Understanding speech in noise (SIN) is the dominant complaint of individuals with hearing loss. For decades, the default test of speech perception in routine audiologic assessment has been monosyllabic word recognition in quiet (WRQ), which does not directly address patient concerns, leading some to advocate that measures of SIN should be integrated into routine practice. However, very little is known with regard to how SIN abilities are affected by different types of hearing loss. Here, we examine performance on clinical measures of WRQ and SIN in a large patient base consisting of a variety of hearing loss types, including conductive (CHL), mixed (MHL), and sensorineural (SNHL) losses. In a retrospective study, we examined data from 5593 patients (51% female) who underwent audiometric assessment at the Stanford Ear Institute. All individuals completed pure-tone audiometry, and speech perception testing of monaural WRQ, and monaural QuickSIN. Patient ages ranged from 18 to 104 years (average = 57). The average age in years for the different classifications of hearing loss was 51.1 (NH), 48.5 (CHL), 64.2 (MHL), and 68.5 (SNHL), respectively. Generalized linear mixed-effect models and quartile regression were used to determine the relationship between hearing loss type and severity for the different speech-recognition outcome measures. Patients with CHL had similar performance to patients with normal hearing on both WRQ and QuickSIN, regardless of the hearing loss severity. In patients with MHL or SNHL, WRQ scores remained largely excellent with increasing hearing loss until the loss was moderately severe or worse. In contrast, QuickSIN signal to noise ratio (SNR) losses showed an orderly systematic decrease as the degree of hearing loss became more severe. This effect scaled with the data, with threshold-QuickSIN relationships absent for CHL, and becoming increasingly stronger for MHL and strongest in patients with SNHL. However, the variability in these data suggests that only 57% of the variance in WRQ scores, and 50% of the variance in QuickSIN SNR losses, could be accounted for by the audiometric thresholds. Patients who would not be differentiated by WRQ scores are shown to be potentially differentiable by SIN scores. In this data set, conductive hearing loss had little effect on WRQ scores or QuickSIN SNR losses. However, for patients with MHL or SNHL, speech perception abilities decreased as the severity of the hearing loss increased. In these data, QuickSIN SNR losses showed deficits in performance with degrees of hearing loss that yielded largely excellent WRQ scores. However, the considerable variability in the data suggests that even after classifying patients according to their type of hearing loss, hearing thresholds only account for a portion of the variance in speech perception abilities, particularly in noise. These results are consistent with the idea that variables such as cochlear health and aging add explanatory power over audibility alone.

Multimodal mechanophores that exhibit complex mechanochromic behavior beyond the typical binary response are capable of distinguishing between multiple stress states through discrete changes in color. Naphthodipyran photoswitches contain two pyran rings fused to a central naphthalene core and represent a potentially promising framework for multimodal reactivity. However, the concurrent ring opening of both pyran moieties has previously proven inaccessible via photochemical activation. Here, we demonstrate that mechanical force supplied to naphthodipyran through covalently bound polymer chains generates the elusive dual ring-opened dimerocyanine product with unique near-infrared absorption properties. Trapping with boron trifluoride renders the merocyanine dyes thermally persistent and reveals unusual sequential ring-opening behavior that departs from the reactivity of previously studied mechanophores under the high strain rates imposed by ultrasound-induced solvodynamic chain extension.

In prostate cancer, 5-hydroxymethylcytosine delineates oncogene activation and stage-specific cell states and can be analyzed in liquid biopsies to detect cancer phenotypes. See related article by Wu and Attard, p. 3880.

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. Retrospective chart review study. Tertiary referral center. Eighty-three adult cochlear implant recipients were included in the study. Both cochleae were measured for each patient (n = 166). 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. The primary outcome measure is the strength of the inter- and intra-rater reliability. 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. This software produces reliable measurements of CDL between and within raters, regardless of CT scan thickness.

