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OBJECTIVE: To determine if increasing obstructive sleep apnea syndrome (OSAS) severity, as determined by preoperative polysomnography data, is an independent risk for respiratory complications and level of follow-up care after adenotonsillectomy or tonsillectomy. METHODS: A retrospective analysis of patients ≤21 years of age with severe OSAS (obstructive apnea-hypopnea index [OAHI] >10) undergoing adenotonsillectomy or tonsillectomy. Patients were categorized based on preoperative polysomnography data (PSG). Outcome measures including respiratory complications were collected via chart review. Logistic regression was used in the analysis of all parameters, and Wilcoxon Rank Sum tests were used for analysis of both OAHI and oxygen saturation nadir as continuous variables. All surgeries were performed at Johns Hopkins Hospital, a tertiary care center. RESULTS: We identified 358 patients with severe OSAS who had adenotonsillectomy or tonsillectomy. OAHI >40 and oxygen saturation nadir <80% were significantly associated with postoperative respiratory complications. Increasing OAHI and O2 saturation <80% was each associated with unplanned continuous positive airway pressure (CPAP) initiations postoperatively. There was no association between hypercarbia and presence of any complications. CONCLUSION: Patients with very severe OSAS (preoperative OAHI ≥40) as determined by preoperative PSG may be at higher risk of developing respiratory complications postoperatively. However, there does not appear to be a linear association with increasing severity of OAHI on regression analysis. Further research is needed to understand factors associated with complications in severe and very severe OAHI. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:4148-4155, 2024.

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This paper presents inversion results for three datasets collected on three spatially separated mud depocenters (hereafter called mud ponds) during the 2022 Seabed Characterization Experiment (SBCEX). The data considered here represent modal time-frequency (TF) dispersion as estimated from a single hydrophone. Inversion is performed using a trans-dimensional (trans-D) Bayesian inference method that jointly estimates water-column and seabed properties along with associated uncertainties. This enables successful estimation of the seafloor properties, consistent with in situ acoustic core measurements, even when the water column is dynamical and mostly unknown. A quantitative analysis is performed to (1) compare results with previous modal TF trans-D studies for one mud pond but under different oceanographic condition, and (2) inter-compare the new SBCEX22 results for the three mud ponds. Overall, the estimated mud geoacoustic properties show no significant temporal variability. Further, no significant spatial variability is found between two of the mud ponds while the estimated geoacoustic properties of the third are different. Two hypotheses, considered to be equally likely, are explored to explain this apparent spatial variability: it may be the result of actual differences in the mud properties, or the mud properties may be similar but the inversion results are driven by difference in data information content.

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This paper reports on an observation of three-dimensional (3D) arrivals for which the change in the direction of horizontally refracted sound is nearly 180°. The experimental site is Jan Mayen Channel (JMCh), which connects the Greenland and Norwegian Seas. During the experiment, signals from a moored source transmitting a 500-1500 Hz sweep every 4 h were recorded by three surface drifters equipped with hydrophone arrays. Over a 3-day period, the drifters moved north across JMCh toward the moored source. In each recording, an in-plane arrival is identified. In a subset of these recordings, a second arrival is observed, having travel time consistent with propagation from the moored source, turning at the ridge on the south side of the channel, and arriving at the drifters. In a smaller subset of recordings, a third arrival is also observed having travel time consistent with a turning point on the face of the bathymetric rise on the west end of the channel that forms the Jan Mayen volcano. A 3D ray trace is employed to show the change in direction results from repeated reflections from the seafloor such that it is classified as horizontal refraction and not a single-bounce reflection.

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This paper explores the challenging polyphonic sound event detection problem using machine learning architectures applied to data recorded in the Beaufort Sea during the Canada Basin Acoustic Propagation Experiment. Four candidate architectures were investigated and evaluated on nine classes of signals broadcast from moored sources that were recorded on a vertical line array of hydrophones over the course of the yearlong experiment. These signals represent a high degree of variability with respect to time-frequency characteristics, changes in signal-to-noise ratio (SNR) associated with varying signal levels as well as fluctuating ambient sound levels, and variable distributions, which resulted in class imbalances. Within this context, binary relevance, which decomposes the multi-label learning task into a number of independent binary learning tasks, was examined as an alternative to the conventional multi-label classification (MLC) approach. Binary relevance has several advantages, including flexible, lightweight model configurations that support faster model inference. In the experiments presented, binary relevance outperformed conventional MLC approach on classes with the most imbalance and lowest SNR. A deeper investigation of model performance as a function of SNR showed that binary relevance significantly improved recall within the low SNR range for all classes studied.

