Assessing nitrate groundwater hotspots in Europe reveals an inadequate designation of Nitrate Vulnerable Zones

Monitoring networks show that the European Union Nitrates Directive (ND) has had mixed success in reducing nitrate concentrations in groundwater. By combining machine learning and monitored nitrate concentrations (1992-2019), we estimate the total area of nitrate hotspots in Europe to be 401,000 km2, with 47% occurring outside of Nitrate Vulnerable Zones (NVZs). We also found contrasting increasing or decreasing trends, varying per country and time periods. We estimate that only 5% of the 122,000 km2 of hotspots in 2019 will meet nitrate quality standards by 2040 and that these may be offset by the appearance of new hotspots. Our results reveal that the effectiveness of the ND is limited by both time-lags between the implementation of good practices and pollution reduction and an inadequate designation of NVZs. Substantial improvements in the designation and regulation of NVZs are necessary, as well as in the quality of monitoring stations in terms of spatial density and information available concerning sampling depth, if the objectives of EU legislation to protect groundwater are to be achieved.

Holistic assessment of cochlear implant outcomes using the international classification of functioning disability and health model: data analysis of a longitudinal prospective multicenter study

PURPOSE

To study outcome after cochlear implantation using the Cochlear Implant (CI) outcome assessment protocol based on the International Classification of Functioning, Disability and Health (ICF) model (CI-ICF).

METHODS

Raw data of a prospective, longitudinal, multicenter study was analyzed. Seventy-two CI candidates were assessed preoperatively and six months postoperatively using the CI-ICF protocol. Following tools were used: (1) Work Rehabilitation Questionnaire (WORQ), (2) Abbreviated Profile of Hearing Aid Benefit (APHAB), (3) Audio Processor Satisfaction Questionnaire (APSQ), (4) Speech, Spatial, and Qualities of Hearing Scale (SSQ12), (5) Hearing Implant Sound Quality Index (HISQUI19), (6) Nijmegen CI Questionnaire (NCIQ) (7) pure tone audiometry, (8) speech audiometry, (9) sound localization.

RESULTS

There was a significant improvement of speech discrimination in quiet (p = 0.015; p < 0.001) and in noise (p = 0.041; p < 0.001), sound detection (p < 0.001), tinnitus (p = 0.026), listening (p < 0.001), communicating with-receiving-spoken messages (p < 0.001), conversation (p < 0.001), family relationships (p < 0.001), community life (p = 0.019), NCIQ total score and all subdomain scores (p < 0.001). Subjective sound localization significantly improved (p < 0.001), while psychometric sound localization did not. There was no significant subjective deterioration of vestibular functioning and no substantial change in sound aversiveness. CI users reported a high level of implant satisfaction postoperatively.

CONCLUSION

This study highlights the positive impact of cochlear implantation on auditory performance, communication, and subjective well-being. The CI-ICF protocol provides a holistic and comprehensive view of the evolution of CI outcomes.

Chronic otorrhea and osteomyelitis of the external auditory canal by Achromobacter xylosoxidans: an uncommon diagnosis

PURPOSE

Achromobacter xylosoxidans is an emerging pathogen mainly associated with resistant nosocomial infections. This bacteria had been isolated in the ear together with other pathogens in cultures from patients with chronic otitis media, but it had never been reported as a cause of osteomyelitis of the external auditory canal.

CASE PRESENTATION

We present a unique case of a healthy 81-year-old woman who presented with left chronic otorrhea refractory to topical and oral antibiotic treatment. Otomicroscopy revealed an erythematous and exudative external auditory canal (EAC) with scant otorrhea. The tympanic membrane was intact, but an area of bone remodeling with a small cavity anterior and inferior to the bony tympanic frame was observed. Otic culture isolated multi-drug-resistant A. xylosoxidans, only sensitive to meropenem and cotrimoxazole. Temporal bone computed tomography showed an excavation of the floor of the EAC compatible with osteomyelitis. Targeted antibiotherapy for 12 weeks was conducted, with subsequent resolution of symptoms and no progression of the bone erosion.

CONCLUSIONS

Atypical pathogens such as A. xylosoxidans can be the cause of chronic otitis externa. Early diagnosis and specific antibiotherapy can prevent the development of further complications, such as osteomyelitis. In these cases, otic cultures play an essential role to identify the causal germ. This is the first case of EAC osteomyelitis due to A. xylosoxidans reported to date.

Intraoperative assessment of cochlear nerve functionality in various vestibular schwannoma scenarios: Lessons learned

The use of cochlear implants (CIs) is on the rise for patients with vestibular schwannoma (VS). Besides CI following tumor resection, new scenarios such as implantation in observed and/or irradiated tumors are becoming increasingly common. A significant emerging trend is the need of intraoperative evaluation of the functionality of the cochlear nerve in order to decide if a CI would be placed. The purpose of this paper is to explore the experience of a tertiary center with the application of the Auditory Nerve Test System (ANTS) in various scenarios regarding VS patients. The results are compared to that of the studies that have previously used the ANTS in this condition. Patients with unilateral or bilateral VS (NF2) who were evaluated with the ANTS prior to considering CI in a tertiary center between 2021 and 2023 were analyzed. The presence of a robust wave V was chosen to define a positive electrical auditory brainstem response (EABR). Two patients underwent promontory stimulation (PromStim) EABR previous to ANTS evaluation. Seven patients, 2 NF-2 and 5 with sporadic VS were included. The initial scenario was simultaneous translabyrinthine (TL) tumor resection and CI in 3 cases while a CI placement without tumor resection was planned in 4 cases. The ANTS was positive in 4 cases, negative in 2 cases, and uncertain in one case. Two patients underwent simultaneous TL and CI, 1 patient simultaneous TL and auditory brainstem implant, 3 patients posterior tympanotomy with CI, and 1 patient had no implant placement. In the 5 patients undergoing CI, sound detection was present. There was a good correlation between the PromStim and ANTS EABR. The literature research yielded 35 patients with complete information about EABR response. There was one false negative and one false positive case; that is, the 28 implanted cases with a present wave V following tumor resection had some degree of auditory perception in all but one case. The ANTS is a useful intraoperative tool to asses CI candidacy in VS patients undergoing observation, irradiation or surgery. A positive strongly predicts at least sound detection with the CI.

Clinical practice guideline on the management of vestibular schwannoma

INTRODUCTION

Vestibular schwannoma (VS) is the most common tumour of the cerebellopontine angle. The greater accessibility to radiological tests has increased its diagnosis. Taking into account the characteristics of the tumour, the symptoms and the age of the patient, three therapeutic strategies have been proposed: observation, surgery or radiotherapy. Choosing the most appropriate for each patient is a frequent source of controversy.

MATERIAL AND METHODS

This paper includes an exhaustive literature review of issues related to VS that can serve as a clinical guide in the management of patients with these lesions. The presentation has been oriented in the form of questions that the clinician usually asks himself and the answers have been written and/or reviewed by a panel of national and international experts consulted by the Otology Commission of the SEORL-CCC.

RESULTS

A list has been compiled containing the 13 most controversial thematic blocks on the management of VS in the form of 50 questions, and answers to all of them have been sought through a systematic literature review (articles published on PubMed and Cochrane Library between 1992 and 2023 related to each thematic area). Thirty-three experts, led by the Otology Committee of SEORL-CCC, have analyzed and discussed all the answers. In Annex 1, 14 additional questions divided into 4 thematic areas can be found.

CONCLUSIONS

This clinical practice guideline on the management of VS offers agreed answers to the most common questions that are asked about this tumour. The absence of sufficient prospective studies means that the levels of evidence on the subject are generally medium or low. This fact increases the interest of this type of clinical practice guidelines prepared by experts.

