Speech recognition in noise under hearing protection: A computational study of the combined effects of hearing loss and hearing protector attenuation

Volume 55, Issue sup1, February 2016, pages S30-S40<br/>10.3109/14992027.2015.1129460<br/>Christian Giguère

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Celebrating hearing loss prevention

Volume 55, Issue sup1, February 2016, pages S1-S2<br/>10.3109/14992027.2016.1140989<br/>Colleen G. Le Prell

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Auditory risk of air rifles

Volume 55, Issue sup1, February 2016, pages S51-S58<br/>10.3109/14992027.2015.1131851<br/>James E. Lankford

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Speech recognition in noise under hearing protection: A computational study of the combined effects of hearing loss and hearing protector attenuation

Volume 55, Issue sup1, February 2016, pages S30-S40<br/>10.3109/14992027.2015.1129460<br/>Christian Giguère

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Celebrating hearing loss prevention

Volume 55, Issue sup1, February 2016, pages S1-S2<br/>10.3109/14992027.2016.1140989<br/>Colleen G. Le Prell

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Auditory risk of air rifles

Volume 55, Issue sup1, February 2016, pages S51-S58<br/>10.3109/14992027.2015.1131851<br/>James E. Lankford

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Speech recognition in noise under hearing protection: A computational study of the combined effects of hearing loss and hearing protector attenuation

Volume 55, Issue sup1, February 2016, pages S30-S40<br/>10.3109/14992027.2015.1129460<br/>Christian Giguère

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Celebrating hearing loss prevention

Volume 55, Issue sup1, February 2016, pages S1-S2<br/>10.3109/14992027.2016.1140989<br/>Colleen G. Le Prell

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Auditory risk of air rifles

Volume 55, Issue sup1, February 2016, pages S51-S58<br/>10.3109/14992027.2015.1131851<br/>James E. Lankford

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Speech recognition in noise under hearing protection: A computational study of the combined effects of hearing loss and hearing protector attenuation

Volume 55, Issue sup1, February 2016, pages S30-S40<br/>10.3109/14992027.2015.1129460<br/>Christian Giguère

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Celebrating hearing loss prevention

Volume 55, Issue sup1, February 2016, pages S1-S2<br/>10.3109/14992027.2016.1140989<br/>Colleen G. Le Prell

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Auditory risk of air rifles

Volume 55, Issue sup1, February 2016, pages S51-S58<br/>10.3109/14992027.2015.1131851<br/>James E. Lankford

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Speech recognition in noise under hearing protection: A computational study of the combined effects of hearing loss and hearing protector attenuation

Volume 55, Issue sup1, February 2016, pages S30-S40<br/>10.3109/14992027.2015.1129460<br/>Christian Giguère

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Celebrating hearing loss prevention

Volume 55, Issue sup1, February 2016, pages S1-S2<br/>10.3109/14992027.2016.1140989<br/>Colleen G. Le Prell

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Danish reading span data from 283 hearing-aid users, including a sub-group analysis of their relationship to speech-in-noise performance.

Related Articles

Danish reading span data from 283 hearing-aid users, including a sub-group analysis of their relationship to speech-in-noise performance.

Int J Audiol. 2016 Feb 2;:1-8

Authors: Borch Petersen E, Lunner T, Vestergaard MD, Sundewall Thorén E

Abstract
OBJECTIVE: This study provides descriptive statistics of the Danish reading span (RS) test for hearing-impaired adults. The combined effect of hearing loss, RS score, and age on speech-in-noise performance in different spatial settings was evaluated in a subset of participants.
DESIGN: Data from published and unpublished studies were re-analysed. Data regarding speech-in-noise performance with co-located or spatially separated sound sources were available for a subset of participants.
STUDY SAMPLE: RS scores from 283 hearing-impaired participants were extracted from past studies, and 239 of these participants had completed a speech-in-noise test.
RESULTS: RS scores (mean = 41.91%, standard deviation = 11.29%) were related to age (p <0.01), but not pure-tone average (PTA) (p = 0.29). Speech-in-noise performance for co-located sound sources was related to PTA and RS score (both p < 0.01, adjusted R-squared = 0.226). Performance for spatially separated sounds was related to PTA (p < 0.01, adjusted R-squared = 0.10) but not RS score (p = 0.484). We found no differences between the standardized coefficients of the two regression models.
CONCLUSIONS: The distribution of RS scores indicated a high test difficulty. We found that age should be controlled when RS scores are compared across populations. The experimental setup of the speech-in-noise test may influence the relationship between performance and RS score.

