The maxillary defect after ablative tumor surgery typically involves the mucosal lining, the midface osseous framework, and the adjacent soft tissue.¹ Reconstruction of this defect remains a considerable challenge because the 3-dimensional architecture of the midface serves both functional and aesthetic roles. Based on these considerations, the final goals for midface reconstruction should ideally be (1) to give support to the orbital content, thus minimizing changes in globe position, orbital volume, and eyelid functions, or treat the exenterated orbit cosmetically; (2) to maintain a patent nasal airway and oronasal separation creating a sufficient platform for mastication, speech quality, and potential dental rehabilitation; and (3) to restore an adequate and symmetric facial contour with the other side of the face.²

The main objective of this study was to determine the influence of listening environment and earphone style on the preferred-listening levels (PLLs) measured in users' ear canals with a commercially-available MP3 player. It was hypothesized that listeners would prefer higher levels with earbud headphones as opposed to over-the-ear headphones, and that the effects would depend on the environment in which the user was listening. A secondary objective was to use the measured PLLs to determine the permissible listening duration to reach 100% daily noise dose. There were two independent variables in this study. The first, headphone style, had three levels: earbud, over-the-ear, and over-the-ear with noise reduction (the same headphones with a noise reduction circuit). The second, environment, also had 3 levels: quiet, street noise and multi-talker babble. The dependent variable was ear canal A-weighted sound pressure level. A 3 × 3 within-subjects repeated-measures ANOVA was used to analyze the data. Thirty-eight normal hearing adults were recruited from the Faculty of Rehabilitation Medicine at the University of Alberta. Each subject listened to the same song and adjusted the level until it “sounded best” to them in each of the 9 conditions. Significant main effects were found for both the headphone style and environment factors. On average, listeners had higher preferred listening levels with the earbud headphones, than with the over-the-ear headphones. When the noise reduction circuit was used with the over-the-ear headphones, the average PLL was even lower. On average, listeners had higher PLLs in street noise than in multi-talker babble and both of these were higher than the PLL for the quiet condition. The interaction between headphone style and environment was also significant. Details of individual contrasts are explored. Overall, PLLs were quite conservative, which would theoretically allow for extended permissible listening durations. Finally, we investigated the maximum output level of the MP3 player in the ear canals of authors 1 and 3 of this paper. Levels were highest with the earbud style, followed by the over-the-ear with noise reduction. The over-the-ear headphone without noise reduction had the lowest maximum output. The majority of MP3 players are sold with the earbud style of headphones. Preferred listening levels are higher with this style of headphone compared to the over-the-ear style. Moreover, as the noise level in the environment increases, earbud users are even more susceptible to background noise and consequently increase the level of the music to overcome this. The result is an increased sound pressure level at the eardrum. However, the levels chosen by our subjects suggest that MP3 listening levels may not be as significant a concern as has been reported recently in the mainstream media.

Research from JAMA Otolaryngology–Head & Neck Surgery — Long-term Outcomes of Submandibular Gland Transfer for Prevention of Postradiation Xerostomia