Nael Shoman | University of Saskatchewan (original) (raw)

Papers by Nael Shoman

We introduce a novel system for geometrically accurate, continuous, live, volumetric middle ear o... more We introduce a novel system for geometrically accurate, continuous, live, volumetric middle ear optical coherence tomography imaging over a 10.9 × 30° × 30° field of view (FOV) from a handheld imaging probe. The system employs a discretized spiral scanning (DC-SC) pattern to rapidly collect volumetric data and applies real-time scan conversion and lateral angular distortion correction to reduce geometric inaccuracies to below the system's lateral resolution over 92% of the FOV. We validate the geometric accuracy of the resulting images through comparison with co-registered micro-computed tomography (micro-CT) volumes of a phantom target and a cadaveric middle ear. The system's real-time volumetric imaging capabilities are assessed by imaging the ear of a healthy subject while performing dynamic pressurization of the middle ear in a Valsalva maneuver.

Journal of otolaryngology-head and neck surgery, Nov 12, 2022

Objective: Transcutaneous bone anchored hearing devices (BAHDs) were introduced in an effort to a... more Objective: Transcutaneous bone anchored hearing devices (BAHDs) were introduced in an effort to avoid potential complications associated with the abutment of percutaneous BAHDs. Transcutaneous BAHDs can be active or passive. While studies have demonstrated good outcomes with both, a direct comparison of audiological and clinical outcomes of these devices in the pediatric population has not yet been studied. Study design: Retrospective, multicenter study. Setting: Two tertiary academic centers. Methods: Between 2015 and 2019, all patients who received an active transcutaneous BAHD (Bonebridge, BB) at one center, and patients that received a passive transcutaneous BAHD (Attract, AT) at another center, were included in this study. Exclusion criteria included age > 18 years, and mixed hearing loss or single-sided deafness. Study outcomes included patient demographics, indications, complications and preoperative and one-year postoperative audiometric data. Results: Eighteen BB and eight AT patients met the inclusion criteria. The age range was 5-16 years. There were no significant differences in complication outcomes. Both devices demonstrated similar mean improvements in hearing thresholds at frequencies of 250 Hz (38 dB Active vs. 38 dB Passive), 500 Hz (34 dB vs. 42 dB), 1000 Hz (34 dB vs. 40 dB) and 2000 Hz (31 dB vs. 22 dB). The BB was significantly more effective at frequencies of 4000 Hz (28 dB vs. 7 dB) and 8000 Hz (29 dB vs. 6 dB) (p < 0.05). Conclusion: This is the first study comparing audiological outcomes between an active and a passive transcutaneous BAHD in the pediatric population. While both devices improved audiometric outcomes in the low and mid frequencies, the active BAHD demonstrated significantly better outcomes in the higher frequencies.

Expert Review of Medical Devices, Sep 1, 2020

Objective: This prospective longitudinal cohort study at six tertiary referral centers in Canada ... more Objective: This prospective longitudinal cohort study at six tertiary referral centers in Canada and Denmark describes the clinical efficiency and surgical safety of cochlear implantation with the Oticon Medical Neuro cochlear implant system, including the Neuro Zti implant, the EVO electrode array, and the Neuro One sound processor. Methods: Patients were adult cochlear implant candidates with bilateral sensorineural hearing loss. Results: The mean HINT scores in quiet pre-operatively and at 3, 6, and 12 months post-activation were 13%, 58%, 67%, and 72%, respectively, and in noise (+10 dB SNR) 13%, 46%, 53%, and 59%, respectively. The mean improvement from baseline to 6 months post-activation was 54% in quiet and 40% in noise. The surgical major complication incidence rate was 0% and the post-surgical major complication incidence rate (until 12 months post-activation) was 4%. There was no adverse event that was fatal, that required explantation, or that resulted in sound processor nonuse, and no implant failure. Conclusion: Cochlear implantation with the Oticon Medical Neuro system enables speech identification both in quiet and in noise and audiologic outcomes continue to improve in the year following activation. No substantial adverse events occurred during the surgical implantation procedure and during the 12 months post-activation.