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OBJECTIVE: Parents often experience uncertainty during decision-making for their child's cochlear implantation (CI) surgery, and online forums provide insight on parental opinions that might not be expressed in clinic. This study aims to evaluate parental perspectives and concerns about pediatric CI using social media analysis. STUDY DESIGN: Qualitative study. SETTING: Three online forums involving parental posts about pediatric CI. INTERVENTION/METHODS: Forums were queried using keywords (e.g., "cochlear implant") to gather all U.S. parent-initiated posts about pediatric CI from 2006 to 2021. Thematic content analysis was performed to classify posts by overarching domain, themes, and subthemes. Posts were reviewed for thematic synthesis and double coded. Descriptive statistics were calculated for each theme by unique users. RESULTS: A total of 79 posts by 41 unique users were analyzed. Themes relating to decision for CI included facilitators, inhibitors, resources, and feelings. Parents posted about lack of benefit from hearing aids promoting decision for CI and high cost as an inhibitor. Some expressed concern about making a major decision for a minor. Parents often mentioned their child's healthcare providers and social media as resources. CONCLUSION: Through social media posts, parental priorities and concerns for decision-making of CI surgery were identified. Findings may guide discussions between physicians and parents and facilitate shared decision-making about CI.

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Seagrasses play an important role in coastal ecosystems and serve as important marine carbon stores. Acoustic monitoring techniques exploit the sensitivity of underwater sound to bubbles, which are produced as a byproduct of photosynthesis and present within the seagrass tissue. To make accurate assessments of seagrass biomass and productivity, a model is needed to describe acoustic propagation through the seagrass meadow that includes the effects of gas contained within the seagrass leaves. For this purpose, a new seagrass leaf model is described for Thalassia testudinum that consists of a comparatively rigid epidermis that composes the outer shell of the leaf and comparatively compliant aerenchyma that surrounds the gas channels on the interior of the leaf. With the bulk modulus and density of the seagrass tissue determined by previous work, this study focused on characterizing the shear moduli of the epidermis and aerenchyma. These properties were determined through a combination of dynamic mechanical analysis and acoustic resonator measurements coupled with microscopic imagery and finite element modeling. The shear moduli varied as a function of length along the leaves with values of 100 and 1.8 MPa at the basal end and 900 and 3.7 MPa at the apical end for the epidermis and aerenchyma, respectively.

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Acoustic propagation measurements were collected in a seagrass meadow in a shallow lagoon for periods of over 65 h in winter and 93 h in summer. A bottom-deployed sound source transmitted chirps (0.1-100 kHz) every 10 min that were received on a four-receiver horizontal hydrophone array. Oceanographic probes measured various environmental parameters. Daytime broadband acoustic attenuation was 2.4 dB greater in summer than winter, and the median received acoustic energy levels were 8.4 dB lower in summer compared to winter. These differences were attributed in part to seasonal changes in photosynthesis bubble production and above-ground seagrass biomass.

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Infauna influence geoacoustic parameters in surficial marine sediments. To investigate these effects, an experiment was conducted in natural sand-silt sediment in the northern Gulf of Mexico. In situ acoustic measurements of sediment sound speed, attenuation, and shear speed were performed, and sediment cores were collected from the upper 20 cm of the seabed. Laboratory measurements of sound speed and attenuation in the cores were conducted, after which the core contents were analyzed for biological and physical properties. Since no model currently accounts for the effects of infauna, a deviation from model predictions is expected. To assess the extent of this, acoustic measurements were compared with the viscous grain shearing model from Buckingham [J. Acoust. Soc. Am. 122, 1486 (2007); J. Acoust. Soc. Am. 148, 962 (2020)], for which depth-dependent profiles of sediment porosity and mean grain size measured from the cores were used as input parameters. Comparison of acoustic results with distributions of infauna, worm tubes, and shell hash suggests biogenic impacts on acoustic variability and model accuracy are important in surficial marine sediments. The presence of infauna and worm tubes were correlated with higher variability in both sound speed and attenuation and greater deviation from the model near the sediment-water interface.

