Objectives-1) Investigate the impact of electrode type and surgical approach on scalar electrode location in a large patient cohort; and 2) examine the relation between electrode location and postoperative audiologic performance. Setting-Tertiary academic hospital. Patients-220 post-lingually deafened adults undergoing cochlear implant (CI).Main Outcome Measures-Primary outcome measures of interest were scalar electrode location and postoperative audiologic performance.Results-In 68% of implants, electrodes were observed to be located solely in the scala tympani (ST). Multivariate analysis demonstrated perimodiolar(PM) and Mid-scala(MS) electrodes were p<0.001) times more likely to have at least one electrode in the scala vestibuli (SV) compared to lateral wall(LW) electrodes, respectively. Compared to cochleostomy(C), round window(RW) and extended round window(ERW) approaches demonstrated 70% reduction in SV insertion (OR 0.28,95%CI:0.1-0.8, p=0.01; ERW (OR O.28,95%CI:0.1-0.7, p=0.005). Examining postoperative audiometric performance, CNC score increased 0.6% with every 10° increase in angular insertion depth beyond the group minimum of 208° (Coefficient 0.0006,95%CI:0.0001-0.001, p=0.03). SV insertion was associated with a 12% decrease in CNC score (Coefficient -0.12,95%CI:-0.22--0.02, p=0.02). CNC score decreased 0.3% for every 1 year increase in age (Coefficient -0.003,95%CI:-0.006--0.0006), p=0.02). HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptConclusions-Electrode design and surgical approach were predictors of scalar electrode location. Specifically, LW electrodes showed higher rates of ST insertion compared to PM or MS. RW and ERW approaches showed higher rates of ST insertion when compared to C. In regards to performance, ST insertion, younger age, and greater angular insertion depth were predictors of improved CNC scores.

Summary Objective Currently, approximately 60–70% of unilateral temporal lobe epilepsy patients remain seizure free three years after surgery. The goal of this work was to develop a presurgical connectivity based biomarker to identify those patients who will have an unfavorable seizure outcome one year post surgery. Methods Resting state functional and diffusion weighted 3T MRI were acquired from 22 unilateral (15 right, 7 left) temporal lobe epilepsy patients and 35 healthy controls. A seizure propagation network including ipsilateral (to seizure focus) and contralateral hippocampus, thalamus, and insula, with bilateral midcingulate and precuneus was identified. Between each pair of regions, functional connectivity based on correlations of low frequency functional MRI signals, and structural connectivity based on streamline density of diffusion MRI data were computed and transformed to metrics related to healthy controls of the same age. Results A consistent connectivity pattern representing the network expected in patients with seizure free outcome was identified using eight patients who were seizure free at one year post surgery. The hypothesis that increased similarity to the model would be associated with better seizure outcome was tested in 14 other patients (Engel 1A, seizure free: n = 5; Engel 1B-2, favorable: n = 4; Engel 3–4, unfavorable: n = 5) using two similarity metrics: Pearson correlation and Euclidean distance. The seizure free connectivity model successfully separated all the patients with unfavorable outcome from the seizure free and favorable outcome patients (p = 0.0005, two-tailed Fisher Exact test) through the combination of the two similarity metrics with 100% accuracy. No other clinical and demographic predictors were successful in this regard. Significance This work introduces a methodological framework to assess individual patients, and demonstrates the ability to use network connectivity as a potential clinical tool for epilepsy surgery outcome prediction after more comprehensive validation.

Hypothesis: Cochlear duct length (CDL) can be automatically measured for custom selection of cochlear implant (CI) electrode arrays. Background: CI electrode array selection can be influenced by measuring the CDL, which is estimated based on the length of the line that connects the round window and the lateral wall of the cochlea when passing through the modiolus. CDL measurement remains time consuming and inter-observer variability has not been studied. Methods: We evaluate an automatic approach to directly measure the two-turn (2T) CDL using existing algorithms for localizing cochlear anatomy in computed tomography (CT). Pre-op CT images of 309 ears were evaluated. Two fellowship-trained neurotologists manually and independently measured CDL. Inter-observer variability between measurements across expert and automatic observers is assessed. Inter-observer differences for choice of electrode type are also investigated. Results: Manual measurement of CDL by experts tends to underestimate cochlea size and has high inter-observer variability, with mean absolute differences between expert CDL estimations of 1.15 mm. Our results show that this can lead to a large number of cochleae for which a different electrode array type would be selected by different observers, depending on the specific threshold value of CDL used to decide between array type. Conclusion: Choosing the best CI electrode array is an important task for optimizing hearing outcomes. Manual cochleae length measurements are user-dependent, and errors impact upon the CI electrode array choice for certain patients. Measuring cochlea length automatically is less time consuming and generates more repeatable results. Our automatic approach could make use of CDL for patient-customized treatment more clinically adoptable.

The acceptance of a split keyboard with a user-adjustable angle (adjustable keyboard) and its impact on postural discomfort and general comfort of users was tested in a comparative laboratory experiment with 26 typists as subjects. The comparison was made with a standard keyboard. The results were interpreted using the findings of an earlier field study with another split keyboard with a fixed angle between the halves of the device. Both split keyboards improved postural comfort; however, the period of familiarization was much longer with the fixed-angle split keyboard. Since the adjustable keyboard allows a change, in the angle from 0 to 30°, a person's posture can be adopted on a step-by-step basis. Thus, the new adjustable design has much better prospects of being accepted in practice than former attempts where the value was more academic than practical. The analysis of throughput and errors, under self-determined angles of the test object and with an angle comparable with those of fixed-angle split keyboards, reveals that users in work situations are not likely to accept fixed-angle split keyboards (30°) since throughput is substantially reduced during the long period of familiarization, accompanied by a substantial increase in errors. The results of this study confirm the assumption that new adjustable split keyboard design, once accepted by the users, may improve postural comfort, general comfort, and reduce fatigue. These effects could be demonstrated both in a short-term experiment and a long-term field study. The basic design feature of the adjustable keyboard, adjustability, is in agreement with the conclusions of recent studies on the introduction of ergonomically designed keyboards.

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