Costs and benefits of synthetic nitrogen for global cereal production in 2015 and in 2050 under contrasting scenarios

Cereals are the most important global staple crop and use more than half of global cropland and synthetic nitrogen (N) fertilizer. While this synthetic N may feed half of the current global population, it has led to a massive increase in reactive N loss to the environment, causing a suite of impacts, offsetting the benefits of N fertilizers for food security and agricultural economy. To address these complex issues, the NBCalCer model was developed to quantify the global effects of N input on crop yields, N budgets and environmental impacts and to assess the associated social benefits and costs. Three Shared Socioeconomic Pathway scenarios (SSPs) were considered with decreasing N agri-environmental ambitions, through contrasting climate and N policy ambitions: sustainability (SSP1H), middle-of-the-road (SSP2M) and fossil-fueled development (SSP5L). In the base year the contribution of synthetic N fertilizer to global cereal production was 44 %. Global modelled grain yield was projected to increase under all scenarios while the use of synthetic N fertilizer decreases under all scenarios except SSP5L. The total N surplus was projected to be reduced up to 20 % under SSP1H but to increase under SSP5L. The Benefit-Cost-Ratio (BCR) was calculated as the ratio between the market benefit of increased grain production by synthetic N and the summed cost of fertilizer purchase and the external cost of the N losses. In base year the BCR was well above one in all regions, but in 2050 under SSP1H and SSP5L decreased to below one in most regions. Given the concerns about food security, environmental quality and its interaction with biodiversity loss, human health and climate change, the new paradigm for global cereal production is producing sufficient food with minimum N pollution. Our results indicate that achieving this goal would require a massive change in global volume and distribution of synthetic N.

Validation of the Spanish version of the Electronic Facial Palsy Assessment (eFACE)

PURPOSE

The clinician-graded electronic facial paralysis assessment (eFACE) is a relatively new digital tool for assessing facial palsy. The present study aimed to determine the validity and reliability of the Spanish version of the eFACE.

METHODS

Forward-backward translation from the original English version was performed. Videos and photographs from 65 adult patients with unilateral facial paralysis (any severity, time course, and etiology) were evaluated twice by five otolaryngologists with varying levels of experience in facial palsy evaluation. Internal consistency was measured using Cronbach's α and the intra- and inter-rater reliability were measured using intraclass correlation coefficient. Concurrent validity was established by calculating Spearman's rho correlation (ρ) between the eFACE and the House-Brackmann scale (H-B) and Pearson's correlation (r) between the eFACE and the Sunnybrook Facial Grading System (SFGS).

RESULTS

The Spanish version of the eFACE showed good internal consistency (Cronbach's α > 0.8). The intra-rater reliability was nearly perfect for the total score (intraclass correlation coefficient: 0.95-0.99), static score (0.92-0.96), and dynamic score (0.96-0.99) and important-to-excellent for synkinesis score (0.79-0.96). The inter-rater reliability was excellent for the total score (0.85-0.93), static score (0.80-0.90), and dynamic score (0.90-0.95) and moderate-to-important for the synkinesis score (0.55-0.78). The eFACE had a very strong correlation with the H-B (ρ =  - 0.88 and  - 0.85 for each evaluation, p < 0.001) and the SFGS (r = 0.92 and 0.91 each evaluation, p < 0.001).

CONCLUSION

The Spanish version of the eFACE is a reliable and valid instrument for assessment of facial function in the diagnosis and treatment of patients with facial paralysis.

Inverted clip technique for cochlear implant electrode array fixation: how I do it

BACKGROUND

Electrode migration has been identified as a complication primarily related to straight electrodes. To address this issue, the use of a fixation clip has been suggested as an alternative to stabilize the electrode lead and reduce the risk of migration.

METHODS

A modified approach to the standard fixation clip procedure is introduced. Steps and technical considerations are presented in the video attached.

CONCLUSIONS

This novel configuration offers enhanced fixation of the electrode array without requiring additional surgical time and without posing any additional risk to the facial nerve.

Meludia platform as a tool to evaluate music perception in pediatric and adult cochlear implant users

PURPOSE

Music perception is one of the greatest challenges for cochlear implant (CI) users. The aims of this study were: (i) to evaluate the music perception of CI users using the online Meludia music training program as music testing platform, (ii) to compare performance among three age groups, and (iii) to compare CI users with their normal hearing (NH) peers.

METHODS

138 individuals participated, divided between children (6-10 y), adolescents (11-16 y), and adults (≥ 17 y). Five music perception tasks were evaluated: Rhythm, Spatialization, Stable/unstable, Melody, and Density. We also administered the music related quality of life (MuRQoL) questionnaire for adults, and a music questionnaire for pediatric population (6-16 y) (MuQPP).

RESULTS

A significantly higher percentage of the adolescent CI users completed the five tasks compared to the other age groups. Both pediatric and adolescent CI users had similar performance to their NH peers in most categories. On the MuRQoL, adult NH listeners reported more music exposure than CI users (3.8 ± 0.6 vs 3.0 ± 0.6, p < 0.01), but both groups reported similar levels of perceived music importance (3.4 ± 0.7 vs 3.2 ± 1.1, p = 0.340). On the MuQPP, pediatric CI users who scored highly on music perception also had higher reported questionnaire scores (54.2 ± 12.9 vs 40.9 ± 12.1, p = 0.009).

CONCLUSIONS

Meludia can be used to evaluate music perception and to use for music training in CI users of all ages. Adolescents had the highest performance in most musical tasks. Pediatric CI users were more similar to their NH peers. The importance of music in adult CI users was comparable to their NH peers.

Objective and Subjective Assessment of Music Perception and Musical Experiences in Young Cochlear Implant Users

For many individuals, music has a significant impact on the quality and enjoyability of life. Cochlear implant (CI) users must cope with the constraints that the CI imposes on music perception. Here, we assessed the musical experiences of young CI users and age-matched controls with normal hearing (NH). CI users and NH peers were divided into subgroups according to age: children and adolescents. Participants were tested on their ability to recognize vocal and instrumental music and instruments. A music questionnaire for pediatric populations (MuQPP) was also used. CI users and NH peers identified a similar percentage of vocal music. CI users were significantly worse at recognizing instruments (p < 0.05) and instrumental music (p < 0.05). CI users scored similarly to NH peers on the MuQPP, except for the musical frequency domain, where CI users in the children subgroup scored higher than their NH peers (p = 0.009). For CI users in the children subgroup, the identification of instrumental music was positively correlated with music importance (p = 0.029). Young CI users have significant deficits in some aspects of music perception (instrumental music and instrument identification) but have similar scores to NH peers in terms of interest in music, frequency of music exposure, and importance of music.

Beyond the Farm to Fork Strategy: Methodology for designing a European agro-ecological future

The publication of the European Commission's Farm to Fork Strategy has sparked a heated debate between those who advocate the intensification of agriculture in the name of food security and those who recommend its de-intensification for environmental reasons. The design of quantified scenarios is a key approach to objectively evaluate the arguments of the two sides. To this end, we used the accounting methodology GRAFS (Generalized Representation of Agri-Food Systems) to describe the agri-food system of Europe divided into 127 geographical units of similar agricultural area, in terms of nitrogen (N) fluxes across cropland, grassland, livestock, and human consumption. This analysis reveals, in current European agriculture, a high level of territorial specialization, a strong dependence on long distance trade, and environmental N losses amounting to about 14 TgN/yr, i.e. nearly 70 % of the annual N input (including N synthetic fertilizers, symbiotic N fixation, oxidized N deposition and import of food and feed). Based on the analysis of the yield-fertilization relationship of cropping systems at the scale of their full rotation cycle, and on a simplified model of livestock ingestion, excretion and production, we advanced the GRAFS methodology for prospective scenario design. Three scenarios for the European agri-food system were explored for 2050: a business-as-usual (BAU) scenario, a scenario based on the measures considered by the EU Farm to Fork Strategy (F2F), and a fully agro-ecological scenario (AE). The results show that the F2F scenario reduces the dependence of Europe on imports of synthetic fertilizers and feed resources by 40 % as well as the environmental N losses by 30 %, but not to the level of its claimed ambitions as N lost to the environment still amounts to about 10 TgN/yr, i.e. 67 % of N inputs. Of the three scenarios studied, only in the AE scenario, involving the relocation of feed production, the generalization of organic crop rotations with N fixing legume crops, and a shift of agricultural production and food consumption toward less animal-based products, would Europe be able to dispense with N imports, still being able to export some cereals, meat, and milk products to the rest of the world, while halving today's reactive N emissions to the environment.