Annals of Otology, Rhinology, and Laryngology, Oct 20, 2018

The aim of this study was to assess the feasibility and safety of ossiculoplasty under local anes... more The aim of this study was to assess the feasibility and safety of ossiculoplasty under local anesthesia in an office setting without sedation. Methods: Between May 2017 and November 2017, patients who presented with conductive hearing loss and known isolated ossicular discontinuities were offered ossiculoplasty under local anesthesia. Inclusion criteria included age ⩾ 18 years, adequate transcanal access, and the ability to lie supine for up to 45 minutes. Exclusion criteria included associated tympanic membrane perforation and the presence of middleear or mastoid cholesteatoma or infection. Results: Fourteen patients underwent the procedure. The mean age was 48.3 years (range, 19-74 years). Six were primary and 8 revision cases. There were 8 partial and 6 total prosthesis placements. The mean operative time was 34 minutes (range, 26-43 minutes). All patients tolerated the procedure to completion. There were no intraoperative complications. The mean air conduction pure-tone average was 76.6 dB and the mean bone conduction pure-tone average was 27.2 dB, with a preoperative air-bone gap of 49.9 dB. Air conduction pure-tone average significantly improved to 45.2 dB (P < .0001). Air-bone gap significantly improved to 17.8 dB (P < .0001). Conclusions: Ossiculoplasty using partial or total prostheses can be safely performed in the office setting under local anesthesia without sedation in carefully selected patients. This has potentially significant patient and system benefits.

Otology & Neurotology, Jul 1, 2011

Objectives: Determine the prevalence of carotid artery injury (CAI) in patients with basilar skul... more Objectives: Determine the prevalence of carotid artery injury (CAI) in patients with basilar skull fractures and describe significant demographic and radiographic risk factors for CAI. Study Design: From January 2004 to December 2008, medical records of 1,279 consecutive adult patients treated for basilar skull fractures at a tertiary care academic hospital were retrospectively reviewed. Diagnostic angiography was performed in 112 patients because of concern for CAI. Computed tomographic studies of the head and cranial base were reviewed for evidence of pneumocephalus, petrous carotid canal fractures, and sphenoid bone fractures. Results: Mean age of patients undergoing angiography was 38.7 years, and 85 patients (75.9%) were male subjects. Thirtyfive (50%) of 70 discrete cerebrovascular injuries on angiography involved the carotid canal. The prevalence of CAI in patients with basilar skull trauma was 2.0%. CAI was associated with female sex (p = 0.001), whereas lower Glasgow Coma Scale score approached statistical significance (p = 0.07). Sensitivity and specificity of the 3 computed tomographic findings individually were 44% to 68% and 41% to 67%, respectively. With all 3 findings concurrently, 85% specificity and 80% negative predictive value for CAI were obtained, although sensitivity declined. Conclusion: The frequency of CAI in patients with basilar skull fractures was higher than that in those without basilar skull involvement. Female sex was strongly associated with CAI. The intimate anatomic relationship between the carotid artery and the cranial base posit substantial diagnostic and therapeutic challenges for the contemporary cranial base surgeon, and thus, understanding the epidemiology and risk factors for CAI is of paramount importance.

