Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P240

P240
Otolaryngology-Head and Neck Surgery 163(1S)
Presentation schedule is subject to change. The Official Program Abstracts supplement does not reflect changes made after August 10, 2020.
in 2017. Concurrently, the number of PCPs billing for CDP
increased 3-fold (5410 to 17,908), as did the proportion of
tests billed by PCPs (23.5% to 42.5%).
Conclusions: CDP use is growing, particularly among PCPs,
who see the majority of older individuals at risk of falling.
Marked geographic and clinician-level variations in rates of
CDP use exist. An aging population underscores the importance of quality improvement efforts aimed at defining the
indications and best practices of diagnostic tests that provide
objective measures of functional balance capacity.

Otology/Neurotology

New Onset Seizures Following Cochlear
Implant Processor Replacement: A Case
Report
Kyle S. Kimura, MD (Presenter); Michael H. Freeman, MD;
Siddharth Patel; Alejandro Rivas, MD
Objectives: Cochlear implantation (CI) has become increasingly popular with improving technology and expanding indications. Although rare, there are complications associated
with surgery such as device failure and wound breakdown.
Seizures, a complication of certain otologic skull-base procedures, are not associated with CI. However, psychogenic nonepileptiform seizures (PNES), a variant seizure disorder
triggered by pain or stress, have not been studied in the setting
of CI. We present an interesting case of a patient diagnosed
with PNES after CI processor replacement, who ultimately
underwent device explantation.
Methods: Case study.
Results: A 28-year-old man with congenital hearing loss and
unilateral CI at age 10 years presented to the emergency department with seizure-like activity over the past 6 months that
began after CI processor replacement. The attacks, characterized by violent body thrashing and screaming, were preceded
by pain over the implant site and facial "shocking." Imaging
and device interrogation were without abnormality. Neurology
performed an electroencephalography that failed to show epileptiform activity and felt these episodes were consistent with
PNES, with pain and shocking as triggers. After lengthy discussion, CI explantation was ultimately performed. The patient
reported improved pain immediately after the procedure and
complete resolution of his episodes at 1-month follow-up.
Conclusions: Certain seizure disorders, such as PNES, have
triggers that unmask underlying disease and provoke episodes.
Soft failures are characterized by adverse symptoms such as
pain or shocking. We theorize that these symptoms related to
CI failure were the trigger for seizures, and removal of the
device resulted in resolution of symptoms. This case represents the only known example of CI explantation in the setting
of PNES.
Ossicular Chain Reconstruction Simulator
With Force Feedback: A Model for Resident
Education
Tyler J. McElwee, MD (Presenter); Gauri Mankekar, MD, PhD;
Alexander B. Sevy, MD

Objectives: We sought to create a training simulation for
ossicular chain reconstruction (OCR) surgery and evaluate its
effectiveness in training residents on efficient placement of a
partial ossicular prosthesis, with minimal pressure exerted on
the stapes, with and without force feedback.
Methods: A proof-of-concept study of an OCR simulation
model using all levels of residency training in otolaryngology
was conducted at a single institution. Sixteen otolaryngology
residents at all levels of training were studied and assigned
randomly into simulation arms: with "feedback" (n = 9) and
"without feedback" (n = 7). Participants underwent 3 trials of
stapes model simulation. We recorded the pressure exerted on
the stapes footplate throughout the simulation for both arms as
well as speed of completion. Only the feedback group received
light and sound feedback of stapes footplate pressure throughout the simulation. Pre- and postsimulation surveys were completed to gauge comfort with the surgery.
Results: There was a statistically significant increase in
speed between trial 1 and 3 in both the feedback (P = .04) and
without feedback (P = .02) arm. In the first trial, feedback was
found to be a statistically significant predictor of faster prosthesis placement (P = .02). The feedback arm also used less
force in trial 1 (P = .03) but did not remain statistically significant when comparing trial 1 with 3 in the feedback and without feedback arms. Participants with feedback applied less
average force over time vs without feedback (P = .01).
Conclusions: Progressive trials resulted in faster prosthesis
placement with less maximum and total force applied for all
participants. Feedback during this process aided participants
with time, maximum force, and total force compared with not.
Ototoxicity of a Novel Antimicrobial
Solution in a Guinea Pig Model
Carolyn Ojano Dirain, PhD (Presenter);
Patrick J. Antonelli, MD
Objectives: Because of the resistance of bacterial biofilms to
antibiotics and the potential adverse impact of quinolones on
tympanic membranes, other treatment options for otitis media
are needed. This study aimed to examine the impact of a novel
antimicrobial solution on hearing loss and vestibular function
and to evaluate the potential use of a novel antimicrobial solution in the treatment of recalcitrant otitis media.
Methods: Eight adult male and female guinea pigs were
randomized to receive a single dose of the antimicrobial solution (Next Science Middle Ear Wash [MEW]) in 1 ear and
saline control in the contralateral ear. The MEW or saline was
administered across the eardrum into the middle ear using a
blunt 27-G sterile needle, up to the capacity of the guinea pig
middle ear. Cochlear action potentials were measured before
solution injections and 1 and 8 weeks later. After final hearing
tests, animals were euthanized. The cochlea underwent scanning electron microscopy (SEM) to assess for outer hair cell
(OHC) loss.
Results: There were no differences in hearing thresholds
between ears that received MEW and saline-treated control

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

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