Drivers of ammonia volatilization in Mediterranean climate cropping systems

Ammonia (NH3) volatilization is the major source of nitrogen (N) loss resulting from the application of synthetic and organic N fertilizers to croplands. It is well known that in Mediterranean cropping systems, there is a relationship between the intrinsic characteristics of the climate and nitrous oxide (N2O) emissions, but whether the same relation exists for NH3 emissions remains uncertain. Here, we estimated the impact of edaphoclimatic conditions (including meteorological conditions after N fertilization), crop management factors, and the measurement technique on both the cumulative emissions and the NH3 emission factor (EF) in Mediterranean climate zones, drawing on a database of 234 field treatments. We used a machine learning method, random forest (RF), to predict volatilization and ranked variables based on their importance in the prediction. Random forest had a good predictive power for the NH3 EF and cumulative emissions, with an R2 of 0.69 and 0.76, respectively. Nitrogen fertilization rate (N rate) was the top-ranked predictor variable, increasing NH3 emissions substantially when N rate was higher than 170 kg N ha-1. Soil pH was the most important edaphoclimatic variable, showing greater emissions (36.7 kg NH3 ha-1, EF = 19.3%) when pH was above 8.2. Crop type, fertilizer type, and N application method also affected NH3 emission patterns, while water management, mean precipitation, and soil texture were ranked low by the model. Our results show that intrinsic Mediterranean characteristics had only an indirect effect on NH3 emissions. For instance, relatively low N fertilization rates result in small NH3 emissions in rainfed areas, which occupy a very significant surface of Mediterranean agricultural land. Overall, N fertilization management is a key driver in reducing NH3 emissions, but additional field factors should be studied in future research to establish more robust abatement strategies.

Has Coranavirus Disease 2019 Changed the Incidence and Outcome of Bell's Palsy?

BACKGROUND

Objectives: (1) To determine whether the incidence of Bell's Palsy (BP) increased during the pandemic. (2) To investigate whether the outcomes of patients with BP and COVID-19 infection or vaccination differ from those in the pre-pandemic era.

METHODS

Patients with BP were studied in 2 periods retrospectively (March 2021-March 2022 and August 2018-August 2019). A prospective study from March 2021 to March 2022 was also performed. Primary outcome was grade ≤Ⅱ in the House-Brackmann (HB) and/or >70 in the Sunnybrook facial grading system (SFGS) scales at the 12-week visit. Reverse transcriptase polymerase chain reaction (PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and enzyme-linked immunosorbent assay-based SARS-CoV-2 immuonoglobulin G (IgG) test (blood) were measured.

RESULTS

About 162 and 196 patients with BP were identified between March 2021 and March 2022 and August 2018 and August 2019, respectively. Forty-seven patients (29%) entered the prospective study; 85% had HB grades I or II, while 92% had an SFGS score of 71-100 at the last visit. Only 3 patients (6.5%) had a positive PCR during the initial episode, whereas 35 patients (77%) had positive IgG SARS-CoV-2. There was no association between positive PCR and facial function outcomes. Of the 162 patients, 105 (67%) had received COVID-19 vaccine. In 23 of them (22%), the paralysis appeared within the first 30 days after a vaccine dose.

CONCLUSION

Coronavirus disease 2019 did not increase the incidence of BP. A direct association between the coronavirus and BP outcome cannot be established. The considerable number of patients developing BP within the first month suggests a possible association between COVID-19 vaccines and BP.

Variations in the treatment of acute peripheral facial paralysis. A nationwide survey

BACKGROUND

Acute peripheral facial paralysis may be diagnosed and treated by different specialists.

OBJECTIVE

The aim of this study was to explore the variability in the treatment of Bell's palsy (BP) and Ramsay Hunt Syndrome (RHS) among different medical specialties.

METHODS

An anonymous nationwide online survey was distributed among the Spanish Societies of Otorhinolaryngology (ORL), Neurology (NRL) and Family and Community Medicine (GP).

RESULTS

1039 responses were obtained. 98% agreed on using corticosteroids, ORL using higher doses than NRL and GP. Among all, only 13% prescribed antivirals in BP routinely, while 31% prescribed them occasionally. The percentage of specialists not using antivirals for RHS was 5% of ORL, 11% of NRL, and 23% of GP (GP vs. NRL p = 0.001; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0,002). 99% recommended eye care. Exercises as chewing gum or blowing balloons were prescribed by 45% of the participants with statistically significant differences among the three specialties (GP vs. NRL p = 0.021; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0.002).

CONCLUSION

There is general agreement in the use of corticosteroids and recommending eye care as part of the treatment of acute peripheral facial paralysis. Yet, there are discrepancies in corticosteroids dosage, use of antivirals and recommendation of facial exercises among specialties.

Rationale for the Development of a Novel Clinical Grading Scale for Postoperative Facial Nerve Function: Results of a Multidisciplinary International Working Group

OBJECTIVE

The objective of the current study was to present the results of an international working group survey identifying perceived limitations of existing facial nerve grading scales to inform the development of a novel grading scale for assessing early postoperative facial paralysis that incorporates regional scoring and is anchored in recovery prognosis and risk of associated complications.

STUDY DESIGN

Survey.

SETTING

A working group of 48 multidisciplinary clinicians with expertise in skull base, cerebellopontine angle, temporal bone, or parotid gland surgery.

RESULTS

House-Brackmann grade is the most widely used system to assess facial nerve function among working group members (81%), although more than half (54%) agreed that the system they currently use does not adequately estimate the risk of associated complications, such as corneal injury, and confidence in interrater and intrarater reliability is generally low. Simplicity was ranked as the most important attribute of a novel postoperative facial nerve grading system to increase the likelihood of adoption, followed by reliability and accuracy. There was widespread consensus (91%) that the eye is the most critical facial region to focus on in the early postoperative setting.

CONCLUSIONS

Members were invited to submit proposed grading systems in alignment with the objectives of the working group for subsequent validation. From these data, we plan to develop a simple, clinically anchored, and reproducible staging system with regional scoring for assessing early postoperative facial nerve function after surgery of the skull base, cerebellopontine angle, temporal bone, or parotid gland.

Is Age a Limiting Factor for Audiological Results in Active Middle Ear Implants?

Active middle ear implants (AMEI) are implantable options for patients with sensorineural, conductive, or mixed hearing loss who are not good candidates for hearing aids. The aim of this study was to compare audiological, surgical, quality of life, and sound quality outcomes in adults <60 and ≥60 years receiving an AMEI. Twenty adult patients who underwent AMEI implantation were divided into two groups, <60 and ≥60 y. Preoperative tests included pure-tone average and speech discrimination score (SDS) at 65 dB for disyllabic words in quiet. Postoperative measures included AMEI-aided bone conduction threshold, free-field warble-tone threshold, and SDS at 65 dB for disyllabic words in quiet 12 months after the AMEI fitting. Subjective benefit was evaluated using the Nijmegen Cochlear Implant Questionnaire (NCIQ), Glasgow Benefit Inventory (GBI), and Hearing Implant Sound Quality Index (HISQUI19). Mean functional gain was 32 and 30 dB, and SDS at 65 dB improved from 19 to 95% and from 31 to 84% in the <60 and ≥60 y groups, respectively. All NCIQ domains improved following surgery, and all patients had a positive overall GBI score. The mean HISQUI19 score was 97 in both age groups. AMEIs are an effective hearing restoration method for older adults suffering from conductive or mixed hearing loss.

