Audiology by Alexandros G. Sfakianakis: Μαΐου 2016

Τρίτη 31 Μαΐου 2016

Lidocaine Tinnitus

In the United States, up to 35 percent of adults will experience an episode of tinnitus. Although most cases of tinnitus are temporary, chronic tinnitus can be incapacitating, making it difficult for you to function and hear the sounds that you want to hear. If you suffer from worsening volume of tinnitus, lidocaine tinnitus may be a solution for you.

Who Qualifies for Lidocaine Tinnitus?
Lidocaine is a way to treat chronic tinnitus that has been worsening over a period of 4 to 8 weeks or longer. Lidocaine would not be used to treat temporary tinnitus. About 8 percent of people have chronic tinnitus and would be under consideration for treatment with lidocaine. Your doctor may evaluate your symptoms and perform some tests such as an EKG to check for abnormal heart rhythms and a hearing exam to check for worsening hearing loss to make sure that you are healthy enough to receive lidocaine tinnitus.

How Lidocaine for Tinnitus Works
Lidocaine for tinnitus is administered intravenously. The medication is added to a saline solution in an intravenous solution bag and delivered to you through a vein. The medication takes 30 to 60 minutes to get into your body. Once the lidocaine is absorbed into your body, it works to numb the nerve endings in your auditory system. When the nerve endings are less stimulated, you will experience a lessening of the volume of your tinnitus. The lidocaine may also reduce hyperactivity of the nerves within your ears. Your normal sense of hearing will not be diminished due to the lidocaine. Some doctors will treat you with a single IV of lidocaine every couple of months to prevent your symptoms from worsening. Other doctors will give you IV lidocaine once per day for a few consecutive days to eliminate tinnitus symptoms.

Benefits of Lidocaine for Tinnitus
There are many benefits to using lidocaine for incapacitating tinnitus symptoms. Lidocaine is generally regarded as safe and has been widely used in dentistry and medicine to provide local anesthesia for minor procedures such as dental fillings or stitches. There is a minimal amount of pain when getting lidocaine for tinnitus. The only pain you are likely to experience is when the IV line is placed. The lidocaine treatment should last for several months, providing you with a long duration of relief from your tinnitus symptoms. Most people experience no side effects from lidocaine injections.

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Speech Perception in Classroom Acoustics by Children With Cochlear Implants and With Typical Hearing

Purpose

This study measured speech perception ability in children with cochlear implants and children with typical hearing when listening across ranges of reverberation times (RTs) and speech-to-noise ratios.

Method

Participants listened in classroom RTs of 0.3, 0.6, and 0.9 s combined with a 21-dB range of speech-to-noise ratios. Subsets also listened in a low-reverberant audiological sound booth. Performance measures using the Bamford-Kowal-Bench Speech-in-Noise Test (Etymotic Research, Inc., 2005) were 50% correct word recognition across these acoustic conditions, with supplementary analyses of percent correct.

Results

Reduction in RT from 0.9 to 0.6 s benefited both groups of children. A further reduction in RT to 0.3 s provided additional benefit to the children with cochlear implants, with no further benefit or harm to those with typical hearing. Scores in the sound booth were significantly higher for the participants with implants than in the classroom.

Conclusions

These results support the acoustic standards of 0.6 s RT for children with typical hearing and 0.3 s RT for children with auditory issues in learning spaces (≤283 m³) as specified in standards S12.60-2010/Part 1 of the American National Standards Institute /Acoustical Society of America (2010). In addition, speech perception testing in a low-reverberant booth overestimated classroom listening ability in children with cochlear implants.

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Speech Perception in Classroom Acoustics by Children With Cochlear Implants and With Typical Hearing

Purpose

Method

Results

Conclusions

Speech Perception in Classroom Acoustics by Children With Cochlear Implants and With Typical Hearing

Purpose

Method

Results

Conclusions

These results support the acoustic standards of 0.6 s RT for children with typical hearing and 0.3 s RT for children with auditory issues in learning spaces (≤283 m³) as specified in standards S12.60-2010/Part 1 of the American National Standards Institute /Acoustical Society of America (2010). In addition, speech perception testing in a low-reverberant booth overestimated classroom listening ability in children with cochlear implants.

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Save Your Hearing Day

May 31 ends Better Hearing and Speech Month with National #SaveYourHearingDay. It is important to take some time to learn ways to protect your hearing and that of your family. Our hearing is vital, and there are ways that hearing loss can be avoidable.

There are various reasons from which hearing loss can be the result, including the following:

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Impact of peripheral hearing loss on top-down auditory processing

Publication date: Available online 31 May 2016
Source:Hearing Research
Author(s): Alexandria M.H. Lesicko, Daniel A. Llano
The auditory system consists of an intricate set of connections interposed between hierarchically arranged nuclei. The ascending pathways carrying sound information from the cochlea to the auditory cortex are, predictably, altered in instances of hearing loss resulting from blockage or damage to peripheral auditory structures. However, hearing loss-induced changes in descending connections that emanate from higher auditory centers and project back toward the periphery are still poorly understood. These pathways, which are the hypothesized substrate of high-level contextual and plasticity cues, are intimately linked to the ascending stream, and are thereby also likely to be influenced by auditory deprivation. In the current report, we review both the human and animal literature regarding changes in top-down modulation after peripheral hearing loss. Both aged humans and cochlear implant users are able to harness the power of top-down cues to disambiguate corrupted sounds and, in the case of aged listeners, may rely more heavily on these cues than non-aged listeners. The animal literature also reveals a plethora of structural and functional changes occurring in multiple descending projection systems after peripheral deafferentation. These data suggest that peripheral deafferentation induces a rebalancing of bottom-up and top-down controls, and that it will be necessary to understand the mechanisms underlying this rebalancing to develop better rehabilitation strategies for individuals with peripheral hearing loss.

