this group of patients. [ABSTRACT FROM AUTHOR]

Smoking is a risk factor for several conditions associated with dizziness, such as cardiovascular disease and emphysema. However, little is known about the specific association between smoking and dizziness. The purpose of this study was to examine the relationship between smoking and dizziness in the U.S. adult population. Responses from the 2008 National Health Interview Survey of U.S. adults (n = 21,781) were used to identify risk factors for dizziness and smoking. Of the 21,781 adults in the survey, 41.8% smoked more than 100 cigarettes in their lifetime. Of the 2,490 adults who had a self-diagnosed problem with dizziness, 54.1% had smoked more than 100 cigarettes in their lifetime. This corresponded to an odds ratio of 1.72 (95% CI, 1.56–1.89; p <.001) for experiencing dizziness with a history of smoking. In a multivariate analysis that included prior lung disease, cardiovascular disease, diabetes, hypertension, prior stroke, head trauma, age, sex, anxiety, depression, and history of migraines, smoking remained a significant risk factor for dizziness (OR 1.30; 95% CI, 1.17–1.46; p <.001). In a representative nationwide survey of U.S. adults, smoking is independently associated with dizziness, even after controlling for demographic variables, known risk factors for dizziness, and smoking related diseases. [ABSTRACT FROM AUTHOR]

Objective: In small (≤2 cm) oral tongue squamous cell carcinoma (OTSCC), we sought to clarify the contribution of pathologic features including perineural invasion (PNI), lymphovascular invasion (LVI), and worst pattern of invasion-5 (WPOI-5) to clinical outcomes relative to tumor depth of invasion (DOI) of > or ≤ 4 mm.Methods: Cases of ≤2 cm OTSCC treated surgically between 2000 and 2017 at an academic cancer center were reviewed, with retrospective pathologic slide review of DOI, LVI, PNI, and WPOI-5. Primary outcome measures included occult nodal positivity, 2-year locoregional recurrence (LRR), disease-specific survival (DSS), and overall survival (OS).Results: One hundred tumors were included in analyses; 50 had DOI ≤ 4 mm, while 50 had DOI > 4 mm. When DOI was ≤4 mm, the presence of PNI, LVI, or WPOI-5 was not associated with higher rates of occult cervical metastasis, LRR, or OS. When DOI was >4 mm, there was no difference in rates of occult cervical metastasis or LRR with each feature. On multivariate analysis, only the presence of two or more adverse features was associated with higher LRR (OR 5.7, P = .01) and worse DSS (HR 6.5, P = .02).Conclusion: The rate of occult cervical metastases in small (≤2 cm) OTSCC when DOI is ≤4 mm is very low even when PNI, LVI, or WPOI-5 is present, and 2-year LRR is no different. When DOI is >4 mm, the strongest predictor of recurrence and survival on multivariate analysis is the presence of two or more features in the tumor.Level Of Evidence: 4 Laryngoscope, 130:1715-1720, 2020. [ABSTRACT FROM AUTHOR]

Objective/hypothesis: Previous reports have documented the feasibility of utilizing electrocochleographic (ECoG) responses to acoustic signals to assess trauma caused during cochlear implantation. The hypothesis is that intraoperative round window ECoG before and after electrode insertion will help predict postoperative hearing preservation outcomes in cochlear implant recipients.Study Design: Prospective cohort study.Methods: Intraoperative round window ECoG responses were collected from 31 cochlear implant recipients (14 children and 17 adults) immediately prior to and just after electrode insertion. Hearing preservation was determined by postoperative changes in behavioral thresholds.Results: On average, the postinsertion response was smaller than the preinsertion response by an average of 4 dB across frequencies. However, in some cases (12 of 31) the response increased after insertion. The subsequent hearing loss was greater than the acute loss in the ECoG, averaging 22 dB across the same frequency range (250-1,000 Hz). There was no correlation between the change in the ECoG response and the corresponding change in audiometric threshold.Conclusions: Intraoperative ECoG is a sensitive method for detecting electrophysiologic changes during implantation but had limited prognostic value regarding hearing preservation in the current conventional cochlear implant patient population where hearing preservation was not intended.Level Of Evidence: 2b Laryngoscope, 126:1193-1200, 2016. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to illustrate the otorhinolaryngologic manifestations of levamisole toxicity and illuminate the features of this diagnosis. Methods: We describe a case of a known cocaine abuser with suspected levamisole toxicity who developed cutaneous necrosis of the cheeks, earlobes, nose, upper and lower lip, and the midline hard palate. We also review the existing clinical literature about this emerging phenomenon. Results: Levamisole is a common adulterant in cocaine distributed in the United States and has been reported to cause microvascular thrombosis and vasculitis with resultant skin necrosis in cocaine abusers. The distribution of skin findings characteristically involves the cheeks, earlobes, nose, lips, and hard palate and responds variably to cessation of cocaine use. In its most severe cases, immune suppression and/or surgical debridement may be required. Conclusion: Levamisole toxicity can frequently involve the ears, nose, and throat tissues. Otorhinolaryngologists should recognize these manifestations to expeditiously diagnose and manage this condition. Failure to do so promptly can lead to complications that may necessitate reconstructive or amputation surgery. [ABSTRACT FROM AUTHOR]