Investing in mini-livestock production for food security and carbon neutrality in China

Future food farming technology faces challenges that must integrate the core goal of keeping the global temperature increase within 1.5 °C without reducing food security and nutrition. Here, we show that boosting the production of insects and earthworms based on food waste and livestock manure to provide food and feed in China will greatly contribute to meeting the country's food security and carbon neutrality pledges. By substituting domestic products with mini-livestock (defined as earthworms and insects produced for food or feed) protein and utilizing the recovered land for bioenergy production plus carbon capture and storage, China's agricultural sector could become carbon-neutral and reduce feed protein imports to near zero. This structural change may lead to reducing greenhouse gas emissions by 2,350 Tg CO2eq per year globally when both domestic and imported products are substituted. Overall, the success of mini-livestock protein production in achieving carbon neutrality and food security for China and its major trading partners depends on how the substitution strategies will be implemented and how the recovered agricultural land will be managed, e.g., free use for afforestation and bioenergy or by restricting this land to food crop use. Using China as an example, this study also demonstrates the potential of mini-livestock for decreasing the environmental burden of food production in general.

QoL, CIs, QALYs, and Individualized Rehabilitation: The Clinical and Practical Benefits of Regularly Assessing the Quality of Life of Adult Cochlear Implant Recipients

This study aimed to report quality of life (QoL) scores in unilateral cochlear implant (CI) users and to generate guidance for clinicians on using QoL measures to individualize CI counselling and rehabilitation and to increase access to CIs as a mode of rehabilitation. Participants (n = 101) were unilateral CI users with single-sided deafness (SSD; n = 17), asymmetrical hearing loss (AHL; n = 26), or bilateral hearing loss (Uni; n = 58). Generic QoL was assessed via the Health Utilities Index (HUI-3), and disease-specific QoL was assessed via the Speech, Spatial, and Qualities of Hearing scale (SSQ12) and Nijmegen CI Questionnaire (NCIQ) at preimplantation and at 6 and 12 months of CI use. All groups had significantly increased HUI-3 scores at both intervals. The SSD group showed significant benefit on the SSQ12 at visit 3, the AHL group showed significant benefit on the SSQ12 and most NCIQ subdomains at both intervals, and the Uni group showed significant benefit with both tests at both intervals. Unilateral CI recipients demonstrate improved QoL within the first 12 months of device use. Regular assessment with generic and disease-specific questionnaires has the potential to play an important role in personalizing treatment and possibly in increasing access to CI provision.

How much can changes in the agro-food system reduce agricultural nitrogen losses to the environment? Example of a temperate-Mediterranean gradient

Ammonia (NH₃) volatilization, nitrous oxide (N₂O) emissions, and nitrate (NO₃^-) leaching from agriculture cause severe environmental hazards. Research studies and mitigation strategies have mostly focused on one of these nitrogen (N) losses at a time, often without an integrated view of the agro-food system. Yet, at the regional scale, N₂O, NH₃, and NO₃^- loss patterns reflect the structure of the whole agro-food system. Here, we analyzed at the resolution of NUTS2 administrative European Union (EU) regions, N fluxes through the agro-food systems of a Temperate-Mediterranean gradient (France, Spain, and Portugal) experiencing contrasting climate and soil conditions. We assessed the atmospheric and hydrological N emissions from soils and livestock systems. Expressed per ha agricultural land, NH₃ volatilization varied in the range 6.2-44.4 kg N ha^-1 yr^-1, N₂O emission and NO₃ leaching 0.3-4.9 kg N ha^-1 yr^-1 and 5.4-154 kg N ha^-1 yr^-1 respectively. Overall, lowest N₂O emission was found in the Mediterranean regions, where NO₃^- leaching was greater. NH₃ volatilization in both temperate and Mediterranean regions roughly follows the distribution of livestock density. We showed that these losses are also closely correlated with the level of fertilization intensity and agriculture system specialization into either stockless crop farming or intensive livestock farming in each region. Moreover, we explored two possible future scenarios at the 2050 horizon: (1) a scenario based on the prescriptions of the EU-Farm-to-Fork (F2F) strategy, with 25% of organic farming, 10% of land set aside for biodiversity, 20% reduction in N fertilizers, and no diet change; and (2) a hypothetical agro-ecological (AE) scenario with generalized organic farming, reconnection of crop and livestock farming, and a healthier human diet with an increase in the share of vegetal protein to 65% (i.e., the Mediterranean diet). Results showed that the AE scenario, owing to its profound reconfiguration of the entire agro-food system would have the potential for much greater reductions in NH₃, N₂O, and NO₃^- emissions, namely, 60-81% reduction, while the F2F scenario would only reach 24-35% reduction of N losses.

Long-Term Non-Users of Transcutaneous Auditory Implants: Thirty Years of Experience at a Single Institution

Background: Although it is a recognized phenomenon, there is little published in the literature on the discontinuation of auditory implant use. Aim: To evaluate the incidence of device non-use of transcutaneous auditory implants. Patients and Methods: This is a retrospective study of all living individuals (children and adults) implanted at the La Paz Hospital (Madrid, Spain) between 1992-2015, with a follow-up examination endpoint of December 2022. 356 device recipients were included: 316 with cochlear implants (CI), 22 with middle-ear implants (Vibrant Soundbridge, VSB), and 18 with bone conduction implants (Bonebridge, BB). Results: Nine CI recipients (2.8%) were identified as non-users (mean follow-up 15.1 ± 5.4 years). The reasons for non-use were implant failure and reimplantation rejection, lack of benefit, non-attendance of rehabilitation sessions, loss of the audio processor, and cognitive and linguistic difficulties. None of them experienced any surgical complications. Six VSB recipients (27.3%) were device non-users (mean follow-up 11.4 ± 2.1 years). All of them experienced device failure or surgical complications. To date, none of the BB recipients is a non-user (mean follow-up 8.6 ± 1.1 years). Conclusion: The rates of non-use of transcutaneous auditory implants vary widely between different types of implants. Given the small proportion of non-users, information on what are the predictive factors could not be determined. The reasons for non-use should be carefully documented and used to guide careful patient selection to reduce the risk of non-use in future candidates.

Nesting nitrogen budgets through spatial and system scales in the Spanish agro-food system over 26 years

Along its route through the agro-food system nitrogen (N) can be wasted, heightening diverse environmental problems. Geopolitical instabilities affect prices of N fertilisers and livestock feed, challenging production systems and increasing their need to reduce N waste. The analysis of N flows is essential to understanding the agroenvironmental performance of agro-food systems to detect leakages and to design strategies for reducing N pollution while producing feed and food. Sectorial analyses can mislead conclusions, prompting the need for integrated approaches. We present a multiscale analysis of N flows for the 1990-2015 period to identify both the strengths and weaknesses of the Spanish agro-food system. We constructed N budgets at three system scales, namely crop, livestock and the agro-food system, and at two spatial scales: national and regional (50 provinces). The big picture shows a country with increasing crop (575 to 634 GgN/yr) and livestock (138 to 202 GgN/yr, edible) production and nitrogen use efficiency improvements (39 to 43 % for crops, 13 to 15 % for animals), especially for certain crop and livestock categories. Nevertheless, this falls short of reducing agricultural surpluses (812 GgN/yr) and external dependency, which is closely related to the externalisation of certain environmental impacts (system NUE, from 31 % to 19 % considering externalisation). The regional picture shows the contrasted operation between provinces, assigned to three agro-food system categories: fuelled by synthetic fertiliser (29 provinces), grassland inputs to livestock (5 provinces) or the net import of feed (16 provinces). Regional specialisation on crop or livestock production was reinforced, hampering good recirculation of N through livestock feed from regional cropland and their N fertilisation by regional livestock excretion. We conclude that pollution and external dependency need to be further reduced in Spain. To do so, the big picture of the full system is paramount but must be adapted to the regional particularities.