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A cool approach to reducing electrode-induced trauma: localized therapeutic hypothermia conserves residual hearing in cochlear implantation

Publication date: Available online 31 May 2016
Source:Hearing Research
Author(s): Ilmar Tamames, Curtis King, Esperanza Bas, W. Dalton Dietrich, Fred Telischi, Suhrud M. Rajguru
ObjectiveThe trauma caused during cochlear implant insertion can lead to cell death and a loss of residual hair cells in the cochlea. Various therapeutic approaches have been studied to prevent cochlear implant-induced residual hearing loss with limited success. In the present study, we show the efficacy of mild to moderate therapeutic hypothermia of 4 to 6ºC applied to the cochlea in reducing residual hearing loss associated with the electrode insertion trauma.ApproachRats were randomly distributed in three groups: control contralateral cochleae, normothermic implanted cochleae and hypothermic implanted cochleae. Localized hypothermia was delivered to the middle turn of the cochlea for 20 minutes before and after implantation using a custom-designed probe perfused with cooled fluorocarbon. Auditory brainstem responses (ABRs) were recorded to assess the hearing function prior to and post-cochlear implantation at various time points up to 30 days. At the conclusion of the trials, inner ears were harvested for histology and cell count. The approach was extended to cadaver temporal bones to study the potential surgical approach and efficacy of our device. In this case, the hypothermia probe was placed next to the round window niche via the facial recess or a myringotomy.Main ResultsA significant loss of residual hearing was observed in the normothermic implant group. Comparatively, the residual hearing in the cochleae receiving therapeutic hypothermia was significantly conserved. Histology confirmed a significant loss of outer hair cells in normothermic cochleae receiving the surgical trauma when compared to the hypothermia treated group. In human temporal bones, a controlled and effective cooling of the cochlea was achieved using our approach.SignificanceCollectively, these results suggest that therapeutic hypothermia during cochlear implantation may reduce traumatic effects of electrode insertion and improve conservation of residual hearing.

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Impact of peripheral hearing loss on top-down auditory processing

A cool approach to reducing electrode-induced trauma: localized therapeutic hypothermia conserves residual hearing in cochlear implantation

Impact of peripheral hearing loss on top-down auditory processing

Publication date: Available online 31 May 2016
Source:Hearing Research
Author(s): Alexandria M.H. Lesicko, Daniel A. Llano
The auditory system consists of an intricate set of connections interposed between hierarchically arranged nuclei. The ascending pathways carrying sound information from the cochlea to the auditory cortex are, predictably, altered in instances of hearing loss resulting from blockage or damage to peripheral auditory structures. However, hearing loss-induced changes in descending connections that emanate from higher auditory centers and project back toward the periphery are still poorly understood. These pathways, which are the hypothesized substrate of high-level contextual and plasticity cues, are intimately linked to the ascending stream, and are thereby also likely to be influenced by auditory deprivation. In the current report, we review both the human and animal literature regarding changes in top-down modulation after peripheral hearing loss. Both aged humans and cochlear implant users are able to harness the power of top-down cues to disambiguate corrupted sounds and, in the case of aged listeners, may rely more heavily on these cues than non-aged listeners. The animal literature also reveals a plethora of structural and functional changes occurring in multiple descending projection systems after peripheral deafferentation. These data suggest that peripheral deafferentation induces a rebalancing of bottom-up and top-down controls, and that it will be necessary to understand the mechanisms underlying this rebalancing to develop better rehabilitation strategies for individuals with peripheral hearing loss.

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A cool approach to reducing electrode-induced trauma: localized therapeutic hypothermia conserves residual hearing in cochlear implantation

Publication date: Available online 31 May 2016
Source:Hearing Research
Author(s): Ilmar Tamames, Curtis King, Esperanza Bas, W. Dalton Dietrich, Fred Telischi, Suhrud M. Rajguru
ObjectiveThe trauma caused during cochlear implant insertion can lead to cell death and a loss of residual hair cells in the cochlea. Various therapeutic approaches have been studied to prevent cochlear implant-induced residual hearing loss with limited success. In the present study, we show the efficacy of mild to moderate therapeutic hypothermia of 4 to 6ºC applied to the cochlea in reducing residual hearing loss associated with the electrode insertion trauma.ApproachRats were randomly distributed in three groups: control contralateral cochleae, normothermic implanted cochleae and hypothermic implanted cochleae. Localized hypothermia was delivered to the middle turn of the cochlea for 20 minutes before and after implantation using a custom-designed probe perfused with cooled fluorocarbon. Auditory brainstem responses (ABRs) were recorded to assess the hearing function prior to and post-cochlear implantation at various time points up to 30 days. At the conclusion of the trials, inner ears were harvested for histology and cell count. The approach was extended to cadaver temporal bones to study the potential surgical approach and efficacy of our device. In this case, the hypothermia probe was placed next to the round window niche via the facial recess or a myringotomy.Main ResultsA significant loss of residual hearing was observed in the normothermic implant group. Comparatively, the residual hearing in the cochleae receiving therapeutic hypothermia was significantly conserved. Histology confirmed a significant loss of outer hair cells in normothermic cochleae receiving the surgical trauma when compared to the hypothermia treated group. In human temporal bones, a controlled and effective cooling of the cochlea was achieved using our approach.SignificanceCollectively, these results suggest that therapeutic hypothermia during cochlear implantation may reduce traumatic effects of electrode insertion and improve conservation of residual hearing.

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Impact of peripheral hearing loss on top-down auditory processing

A cool approach to reducing electrode-induced trauma: localized therapeutic hypothermia conserves residual hearing in cochlear implantation

Impact of peripheral hearing loss on top-down auditory processing

A cool approach to reducing electrode-induced trauma: localized therapeutic hypothermia conserves residual hearing in cochlear implantation

Time-domain comparisons of power law attenuation in causal and noncausal time-fractional wave equations

The attenuation of ultrasound propagating in human tissue follows a power law with respect to frequency that is modeled by several different causal and noncausal fractional partial differential equations. To demonstrate some of the similarities and differences that are observed in three related time-fractional partial differential equations, time-domain Green's functions are calculated numerically for the power law wave equation, the Szabo wave equation, and for the Caputo wave equation. These Green's functions are evaluated for water with a power law exponent of y = 2, breast with a power law exponent of y = 1.5, and liver with a power law exponent of y = 1.139. Simulation results show that the noncausal features of the numerically calculated time-domain response are only evident very close to the source and that these causal and noncausal time-domain Green's functions converge to the same result away from the source. When noncausal time-domain Green's functions are convolved with a short pulse, no evidence of noncausal behavior remains in the time-domain, which suggests that these causal and noncausal time-fractional models are equally effective for these numerical calculations.

