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All Publications

  • Assessment of Inter- and Intra-Rater Reliability of Tablet-Based Software to Measure Cochlear Duct Length. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Cooperman, S. P., Aaron, K. A., Fouad, A., Tran, E., Blevins, N. H., Fitzgerald, M. B. 2021


    OBJECTIVE: The objective of this study is to build upon previous work validating a tablet-based software to measure cochlear duct length (CDL). Here, we do so by greatly expanding the number of cochleae (n?=?166) analyzed, and examined whether computed tomography (CT) slice thickness influences reliability of CDL measurements.STUDY DESIGN: Retrospective chart review study.SETTING: Tertiary referral center.PATIENTS: Eighty-three adult cochlear implant recipients were included in the study. Both cochleae were measured for each patient (n?=?166).INTERVENTIONS: Three raters analyzed the scans of 166 cochleae at 2 different time points. Each rater individually identified anatomical landmarks that delineated the basal turn diameter and width. These coordinates were applied to the elliptic approximation method (ECA) to estimate CDL. The effect of CT scan slice thickness on the measurements was explored.MAIN OUTCOME MEASURES: The primary outcome measure is the strength of the inter- and intra-rater reliability.RESULTS: The mean CDL measured was 32.84??2.03?mm, with a range of 29.03 to 38.07?mm. We observed no significant relationship between slice thickness and CDL measurement (F1,164?=?3.04; p?=?0.08). The mean absolute difference in CDL estimations between raters was 1.76??1.24?mm and within raters was 0.263??0.200?mm. The intra-class correlation coefficient (ICC) between raters was 0.54 and ranged from 0.63 to 0.83 within raters.CONCLUSIONS: This software produces reliable measurements of CDL between and within raters, regardless of CT scan thickness.

    View details for DOI 10.1097/MAO.0000000000003015

    View details for PubMedID 33492059

  • Stereotactic Radiosurgery for Vestibular Schwannoma Outcomes in Patients With Perfect Word Recognition-A Retrospective Cohort Study. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Fouad, A. n., Tran, E. D., Feng, A. Y., Alyono, J. C., Ma, Y. n., Blevins, N. H., Jackler, R. K., Santa Maria, P. L. 2021


    To investigate tumor control rate and hearing outcomes following stereotactic radiosurgery (SRS) for vestibular schwannoma (VS) cases with perfect (100%) word recognition score (WRS).A retrospective cohort study.Tertiary referral center.Inclusion criteria were receiving primary SRS, a pretreatment WRS of 100%, and availability of both pre- and posttreatment audiometric data for evaluation.SRS delivered by Cyberknife.Tumor growth rates and audiological outcomes after SRS.The cohort consisted of 139 patients, with more than 1-year follow-up (mean 6.1 yrs). SRS tumor control rate was 87% for the whole cohort. Growth before SRS was documented in 24% (n?=?34 of 139). The proportion of sporadic VS cases who maintained hearing (decline <10?dB of pure-tone audiometry or <20% of WRS) at 3 years was 50%, at 5 years was 45%, and at 10 years was 42%. In multivariate analysis, increased age was found to be predictive of increased hearing loss (p?=?0.03), while the following factors were shown not to be significant: sex (p?=?0.5), tumor size (p?=?0.2), pre-SRS tumor growth (p?=?0.5), and target volume (p?=?0.42).Among patients with VS who had perfect WRS and underwent SRS, the overall tumor control rate was 87% comparable to observation. Hearing maintenance and preservation of "serviceable" hearing rates after 5 years in VS patients with perfect WRS treated by SRS is less than that when comparing to similar observation cohorts. Given this finding we do not advocate using SRS to preserve hearing, over observation, in tumors with perfect WRS.

    View details for DOI 10.1097/MAO.0000000000003039

    View details for PubMedID 33443977

  • Ocular Vestibular-Evoked Myogenic Potential Amplitudes Elicited at 4 kHz Optimize Detection of Superior Semicircular Canal Dehiscence. Frontiers in neurology Tran, E. D., Swanson, A. n., Sharon, J. D., Vaisbuch, Y. n., Blevins, N. H., Fitzgerald, M. B., Steenerson, K. K. 2020; 11: 879