Abstract Background: Low pH is an important factor facilitating entry of enveloped viruses including coronaviruses and further fusion with the host epithelial cell membrane. pH in the pulmonary environment can be maintained by supplying a negative electric charge. The main objective was to check if earthing (direct or indirect connection to Earth) changes the pH of the respiratory tract.Methods: Nine participants were evaluated and pH measurements were taken on the mucous membrane of the throat before and after 15 minutes of earthing.Results: Mean pH before earthing was 5.83±0.43 and after earthing was 6.33± 0.43 (p=0.000323). Conclusions: Earthing is able to supply a negative charge resulting in alkalization of the pulmonary environment. The increased pH value in the respiratory tract reduces the pH-dependent entry of coronaviruses into epithelial cells. Earthing can have an impact on the course of respiratory tract infection both viral and bacterial decreasing the susceptibility of the development of fatal forms of SARS (Severe Acute Respiratory Syndrome).

To prospectively evaluate opioid consumption following adult outpatient otologic surgery. Prospective observational. Single-tertiary referral center. Patients scheduled for otologic surgery who did not have a history of chronic opioid use were recruited between February 2018 and February 2019. Opioid consumption was queried using telephone or in-person surveys administered between postoperative days 5 and 15. Patient demographics, surgical details, and opioid prescription patterns were abstracted from medical records. Opioid distribution was determined by querying records maintained by the California Department of Justice through a state-wide prescription drug monitoring program mandated since 2016. Seventy patients were prescribed an average of 68.9 ± 31.8 mg of morphine equivalents (MME) and consumed 47.3 ± 42.9 MME over 2.4 ± 2.3 days postoperatively. Patients who received a postauricular incision were prescribed significantly more than those who underwent transcanal procedures (86.2 vs 55.9 MME; t test, p < 0.001), consumed significantly more (72.2 vs 28.6 MME; t test, p < 0.001), and for a significantly longer duration (3.4 vs 1.6 days; t test, p = 0.001). In the postauricular group, there was no significant difference in consumption between mastoidectomy and nonmastoidectomy subgroups (64.9 vs 89.2 MME; t test, p = 0.151). Eighty percent of transcanal patients consumed 50 MME (10 pills) or less, while 80% of postauricular patients consumed 80 MME (16 pills) or less. Patients in our cohort consumed approximately 3/4 of the prescribed opioids. Those with postauricular incisions used significantly more than those with transcanal incisions. Postoperative opioid prescription recommendations should be tailored according to the extent of surgery.

To document the case of a patient with bilateral enlarged vestibular aqueducts who experienced sensorineural hearing loss in the nonimplanted ear following unilateral cochlear implantation complicated by perilymph gusher requiring lumbar drain insertion and to highlight the need to counsel regarding the risk of potential hearing loss to the contralateral ear when preparing for cochlear implants in the setting of inner ear malformations. One patient with bilateral enlarged vestibular aqueducts in a tertiary referral center. Cochlear implantation complicated by perilymph gusher requiring lumbar drain insertion. Bone conduction hearing thresholds, word recognition scores. The patient underwent unilateral cochlear implantation, which was complicated by a perilymphatic gusher and necessitated placement of an intraoperative lumbar drain. On postoperative day 1, the patient reported hearing loss in the opposite ear. The word recognition score in the contralateral ear dropped from 24% at preimplantation to 8% at 2-weeks postimplantation, and did not improve at 6 months postimplantation. Moreover, the bone conduction threshold at 1 kHz worsened from 20 dB preoperatively to no response at 75 dB (the limit of the testing equipment) at 2-weeks postoperatively and only partially improved to 40 dB at 6 months postimplantation. As patients with inner ear malformations potentially have direct high-pressure anatomical connections between the perilymphatic spaces and the cerebrospinal fluid, they are at risk of hearing loss in the nonimplanted ear during cochlear implantation. This case highlights the need for potential additional patient counseling regarding this risk in the nonimplanted ear.