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Acoustic scattering from phononic crystals with complex geometry

This work introduces a formalism for computing external acoustic scattering from phononic crystals (PCs) with arbitrary exterior shape using a Bloch wave expansion technique coupled with the Helmholtz-Kirchhoff integral (HKI). Similar to a Kirchhoff approximation, a geometrically complex PC's surface is broken into a set of facets in which the scattering from each facet is calculated as if it was a semi-infinite plane interface in the short wavelength limit. When excited by incident radiation, these facets introduce wave modes into the interior of the PC. Incorporation of these modes in the HKI, summed over all facets, then determines the externally scattered acoustic field. In particular, for frequencies in a complete bandgap (the usual operating frequency regime of many PC-based devices and the requisite operating regime of the presented theory), no need exists to solve for internal reflections from oppositely facing edges and, thus, the total scattered field can be computed without the need to consider internal multiple scattering. Several numerical examples are provided to verify the presented approach. Both harmonic and transient results are considered for spherical and bean-shaped PCs, each containing over 100 000 inclusions. This facet formalism is validated by comparison to an existing self-consistent scattering technique.

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In-air hearing of a diving duck: A comparison of psychoacoustic and auditory brainstem response thresholds

Auditory sensitivity was measured in a species of diving duck that is not often kept in captivity, the lesser scaup. Behavioral (psychoacoustics) and electrophysiological [the auditory brainstem response (ABR)] methods were used to measure in-air auditory sensitivity, and the resulting audiograms were compared. Both approaches yielded audiograms with similar U-shapes and regions of greatest sensitivity (2000−3000 Hz). However, ABR thresholds were higher than psychoacoustic thresholds at all frequencies. This difference was least at the highest frequency tested using both methods (5700 Hz) and greatest at 1000 Hz, where the ABR threshold was 26.8 dB higher than the behavioral measure of threshold. This difference is commonly reported in studies involving many different species. These results highlight the usefulness of each method, depending on the testing conditions and availability of the animals.

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Paediatric Cochlear Implantation in Patients with Waardenburg Syndrome

Objective: To analyse the benefit of cochlear implantation in young deaf children with Waardenburg syndrome (WS) compared to a reference group of young deaf children without additional disabilities. Method: A retrospective study was conducted on children with WS who underwent cochlear implantation at the age of 2 years or younger. The post-operative results for speech perception (phonetically balanced standard Dutch consonant-vocal-consonant word lists) and language comprehension (the Reynell Developmental Language Scales, RDLS), expressed as a language quotient (LQ), were compared between the WS group and the reference group by using multiple linear regression analysis. Results: A total of 14 children were diagnosed with WS, and 6 of them had additional disabilities. The WS children were implanted at a mean age of 1.6 years and the 48 children of the reference group at a mean age of 1.3 years. The WS children had a mean phoneme score of 80% and a mean LQ of 0.74 at 3 years post-implantation, and these results were comparable to those of the reference group. Only the factor additional disabilities had a significant negative influence on auditory perception and language comprehension. Conclusions: Children with WS performed similarly to the reference group in the present study, and these outcomes are in line with the previous literature. Although good counselling about additional disabilities concomitant to the syndrome is relevant, cochlear implantation is a good rehabilitation method for children with WS.
Audiol Neurotol 2016;21:187-194

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Exploring Methods to Measure the Prevalence of Ménière's Disease in the US Clinformatics™ Database, 2010-2012

Recent studies on the epidemiology of the inner-ear disorder Ménière's disease (MD) use disparate methods for sample selection, case identification and length of observation. Prevalence estimates vary geographically from 17 to 513 cases per 100,000 people. We explored the impact of case detection strategies and observation periods in estimating the prevalence of MD in the USA, using data from a large insurance claims database. Using case detection strategies of ≥1, ≥2 and ≥3 ICD-9 claim codes for MD within a 1-year period, the 2012 prevalence estimates were 66, 27 and 14 cases per 100,000 people, respectively. For ≥1, ≥2 and ≥3 insurance claims within a 3-year observation period, the prevalence estimates were 200, 104 and 66 cases per 100,000 people, respectively. Estimates based on a single claim are likely to overestimate prevalence; this conclusion is aligned with the American Academy of Otolaryngology-Head and Neck Foundation criteria requiring ≥2 definitive episodes for a definite diagnosis, and it has implications for future epidemiologic research. We believe estimates for ≥2 claims may be a more conservative estimate of the prevalence of MD, and multiyear estimates may be needed to allow for adequate follow-up time.
Audiol Neurotol 2016;21:172-177

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Παρασκευή 27 Μαΐου 2016

Book Review

10.1080/14992027.2016.1183826 David M. Baguley

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Perception of hearing impairment and the willingness to use hearing aids in an elderly population in southern Taiwan: A community-based study

10.1080/14992027.2016.1182651 Ning-Chia Chang

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Perception of hearing impairment and the willingness to use hearing aids in an elderly population in southern Taiwan: A community-based study

10.1080/14992027.2016.1182651 Ning-Chia Chang

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Perception of hearing impairment and the willingness to use hearing aids in an elderly population in southern Taiwan: A community-based study.

Perception of hearing impairment and the willingness to use hearing aids in an elderly population in southern Taiwan: A community-based study.

Int J Audiol. 2016 May 24;:1-8

Authors: Chang NC, Dai CY, Lin WY, Chien CY, Hsieh MH, Ho KY

Abstract
OBJECTIVES: To estimate the prevalence and severity of hearing impairment (HI), the self-perception of HI, and the willingness to use a hearing aid (HA) in the elderly population in southern Taiwan.
DESIGN: This community-based study was performed in a metropolitan hospital. A questionnaire about the perception of HI and the willingness to use a HA was used. The severity of HI in speech-frequency pure-tone average (PTA) was evaluated. The associations between sex, age, severity of HI, self-perception of HI, and the willingness to use a HA were analysed.
STUDY SAMPLE: A total of 599 volunteers were recruited from the health management center; 324 (54.1%) males and 275 (45.9%) females, who were 65 years of age or older.
RESULTS: The prevalence of HI >25 dBHL in the elderly was 78%. The predicted levels for elderly persons to perceive HI and hearing difficulties were 34.38 dBHL and 54.38 dBHL, respectively. Males and younger participants were more willing to use HA. The primary reasons for refusing HA use were discomfort (25.1%) and a self-perception that the HA was unnecessary (19.7%).
CONCLUSIONS: The prevalence of HI was high among the elderly population in southern Taiwan. Age and sex were the determinants of HA use.