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Glacier ice loss impacts sound propagation within Arctic fjords. Regular calving events contribute to a collection of floating ice fragments, known as brash ice, at the ocean surface that obstruct the natural and anthropogenic acoustic signals, yet are difficult to characterize. Transmission loss measurements using a maximum length sequence (m-sequence) signal were conducted in September 2017 near Hansbreen glacier in Hornsund Fjord, Svalbard with dense brash ice present at the water surface. An acoustic model of the brash ice surface was inferred through consideration of the experimental geometry, arrival amplitude, and travel time difference between the direct and surface reflected arrivals from the source to two receivers. The inferred surface was then incorporated into a forward simulation of the environment using sound speed profiles measured during the experiment. BELLHOP ([Porter and Bucker (1987). J. Acoust. Soc. Am. 82(4), 1349-1359],), a ray tracing code available in the Acoustics Toolbox (HLS Inc., San Diego, CA), was used to track the time difference of arrivals and amplitudes of the modeled direct and surface reflected rays. Comparisons between the measured and simulated results provide insight into the geometric shape and reflection characteristics of the brash ice surface within this and similar environments.

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Changes in the Arctic environment with regard to declining sea ice are expected to alter the ambient sound field, affecting both the sound generating processes and the sound propagation. This paper presents acoustic recordings collected on the 150-m isobath on the Chukchi Shelf over a yearlong period spanning October 2016 to October 2017. The analysis uses sections of recordings approximately 12 min long collected six times daily. The measurements were collected on a vertical line array spanning the lower 110 m of the water column. The 25th percentile level is used to characterize the spectral shape of the background sound between 40 Hz and 4 kHz. The ambient sound data are analyzed using k-means clustering to quantify the occurrence of six spectral shapes over the yearlong experiment. Each cluster type is associated with a different sound generation process based on the correlations with environmental observations. The cluster observed most frequently was associated with wind-generated sound based on a correlation of sound level with wind speed as well as occurrence during the open water season. The cluster with the smallest number of observations was attributed to wind effects on frazil ice forming in open leads during the ice-covered season.

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The Pacific Arctic Region has experienced decadal changes in atmospheric conditions, seasonal sea-ice coverage, and thermohaline structure that have consequences for underwater sound propagation. To better understand Arctic acoustics, a set of experiments known as the deep-water Canada Basin acoustic propagation experiment and the shallow-water Canada Basin acoustic propagation experiment was conducted in the Canada Basin and on the Chukchi Shelf from summer 2016 to summer 2017. During the experiments, low-frequency signals from five tomographic sources located in the deep basin were recorded by an array of hydrophones located on the shelf. Over the course of the yearlong experiment, the surface conditions transitioned from completely open water to fully ice-covered. The propagation conditions in the deep basin were dominated by a subsurface duct; however, over the slope and shelf, the duct was seen to significantly weaken during the winter and spring. The combination of these surface and subsurface conditions led to changes in the received level of the sources that exceeded 60 dB and showed a distinct spacio-temporal dependence, which was correlated with the locations of the sources in the basin. This paper seeks to quantify the observed variability in the received signals through propagation modeling using spatially sparse environmental measurements.

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Seagrasses provide a multitude of ecosystem services and serve as important organic carbon stores. However, seagrass habitats are declining worldwide, threatened by global climate change and regional shifts in water quality. Acoustical methods have been applied to assess changes in oxygen production of seagrass meadows since sound propagation is sensitive to the presence of bubbles, which exist both within the plant tissue and freely floating the water as byproducts of photosynthesis. This work applies acoustic remote sensing techniques to characterize two different regions of a seagrass meadow: a densely vegetated meadow of Thalassia testudinum and a sandy region sparsely populated by isolated stands of T. testudinum. A Bayesian approach is applied to estimate the posterior probability distributions of the unknown model parameters. The sensitivity of sound to the void fraction of gas present in the seagrass meadow was established by the narrow marginal probability distributions that provided distinct estimates of the void fraction between the two sites. The absolute values of the estimated void fractions are biased by limitations in the forward model, which does not capture the full complexity of the seagrass environment. Nevertheless, the results demonstrate the potential use of acoustical methods to remotely sense seagrass health and density.