    Introduction: High-resolution temporal bone computed tomography (CT) is considered the gold standard for diagnosing superior semicircular canal dehiscence (SCD). However, CT has been shown over-detect SCD and provide results that may not align with patient-reported symptoms. Ocular vestibular-evoked myogenic potentials (oVEMPs)-most commonly conducted at 500 Hz stimulation-are increasingly used to support the diagnosis and management of SCD. Previous research reported that stimulation at higher frequencies such as 4 kHz can have near-perfect sensitivity and specificity in detecting radiographic SCD. With a larger cohort, we seek to understand the sensitivity and specificity of 4 kHz oVEMPs for detecting clinically significant SCD, as well as subgroups of radiographic, symptomatic, and surgical SCD. We also investigate whether assessing the 4 kHz oVEMP n10-p15 amplitude rather than the binary n10 response alone would optimize the detection of SCD. Methods: We conducted a cross-sectional study of patients who have undergone oVEMP testing at 4 kHz. Using the diagnostic criteria proposed by Ward et al., patients were determined to have SCD if dehiscence was confirmed on temporal bone CT by two reviewers, patient-reported characteristic symptoms, and if they had at least one positive vestibular or audiometric test suggestive of SCD. Receiver operating characteristic (ROC) analysis was conducted to identify the optimal 4 kHz oVEMP amplitude cut-off. Comparison of 4 kHz oVEMP amplitude across radiographic, symptomatic, and surgical SCD subgroups was conducted using the Mann-Whitney U test. Results: Nine hundred two patients (n, ears = 1,804) underwent 4 kHz oVEMP testing. After evaluating 150 temporal bone CTs, we identified 49 patients (n, ears = 61) who had radiographic SCD. Of those, 33 patients (n, ears = 37) were determined to have clinically significant SCD. For this study cohort, 4 kHz oVEMP responses had a sensitivity of 86.5% and a specificity of 87.8%. ROC analysis demonstrated that accounting for the inter-amplitude of 4 kHz oVEMP was more accurate in detecting SCD than the presence of n10 response alone (AUC 91 vs. 87%). Additionally, using an amplitude cut-off of 15uV reduces false positive results and improves specificity to 96.8%. Assessing 4 kHz oVEMP response across SCD subgroups demonstrated that surgical and symptomatic SCD cases had significantly higher amplitudes, while radiographic SCD cases without characteristic symptoms had similar amplitudes compared to cases without evidence of SCD. Conclusion: Our results suggest that accounting for 4 kHz oVEMP amplitude can improve detection of SCD compared to the binary presence of n10 response. The 4 kHz oVEMP amplitude cut-off that maximizes sensitivity and specificity for our cohort is 15 uV. Our results also suggest that 4 kHz oVEMP amplitudes align better with symptomatic SCD cases compared to cases in which there is radiographic SCD but no characteristic symptoms.

    View details for DOI 10.3389/fneur.2020.00879

    View details for PubMedID 32982915

    View details for PubMedCentralID PMC7477389

  • Health Literacy and Hearing Healthcare Use. The Laryngoscope Tran, E. D., Vaisbuch, Y. n., Qian, Z. J., Fitzgerald, M. B., Megwalu, U. C. 2020


    To assess whether health literacy is associated with: 1) degree of hearing loss at initial presentation for audiogram and 2) hearing aid adoption for hearing aid candidates.We identified 1376 patients who underwent audiometric testing and completed a brief health literacy questionnaire at our institution. The association between health literacy and degree of hearing loss at initial presentation was examined using linear regression, adjusted for age, gender, marital status, education level, race, language, employment status, and insurance coverage. The association between health literacy and hearing aid adoption was examined in the subset of patients identified as hearing aid candidates using logistic regression, adjusted for demographic factors and insurance coverage.Patients with inadequate health literacy were more likely to present with more severe hearing loss (adjusted mean pure-tone average [PTA] difference, 5.38?dB, 95% confidence interval [CI] 2.75 to 8.01). For hearing aid candidates (n = 472 [41.6%]), health literacy was not associated with hearing aid adoption rate (odds ratio [OR] 0.85, 95% CI 0.40 to 1.76). Hearing aid coverage through Medicaid (OR 2.22, 95% CI 1.13 to 4.37), and moderate (OR 2.70, 95% CI 1.58 to 4.69) or moderate-severe (OR 2.23, 95% CI 1.19 to 4.16) hearing loss were associated with hearing aid adoption.In our population, patients with low health literacy are more likely to present with higher degrees of hearing loss, but no less likely to obtain hearing aids compared with patients with adequate health literacy. Hearing loss severity and hearing aid coverage by insurance appear to be the main drivers of hearing aid adoption.3 Laryngoscope, 2020.

    View details for DOI 10.1002/lary.29313

    View details for PubMedID 33305829

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