PMID: 27218891 [PubMed - as supplied by publisher]

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Influence of contralateral acoustic hearing on adult bimodal outcomes after cochlear implantation.

Influence of contralateral acoustic hearing on adult bimodal outcomes after cochlear implantation.

Int J Audiol. 2016 May 23;:1-11

Authors: Plant K, van Hoesel R, McDermott H, Dawson P, Cowan R

Abstract
OBJECTIVE: To examine post-implantation benefit and time taken to acclimate to the cochlear implant for adult candidates with more hearing in the contralateral non-implanted ear than has been previously considered within local candidacy guidelines.
DESIGN: Prospective, within-subject experimental design.
STUDY SAMPLE: Forty postlingual hearing-impaired adult subjects with a contralateral ear word score in quiet ranging from 27% to 100% (median 67%).
RESULTS: Post-implantation improvement of 2.4 dB and 4.0 dB was observed on a sentence in coincident babble test at presentation levels of 65 and 55 dB SPL respectively, and a 2.1 dB benefit in spatial release from masking (SRM) advantage observed when the noise location favoured the implanted side. Significant post-operative group mean change of between 2.1 and 3.0 was observed on the sub-scales of the speech, spatial, and qualities (SSQ) questionnaire. Degree of post-implantation speech reception threshold (SRT) benefit on the coincident babble test and on perception of soft speech and sounds in the environment was greater for subjects with less contralateral hearing. The degree of contralateral acoustic hearing did not affect time taken to acclimate to the device.
CONCLUSIONS: The findings from this study support cochlear implantation for candidates with substantial acoustic hearing in the contralateral ear, and provide guidance regarding post-implantation expectations.

PMID: 27216386 [PubMed - as supplied by publisher]

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Perception of hearing impairment and the willingness to use hearing aids in an elderly population in southern Taiwan: A community-based study.

Perception of hearing impairment and the willingness to use hearing aids in an elderly population in southern Taiwan: A community-based study.

Int J Audiol. 2016 May 24;:1-8

Authors: Chang NC, Dai CY, Lin WY, Chien CY, Hsieh MH, Ho KY

PMID: 27218891 [PubMed - as supplied by publisher]

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Influence of contralateral acoustic hearing on adult bimodal outcomes after cochlear implantation.

Influence of contralateral acoustic hearing on adult bimodal outcomes after cochlear implantation.

Int J Audiol. 2016 May 23;:1-11

Authors: Plant K, van Hoesel R, McDermott H, Dawson P, Cowan R

PMID: 27216386 [PubMed - as supplied by publisher]

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The effect of proprioceptive knee bracing on knee stability during three different sport related movement tasks in healthy subjects and the implications to the management of Anterior Cruciate Ligament (ACL) injuries

Publication date: Available online 24 May 2016
Source:Gait & Posture
Author(s): I. Hanzlíková, J. Richards, M. Tomsa, A. Chohan, K. May, D. Smékal, J. Selfe
IntroductionProprioceptive knee braces have been shown to improve knee mechanics, however much of the work to date has focused on tasks such as slow step down tasks rather than more dynamic sporting tasks.ObjectiveThis study aimed to explore if such improvements in stability may be seen during faster sports specific tasks as well as slower tasks.MethodTwelve subjects performed a slow step down, single leg drop jump and pivot turn jump with and without a silicone web brace. 3D kinematics of the knee were collected using a ten camera Qualisys motion analysis system. Reflective markers were placed on the foot, shank, thigh and pelvis using the Calibrated Anatomical Systems Technique. A two way ANOVA with repeated measures was performed with post-hoc pairwise comparison to explore the differences between the two conditions and three tasks.ResultsSignificant differences were seen in the knee joint angles and angular velocities in the sagittal, coronal and transverse planes between the tasks. The brace showed a reduction in knee valgum and internal rotation across all tasks, with the most notable effect during the single leg drop jump and pivot turn jump. The transverse plane also showed a significant reduction in the external rotation knee angular velocity when wearing the brace.DiscussionThe brace influenced the knee joint kinematics in coronal and transverse planes which confirms that such braces can have a significant effect on knee control during dynamic tasks. Further studies are required exploring the efficacy of proprioceptive braces in athletic patient cohort.

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The effects of visual feedback during a rhythmic weight-shifting task in patients with Parkinson's disease

Publication date: Available online 24 May 2016
Source:Gait & Posture
Author(s): Maarten R.C. van den Heuvel, Andreas Daffertshofer, Peter J. Beek, Gert Kwakkel, Erwin E.H. van Wegen
Augmented visual feedback (VF) may offer benefits similar to those of rhythmic external cues in alleviating some mobility-related difficulties in individuals with Parkinson's disease (PD). However, due to an impaired ability to reweigh sensory information under changing circumstances, subjects with PD may be rather vulnerable to incongruity of visual information. In the present study, we investigated whether VF is indeed effective in improving motor functioning in a weight-shifting task during upright stance, and whether subjects with PD are affected more by incongruent VF than healthy controls. Participants performed sideways swaying motions based on tracking of real-time and delayed VF–the first providing congruent, and hence more accurate, visual information than the latter. We analyzed center-of-pressure signals patterns for 28 individuals with PD and 16 healthy, age- and gender-matched controls by estimating task accuracy, movement pattern variability, and normalized movement amplitude. For conditions without feedback and with real-time feedback, subjects with PD performed lateral swaying motions with greater error (F(1,42)=12.065, p=.001) and with more variable movement patterns than healthy controls (F(1, 24)=113.086, p<.001). Error change scores revealed that patients with PD were nevertheless still able to use VF to improve tracking performance (t(24)=-2.366, p=.026). However, whereas controls were able to adapt to a certain amount of visual incongruity, patients with PD were not. Instead, movement amplitude was significantly reduced in this group (F(1.448, 60.820)=17.639, p<.001). By reducing movement amplitude, subjects with PD appear to resort to a ‘conservative’ strategy to minimize performance breakdown.

