“It does seem like there are consistent improvements at six months across some domains, and additional gains may be seen at 12 months after cochlear implantation in the same domains or in additional domains,” Dr. Moberly said.
Explore This IssueJune 2022
“I take with a grain of salt the actual, specific findings of which domains were affected because all these tests are different.” More consistent tests would help pinpoint the areas that are truly improving, he said.
Enrolling patients who have shown a more serious decline at the time of receiving their implant in similar studies would also help the field, he said. “As otologists, occasionally we see these patients who have obvious cognitive deficits already—what do we do with them, and what’s the best way to clinically manage them?” he said. “And how much do we expect improvement in cognition? We have to be careful about how we talk to our patients about that.”
HPV Vaccination in Older Individuals
Maie St. John, MD, PhD, chair of head and neck surgery at the University of California, Los Angeles, shared evidence to support human papillomavirus (HPV) vaccination in adult individuals.
“Given the demonstrated benefits in women and men age 26 to 45, even in those with prior HPV infection, as well as the high safety profile, we should be recommending the HPV vaccine to all our patients age 26 to 45 who have not yet been vaccinated, based on published evidence,” she said.
In 2018, the FDA expanded the age range for vaccine approval from 9 to 26 years of age to 9 to 45 years of age. Still, uptake of the vaccine is less than ideal— it currently stands at less than 60% for adolescents and young adults, said Dr. St. John.
In 2020, the agency approved the vaccine for preventing oropharyngeal cancer, but the Advisory Committee on Immunization Practices did not expressly recommend routine HPV vaccination for adults 26 to 45 years old, saying it could be given with shared decision-making between physicians and patients. There is concern that this could be seen as a recommendation against the vaccine, Dr. St. John said, but this shouldn’t be the perception.
A phase 3 trial of almost 5,000 women ages 26 to 45 found that the HPV vaccine against the 16 and 18 strains showed 50% to 70% efficacy in reducing persistent infections over a six-month period and in low-grade squamous intraepithelial cervical lesions, regardless of whether the women had been infected with HPV previously. The vaccine also cross-protected against HPV types 31 and 45, which are also oncogenic, Dr. St. John said (Lancet Infect Dis. 2016;16:1154-1168).