Publications

2015
Hight AE Darrow Remenschneider Kozin ED Lee DJ KA Saxena RC, Lehmann AE. 2/2015. “Social media utilization in the cochlear implant community.” J Am Acad Audiol, 26, 2, Pp. 197-204. Publisher's VersionAbstract

BACKGROUND:

More than 200,000 individuals worldwide have received a cochlear implant (CI). Social media Websites may provide a paramedical community for those who possess or are interested in a CI. The utilization patterns of social media by the CI community, however, have not been thoroughly investigated.

PURPOSE:

The purpose of this study was to investigate participation of the CI community in social media Websites.

RESEARCH DESIGN:

We conducted a systematic survey of online CI-related social media sources. Using standard search engines, the search terms cochlear implant, auditory implant, forum, and blog identified relevant social media platforms and Websites. Social media participation was quantified by indices of membership and posts.

STUDY SAMPLE:

Social media sources included Facebook, Twitter, YouTube, blogs, and online forums. Each source was assigned one of six functional categories based on its description.

INTERVENTION:

No intervention was performed.

DATA COLLECTION AND ANALYSIS:

We conducted all online searches in February 2014. Total counts of each CI-related social media source were summed, and descriptive statistics were calculated.

RESULTS:

More than 350 sources were identified, including 60 Facebook groups, 36 Facebook pages, 48 Twitter accounts, 121 YouTube videos, 13 forums, and 95 blogs. The most active online communities were Twitter accounts, which totaled 35,577 members, and Facebook groups, which totaled 17,971 members. CI users participated in Facebook groups primarily for general information/support (68%). Online forums were the next most active online communities by membership. The largest forum contained approximately 9,500 topics with roughly 127,000 posts. CI users primarily shared personal stories through blogs (92%), Twitter (71%), and YouTube (62%).

CONCLUSIONS:

The CI community engages in the use of a wide range of online social media sources. The CI community uses social media for support, advocacy, rehabilitation information, research endeavors, and sharing of personal experiences. Future studies are needed to investigate how social media Websites may be harnessed to improve patient-provider relationships and potentially used to augment patient education.

American Academy of Audiology.