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Acquired Hearing Loss and Brain Plasticity

Publication date: Available online 24 May 2016
Source:Hearing Research
Author(s): Jos J. Eggermont
Acquired hearing loss results in an imbalance of the cochlear output across frequency. Central auditory system homeostatic processes responding to this result in frequency specific gain changes consequent to the emerging imbalance between excitation and inhibition. Several consequences thereof are increased spontaneous firing rates, increased neural synchrony, and (in adults) potentially restricted to the auditory thalamus and cortex a reorganization of tonotopic areas. It does not seem to matter much whether the hearing loss is acquired neonatally or in adulthood. In humans, no clear evidence of tonotopic map changes with hearing loss has so far been provided, but frequency specific gain changes are well documented. Unilateral hearing loss in addition makes brain activity across hemispheres more symmetrical and more synchronous. Molecular studies indicate that in the brainstem, after 2-5 days post trauma, the glutamatergic activity is reduced, whereas glycinergic and GABAergic activity is largely unchanged. At 2 months post trauma, excitatory activity remains decreased but the inhibitory one is significantly increased. In contrast protein assays related to inhibitory transmission are all decreased or unchanged in the brainstem, midbrain and auditory cortex. Comparison of neurophysiological data with the molecular findings during a time-line of changes following noise trauma suggests that increases in spontaneous firing rates are related to decreases in inhibition, and not to increases in excitation. Because noise-induced hearing loss in cats resulted in a loss of cortical temporal processing capabilities, this may also underlie speech understanding in humans.

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Dexamethasone Is One of the Factors Minimizing the Inner Ear Damage from Electrode Insertion in Cochlear Implantation

The aim of this study was to investigate the efficacy of preoperative and intraoperative steroid administration for inner ear protection in cochlear implantation (CI). Nineteen subjects who underwent CI were included in the study, and 10 subjects were enrolled as controls (steroid-administered group, n = 19; control group, n = 10). Dexamethasone (dexamethasone sodium phosphate, 5 mg/ml) was systemically administered preoperatively (1 ml) and topically applied during CI (0.5 ml). The extent of hearing preservation (HP) after CI and the change in the bithermal caloric response were evaluated. Hearing level was calculated using mean thresholds [(250 Hz + 500 Hz + 1,000 Hz + 2,000 Hz)/4]. Preoperative hearing thresholds were similar in the steroid-administered and control groups (100.92 ± 12.60 vs. 103.29 ± 14.39 dB, p = 0.650). The mean thresholds significantly increased in both groups after surgery (108.46 ± 14.08 dB, p = 0.006, for the steroid-administered group; 117.50 ± 6.34 dB, p = 0.027, for the control group), and the difference between the groups was also significant (p = 0.027). The postoperative shift in the hearing thresholds at frequencies of 500 and 1,000 Hz was significant in the steroid-administered group and that at the frequencies of 500, 1,000 and 2,000 Hz was significant in the control group. However, the extent of the shift in hearing threshold levels at each frequency was not significantly different between the groups. Preservation of hearing thresholds was compared between the groups, and there were significantly more subjects with complete and partial HP in the steroid-administered group than in the control group (p = 0.008). The preoperative caloric response was maintained after CI in the steroid-administered group. This study suggests that the perioperative use of a steroid could minimize the inner ear damage after CI.
Audiol Neurotol 2016;21:178-186

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Comparing Distortion Product Otoacoustic Emissions to Intracochlear Distortion Products Inferred from a Noninvasive Assay

Abstract

The behavior of intracochlear distortion products (iDPs) was inferred by interacting a probe tone (f₃) with the iDP of interest to produce a “secondary” distortion product otoacoustic emission termed DPOAE^2ry. Measures of the DPOAE^2ry were then used to deduce the properties of the iDP. This approach was used in alert rabbits and anesthetized gerbils to compare ear-canal 2f₁-f₂ and 2f₂-f₁ DPOAE f₂/f₁ ratio functions, level/phase (L/P) maps, and interference-response areas (IRAs) to their simultaneously collected DPOAE^2ry counterparts. These same measures were also collected in a human volunteer to demonstrate similarities with their laboratory animal counterparts and their potential applicability to humans. Results showed that DPOAEs and inferred iDPs evidenced distinct behaviors and properties. That is, DPOAE ratio functions elicited by low-level primaries peaked around an f₂/f₁ = 1.21 or 1.25, depending on species, while the corresponding inferred iDP ratio functions peaked at f₂/f₁ ratios of ~1. Additionally, L/P maps showed rapid phase variation with DPOAE frequency (f_dp) for the narrow-ratio 2f₁-f₂ and all 2f₂-f₁ DPOAEs, while the corresponding DPOAE^2ry measures evidenced relatively constant phases. Common features of narrow-ratio DPOAE IRAs, such as large enhancements for interference tones (ITs) presented above f₂, were not present in DPOAE^2ry IRAs. Finally, based on prior experiments in gerbils, the behavior of the iDP directly measured in intracochlear pressure was compared to the iDP inferred from the DPOAE^2ry and found to be similar. Together, these findings are consistent with the notion that under certain conditions, ear-canal DPOAEs provide poor representations of iDPs and thus support a “beamforming” hypothesis. According to this concept, distributed emission components directed toward the ear canal from the f₂ and basal to f₂ regions can be of differing phases and thus cancel, while these same components directed toward f_dp add in phase.

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Clinical Verification of Ear Level FM Systems: Classroom & Personal Use Applications

Dave Smriga: In today’s course, we’ll explore how Audioscan equipment easily facilitates the execution of the most current recommended FM verification procedures. In addition, we’ll discuss how you can use these procedures for both FM system verification and verification of remote microphone technology. Although we will be depicting the various test procedures included in today's webinar with images created using the Verifit2 hearing instrument fitting system, the same tests can be performed with the original Verifit system.