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The activities of infaunal organisms, including feeding, locomotion, and home building, alter sediment physical properties including grain size and sorting, porosity, bulk density, permeability, packing, tortuosity, and consolidation behavior. These activities are also known to affect the acoustic properties of marine sediments, although previous studies have demonstrated complicated relationships between infaunal activities and geoacoustic properties. To avoid difficulties associated with real animals, whose exact locations and activities are unknown, this work uses artificial burrows and simulates infaunal activities such as irrigation, compaction, and tube building in controlled laboratory experiments. The results show statistically significant changes in sound speed and attenuation over a frequency range of 100-400 kHz, corresponding to wavelengths on the order of the burrow diameter. The greatest effects were observed for tubes constructed of hard shells which increased the attenuation by ∼30 dB m-1 across the measurement band. These results highlight the importance of biogenic hard structures such as tubes on sound attenuation and suggest that organisms that create hard structures may be good targets for acoustic mapping of infaunal abundance and distribution.

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OBJECTIVES/HYPOTHESIS: P2RX2 encoding P2X purinoreceptor 2 has been identified as the gene responsible for autosomal dominant deafness-41 (DFNA41) as well as mediating vulnerability to noise-induced hearing loss (NIHL). The objective of this study was to investigate the audiological and molecular characteristics of P2RX2-related deafness, with emphasis on its role in NIHL by determining the audiological characteristics of a previously reported six-generation DFNA41 family with a 10-year follow-up. We have also summarized phenotype-genotype correlations of P2RX2-related deafness in human and mouse models. STUDY DESIGN: We describe clinical longitudinal follow-up in the DFNA41 family with P2RX2 (p.Val60Leu) mutation and perform a systematic literature search in PubMed and poster presentations on meeting/conference websites to identify current insights into P2RX2-mediated NIHL. METHODS: Clinical and physical examinations of the family members were performed, and audiograms were obtained to assess the hearing thresholds. Clinical follow-up features in this DFNA41 family are presented along with correlation analyses of phenotype-genotype in all reported families with P2RX2-related deafness. RESULTS: Progressive hearing impairment was confirmed by history and by audiological follow-up testing in all the patients. The onset of hearing loss was between age 25 and 35 years. All affected subjects had bilateral sensorineural hearing loss involving all frequencies with some significant gender differences. CONCLUSIONS: Our study and the review of the literature suggest that P2RX2 plays a crucial role in predisposition to noise-induced and age-related hearing loss. A better knowledge about the P2RX2-associated genetic variants can help in developing novel therapeutic strategies. LEVEL OF EVIDENCE: 2b Laryngoscope, 130:1657-1663, 2020.

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Acoustic propagation measurements were conducted in a Thalassia testudinum meadow in the Lower Laguna Madre, a shallow bay on the Texas Gulf of Mexico coast. A piezoelectric source transmitted frequency-modulated chirps (0.1 to 100 kHz) over a 24-h period during which oceanographic probes measured environmental parameters including dissolved oxygen and solar irradiance. Compared to a nearby less vegetated area, the received level was lower by as much as 30 dB during the early morning hours. At the peak of photosynthesis-driven bubble production in the late afternoon, an additional decrease in level of 11 dB was observed.

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This work examines three-dimensional (3D) propagation caused by interaction with the sea ice canopy using an approximate normal mode/parabolic equation hybrid model. The effects of horizontal refraction are assessed through comparison of two-dimensional (2D) and 3D solutions for the modal amplitudes and depth-averaged transmission loss. The following 3D effects are described: diffraction of sound into shadow zones behind ice keels, horizontal defocusing of sound behind ice keels, and horizontal focusing of sound that has propagated between ice keels. A statistical analysis shows that the 3D solution is characterized by 20% greater variance in the depth-averaged transmission loss than the 2D solution.