Elliott D Kozin, Rosh KV Sethi, Ashton Lehmann, Aaron K Remenschneider, Justin S Golub, Samuel A Reyes, Kevin S Emerick, Daniel J Lee, and Stacey T Gray. 2015. “Analysis of an online match discussion board: improving the otolaryngology-head and neck surgery match.” Otolaryngol Head Neck Surg, 152, 3, Pp. 458-64.Abstract
OBJECTIVE: "The Match" has become the accepted selection process for graduate medical education. Otomatch.com has provided an online forum for Otolaryngology-Head and Neck Surgery (OHNS) Match-related questions for over a decade. Herein, we aim to delineate the type of posts on Otomatch to better understand the perspective of medical students applying for OHNS residency. STUDY DESIGN: Retrospective review of an OHNS Match-related online forum. SUBJECTS AND METHODS: Subjects were contributors to an OHNS Match-related online forum. Posts on Otomatch between December 2001 and April 2014 were reviewed. The title of each thread and number of views were recorded for quantitative analysis. Each thread was organized into 1 of 6 major categories and 1 of 18 subcategories. National Resident Matching Program (NRMP) data were utilized for comparison. RESULTS: We identified 1921 threads corresponding to over 2 million page views. Over 40% of threads were related to questions about specific programs, and 27% were discussions about interviews. Views, a surrogate measure for popularity, reflected different trends. The majority of individuals viewed posts on interviews (42%), program-specific questions (20%), and how to rank programs (11%). There was an increase in viewership tracked with a rise in applicant numbers based on NRMP data. CONCLUSION: Our study provides an in-depth analysis of a popular discussion forum for medical students interested in the OHNS Match process. The most viewed posts are about interview dates and questions regarding specific programs. We provide suggestions to address unmet needs for medical students and potentially improve the Match process.
Elliott D Kozin, Keith N Darrow, Ariel E Hight, Ashton E Lehmann, Alyson B Kaplan, Christian M Brown, and Daniel J Lee. 2015. “Direct visualization of the murine dorsal cochlear nucleus for optogenetic stimulation of the auditory pathway.” J Vis Exp, 95, Pp. 52426.Abstract
Investigation into the use of virus-mediated gene transfer to arrest or reverse hearing loss has largely been relegated to the peripheral auditory system. Few studies have examined gene transfer to the central auditory system. The dorsal cochlear nucleus (DCN) of the brainstem, which contains second order neurons of the auditory pathway, is a potential site for gene transfer. In this protocol, a technique for direct and maximal exposure of the murine DCN via a posterior fossa approach is demonstrated. This approach allows for either acute or survival surgery. Following direct visualization of the DCN, a host of experiments are possible, including injection of opsins into the cochlear nucleus and subsequent stimulation by an optical fiber coupled to a blue light laser. Other neurophysiology experiments, such as electrical stimulation and neural injector tracings are also feasible. The level of visualization and the duration of stimulation achievable make this approach applicable to a wide range of experiments.
Kyle J Chambers, Ashton E Lehmann, Aaron Remenschneider, Matthew Dedmon, Josh Meier, Stacey T Gray, and Derrick T Lin. 2015. “Incidence and survival patterns of sinonasal undifferentiated carcinoma in the United States.” J Neurol Surg B Skull Base, 76, 2, Pp. 94-100.Abstract
Objective To determine trends in sinonasal undifferentiated carcinoma (SNUC) survival patterns in the United States. Design Retrospective review of national database. Participants All cases of SNUC in the National Cancer Institute's Surveillance Epidemiology and End Results program from 1973 to 2010 were examined. Main Outcome Measures Age-adjusted incidence and survival rates were calculated and stratified by demographic information and treatment modality. Cohort analysis was performed to analyze survival patterns over time. Results A total of 318 SNUC cases were identified. Age-adjusted incidence rate (IR) was 0.02 per 100,000. Incidence was greater in males (IR: 0.03) than females (IR: 0.01; p = 0.03). Overall 5- and 10-year relative survival rate was 34.9% and 31.3%, respectively. Overall median survival was 22.1 months. Median survival following surgery combined with radiation was 41.9 months. Five-year relative survival rate following surgery, radiation, or surgery combined with radiation was 38.7%, 36.0%, and 39.1%, respectively. Median survival from 1973-1986 and 1987-2010 was 14.5 and 23.5 months, respectively. Conclusions This study provides new data regarding survival patterns of SNUC in the United States, confirming survival benefit with surgery and radiation as well as identifying a trend toward improved survival in recent decades.
Rajeev C Saxena, Ashton E Lehmann, Ed A Hight, Keith Darrow, Aaron Remenschneider, Elliott D Kozin, and Daniel J Lee. 2015. “Social media utilization in the cochlear implant community.” J Am Acad Audiol, 26, 2, Pp. 197-204.Abstract
BACKGROUND: More than 200,000 individuals worldwide have received a cochlear implant (CI). Social media Websites may provide a paramedical community for those who possess or are interested in a CI. The utilization patterns of social media by the CI community, however, have not been thoroughly investigated. PURPOSE: The purpose of this study was to investigate participation of the CI community in social media Websites. RESEARCH DESIGN: We conducted a systematic survey of online CI-related social media sources. Using standard search engines, the search terms cochlear implant, auditory implant, forum, and blog identified relevant social media platforms and Websites. Social media participation was quantified by indices of membership and posts. STUDY SAMPLE: Social media sources included Facebook, Twitter, YouTube, blogs, and online forums. Each source was assigned one of six functional categories based on its description. INTERVENTION: No intervention was performed. DATA COLLECTION AND ANALYSIS: We conducted all online searches in February 2014. Total counts of each CI-related social media source were summed, and descriptive statistics were calculated. RESULTS: More than 350 sources were identified, including 60 Facebook groups, 36 Facebook pages, 48 Twitter accounts, 121 YouTube videos, 13 forums, and 95 blogs. The most active online communities were Twitter accounts, which totaled 35,577 members, and Facebook groups, which totaled 17,971 members. CI users participated in Facebook groups primarily for general information/support (68%). Online forums were the next most active online communities by membership. The largest forum contained approximately 9,500 topics with roughly 127,000 posts. CI users primarily shared personal stories through blogs (92%), Twitter (71%), and YouTube (62%). CONCLUSIONS: The CI community engages in the use of a wide range of online social media sources. The CI community uses social media for support, advocacy, rehabilitation information, research endeavors, and sharing of personal experiences. Future studies are needed to investigate how social media Websites may be harnessed to improve patient-provider relationships and potentially used to augment patient education.
Ariel Edward Hight, Elliott D Kozin, Keith Darrow, Ashton Lehmann, Edward Boyden, Christian M Brown, and Daniel J Lee. 2015. “Superior temporal resolution of Chronos versus channelrhodopsin-2 in an optogenetic model of the auditory brainstem implant.” Hear Res, 322, Pp. 235-41.Abstract
Contemporary auditory brainstem implant (ABI) performance is limited by reliance on electrical neurostimulation with its accompanying channel cross talk and current spread to non-auditory neurons. A new generation ABI based on optogenetic technology may ameliorate limitations fundamental to electrical stimulation. The most widely studied opsin is channelrhodopsin-2 (ChR2); however, its relatively slow kinetic properties may prevent the encoding of auditory information at high stimulation rates. In the present study, we compare the temporal resolution of light-evoked responses of ChR2 to a recently developed fast opsin, Chronos, to ChR2 in a murine ABI model. Viral mediated gene transfer via a posterolateral craniotomy was used to express Chronos or ChR2 in the cochlear nucleus (CN). Following a four to eight week incubation period, blue light (473 nm) was delivered via an optical fiber placed directly on the surface of the infected CN, and neural activity was recorded in the contralateral inferior colliculus (IC). Both ChR2 and Chronos evoked sustained responses to all stimuli, even at high pulse rates. In addition, optical stimulation evoked excitatory responses throughout the tonotopic axis of the IC. Synchrony of the light-evoked response to stimulus rates of 14-448 pulses/s was higher in Chronos compared to ChR2 mice (p < 0.05 at 56, 168, and 224 pulses/s). Our results demonstrate that Chronos has the ability to drive the auditory system at higher stimulation rates than ChR2 and may be a more ideal opsin for manipulation of auditory pathways in future optogenetic-based neuroprostheses. This article is part of a Special Issue entitled "Lasker Award".
Elliott D Kozin, Shawn Gulati, Alyson B Kaplan, Ashton E Lehmann, Aaron K Remenschneider, Lukas D Landegger, Michael S Cohen, and Daniel J Lee. 2015. “Systematic review of outcomes following observational and operative endoscopic middle ear surgery.” Laryngoscope, 125, 5, Pp. 1205-14.Abstract
OBJECTIVES: Middle ear surgery increasingly employs endoscopes as an adjunct to or replacement for the operative microscope. We provide a systematic review of endoscope applications in middle ear surgery with an emphasis on outcomes, including the need for conversion to microscope, audiometric findings, length of follow-up, as well as disease-specific outcomes. DATA SOURCES: PubMed, Embase, and Cochrane CENTRAL database. METHODS: A literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations. Articles were categorized based on study design, indication, and use of an endoscope either as an adjunct to or as a replacement for a microscope. Qualitative and descriptive analyses of studies and outcomes data were performed. RESULTS: One-hundred three articles met inclusion and exclusion criteria. Of the identified articles, 38 provided outcomes data. The majority of these studies were moderate quality, retrospective, case-series reports. The indications for use of the endoscope were broad, with the most common being resection of cholesteatoma. In cholesteatoma surgery, endoscope approaches routinely identified residual cholesteatoma in primary and second-look cases. Other outcomes, including robust audiometric data, operating room times, wound healing, and quality of life surveys were not well described. CONCLUSIONS: Endoscopes have consistently been used as an adjunct to the microscope to improve visualization of the tympanic cavity. Recent reports utilize the endoscope exclusively during surgical dissection; however, data comparing patient outcomes following the use of an endoscope to a microscope are lacking. Areas in need of additional research are highlighted. LEVEL OF EVIDENCE: NA
2014
Elliott D Kozin, Ashton Lehmann, Margaret Carter, Ed Hight, Michael Cohen, Hideko H Nakajima, and Daniel J Lee. 2014. “Thermal effects of endoscopy in a human temporal bone model: implications for endoscopic ear surgery.” Laryngoscope, 124, 8, Pp. E332-9.Abstract
OBJECTIVES/HYPOTHESIS: Although the theoretical risk of elevated temperatures during endoscopic ear surgery has been reported previously, neither temperature change nor heat distribution associated with the endoscope has been quantified. In this study, we measure temperature changes during rigid middle ear endoscopy in a human temporal bone model and investigate whether suction can act as a significant cooling mechanism. STUDY DESIGN: Human temporal bone model of endoscopic middle ear surgery. METHODS: Fresh human temporal bones were maintained at body temperature (∼ 36°C). Temperature fluctuations were measured as a function of 1) distance between the tip of a 3-mm 0° Hopkins rod and round window membrane, and 2) intensity of the light source. Infrared imaging determined the thermal gradient. For suction, a 20-Fr suction catheter was utilized. RESULTS: We found: 1) an endoscope maximally powered by a xenon or light-emitting diode light source resulted in a rapid temperature elevation up to 46°C within 0.5 to 1 mm from the tip of the endoscope within 30 to 124 seconds, 2) elevated temperatures occurred up to 8 mm from the endoscope tip; and 3) temperature decreased rapidly within 20 to 88 seconds of turning off the light source or applying suction. CONCLUSIONS: Our findings have direct implications for avoiding excessive temperature elevation in endoscopic ear surgery. We recommend: 1) using submaximal light intensity, 2) frequent repositioning of the endoscope, and 3) removing the endoscope to allow tissue cooling. Use of suction provides rapid cooling of the middle ear space and may be incorporated in the design of new instrumentation for prolonged dissection.
2011
Georgieff MK Rao Tran PV R Lehmann AE, Ennis K. 8/2011. “Evidence for ahyporesponsive limbic-hypothalamic-pituitary-adrenal axis following early-liferepetitive hypoglycemia in adult male rats.” Am J Physiol Regul Integr Comp Physiol, 301, 2, Pp. R484-90. Publisher's VersionAbstract