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The Ponto Bone Anchored System: The Right Choice for Pediatrics

Today, I will begin with the fundamentals of bone anchored technology including an overview of osseointegration, and that will give us the foundation to discuss patient candidacy as well as surgical and fitting considerations. I will review Ponto practicalities, such as how the processor was designed to be durable and reliable – which is especially important when we fit children. I will talk about the signal processing in the Ponto processors and present evidence that supports how it benefits our youngest bone anchored patients. When fitting children with amplification, what is the goal?

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Direction-reversing Nystagmus in Horizontal and Posterior Semicircular Canal Canalolithiasis.

Objectives: To investigate the incidence and characteristics of direction-reversing nystagmus in patients with horizontal (HSCC) and posterior semicircular canal (PSCC) canalolithiasis, and evaluate the effect of direction-reversing nystagmus on the treatment outcome. Study Design: A retrospective study. Methods: Between March 2014 and September 2015, 63 and 92 consecutive patients with HSCC and PSCC canalolithiasis, respectively, were enrolled. Positional nystagmus characteristics were examined using video-nystagmography. Results: In HSCC canalolithiasis, direction-reversing nystagmus was observed in 73% of patients (46 of 63), of which 19 cases were bilateral and 27 unilateral. In patients with bilateral reversal, maximal slow-phase velocity (mSPV) was significantly greater when the head turned to the lesioned side than to the healthy side in both the first and second phase. In all patients with unilateral reversal, direction-reversing nystagmus always occurred in the side of stronger initial nystagmus in a supine roll test. The mean mSPV of first phase nystagmus was significantly greater on the side with reversal than without (p

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The Effect of Simulated Mastoid Obliteration on the Mechanical Output of Electromagnetic Transducers.

Background: The electromagnetic transducers of implantable middle ear hearing devices or direct acoustic cochlear implants (DACIs) are intended for implantation in an air-filled middle ear cavity. When implanted in an obliterated radical mastoid cavity, they would be surrounded by fatty tissue of unknown elastic properties, potentially attenuating the mechanical output. Here, the elastic properties of this tissue were determined experimentally and the vibrational output of commonly used electromagnetic transducers in an obliterated radical mastoid cavity was investigated in vitro using a newly developed method. Methods: The Young's moduli of human fatty tissue samples (3-mm diameter), taken fresh from the abdomen or from the radical mastoid cavity during revision surgeries, were determined by indentation tests. Two phantom materials having Young's moduli similar to and higher than (worst case scenario) the tissue were identified. The displacement output of a DACI, a middle ear transducer (MET) and a floating mass transducer (FMT), was measured when embedded in the phantom materials in a model radical cavity and compared with the output of the nonembedded transducers. Results: The here-determined Young's moduli of fresh human abdominal fatty tissue were comparable to the moduli of human breast fat tissue. When embedded in the phantom materials, the displacement output amplitude at 0.1 to 10 kHz of the DACI and MET was attenuated by maximally 5 dB. The attenuation of the output of the FMT was also minor at 0.5 to 10 kHz, but significantly reduced by up to 35 dB at lower frequencies. Conclusion: Using the method developed here, the Young's moduli of small soft tissue samples could be estimated and the effect of obliteration on the mechanical output of electromagnetic transducers was investigated in vitro. Our results demonstrate that the decrease in vibrational output of the DACI and MET in obliterated mastoid cavities is expected to be minor, having no major impact on clinical indication. Although no major attenuation of vibrational output of the FMT was found for frequencies >0.5 kHz, for implantations in patients the attenuation at frequencies

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Surgical Anatomy of the Human Round Window Region: Implication for Cochlear Endoscopy Through the External Auditory Canal.

Objective: To enable development of an endoscope for cellular-level optical imaging of the inner ear. Study Design: A prospective study of 50 cadaveric human temporal bones to define detailed surgical anatomy of the round window (RW) region and the range of angles necessary to reach the RW membrane perpendicularly via the external ear canal. Main Outcome Measure: The transcanal angle to the RW membrane was surgically measured in 3D intact specimens, and correlated with the angle calculated from temporal bone computed tomography (CT) scans of the same specimens obtained before and after measurements in situ. Results: Surgically measured transcanal angles to the RW membrane correlated well with the radiographically measured angles. The angles ranged from 110 to 127 degrees, with the median of 115 degrees and the middle 50% ranging from 109 to 119 degrees. Four temporal bones were excluded because of pathology. The opening of the RW niche was located posteriorly in six bones (13%), inferiorly in 18 bones (39%), and postero-inferiorly in 22 bones (48%). The angles were not statistically different among the three orientations of the RW niche. Conclusions: By correlating measurement from cadaveric human temporal bones and their CT scans, we defined key parameters necessary for designing an endoscope for intracochlear imaging using a minimally invasive approach through the external auditory canal. The excellent correlation between the measurement on the CT scan and the actual shape of the probe that was able to reach the RW through the ear canal enables selection of the probe using the CT data. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Using Balance Function to Screen for Vestibular Impairment in Children With Sensorineural Hearing Loss and Cochlear Implants.

Objectives: 1) To determine if bilateral vestibular dysfunction can be predicted by performance on standardized balance tasks in children with sensorineural hearing loss (SNHL) and cochlear implants (CI). 2) To provide clinical recommendations for screening for vestibular impairment in children with SNHL. Study Design: Retrospective cohort study. Setting: Tertiary care pediatric implant center. Patients: Pediatric patients (4.8-18.6 years) with profound SNHL using CIs. Interventions: Vestibular end-organ (horizontal canal and otoliths), and balance assessment. Main Outcome Measures: Comparison of balance skills, measured by the Bruininks Oseretsky Test of Motor Proficiency II (BOT-2), was performed between two groups of children with SNHL and CI: 1) total bilateral vestibular loss (TBVL) (n = 45), and 2) normal bilateral vestibular function (n = 20). Sensitivity, specificity, and suitability of each task as a screening tool for the detection of TBVL were assessed. Results: Balance as measured by the BOT-2 balance subtest was significantly poorer in children with TBVL then those with normal vestibular function (p

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Participant-generated Cochlear Implant Programs: Speech Recognition, Sound Quality, and Satisfaction.