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Two Autonomous Underwater Multi-Dimensional Acoustic Recorders (AUMDAR) were deployed in the southeastern part of Lake Travis during the summer of 2018. Each AUMDAR system possessed a three-axis acoustic vector sensor capable of estimating the azimuthal and vertical arrival angles from discrete sound sources. A unique and complicated propagation environment existed during the experiment due to the mooring locations and the range-dependent lake bathymetry. The AUMDAR systems were almost entirely shielded from sound emanating from surface vessels to the south and southeast of the deployment location, while a larger, yet limited, direct acoustical field of view was realized to the north and northeast. During the evening hours, the low-frequency received level increased without a corresponding increase in the number of detected discrete surface vessels. During the same time, the predominant direction of the received sound pointed toward the bend in the river channel. A three-dimensional ray model was employed to assess the various arrival angles from a grid of source positions located throughout the lake. The model results are consistent with the observations and suggest that the ambient noise field originated from vessels physically located to the northwest of the sensors, but arriving at angles consistent with out-of-plane sound propagation.

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Scale-model tank experiments offer a controlled environment in which to make underwater acoustic propagation measurements that can provide high-quality data for comparison with numerical models. This paper presents results from a scale model experiment for a translationally invariant wedge with a 10° slope fabricated from closed-cell polyurethane foam to investigate three-dimensional (3-D) propagation effects. A computer controlled positioning system accurately located a receiving hydrophone in 3-D space to create a dense field of synthetic vertical line arrays, which are subsequently used to mode filter the measured pressure field. The resulting mode amplitudes show the modal propagation zone, the modal shadow zone, and the classical intra-mode interference pattern resulting from rays launched up and along the slope. The observed features of the measured data are compared to three different propagation models: an exact, closed-form solution for a point source in wedge with pressure release boundaries, a 3-D ray trace model, and an adiabatic model. Examination of the mode amplitudes produced by the models reveals how the effects of vertical mode coupling can be observed in the measured data.

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Two scale-model acoustic propagation experiments were conducted in a laboratory tank to investigate three-dimensional (3D) propagation effects induced by range-dependent bathymetry. The model bathymetry, patterned after measured bathymetric data, represents a portion of the Hudson Canyon at 1:7500 scale. The bottom condition in the scale model is nearly pressure release, and as a result, the bottom reflection and backscattering are stronger than that of the real ocean environment. Measurements are presented for propagation paths oriented along and across the axis of the canyon. The measured data are interpreted using both 3D adiabatic-mode and 3D ray models. For propagation along the canyon axis, horizontal focusing is observed, and the out-of-plane arrivals are identified using the vertical mode/horizontal ray analogy to determine which wall or walls of the canyon refracted the sound. For the across-canyon propagation, out-of-plane arrivals are observed for both forward scattered and backward scattered sound. Using the 3D ray model, an investigation of the horizontal and vertical launch angles is used to identify features on the canyon walls responsible for the measured out-of-plane propagation. For both the along- and across-canyon experiments, the 3D ray model produced a solution that was more accurate and less computationally intensive.

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An acoustic propagation experiment was conducted in Currituck Sound to characterize low-frequency propagation in a very-shallow-water estuarine environment. The water column properties were homogeneous over the study area, and the emphasis of this work is on understanding the propagation effects induced by the estuarine bed. During the experiment, low-frequency sound propagation measurements of waterborne sound and interface waves were acquired, and direct measurements of the compressional and shear wave properties were obtained at high frequencies. The propagation data consist of signals from a Combustive Sound Source recorded on bottom mounted geophones and a vertical line array of hydrophones. A statistical inference method was applied to obtain an estimate of the sediment compressional and shear wave speed profiles as a function of depth within the estuarine bed. The direct measurements were obtained in situ by inserting probes 30 cm into the sediment. Sediment acoustics models were fit to the high-frequency in situ data to enable comparison with the inferred low-frequency wave speeds. Overall, good agreement was found between the directly measured and inferred wave speeds for both the compressional and shear wave data.