ORL, Dec 2, 2015

Background: The middle cranial fossa (MCF) approach is a valuable yet technically challenging tec... more Background: The middle cranial fossa (MCF) approach is a valuable yet technically challenging technique. Identification of the superior semicircular canal (SCC) using the arcuate eminence (AE) was proposed as a surface landmark. However, the AE is sometimes absent, with inconsistent relationship to the SCC. Air cells in the AE area facilitate safer identification of the SCC. The aim of this study is to determine the radiographic prevalence of AE pneumatization. Methods: Two hundred consecutive fine-cut temporal bone CT scans were retrospectively reviewed. The region of the petrosal bone at and above the level of the SCC dome was assessed for the presence of air cells, and graded 0 (no pneumatization) to 2 (well pneumatized). Results: Four hundred temporal bones were studied. The average age was 49 years (range 18-89). Of all AE assessments, 47 (12%) were nonpneumatized, 62 (15%) partially pneumatized, and 291 (73%) well pneumatized. There was no significant correlation between patient age and pneumatization grade (p = 0.72). Conclusion: The SCC is a valuable landmark in MCF surgery as it holds consistent relationships to adjacent critical structures. Surrounding air cells should facilitate safer initial identification of the SCC, as the AE region is well pneumatized in 73% of patients.

Current Opinion in Otolaryngology & Head and Neck Surgery, Oct 1, 2021

Purpose of review To highlight the recent literature on artificial intelligence (AI) pertaining t... more Purpose of review To highlight the recent literature on artificial intelligence (AI) pertaining to otological imaging and to discuss future directions, obstacles and opportunities. Recent findings The main themes in the recent literature centre around automated otoscopic image diagnosis and automated image segmentation for application in virtual reality surgical simulation and planning. Other applications that have been studied include identification of tinnitus MRI biomarkers, facial palsy analysis, intraoperative augmented reality systems, vertigo diagnosis and endolymphatic hydrops ratio calculation in Meniere's disease. Studies are presently at a preclinical, proof-of-concept stage. Summary The recent literature on AI in otological imaging is promising and demonstrates the future potential of this technology in automating certain imaging tasks in a healthcare environment of ever-increasing demand and workload. Some studies have shown equivalence or superiority of the algorithm over physicians, albeit in narrowly defined realms. Future challenges in developing this technology include the compilation of large high quality annotated datasets, fostering strong collaborations between the health and technology sectors, testing the technology within real-world clinical pathways and bolstering trust among patients and physicians in this new method of delivering healthcare.

Biomedical Optics Express, May 22, 2023

$Research paper thumbnail of Infracochlear Drainage of Cholesterol Granulomas with Double-Barrel Stents$

Journal of neurological surgery, Mar 16, 2013

Current Opinion in Otolaryngology & Head and Neck Surgery, Oct 1, 2014

Purpose of review Deafness is indeed a silent disability in many parts of the world, and the majo... more Purpose of review Deafness is indeed a silent disability in many parts of the world, and the majority of people who have hearing impairment live in developing countries. With rising economy and developing nations becoming hub of industrialization, hearing loss may increase in these countries. In this review, the authors have elected to focus the discussion on India to frame the challenges of cochlear implants in a developing country. This article reviews the common causes of hearing loss, the challenges faced by those with hearing impairment and why the penetration of these devices is low and also reviews some reasons for the inability of the government to support the implant programme in India. Recent findings Early identification of hearing is crucial towards ensuring appropriate hearing rehabilitation; it is, however, challenged by various factors, including public awareness, absence of a national new born screening programme, accessibility to diagnostic centres, availability of trained personnel and equipment and patient affordability. Cochlear implants are a proven auditory rehabilitative option for individuals with severe to profound sensorineural hearing loss, who otherwise do not benefiting from hearing aids. Nevertheless, only a small percentage of these individuals receive cochlear implants, and cost remains a leading prohibitive factor, particularly in developing countries. For example, in India, the personal average annual income is well below US 2000,whereasthesedevicescostbetween2000, whereas these devices cost between 2000,whereasthesedevicescostbetween12 000 and $25 000, exclusive of hospital and staff fees. Hence, the technology is virtually unavailable to the masses. Summary To overcome the cost limitation of those who would benefit from cochlear implants countries such as India and China have started to develop their own indigenous implants.