Objective: To determine whether patient-derived programming of one's cochlear implant (CI) stimulation levels may affect performance outcomes. Background: Increases in patient population, device complexity, outcome expectations, and clinician responsibility have demonstrated the necessity for improved clinical efficiency. Methods: Eighteen postlingually deafened adult CI recipients (mean = 53 years; range, 24-83 years) participated in a repeated-measures, within-participant study designed to compare their baseline listening program to an experimental program they created. Results: No significant group differences in aided sound-field thresholds, monosyllabic word recognition, speech understanding in quiet, speech understanding in noise, nor spectral modulation detection (SMD) were observed (p > 0.05). Four ears (17%) improved with the experimental program for speech presented at 45 dB SPL and two ears (9%) performed worse. Six ears (27.3%) improved significantly with the self-fit program at +10 dB signal-to-noise ratio (SNR) and four ears (26.6%) improved in speech understanding at +5 dB SNR. No individual scored significantly worse when speech was presented in quiet at 60 dB SPL or in any of the noise conditions tested. All but one participant opted to keep at least one of the self-fitting programs at the completion of this study. Participants viewed the process of creating their program more favorably (t = 2.11, p = 0.012) and thought creating the program was easier than the traditional fitting methodology (t = 2.12, p = 0.003). Average time to create the self-fit program was 10 minutes, 10 seconds (mean = 9:22; range, 4:46-24:40). Conclusions: Allowing experienced adult CI recipients to set their own stimulation levels without clinical guidance is not detrimental to success. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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"Self-Assessment of Hearing Disabilities in Cochlear Implant Users Using the SSQ and the Reduced SSQ5 Version. Otology & Neurotology, 2013 Dec; 34(9): 1622-1629".

No abstract available

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Endoscopic Ear Surgery: Principles, Indications and Techniques: Livio Presutti and Daniele Marchioni, eds.; Stuttgart: Thieme, 2015.

No abstract available

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Bilateral Petrous Apex Cephaloceles and Skull Base Attenuation in Setting of Idiopathic Intracranial Hypertension.

No abstract available

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Long-term Follow-up Study of the Sandwich Cartilage Shoe Technique in Cases of Insecure Stapes Footplate.

Objective: Analysis of the audiometric results after repair of a defective footplate with the sandwich cartilage shoe technique in a follow-up study. Study Design: Retrospective analysis of audiometric data. Setting: Hospital. Patients: The cohort consisted of 12 patients, who underwent ossicular reconstruction after sandwich cartilage shoe technique in a case of insecure stapes footplate. The mean age was 42.7 years with an equal sex distribution. In every patient, cholesteatoma was the reason for surgery with 75% being revision cases. Intervention: Sandwich cartilage shoe technique in case of insecure stapes footplate at the department of otorhinolaryngology, head and neck surgery at the University of Cologne over an 8-year period (2007-2015). Main Outcome Measure: The use of the "sandwich cartilage shoe technique" in case of a broken or unstable footplate allows a safe occlusion of the open vestibule. Results: The statistical analysis revealed a significant improvement of the pure-tone average (p = 0.011) and air-bone gap (ABG) (p = 0.016) after total ossicular replacement prosthesis (TORP) implantation. The hearing was stable at 9 months of follow up. Conclusion: The sandwich cartilage shoe technique offers a safe and effective option as a two-stage procedure in treating patients with fractures of the stapes footplate in case of chronic otitis media. In view of the possible risk of deafness going along with a destruction of an inner ear window, our results can be considered substantial as all our patients will at least be able to regain "social hearing" as they all either achieved a hearing threshold is less than 30 dB or can be sufficiently supplied with a conventional hearing aid. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Characteristics and Spontaneous Recovery of Tinnitus Related to Idiopathic Sudden Sensorineural Hearing Loss.

Objective: To evaluate the characteristics and spontaneous recovery of tinnitus related to idiopathic sudden sensorineural hearing loss (ISSNHL). Study Design: Retrospective analysis from two randomized placebo-controlled clinical trials for treatment of ISSNHL within 48 hours from onset (Study A), or of tinnitus related to ISSNHL within 3 months from onset (Study B). Setting: Forty-eight European sites (academic tertiary referral centers, private ENT practices). Patients: One hundred thirteen adult patients of which 65 with hearing loss >=30 dB (Study A) and 48 with persistent acute tinnitus (Study B) at baseline. Interventions: Intratympanic (i.t.) injection of placebo gel in single dose or in triple dose during 3 consecutive days. Main Outcome Measures: Frequency of tinnitus, subjective tinnitus loudness, rates of complete tinnitus remission, and complete hearing recovery during 3 months follow-up. Results: In acute ISSNHL, tinnitus loudness decreased rapidly in cases of mild-moderate hearing loss, and tinnitus had completely resolved in two-thirds of patients after 3 months. Hearing recovery preceded tinnitus resolution. When associated with severe-profound hearing loss, tinnitus improved significantly less. Complete hearing recovery and full tinnitus remission were both about three times more frequent in mild-moderate hearing loss patients than in severe-profound cases. Improvement in tinnitus loudness over time can be approximated by a negative exponential function. Conclusions: Prognosis for ISSNHL-related tinnitus is relatively poor in case of severe-profound hearing loss and the longer it has persisted. Alleviation or management of tinnitus should be a key therapeutic objective especially in pronounced ISSNHL cases. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0, where it is permissible to download, share and reproduce the work in any medium, provided it is properly cited. The work cannot be changed in any way or used commercially. http://ift.tt/OBJ4xP Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Symbolic Play and Novel Noun Learning in Deaf and Hearing Children: Longitudinal Effects of Access to Sound on Early Precursors of Language

by Alexandra L. Quittner, Ivette Cejas, Nae-Yuh Wang, John K. Niparko, David H. Barker

In the largest, longitudinal study of young, deaf children before and three years after cochlear implantation, we compared symbolic play and novel noun learning to age-matched hearing peers. Participants were 180 children from six cochlear implant centers and 96 hearing children. Symbolic play was measured during five minutes of videotaped, structured solitary play. Play was coded as "symbolic" if the child used substitution (e.g., a wooden block as a bed). Novel noun learning was measured in 10 trials using a novel object and a distractor. Cochlear implant vs. normal hearing children were delayed in their use of symbolic play, however, those implanted before vs. after age two performed significantly better. Children with cochlear implants were also delayed in novel noun learning (median delay 1.54 years), with minimal evidence of catch-up growth. Quality of parent-child interactions was positively related to performance on the novel noun learning, but not symbolic play task. Early implantation was beneficial for both achievement of symbolic play and novel noun learning. Further, maternal sensitivity and linguistic stimulation by parents positively affected noun learning skills, although children with cochlear implants still lagged in comparison to hearing peers.