The developing limbic-hypothalamic-pituitary-adrenal (LHPA) axis is highly vulnerable to programming by early-life environmental factors, including exposure to synthetic glucocorticoids and nutrient deficiencies. Early-life repetitive hypoglycemia (RHG) is a common complication of insulin therapy for type-1 diabetes that may have long-term consequences in adulthood. Recent observations in a rat model of early RHG suggest persistent changes in LHPA axis function, including changes in relevant hormones and affective behaviors, which support a hyperresponsive LHPA axis. Thus, we hypothesized that early RHG would alter the expression of key genes regulating LHPA axis function in adulthood. The present study employed a rat model of insulin-induced RHG spanning postnatal days (P)24-28, a neurodevelopmental equivalent of early childhood in humans, to assess the long-term effects on mRNA levels for proteins relevant to the LHPA function and the corticosterone responses to ACTH stimulation of dispersed adrenocortical cells in vitro and restraint stress in vivo at adulthood. This early RHG model resulted in a hyporesponsive LHPA axis characterized by impaired corticosterone response, increased hippocampal glucocorticoid and mineralocorticoid receptor (GR and MR), decreased hypothalamic corticotropin-releasing hormone, increased adrenal steroidogenic-acute-regulatory protein and GR, and decreased adrenal MR, melanocortin-type-2 receptor and low-density lipoprotein receptor expression. Our findings highlight a complex environmental-gene interaction between RHG and LHPA axis during development that influences regulation of this axis in adulthood. The findings are consistent with the developmental origins of disease and underscore the influences of early-life events on the programming of a major regulatory system.