Nitrogen inputs by irrigation is a missing link in the agricultural nitrogen cycle and related policies in Europe

Irrigation, one of the 28 agri-environmental indicators defined in the European Common Agricultural Policy, is often neglected in agricultural nitrogen (N) budgets, while it can be a considerable source of N in irrigated agriculture. The annual N input from irrigation water sources (NIrrig) to cropping systems was quantified for Europe for 2000-2010 at a resolution of 10 × 10 km, accounting for crop-specific gross irrigation requirements (GIR) and surface- and groundwater nitrate concentration. GIR were computed for 20 crops, while spatially explicit nitrate concentration in groundwater was derived using a random forest model. We show that although GIR were relatively stable (46-60 km3 yr-1), the Nirrig in Europe increased over the 10-year period (184 to 259 Gg N yr-1), approximately 68 % of which occurred in the Mediterranean region. The main hotspots appeared in areas with both high irrigation requirements and high groundwater nitrate concentration, reaching up to averaged values of 150 kg N ha-1 yr1. These were mainly located in Mediterranean Europe (Greece, Portugal and Spain) and to a lesser extent in Northern Europe (The Netherlands, Sweden and Germany). By not including NIrrig, environmental and agricultural policies are underestimating the real extent of N pollution hotspots in European irrigated systems.

A Novel Representation of Audiological and Subjective Findings for Acoustical, Bone Conduction and Direct Drive Hearing Solutions

Background: The benefit of hearing rehabilitation is often measured using audiological tests or subjective questionnaires/interviews. It is important to consider both aspects in order to evaluate the overall benefits. Currently, there is no standardized method for reporting combined audiological and patient reported subjective outcome measures in clinical practice. Therefore, this study focuses on showing the patient’s audiological, as well as subjective outcomes in one graph using data from an existing study. Method: The present paper illustrated a graph presenting data on four quadrants with audiological and subjective findings. These quadrants represented speech comprehension in quiet (unaided vs. aided) as WRS% at 65 dB SPL, speech recognition in noise (unaided vs. aided) as SRT dB SNR, sound field threshold (unaided vs. aided) as PTA4 in dB HL, wearing time and patient satisfaction questionnaire results. Results: As an example, the HEARRING graph in this paper represented audiological and subjective datasets on a single patient level or a cohort of patients for an active bone conduction hearing implant solution. The graph offered the option to follow the user’s performance in time. Conclusion: The HEARRING graph allowed representation of a combination of audiological measures with patient reported outcomes in one single graph, indicating the overall benefit of the intervention. In addition, the correlation and consistency between some results (e.g., aided threshold and aided WRS) can be better visualized. Those users who lacked performance benefits on one or more parameters and called for further insight could be visually identified.

Validation of the Spanish version of the Sunnybrook facial grading system

PURPOSE

The Sunnybrook facial grading system (SFGS) is one of the most widely employed tools to assess facial function. The present study aimed to determine the validity and reliability of the Spanish language version of the SFGS.

METHODS

Forward-backward translation from the original English version was performed by fluent speakers of English and Spanish. Videos from 65 patients with facial paralysis (FP) were evaluated twice by five otolaryngologists with experience in FP evaluation. Internal consistency and intra- and inter-rater reliability were assessed. The House-Brackmann scale was used to display concurrent validity which was established by Spearman's rho correlation.

RESULTS

The Cronbach's α score exceeded 0.70. The intra-rater intraclass correlation coefficient (ICC) was nearly perfect for the composite score (0.96-0.99), voluntary movements (0.97-0.99), and synkinesis (0.91-0.98), and important to almost perfect for symmetry at rest (0.79-0.97). In both evaluations, the inter-rater ICC was higher than 0.90 for the composite score (0.92-0.96) and voluntary movements (0.91-0.96) and slightly lower for symmetry at rest (0.66-0.85) and synkinesis (0.72-0.87). A strong negative correlation was found between the H-B scale and SFGS (Spearman's rho coefficient = - 0.92, p < 0.001) in both evaluations.

CONCLUSION

The Spanish version of the SFGS is a reliable and valuable instrument for the assessment of facial function in the diagnosis and treatment of patients with FP.

Minimally Traumatic Cochlear Implant Surgery: Expert Opinion in 2010 and 2020

This study aimed to discover expert opinion on the surgical techniques and materials most likely to achieve maximum postoperative residual hearing preservation in cochlear implant (CI) surgery and to determine how these opinions have changed since 2010. A previously published questionnaire used in a study published in 2010 was adapted and expanded. The questionnaire was distributed to an international group of experienced CI surgeons. Present results were compared, via descriptive statistics, to those from the 2010 survey. Eighteen surgeons completed the questionnaire. Respondents clearly favored the following: round window insertion, slow array insertion, and the peri- and postoperative use of systematic antibiotics. Insertion depth was regarded as important, and electrode arrays less likely to induce trauma were preferred. The usefulness of dedicated soft-surgery training was also recognized. A lack of agreement was found on whether the middle ear cavity should be flushed with a non-aminoglycoside antibiotic solution or whether a sheath or insertion tube should be used to avoid contaminating the array with blood or bone dust. In conclusion, this paper demonstrates how beliefs about CI soft surgery have changed since 2010 and shows areas of current consensus and disagreement.

The effect of risk factors on cognition in adult cochlear implant candidates with severe to profound hearing loss

Hearing loss has been identified as a major modifiable risk factors for dementia. Adult candidates for cochlear implantation (CI) represent a population at risk of hearing loss-associated cognitive decline. This study investigated the effect of demographics, habits, and medical and psychological risk factors on cognition within such a cohort. Data from 34 consecutive adults with post-lingual deafness scheduled for CI were analyzed. Pure tone audiometry (PTA4) and Speech Discrimination Score (SDS) were recorded. The Repeatable Battery for Assessment of Neuropsychological Status for Hearing impaired individuals (RBANS-H) was used to measure cognition. Demographics (sex, age, years of education), habits (smoking, alcohol intake, physical inactivity), and medical factors (hypertension, diabetes, traumatic brain injury) were evaluated. Depression was measured using the Hospital Anxiety and Depression Scale (HADS), and social inhibition with the Type D questionnaire (DS14). All participants (mean age 62 ± 15 years) suffered from severe to profound hearing loss (PTA4:129 ± 60 dB; SDS:14 ± 24%). The mean RBANS-H total score was 83 ± 16. Participants reported a mean of years of formal education of 12 ± 5 years. The prevalence of habits and medical risk factors was: physical inactivity (29%), body mass index >30 (28%), traumatic brain injury (25%), hypertension (24%), heavy alcohol consumption (13%), smoking (13%), and diabetes (0%). Regarding psychological factors, the mean scores of social inhibition and depression were 10 ± 6 and 6 ± 5, respectively. The number of years of education was significantly correlated with the RBANS-H total score (p < 0.001), and with the domains “Immediate memory” (p = 0.003), “Visuospatial/constructional” (p < 0.001), and “Attention” (p < 0.001). The mean RBANS-H total score in participants who had university studies or higher level (12/34) was 97 ± 9, with the remaining participants reporting a mean score of 75 ± 15. Men performed better in the “Visuospatial/constructional” (p = 0.008). Physical inactivity was associated with lower scores in the “Delayed memory” (p = 0.031); hypertension correlated with lower RBANS-H total scores (p = 0.025) and “Attention” (p = 0.006). Depression and social inhibition were negatively correlated with RBANS-H total score and with the “Immediate memory,” “Visuospatial/constructional,” and “Attention” (all p < 0.05). In adults with late-onset deafness scheduled to CI, educational level has a significant effect. Additionally, sex, physical inactivity, hypertension, and psychological traits of social inhibition and depression may also influence cognitive status. Long-term studies with more participants would enable us better understand the effects different risk factors on cognitive status.

Contribution and safety of the side-to-end hypoglossal-to-facial transfer in multidisciplinary facial reanimation

BACKGROUND

This study evaluates facial and tongue function in patients undergoing side-to-end hypoglossal-to-facial transfer (HFT) with additional techniques.