Journal of neurological surgery, Feb 1, 2012

Springer eBooks, Nov 9, 2013

Malformations affecting the ear encompass a wide spectrum of clinical entities. Interestingly, 50... more Malformations affecting the ear encompass a wide spectrum of clinical entities. Interestingly, 50 % of all congenital malformations of the head and neck involve the ear. These malformations may present themselves as cosmetic and/or functional defects and can occur in isolation or as part of a constellation of features that define various associations and syndromes. They can affect the outer, middle, and/or inner ear, frequently in combination. The embryologic development of the outer and middle ear differs from that of the inner ear; this is reflected in the clinical presentation of ear malformations and forms the basis for many of the classification systems employed in clinical practice. This chapter reviews the embryology of the ear as well as the diagnosis and management of the most common malformations.

American Journal of Otolaryngology, Jul 1, 2019

Objective: Assess clinical and functional outcomes of a modified palisade cartilage-perichondrium... more Objective: Assess clinical and functional outcomes of a modified palisade cartilage-perichondrium graft myringoplasty under local in an office setting. Study design: Retrospective case series Setting: Tertiary care facility Patients: Patients with a tympanic membrane perforation presenting between March 2013 and October 2017. Inclusion criteria included age ≥7 years, entire perforation margin visualized through a transcanal view, and the ability to lie supine for up to 45 minutes. Exclusion criteria included a conductive hearing loss larger than expected, and presence of active infection. Intervention: In-office modified myringoplasty technique under local anesthesia without sedation. Main outcome measures: Complete perforation closure rate and audiometric outcomes. Results: 250 patients underwent the procedure, of whom 13 had bilateral sequential procedures (total 263 ears). Of those, 197 were primary and 66 revision. Average age was 46.3 years. Perforation sizes were categorized as small (32), moderate (109), large (78), and subtotal (44). Complete perforation closure was evident in 219 of the 250 cases (88%). Preoperative mean air pure tone average (PTA) was 56.7 dB and mean bone PTA was 27.5 dB (pre-operative ABG 29.2 dB). AC-PTA significantly improved to 35.0 dB (p < 0.0001), and ABG to 9.6 dB (p < 0.0001). Only subtotal perforations showed a statistically significant negative relationship with outcome (p=0.04). Conclusion: The modified palisade cartilage-perichondrium graft myringoplasty under local anesthetic is a highly successful procedure well tolerated by adult and pediatric patients with variable perforation sizes. This may have significant potential patient benefits, as well as cost savings to the health care system.

$Research paper thumbnail of Do contemporary temporal bone fracture classification systems reflect concurrent intracranial and cervical spine injuries?$

Laryngoscope, Apr 25, 2011

1. Establish the prevalence of concurrent intracranial (ICI) and cervical spine injuries (CSI) in... more 1. Establish the prevalence of concurrent intracranial (ICI) and cervical spine injuries (CSI) in a series of patients with temporal bone fractures (TBFs) 2. Identify statistically significant associations between current TBF classification systems and either ICI or CSI.

Journal of Laryngology and Otology, Oct 24, 2006

Positional and positioning vertigo and nystagmus syndromes are usually due to peripheral vestibul... more Positional and positioning vertigo and nystagmus syndromes are usually due to peripheral vestibular dysfunction. The most common form is benign paroxysmal positioning. In this paper, we discuss more serious aetiologies in the differential diagnosis for patients presenting with a history suggestive of benign paroxysmal positioning vertigo. We draw attention to the diagnosis of cerebellar vermis lesions and tumours of the fourth ventricle by presenting two cases of patients with positional nystagmus of so called benign paroxysmal type. We review the literature on positional nystagmus, highlighting key findings on history and physical examination to aid in the correct diagnosis of benign paroxysmal positioning vertigo, and to differentiate it from the rare yet sinister central aetiologies that can present with positional vertigo of the benign positional type. This is with the aim to avoid over-investigating a common presentation without missing a serious diagnosis.

Current Opinion in Otolaryngology & Head and Neck Surgery, Aug 15, 2023

Otology & Neurotology, Aug 27, 2022