Åsa Bonnard

Cochlear implants (CI) provide immense benefit, yet patient outcomes are highly variable. This variability is often due to underlying cochlear health and neural integrity, which are poorly captured by current pre-operative imaging. We propose that electrophysiological signals recorded from the implant can serve as objective biomarkers to guide therapy. This project is a one-year pilot study to establish the feasibility of this approach for a future national clinical trial.  We will: (1) conduct a systematic review

(2) perform a retrospective analysis of the rich Karolinska Hospital CI database using linear mixed-effects models to identify predictors of outcomes

(3) conduct a prospective pilot study to assess the clinical feasibility of recording novel biomarkers, such as summating potential (SP) polarity, from new patients

and (4) build a national network of clinicians, researchers, and patient representatives. This work, conducted by a uniquely synergistic team of a data scientist, CI surgeon, CI engineer, and a world-leading authority on cochlear surgical anatomy, will lay the foundation for a clinical decision support tool to personalize CI programming, improving efficacy and patient benefit.

Background: Venous thromboembolic events (VTE), such as deep vein thrombosis (DVT) and pulmonary embolism (PE), are serious surgical complications with potentially fatal outcomes. The average annual incidence of VTE in Sweden between 2008 and 2018 was 231.3 per 100,000 inhabitants. Cholesteatoma surgery of the middle ear, which often lasts several hours, may promote thrombus formation through blood flow stasis during general anesthesia as well as local inflammation and vascular injury. There are no previous studies investigating the risk of VTE associated with this type of surgery. Aim: To estimate the risk of DVT, PE, and postoperative mortality following cholesteatoma surgery. Methods: All patients who underwent surgery in Sweden between 1987 and 2018 will be identified through the National Patient Register using ICD-9 and ICD-10 diagnosis codes and KVÅ procedure codes. VTE diagnoses, comorbidities (previous VTE, diabetes, hypertension, ischemic disease, arterial embolism, arrhythmia, and coagulopathies), and dates of death will be extracted. Two controls, matched for sex, age, and county of residence, will be linked to each case. Expected Results: We expect an increased risk of VTE following cholesteatoma surgery compared with the general population. Relevance: This study will contribute to increased knowledge of postoperative risks in otologic surgery. The results may form the basis for improved preoperative risk assessment and better thromboprophylaxis routines in Region Jämtland Härjedalen. The insights generated may also be valuable at a national level and used to inform the development of guidelines for otologic surgery throughout Sweden.