METHODS

Thirty-seven patients underwent a side-to-end HFT. Twelve had additional cross-face grafts, and 9 had an additional masseter-to-facial transfer. Facial was assessed with House-Brackmann (HB), Sunnybrook Facial Grading Scale (SFGS), and eFACE. Martins scale and the Oral-Pharyngeal Disability Index (OPDI) were used to assess tongue function.

RESULTS

Ninety-four percent of cases reached HB grades III-IV. Mean total SFGS score improved from 16 ± 15 to 59 ± 11, while total eFACE score from 52 ± 13 to 80 ± 5. Dual nerve transfers were a predictor for a better eFACE total score p = 0.034, β = 2.350 [95% CI, 0.184-4.516]), as well as for a higher SFGS total score (p = 0.036, β = 5.412 [95% CI, 0.375-10.449]). All patients had Martin's grade I. Mean postoperative OPDI scores were 84 ± 17 (local physical), 69 ± 16 (simple and sensory motor components), 82 ± 14 (complex functions), and 73 ± 22 (psychosocial).

CONCLUSIONS

The side-to-end HFT offers predictable facial function outcome and preserves tongue function in nearly all cases. Dual nerve transfers appear to improve the final outcome.

Systematic Literature Review of Hearing Preservation Rates in Cochlear Implantation Associated With Medium- and Longer-Length Flexible Lateral Wall Electrode Arrays

Background

The last two decades have demonstrated that preoperative functional acoustic hearing (residual hearing) can be preserved during cochlear implant (CI) surgery. However, the relationship between the electrode array length and postoperative hearing preservation (HP) with lateral wall flexible electrode variants is still under debate.

Aims/Objectives

This is a systematic literature review that aims to analyze the HP rates of patients with residual hearing for medium-length and longer-length lateral wall electrodes.

Method

A systematic literature review methodology was applied following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) recommendations to evaluate the HP rates of medium-length and longer-length lateral wall electrodes from one CI manufacturer (medium length FLEX 24, longer length FLEX 28 and FLEX SOFT, MED-EL, Innsbruck, Austria). A search using search engine PubMed (https://www.ncbi.nlm.nih.gov/pubmed/) was performed using the search terms “hearing preservation” or “residual hearing” and “cochlear implant” in “All fields.” Articles published only in English between January 01, 2009 and December 31, 2020 were included in the search.

Results

The HP rate was similar between medium-length (93.4%–93.5%) and longer (92.1%–86.8%) electrodes at 4 months (p = 0.689) and 12 months (p = 0.219). In the medium-length electrode group, patients under the age of 45 years had better HP than patients above the age of 45 years.

Conclusions

Both medium-length and longer electrode arrays showed high hearing preservation rates. Considering the hearing deterioration over time, implanting a longer electrode at primary surgery should be considered, thus preventing the need for future reimplantation.

Suitable Electrode Choice for Robotic-Assisted Cochlear Implant Surgery: A Systematic Literature Review of Manual Electrode Insertion Adverse Events

Background and Objective

The cochlear implant (CI) electrode insertion process is a key step in CI surgery. One of the aims of advances in robotic-assisted CI surgery (RACIS) is to realize better cochlear structure preservation and to precisely control insertion. The aim of this literature review is to gain insight into electrode selection for RACIS by acquiring a thorough knowledge of electrode insertion and related complications from classic CI surgery involving a manual electrode insertion process.

Methods

A systematic electronic search of the literature was carried out using PubMed, Scopus, Cochrane, and Web of Science to find relevant literature on electrode tip fold over (ETFO), electrode scalar deviation (ESD), and electrode migration (EM) from both pre-shaped and straight electrode types.

Results

A total of 82 studies that include 8,603 ears implanted with a CI, i.e., pre-shaped (4,869) and straight electrodes (3,734), were evaluated. The rate of ETFO (25 studies, 2,335 ears), ESD (39 studies, 3,073 ears), and EM (18 studies, 3,195 ears) was determined. An incidence rate (±95% CI) of 5.38% (4.4–6.6%) of ETFO, 28.6% (26.6–30.6%) of ESD, and 0.53% (0.2–1.1%) of EM is associated with pre-shaped electrodes, whereas with straight electrodes it was 0.51% (0.1–1.3%), 11% (9.2–13.0%), and 3.2% (2.5–3.95%), respectively. The differences between the pre-shaped and straight electrode types are highly significant (p < 0.001). Laboratory experiments show evidence that robotic insertions of electrodes are less traumatic than manual insertions. The influence of round window (RW) vs. cochleostomy (Coch) was not assessed.

Conclusion

Considering the current electrode designs available and the reported incidence of insertion complications, the use of straight electrodes in RACIS and conventional CI surgery (and manual insertion) appears to be less traumatic to intracochlear structures compared with pre-shaped electrodes. However, EM of straight electrodes should be anticipated. RACIS has the potential to reduce these complications.

Establishing long-term nitrogen response of global cereals to assess sustainable fertilizer rates

Insight into the response of cereal yields to nitrogen fertilizer is fundamental to improving nutrient management and policies to sustain economic crop benefits and food sufficiency with minimum nitrogen pollution. Here we propose a new method to assess long-term (LT) regional sustainable nitrogen inputs. The core is a novel scaled response function between normalized yield and total net nitrogen input. The function was derived from 25 LT field trials for wheat, maize and barley in Europe, Asia and North America and is fitted by a second-order polynomial (R2 = 0.82). Using response functions derived from common short-term field trials, with soil nitrogen not in steady state, gives the risks of soil nitrogen depletion or nitrogen pollution. The scaled LT curve implies that the total nitrogen input required to attain the maximum yield is independent of this maximum yield as postulated by Mitscherlich in 1924. This unique curve was incorporated into a simple economic model with valuation of externalities of nitrogen surplus as a function of regional per-capita gross domestic product. The resulting LT sustainable nitrogen inputs range from 150 to 200 kgN ha-1 and this interval narrows with increasing yield potential and decreasing gross domestic product. The adoption of LT response curves and external costs in cereals may have important implications for policies and application ceilings for nitrogen use in regional and global agriculture and ultimately the global distribution of cereal production.

CIBERER: Spanish National Network for Research on Rare Diseases: a highly productive collaborative initiative

CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low‐prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15‐year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research.

Effect of cochlear implantation on cognitive decline and quality of life in younger and older adults with severe-to-profound hearing loss

Purpose

(a) To measure the change in cognition, the improvement of speech perception, and the subjective benefit in people under and over 60 years following cochlear implantation. (b) To assess the relationship between cognition, demographic, audiometric, and subjective outcomes in both age groups.

Methods

28 cochlear implant (CI) users were assigned to the < 60y group and 35 to the ≥ 60y group. Cognition was measured using the Repeatable Battery for the Assessment of Neuropsychological Status for Hearing impaired individuals (RBANS-H); subjective benefit was measured using the Nijmegen Cochlear Implant Questionnaire (NCIQ); the Glasgow Benefit Inventory (GBI); the Hearing Implant Sound Quality Index (HISQUI₁₉); Speech, Spatial and Qualities of Hearing Scale (SSQ₁₂); and the Hospital Anxiety and Depression Scale (HADS).

Results

Prior to surgery: the RBANS-H total score positively correlated with the domains “Advanced sound”, “Self-esteem”, and “Social functioning” of NCIQ, and negatively with HADS scores. 12 months post-implantation: the RBANS-H total score increased in the < 60y (p = 0.038) and in the ≥ 60y group (p < 0.001); speech perception and subjective outcomes also improved; RBANS-H total score positively correlated with “Self-esteem” domain in NCIQ. Age and the RBANS-H total score correlated negatively in the ≥ 60y group (p = 0.026).

Conclusions

After implantation, both age groups demonstrated improved cognition, speech perception and quality of life. Their depression scores decreased. Age was inversely associated with cognition.

