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To determine the timing of acoustic hearing changes among hearing preservation Cochlear implant (CI) recipients. To determine differences in hearing outcomes based on device type and demographic factors. To determine if there is a relationship between the extent of early hearing loss after CI and the subsequent rate of continued hearing loss.Prospective, single subject study.Two hundred and eleven subjects who received a hearing preservation CI were included in the study-80 Nucleus Hybrid L24 (Cochlear), 47 422/522 (Cochlear), 24 S8 (Cochlear), 14 S12 (Cochlear), 6 SRW (Cochlear), 21 SLIM J (Advanced Bionics), and 19 Flex (Med-EL). Of these, 127 were included in the subsequent analyses. Audiometric thresholds (low frequency pure-tone-averages) were collected and compared pre and postoperatively.Long-term hearing preservation rates were 65% (52/80) for L24, 83% (20/24) for S8, 79% (11/14) for S12, 83% (5/6) for SRW, 54% (25/47) for 422/522, 91% (21/23) for SLIM J, and 84% (16/19) for Flex. Hearing loss was not related to device type (P = .9105) or gender (P = .2169). Older subjects (age ≥65) had worse hearing outcomes than younger subjects after initial device activation (age65, P = .0262). There was no significant difference in rate of hearing loss over time between older and younger patients (P = .0938). Initial postoperative hearing loss was not associated with the rate of long-term hearing loss.Long-term low frequency hearing preservation is possible for CI recipients and is not associated with gender or device type. Rate of hearing loss over time is not dependent on patient age. Early hearing loss after CI does not predict the rate of long-term hearing loss.3 Laryngoscope, 132:2036-2043, 2022.

Acoustic hearing can be preserved after cochlear implant (CI) surgery, allowing for combined electric-acoustic stimulation (EAS) and superior speech understanding compared to electric-only hearing. Among patients who initially retain useful acoustic hearing, 30–40 % experience a delayed hearing loss that occurs 3 or more months after CI activation. Increases in electrode impedances have been associated with delayed loss of residual acoustic hearing, suggesting a possible role of intracochlear inflammation/fibrosis as reported by Scheperle et al. (Hear Res 350:45–57, 2017) and Shaul et al. (Otol Neurotol 40(5):e518–e526, 2019). These studies measured only total impedance. Total impedance consists of a composite of access resistance, which reflects resistance of the intracochlear environment, and polarization impedance, which reflects resistive and capacitive properties of the electrode–electrolyte interface as described by Dymond (IEEE Trans Biomed Eng 23(4):274–280, 1976) and Tykocinski et al. (Otol Neurotol 26(5):948–956, 2005). To explore the role of access and polarization impedance components in loss of residual acoustic hearing, these measures were collected from Nucleus EAS CI users with stable acoustic hearing and subsequent precipitous loss of hearing. For the hearing loss group, total impedance and access resistance increased over time while polarization impedance remained stable. For the stable hearing group, total impedance and access resistance were stable while polarization impedance declined. Increased access resistance rather than polarization impedance appears to drive the increase in total impedances seen with loss of hearing. Moreover, access resistance has been correlated with intracochlear fibrosis/inflammation in animal studies as observed by Xu et al. (Hear Res 105(1–2):1–29, 1997) and Tykocinski et al. (Hear Res 159(1–2):53–68, 2001). These findings thus support intracochlear inflammation as one contributor to loss of acoustic hearing in our EAS CI population.

