Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P103

their pain control and narcotic usage in the postoperative
period following otologic surgery (tympanoplasty, tympanomastoidectomy, stapedectomy, and cochlear implantation).
Methods: We began a prospective study in December 2019
to survey patients who underwent otologic procedures at our
tertiary care institution. Ten patients underwent tympanomastoidectomy, 9 underwent tympanoplasty, 1 patient underwent
a stapedectomy, and 1 patient received a cochlear implant. A
survey was administered that evaluates postoperative pain and
narcotic usage from day of discharge to first follow-up
appointment. We used a validated visual analog scale to query
pain level on postoperative days (POD) 0, 1, 3, and 7. All narcotic prescriptions and amount used were converted to standard units of morphine milligram equivalents (MMEs).
Results: A total of 21 patients have completed this ongoing
prospective study as of January 2020. A total of 1248 MMEs
were prescribed and 748 MMEs (60%) were used. Average
MMEs prescribed were 59.4 MMEs and average usage was
35.5 MMEs. Forty percent of prescribed narcotic medication
went unused. Results did not vary significantly when controlling for procedure. Pain was moderate on POD 0 and POD 1
but had nearly entirely resolved for most patients by POD 7.
Conclusions: A significant amount of narcotic medication
went underused for successful pain management of otologic
surgery. There is clearly a role for narcotics in the management of postoperative pain; however, patients may not need as
much as previously thought.
The Neural Basis of Cortical Adaptions
in Cochlear Implant Use
Yew Song Cheng, BM, BCh (Presenter); Ariel E. Hight, MS;
Mario A. Svirsky, PhD
Objectives: Cochlear implants (CIs) can restore functional
hearing, but outcomes are variable. Significant time and listening experience are required to attain good speech recognition. This experience-dependent adaptation is a process driven
by plasticity in central auditory processing, which is difficult
to study in humans. We explored a novel rat model that combines electrophysiology with behavioral training on auditory
tasks.
Methods: Normal-hearing rats are first trained to detect a target tone and withhold response to nontarget frequencies. They
are bilaterally deafened, then implanted with both an 8-channel
cochlear array and a custom 64-channel epidural electrode array
over the auditory cortex for chronic microelectrocorticography
(µECoG). We then track µECoG responses in conjunction with
behavioral task performance as the animals relearn the go/no-go
task using auditory input provided by the CI.
Results: Pretrained rats (n = 4) were able to discriminate
stimulation from a target vs a nontarget CI channel, with varying degrees of improvement over time. Discrimination performance is abolished by turning the CI off. µECoG data were
successfully acquired in real time from all channels simultaneously; these data are then analyzed to create stimulus/
response profiles across the auditory cortex. µECoG channels
with the largest response amplitude were designated as

P103
"preferring" that stimulus. This was then compiled into a
channel-topic map in 2 rats, akin to tonotopic maps for pure
tones. Cross-channel correlation value indicates that different
CI channels showed unique cortical responses.
Conclusions: Our study establishes data that demonstrate
feasibility of a novel experimental model. CI stimulation at
the cortical level appear to be organized in tonotopical
fashion.
Normative Data for Assessment of Surgical
Competency in Cochlear Implantation
Eric M. Dowling, MD (Presenter); Matthew L. Carlson, MD
Objectives: An objective instrument assessing surgical competency in cochlear implantation has previously been developed and validated that differentiated surgical proficiency of
residents compared with experts. The objective of this study is
to derive normative data for this tool based on postgraduate
year (PGY) and number of otology rotations completed.
Methods: Fourteen trainees, ranging from PGY 1 to 6, performed cochlear implantation on cadaveric specimens in an
anatomy laboratory setting. Deidentified recordings of the procedure were viewed by both a fellowship-trained neurotologist
and a senior otolaryngology resident, and competency was
scored using the previously validated instrument. Results were
assessed for interobserver reliability and construct validity.
Results: Interrater reliability was demonstrated for competence and calculated using the Cohen's kappa. Overall agreement between raters was high (κ = 0.82). Construct validity
was supported by a positive association between higher TaskBased Checklist and Global Rating Scale scores and both resident PGY level (P < .05) and number of otology rotations
completed (P < .05). Time to complete the exercise was
inversely related to PGY level and number of otology rotations completed (P < .05). With increasing PGY level, scores
improved an average of 0.63 points and 0.59 points on the
Task-Based Checklist and Global Rating Scale, respectively.
Conclusions: Herein, we provide normative data to assess
surgical competency in a core otologic procedure through the
resident training continuum. These data can be used to provide
objective feedback on overall and task-specific competency in
cochlear implantation to identify surgical deficiencies early
on and to guide supportive course correction.
A Novel Optical Coherence Tomography Doppler
Device for Measurement of Ossicular Vibration in
Human Subjects: A Pilot Study
Marc Polanik (Presenter); Melissa Castillo-Bustamante;
Jeffrey T. Cheng; Dan MacDougall; Robert B. A. Adamson;
Aaron K. Remenschneider, MD, MPH
Objectives: Assessment of ossicular mobility in living patients
is traditionally limited to intraoperative visualization following exploratory tympanotomy. Novel handheld optical coherence tomography Doppler vibrometry (OCT-DV) is a new
technology that can be used to noninvasively measure soundinduced displacement of middle ear structures through an

Otology/Neurotology

Oral Presentations

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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