Crop production and nitrogen use in European cropland and grassland 1961-2019

This paper presents EuropeAgriDB v1.0, a dataset of crop production and nitrogen (N) flows in European cropland 1961-2019. The dataset covers 26 present-day countries, detailing the cropland N harvests in 17 crop categories as well as cropland N inputs in synthetic fertilizers, manure, symbiotic fixation, and atmospheric deposition. The study builds on established methods but goes beyond previous research by combining data from FAOSTAT, Eurostat, and a range of national data sources. The result is a detailed, complete, and consistent dataset, intended as a basis for further analyses of past and present agricultural production patterns, as well as construction of scenarios for the future.

A state-of-the-art implementation of a binaural cochlear-implant sound coding strategy inspired by the medial olivocochlear reflex

Cochlear implant (CI) users find it hard and effortful to understand speech in noise with current devices. Binaural CI sound processing inspired by the contralateral medial olivocochlear (MOC) reflex (an approach termed the 'MOC strategy') can improve speech-in-noise recognition for CI users. All reported evaluations of this strategy, however, disregarded automatic gain control (AGC) and fine-structure (FS) processing, two standard features in some current CI devices. To better assess the potential of implementing the MOC strategy in contemporary CIs, here, we compare intelligibility with and without MOC processing in combination with linked AGC and FS processing. Speech reception thresholds (SRTs) were compared for an FS and a MOC-FS strategy for sentences in steady and fluctuating noises, for various speech levels, in bilateral and unilateral listening modes, and for multiple spatial configurations of the speech and noise sources. Word recall scores and verbal response times in a word recognition test (two proxies for listening effort) were also compared for the two strategies in quiet and in steady noise at 5 dB signal-to-noise ratio (SNR) and the individual SRT. In steady noise, mean SRTs were always equal or better with the MOC-FS than with the standard FS strategy, both in bilateral (the mean and largest improvement across spatial configurations and speech levels were 0.8 and 2.2 dB, respectively) and unilateral listening (mean and largest improvement of 1.7 and 2.1 dB, respectively). In fluctuating noise and in bilateral listening, SRTs were equal for the two strategies. Word recall scores and verbal response times were not significantly affected by the test SNR or the processing strategy. Results show that MOC processing can be combined with linked AGC and FS processing. Compared to using FS processing alone, combined MOC-FS processing can improve speech intelligibility in noise without affecting word recall scores or verbal response times.

Quantification of global and national nitrogen budgets for crop production

Input-output estimates of nitrogen on cropland are essential for improving nitrogen management and better understanding the global nitrogen cycle. Here, we compare 13 nitrogen budget datasets covering 115 countries and regions over 1961-2015. Although most datasets showed similar spatiotemporal patterns, some annual estimates varied widely among them, resulting in large ranges and uncertainty. In 2010, global medians (in TgN yr^-1) and associated minimum-maximum ranges were 73 (64-84) for global harvested crop nitrogen; 161 (139-192) for total nitrogen inputs; 86 (68-97) for nitrogen surplus; and 46% (40-53%) for nitrogen use efficiency. Some of the most uncertain nitrogen budget terms by country showed ranges as large as their medians, revealing areas for improvement. A benchmark nitrogen budget dataset, derived from central tendencies of the original datasets, can be used in model comparisons and inform sustainable nitrogen management in food systems.

More efficient phosphorus use can avoid cropland expansion

Global projections indicate that approximately 500 Mha of new arable land will be required to meet crop demand by 2050. Applying a dynamic phosphorus (P) pool simulator under different socioeconomic scenarios, we find that cropland expansion can be avoided with less than 7% additional cumulative P fertilizer over 2006-2050 when comparing with cropland expansion scenarios, mostly targeted at nutrient-depleted soils of sub-Saharan Africa. Additional P fertilizer would replenish P withdrawn from crop production, thereby allowing higher productivity levels. We also show that further agronomic improvements such as those that allow for better (legacy) P use in soils could reduce both P outflows to freshwater and coastal ecosystems and the overall demand for P fertilizer.

Quality of Life Following Cochlear Implantation in Patients With Menière's Disease

Background: Menière's disease (MD) is a disorder characterized by auditory and vestibular dysfunction that significantly deteriorates patients' quality of life (QoL). In addition to the management of vestibular symptoms, some patients with bilateral hearing loss meet criteria for cochlear implantation (CI).

Objectives: (1) To assess hearing results and QoL outcomes following CI in patients with MD. (2) To compare these results to a matched control group of patients who had undergone CI. (3) To analyse differences in MD patients who have undergone simultaneous or sequential labyrinthectomy or previous neurectomy.

Methods: A retrospective analysis of a study group of 18 implanted patients with MD and a matched control group of 18 implanted patients without MD, who had CI at a tertiary referral center. Hearing and speech understanding were assessed via pure-tone audiometry (PTA) and disyllabic perception tests in quiet. QoL was assessed via the Nijmegen Cochlear Implant Questionnaire (NCIQ), the Glasgow Benefit Inventory (GBI), the Speech, Spatial and Qualities of Hearing Scale (SSQ₁₂), and the Hearing Implant Sound Quality Index (HISQUI₁₉). The impact of MD ablative surgeries was analyzed in the study group (MD group).

Results: Mean pre-operative PTA thresholds were significantly lower in the MD group (103 vs. 121 dB). A significant improvement in hearing outcomes was observed following CI in both groups (p < 0.001), with a maximum Speech Discrimination Score of 64 and 65% disyllables at 65 dB for the MD and control group, respectively. Subjective outcomes, as measured by the NCIQ, GBI, SSQ₁₂, and HISQUI₁₉ did not significantly differ between groups. In the MD group, despite achieving similar hearing results, QoL outcomes were worse in patients who underwent simultaneous CI and labyrinthectomy compared to the rest of the MD group. Post-operative NCIQ results were significantly better in patients who had undergone a previous retrosigmoid neurectomy when compared to those who had undergone only CI surgery in the subdomains “basic sound perception” (p = 0.038), “speech” (p = 0.005), “activity” (p = 0.038), and “social interactions” (p = 0.038).

Conclusion: Patients with MD and severe hearing loss obtain hearing results and QoL benefits similar to other CI candidates. Delayed CI after labyrinthectomy or vestibular neurectomy can be performed with similar or better results, respectively, to those of other cochlear implanted patients. Patients who undergo simultaneous CI and labyrinthectomy may achieve similar hearing results but careful pre-operative counseling is needed.

Two-phase survey on the frequency of use and safety of MRI for hearing implant recipients

PURPOSE

Magnetic resonance imaging (MRI) is often used to visualize and diagnose soft tissues. Hearing implant (HI) recipients are likely to require at least one MRI scan during their lifetime. However, the MRI scanner can interact with the implant magnet, resulting in complications for the HI recipient. This survey, which was conducted in two phases, aimed to evaluate the safety and performance of MRI scans for individuals with a HI manufactured by MED-EL (MED-EL GmbH, Innsbruck, Austria).

METHODS

A survey was developed and distributed in two phases to HEARRING clinics to obtain information about the use of MRI for recipients of MED-EL devices. Phase 1 focused on how often MRI is used in diagnostic imaging of the head region of the cochlear implant (CI) recipients. Phase 2 collected safety information about MRI scans performed on HI recipients.

RESULTS

106 of the 126 MRI scans reported in this survey were performed at a field strength of 1.5 T, on HI recipients who wore the SYNCHRONY CI or SYNCHRONY ABI. The head and spine were the most frequently imaged regions. 123 of the 126 scans were performed without any complications; two HI recipients experienced discomfort/pain. One recipient required reimplantation after an MRI was performed using a scanner that had not been approved for that implant. There was only one case that required surgical removal of the implant to reduce the imaging artefact.

CONCLUSION

Individuals with either a SYNCHRONY CI or SYNCHRONY ABI from MED-EL can safely undergo a 1.5 T MRI when it is performed according to the manufacturer's safety policies and procedures.