2008
Kroupina MG Petryk Miller BS Iverson SL Johnson DE Georgieff MK A Fuglestad AJ, Lehmann AE. 8/2008. “Iron deficiency in international adoptees from Eastern Europe.” J Pediatr, 153, 2, Pp. 272-7. Publisher's VersionAbstract

OBJECTIVE:

To assess iron deficiency (ID) in international adoptees after adoption.

STUDY DESIGN:

Participants (n = 37) were adopted into the United States from Eastern Europe before they were 24 months of age. Baseline (within 1 month post-adoption) and follow-up (6 months post-adoption) assessments included routine post-adoption clinical evaluations, anthropometrics, dietary intakes, and iron measures (hemogram and serum analysis).

RESULTS:

At adoption and follow-up, mean percent transferrin saturation and mean corpucuscular volume were low compared with the US population. Mean serum ferritin concentration became lower than the US population at follow-up, although the mean daily iron intake was more than the Recommended Dietary Allowance. Participants with Giardia lamblia at baseline had more compromised iron status at baseline and follow-up. Growth rate (change in z-score/months between assessments) was negatively correlated with change in serum ferritin concentrations between baseline and follow-up (r = -0.34; P < .05).

CONCLUSIONS:

International adoptees had compromised iron status, with ID more prevalent in participants with G lamblia, a parasite that may interfere with iron absorption. The persistent ID at follow-up was likely caused by the erythropoietic demands of catch-up growth.