Steven W. Cheung

Introduction Impaired laryngopharyngeal sensation has been implicated in obstructive sleep apnea (OSA) and may play an important pathophysiological role. We evaluated sensory function in OSA by examining the laryngeal adductor reflex (LAR) response rate and temporal profile to tactile stimulation. Methods Laryngeal sensation testing was performed in awake adults with and without diagnosed OSA by stimulating the medial aryepiglottic fold or arytenoid using 30‐mm 5–0 and 4–0 nylon Cheung‐Bearelly monofilaments. Video analysis by two independent reviewers evaluated for the presence of the LAR in response to satisfactory stimuli and LAR latency to vocal fold adduction. Results Twenty‐six OSA and 12 control subjects were tested with 270 satisfactory stimuli. The mean full LAR response rate to 4–0 stimulation was 38.3% in OSA vs 86.9% in control subjects ( p <0.001) and to 5–0 stimulation was 27% in OSA vs 63.9% in control subjects ( p <0.001). The mean LAR latency to vocal fold closure in OSA was 123.7 ms (SD 35.8) vs 156.4 ms (SD 44.3) in control ( p = 0.04) subjects. OSA LAR latency was positively correlated with the apnea‐hypopnea index ( r = 0.30; p = 0.008). Conclusion The OSA group exhibited reduced LAR response rates and shortened LAR latency, where latency was correlated with disease severity. Laryngeal hyposensitivity was affirmed and changes to LAR sensorimotor temporal dynamics were revealed. These pathophysiological alterations to the LAR may be accounted for by decreased somatosensory receptor sensitivity, increased sympathetic tone, and reorganized brain stem function in OSA. Level of Evidence 3 Laryngoscope , 2024

Background/Objective To compare functional hearing and tinnitus outcomes in treated large (~ 3 cm) vestibular schwannoma (VS) and posterior fossa meningioma cohorts, and construct willingness‐to‐accept profiles for an experimental brain implant to treat unilateral hearing loss. Methods A two‐way MANOVA model with two independent variables (tumor type; time from treatment) and three dependent variables (hearing effort of tumor ear; abbreviated Speech, Spatial, and Qualities of Hearing scale (SSQ12); Tinnitus Functional Index (TFI)) was used to analyze data from VS ( N = 32) and meningioma ( N = 50) patients who were treated at a tertiary care center between 2010 and 2020. A query to probe acceptance of experimental treatment for hearing loss relative to expected benefit was used to construct willingness‐to‐accept profiles. Results Tumor type was statistically significant on the combined dependent variables analysis ( F [3, 76] = 19.172, p < .0005, Wilks' Λ = 0.569). Meningioma showed better outcome for hearing effort ( F [1, 76] = 14.632, p < .0005) and SSQ12 ( F [1, 76] = 16.164, p < .0005), but not for TFI ( F [1, 76] = 1.247, p = .268) on univariate two‐way ANOVA analyses. Superior hearing effort and SSQ12 indices in the short‐term (< 2 years) persisted in the long‐term (> 2 years) ( p ≤ .017). At the 60% speech understanding level, 77% of respondents would accept an experimental brain implant. Conclusion Hearing outcome is better for posterior fossa meningioma compared to VS. Most patients with hearing loss in the tumor ear would consider a brain implant if the benefit level would be comparable to a cochlear implant. Level of Evidence 2