Background/Objectives: For patients with profound deafness resulting from auditory nerve pathology, as in Neurofibromatosis type 2, auditory brainstem implantation (ABI) can restore meaningful acoustic input. The literature reporting real-world results for ABI users is limited, especially regarding patients with bilateral implants. Here, we provide an updated report on the audiologic outcomes among all ABI patients treated at a tertiary institution, including high-performing bilateral ABI users. Methods: In this updated and expanded retrospective case series, audiologic outcomes were reviewed in sixteen consecutive patients who underwent ABI placement by a single neurosurgeon-neurotologist team at our center since 2018. Implantation in four of these patients was on their second side after having undergone first side implantation prior to receiving care at our hospital. Main outcome measures were sound awareness (sound-field threshold testing) and speech understanding (pattern perception, spondee, open-set speech testing). Results: Sound awareness was achieved in 100% of patients (16/16) using an average of 12 electrodes (range 7–20). Persistent non-auditory sensations were reported by 12.5% (2/16). Postoperative speech differentiation (with or without lip-reading) was experienced in 87.5% (14/16). Two second-sided ABI recipients experienced exceptional outcomes as high-performing outliers: one achieved 57% audio only and 86% audio + visual hearing in noise test (HINT) sentence scores; the second bilateral user scored 92% with auditory-only input. Conclusions: ABI represents a viable option for patients who are at risk of developing bilateral profound deafness resulting from auditory nerve disruption. Second sided device implantation is safe and has the potential to significantly improve auditory outcomes.

Drug overdose and poisoning deaths in the pediatric and adolescent population have recently surpassed cancer as the third-leading cause of death, resulting in the opioid epidemic being declared a public health emergency. Federal mandates, such as the Controlled Substance Utilization Review and Evaluation System (CURES) database that followed, were created to improve monitoring of opioid prescriptions. The impact of CURES on pain management for children and adolescents undergoing common arthroscopic procedures has not been assessed. Post-CURES reduction in opioid prescriptions will not result in additional postsurgical triage contacts or additional prescription needs in a pediatric and adolescent cohort undergoing arthroscopic procedures. Cohort study; Level of evidence, 3. Pediatric and adolescent patients (ages 10-19 years) undergoing common arthroscopic knee and shoulder procedures by a single surgeon at a single, tertiary care pediatric hospital from 2013 through 2023 were reviewed. Demographics, surgical details, and postoperative outcomes were compared across pre- (before 2018) and post-CURES (2018 and later) cohorts defined as before and after implementation of a change in opioid prescription habits that occurred in response to the mandatory reporting in CURES. Primary outcomes included phone calls or messages to the triage nurse related to pain. Secondary outcomes included additional opioid prescriptions required to manage pain. The post-CURES cohort (N = 224) was prescribed significantly fewer morphine milligram equivalents (total MMEs prescribed) compared with the pre-CURES cohort (N = 244) (89.4 ± 8.3 vs 444.3 ± 66.0; P < .001). Patients in the post-CURES cohort were more likely to call regarding pain (13% vs 7%; P = .03). However, there were no differences in additional pain prescriptions required (4% pre- vs 4% post-CURES; P≥ .99) to manage pain. Despite a nearly 5-fold decrease in total MMEs prescribed, there was no increase in additional pain prescriptions required even though there was a 2-fold increase in messages related to pain to the triage nurse via education and reassurance. The hypothesis was upheld in part, suggesting that effective pain management can be achieved with fewer opioids, but that the postoperative care of adolescents undergoing arthroscopy could be further improved.