Purpose This dual-aim study was intended to develop and validate a new fitting paradigm for over-the-counter (OTC) hearing aids. Aim 1 was undertaken to create a limited set of evidence-based preconfigured gain–frequency responses (“presets”) for use in OTC devices. Aim 2 tested the efficacy of the presets relative to best-practice verification and determined the best method(s) for older adults to self-select amplification from the set. Method In Aim 1, audiometry data from 267 older adults with mild-to-moderate sensorineural hearing loss were obtained from the National Health and Nutrition Examination Survey database. Using these data and the National Acoustic Laboratories–Non-Linear 2 (NAL-NL2) prescriptive formula, a set of four presets were created that can fit a large percentage of older Americans with presbycusis. In Aim 2, 37 older adults with hearing loss used five methods to select presets. The selection methods were select-by-audiogram, select-by-self-test, select-by-trying, select-by-questionnaire, and random assignment. Using a crossover design, each participant completed speech recognition testing and sound quality ratings in quiet and noise for all selection methods and a verified NAL-NL2 condition. Results The set of presets can fit 67.9% of older Americans with mild-to-moderate hearing loss (Aim 1). Controlling for hearing thresholds and sound quality ratings, liner mixed-effects models indicated that speech recognition scores for select-by-audiogram, select-by-self-test, and select-by-trying were not statistically different from the NAL-NL2 condition. Statistical analysis indicated that select-by-self-test produced outcomes most consistent with individual outcomes for the NAL-NL2 condition (Aim 2). Conclusion This newly developed fitting paradigm may provide efficacy comparable to best-practice verification and could be used in OTC hearing aids.

Introduction: Transferred thrombectomy patients face additional time delays that might worsen outcome when compared to direct admission. In 2015, we moved from an MRI/A to a CTA/P protocol to decrease treatment times in transferred patients. In 2017, we initiated a direct admission to angiosuite (DAN) strategy. Herein, we aim to describe procedural and clinical outcomes in transfer patients with acute LVO stroke triaged by these protocols. Method: We reviewed demographics, clot location, and treatment times for all thrombectomies from 2013 to June 2018. Primary outcome was MRS at 90 days. Secondary outcomes were door to groin time, difference between NIHSS at admission and discharge (ΔNIHSS). Distributions are analyzed with Wilcoxon Rank, chi-squared and Fisher’s Exact Tests. Logistic regression is used to evaluate MRS and mortality outcomes and adjusted for clot location, admission NIHSS and tPA use. Results: The analysis includes 178 patients: 25 MRI/A, 130 CT/A/P, and 23 DAN. The groups significantly differ by tPA (16% vs 4% vs 13%, p=0.03), NIHSS at arrival (median 16 vs 17 vs 21, continuous p=0.03) and clot location (ICA 8% vs 20% vs 35%, BA 24% vs 10% vs 26%, p=0.01) for MRI, CT, and DAN respectively. There is significant reduction in median door to groin time between all groups (MRI 170 min., CT 84 min., DAN 16 min., p Conclusion: DAN is feasible with faster procedural times and may have clinical benefit in select patients. RCTs are needed to assess the advantages and harm of decreasing imaging in benefit of time.

Background: Faster revascularization times are associated with better functional outcome in patients undergoing thrombectomy. We aim to evaluate the impact of time of day presentation on thrombectomy metrics and its association with long-term functional outcome in an IR equipped OR setting. Methods: We retrospective reviewed all stroke patients who received mechanical thrombectomy between December 2012 and December 2017 at our CSC from our prospectively collected database. Work hours were defined by official OR work hours (Monday-Friday 7 AM and 5PM) and after hours as between 5 PM and 7 AM during weekdays and weekends as well as official hospital holidays. Collected data included baseline demographics, admission NIHSS, receipt of tPA, and location of occlusion. Primary outcomes were delta NIHSS between admission and discharge and 90-day modified Rankin Scale (mRS). Secondary outcomes included door to groin time and revascularization rate (TICI2b and 3). Multivariable logistic and Wilcoxon Rank test were performed to compare groups. Results: A total of 78 (38%) patients underwent mechanical thrombectomy during work hours and 125 (62%) during after-hours. There were more females in the after-hours group (55% vs 40%, P=0.046). There was no difference in mean age (66.8 vs 68.1, P=0.457), race (93% whites in both group) and median admission NIHSS (17 in both groups). Median door to groin time was 85 minutes during work hours vs. 94 minutes during after-hours (P=0.93). There was no difference in revascularization rate (70% vs 76%, P=0.67), delta NIHSS (2.9 vs 5.7, P=0.173) or long-term functional outcome (43% vs 53%, P=0.121) between after-hours vs work hours respectively. Conclusion: Studies suggest that after hours delay could impact functional outcomes on stroke patients undergoing thrombectomy. In-house 24/7 Anesthesia and IR tech services might improve metrics and mitigate this effect.