[Satisfaction survey of patients with sequels of peripheral facial palsy treated with botulinum toxin A]

INTRODUCTION

Treatment of peripheral facial palsy with botulinum toxin A is safe and effective. Although its beneficial impact on patients' quality of life is known, to date, there have been no studies specifically analysing patients' subjective perceptions.

PATIENTS AND METHOD

We performed a prospective study in a random sample of patients with sequels of peripheral facial palsy treated with botulinum toxin in the Physical Medicine and Rehabilitation Service of our hospital. We created a simple questionnaire to assess both patient satisfaction and subjective perception of improvement after botulinum toxin treatment.

RESULTS

After infiltration, 95% of the patients felt good or very good. More than 80% noted improvement in the sensation of tightness in the cheek and neck. Around 75% of patients perceived an improvement in the range of voluntary movement and approximately 80% reported improvement in synkinesis. Almost all the patients would repeat the treatment, if proposed, and 100% would recommend botulinum toxin infiltration to other patients with facial palsy.

CONCLUSIONS

Patients treated with botulinum toxin experience substantial subjective improvement in the sequels of peripheral facial palsy, both in repose and in the control of synkinesis. Satisfaction was higher than 8/10 in 99% of patients in this study.

Drug development for noise-induced hearing loss

INTRODUCTION

Excessive exposure to noise is a common occurrence that contributes to approximately 50% of the non-genetic hearing loss cases. Researchers need to develop standardized preclinical models and identify molecular targets to effectively develop prevention and curative therapies.

AREAS COVERED

In this review, the authors discuss the many facets of human noise-induced pathology, and the primary experimental models for studying the basic mechanisms of noise-induced damage, making connections and inferences among basic science studies, preclinical proofs of concept and clinical trials.

EXPERT OPINION

Whilst experimental research in animal models has helped to unravel the mechanisms of noise-induced hearing loss, there are often methodological variations and conflicting results between animal and human studies which make it difficult to integrate data and translate basic outcomes to clinical practice. Standardization of exposure paradigms and application of -omic technologies will contribute to improving the effectiveness of transferring newly gained knowledge to clinical practice.

Fibrovascular Tumor-Like Lesions of the Facial Nerve

BACKGROUND

Facial nerve tumors (FNTs) are relatively rare benign lesions that arise from any segment of the facial nerve (FN). About half of all patients present with FN dysfunction, mainly long-standing or progressive facial paralysis. Diagnosis of an FNT is usually based on radiological imaging and confirmed by histological study. Most reported cases of FNTs are schwannomas and hemangiomas.

OBJECTIVES

The aim of this study was to review 4 cases of lesions with clinical, radiological, and surgical findings that suggested an FNT, the pathology revealing a fibrovascular proliferation with no clear signs of a specific tumor.

METHOD

Medical records of patients who had surgery due to an FN lesion were reviewed. Cases with known tumoral lesions were excluded. Four patients with tumor-like lesions were identified. Their imaging studies were re-evaluated. The pathological study included hematoxylin-eosin, Masson's trichrome, and immunohistochemistry for S100 protein, neurofilaments, CD31, Wilms' tumor 1 (WT1), and D240.

RESULTS

The 4 cases revealed tumor-like fibrovascular lesions that could not be classified as typical pathological entities. All cases had a complete facial palsy preoperatively. Computed tomography and magnetic resonance imaging (MRI) suggested schwannoma or hemangioma. A complete excision was achieved, and a facial reconstruction was performed immediately after interruption. Postoperative FN function was improved in all cases. The histological study showed nervous tracts of normal morphology, with fibrous and vascular tissue interspersed in variable proportions. All cases showed areas of fibrosis with Masson's stain. In all cases, nervous tissue and Schwann cells tested positively for neurofilaments and S100, respectively. In vascular areas, endothelial cells stained positively for CD31, and negatively for D240 and WT1.

CONCLUSIONS

Fibrovascular lesions of the FN may mimic primary FNTs, especially schwannomas and hemangiomas. Surgical excision with grafting or nerve transfer is the procedure of choice if a complete facial paralysis is found. This unusual condition should be considered when counseling patients with FN lesions. The lack of hyperintensity on MRI T2-weighted images may suggest the presence of fibrous tissue.

A retrospective European multicenter analysis of the functional outcomes after active middle ear implant surgery using the third generation vibroplasty couplers

Purpose

To evaluate the safety and performance of three novel vibroplasty couplers that allow attachment of the floating mass transducer of a transcutaneous active middle ear implant (AMEI) to the round window (RW) membrane, the long process (LP), or the incus body and the short process (SP) of the incus.

Methods

Retrospective multicenter cohort study of 25 AMEI users with sensorineural or mixed hearing loss that were among the first implanted with an AMEI vibrating ossicular prosthesis in combination with the third generation of vibroplasty couplers between 2014 and 2016. Main Outcome Measures were bone-conduction pure-tone and vibroplasty thresholds, postoperative aided sound field thresholds and postoperative aided word recognition score (WRS).

Results

Bone conduction threshold changes of more than 10 dB in 4PTA_BC were observed in two subjects. A mean improvement of 57.8% in speech recognition was observed with a mean WRS at 65 dB SPL improving from 14.8% (SD 21.9%) preoperatively to a mean aided score of 72.6% (SD 18.6%). Sound field thresholds improved from an average 4PTA_SF of 64.1 dB HL (SD 9.8 dB HL) to 37.0 dB HL (SD 8.9 dB HL), resulting in a mean functional gain of 27.1 dB. There was no significant difference in WRS or functional gain between the coupler types.

Conclusion

Initial experience shows that all three third generation vibroplasty couplers represent safe and efficient attachment options for the FMT allowing the surgeon to choose the coupling type based on the present pathology.

Integrated management for sustainable cropping systems: Looking beyond the greenhouse balance at the field scale

Cover crops (CC) promote the accumulation of soil organic carbon (SOC), which provides multiple benefits to agro-ecosystems. However, additional nitrogen (N) inputs into the soil could offset the CO2 mitigation potential due to increasing N2 O emissions. Integrated management approaches use organic and synthetic fertilizers to maximize yields while minimizing impacts by crop sequencing adapted to local conditions. The goal of this work was to test whether integrated management, centered on CC adoption, has the potential to maximize SOC stocks without increasing the soil greenhouse gas (GHG) net flux and other agro-environmental impacts such as nitrate leaching. To this purpose, we ran the DayCent bio-geochemistry model on 8,554 soil sampling locations across the European Union. We found that soil N2 O emissions could be limited with simple crop sequencing rules, such as switching from leguminous to grass CC when the GHG flux was positive (source). Additional reductions of synthetic fertilizers applications are possible through better accounting for N available in green manures and from mineralization of soil reservoirs while maintaining cash crop yields. Therefore, our results suggest that a CC integrated management approach can maximize the agro-environmental performance of cropping systems while reducing environmental trade-offs.

Does bimodal hearing increase self-assessed abilities and hearing outcomes when compared to unilateral cochlear implantation?

Objective: The primary objective of this study was to compare the applicability and benefit of providing unilateral cochlear implant (CI) users with a contralateral hearing aid (HA).Design: This retrospective (case-control) study was conducted in a hospital-based CI centre. Participants self-assessed their hearing via two questionnaires (SSQ₁₂ and HISQUI₁₉). Objective postoperative speech perception was assessed via aided thresholds and speech perception tests (monosyllabic words, disyllabic words, and sentences) in quiet and noise.Study sample: A CI-only group (n = 113, mean age 55.1 ± 14.2 years) and a bimodal group (n = 50, mean age 56.7 ± 15.2) participated in the study.Results: No significant difference in SSQ₁₂ or HISQUI₁₉ scores was observed between groups. The bimodal group had a significantly better aided hearing level (p = 0.020) and speech discrimination score (p = 0.019).Conclusions: Bimodal (CI + HA) users have significantly better speech understanding than unilateral CI-only users, although this benefit may not be reflected in self-assessed outcomes. Counselling about bimodal hearing must cover expectations about potential benefits.