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Accuracy and Repeatability of two methods of gait analysis − GaitRite™ und Mobility Lab™ − in subjects with cerebellar ataxia

Publication date: Available online 25 May 2016
Source:Gait & Posture
Author(s): Tanja Schmitz-Hübsch, Alexander U. Brandt, Caspar Pfueller, Leonora Zange, Adrian Seidel, Andrea A. Kühn, Friedemann Paul, Martina Minnerop, Sarah Doss
Instrumental gait analysis is increasingly recognized as a useful tool for the evaluation of movement disorders. The various assessment devices available to date have mostly been evaluated in healthy populations only. We aimed to explore whether reliability and validity seen in healthy subjects can also be assumed in subjects with cerebellar ataxic gait. Gait was recorded simultaneously with two devices − a sensor-embedded walkway and an inertial sensor based system − to explore test accuracy in two groups of subjects: one with mild to moderate cerebellar ataxia due to a subtype of autosomal-dominantly inherited neurodegenerative disorder (SCA14), the other were healthy subjects matched for age and height (CTR). Test precision was assessed by retest within session for each device. In conclusion, accuracy and repeatability of gait measurements were not compromised by ataxic gait disorder. The accuracy of spatial measures was speed-dependent and a direct comparison of stride length from both devices will be most reliably made at comfortable speed. Measures of stride variability had low agreement between methods in CTR and at retest in both groups. However, the marked increase of stride variability in ataxia outweighs the observed amount of imprecision.

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Lexically driven selective adaptation by ambiguous auditory stimuli occurs after limited exposure to adaptors

Limited exposure to ambiguous auditory stimuli results in perceptual recalibration. When unambiguous stimuli are used instead, selective adaptation (SA) effects have been reported, even after few adaptor presentations. Crucially, selective adaptation by an ambiguous sound in biasing lexical contexts had previously been found only after massive adaptor repetition [Samuel (2001). Psychol. Sci. 12(4), 348–351]. The present study shows that extensive exposure is not necessary for lexically driven selective adaptation to occur. Lexically driven selective adaptation can arise after as few as nine adaptor presentations. Additionally, build-up course inspection reveals several parallelisms with the time course observed for SA with unambiguous stimuli.

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Lexically driven selective adaptation by ambiguous auditory stimuli occurs after limited exposure to adaptors

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Does clinician continuity influence hearing aid outcomes?

10.1080/14992027.2016.1185169 Rebecca J. Bennett

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Book Review

10.1080/14992027.2016.1183826 David M. Baguley

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Clinical Verification of Ear Level FM Systems: Classroom & Personal Use Applications

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The Ponto Bone Anchored System: The Right Choice for Pediatrics

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Accuracy and Repeatability of two methods of gait analysis − GaitRite™ und Mobility Lab™ − in subjects with cerebellar ataxia

Publication date: Available online 25 May 2016
Source:Gait & Posture
Author(s): Tanja Schmitz-Hübsch, Alexander U. Brandt, Caspar Pfueller, Leonora Zange, Adrian Seidel, Andrea A. Kühn, Friedemann Paul, Martina Minnerop, Sarah Doss
Instrumental gait analysis is increasingly recognized as a useful tool for the evaluation of movement disorders. The various assessment devices available to date have mostly been evaluated in healthy populations only. We aimed to explore whether reliability and validity seen in healthy subjects can also be assumed in subjects with cerebellar ataxic gait. Gait was recorded simultaneously with two devices − a sensor-embedded walkway and an inertial sensor based system − to explore test accuracy in two groups of subjects: one with mild to moderate cerebellar ataxia due to a subtype of autosomal-dominantly inherited neurodegenerative disorder (SCA14), the other were healthy subjects matched for age and height (CTR). Test precision was assessed by retest within session for each device. In conclusion, accuracy and repeatability of gait measurements were not compromised by ataxic gait disorder. The accuracy of spatial measures was speed-dependent and a direct comparison of stride length from both devices will be most reliably made at comfortable speed. Measures of stride variability had low agreement between methods in CTR and at retest in both groups. However, the marked increase of stride variability in ataxia outweighs the observed amount of imprecision.

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Does clinician continuity influence hearing aid outcomes?

Does clinician continuity influence hearing aid outcomes?

Int J Audiol. 2016 May 25;:1-8

Authors: Bennett RJ, Meyer C, Eikelboom RH

Abstract
OBJECTIVE: To evaluate whether clinician continuity is associated with successful hearing aid outcomes.
DESIGN: A prospective cohort study. Clinician continuity was defined as occurring when a patient was cared for by the same clinician for the hearing assessment, hearing aid selection process, hearing aid fitting and programming, and subsequent hearing aid fine tuning appointments. The hearing aid outcome measures included self-reported hearing aid use, benefit and satisfaction as well as self-reported handling skills and problems experienced with hearing aids.
STUDY SAMPLE: Four hundred and sixty-eight adult hearing aid users (mean age 73.9 years ±10.9) and 26 qualified audiologists (mean age 34 years ±6.34) recruited from a single hearing clinic in Perth, Western Australia.
RESULTS: There were no significant differences in hearing aid outcomes between participants who experienced clinician continuity and those who did not.
CONCLUSIONS: Within a controlled practice setting, hearing aid outcomes may not be adversely effected if services are provided by more than one clinician.

PMID: 27224042 [PubMed - as supplied by publisher]

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