PMID: 26836955 [PubMed - as supplied by publisher]

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Danish reading span data from 283 hearing-aid users, including a sub-group analysis of their relationship to speech-in-noise performance.

Related Articles

Danish reading span data from 283 hearing-aid users, including a sub-group analysis of their relationship to speech-in-noise performance.

Int J Audiol. 2016 Feb 2;:1-8

Authors: Borch Petersen E, Lunner T, Vestergaard MD, Sundewall Thorén E

Abstract
OBJECTIVE: This study provides descriptive statistics of the Danish reading span (RS) test for hearing-impaired adults. The combined effect of hearing loss, RS score, and age on speech-in-noise performance in different spatial settings was evaluated in a subset of participants.
DESIGN: Data from published and unpublished studies were re-analysed. Data regarding speech-in-noise performance with co-located or spatially separated sound sources were available for a subset of participants.
STUDY SAMPLE: RS scores from 283 hearing-impaired participants were extracted from past studies, and 239 of these participants had completed a speech-in-noise test.
RESULTS: RS scores (mean = 41.91%, standard deviation = 11.29%) were related to age (p <0.01), but not pure-tone average (PTA) (p = 0.29). Speech-in-noise performance for co-located sound sources was related to PTA and RS score (both p < 0.01, adjusted R-squared = 0.226). Performance for spatially separated sounds was related to PTA (p < 0.01, adjusted R-squared = 0.10) but not RS score (p = 0.484). We found no differences between the standardized coefficients of the two regression models.
CONCLUSIONS: The distribution of RS scores indicated a high test difficulty. We found that age should be controlled when RS scores are compared across populations. The experimental setup of the speech-in-noise test may influence the relationship between performance and RS score.

PMID: 26836955 [PubMed - as supplied by publisher]

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Clinical Practice Guideline: Otitis Media with Effusion (Update).

Related Articles

Clinical Practice Guideline: Otitis Media with Effusion (Update).

Otolaryngol Head Neck Surg. 2016 Feb;154(1 Suppl):S1-S41

Authors: Rosenfeld RM, Shin JJ, Schwartz SR, Coggins R, Gagnon L, Hackell JM, Hoelting D, Hunter LL, Kummer AW, Payne SC, Poe DS, Veling M, Vila PM, Walsh SA, Corrigan MD

Abstract
OBJECTIVE: This update of a 2004 guideline codeveloped by the American Academy of Otolaryngology-Head and Neck Surgery Foundation, the American Academy of Pediatrics, and the American Academy of Family Physicians, provides evidence-based recommendations to manage otitis media with effusion (OME), defined as the presence of fluid in the middle ear without signs or symptoms of acute ear infection. Changes from the prior guideline include consumer advocates added to the update group, evidence from 4 new clinical practice guidelines, 20 new systematic reviews, and 49 randomized control trials, enhanced emphasis on patient education and shared decision making, a new algorithm to clarify action statement relationships, and new and expanded recommendations for the diagnosis and management of OME.
PURPOSE: The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing OME and to create explicit and actionable recommendations to implement these opportunities in clinical practice. Specifically, the goals are to improve diagnostic accuracy, identify children who are most susceptible to developmental sequelae from OME, and educate clinicians and patients regarding the favorable natural history of most OME and the clinical benefits for medical therapy (eg, steroids, antihistamines, decongestants). Additional goals relate to OME surveillance, hearing and language evaluation, and management of OME detected by newborn screening. The target patient for the guideline is a child aged 2 months through 12 years with OME, with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The guideline is intended for all clinicians who are likely to diagnose and manage children with OME, and it applies to any setting in which OME would be identified, monitored, or managed. This guideline, however, does not apply to patients <2 months or >12 years old.
ACTION STATEMENTS: The update group made strong recommendations that clinicians (1) should document the presence of middle ear effusion with pneumatic otoscopy when diagnosing OME in a child; (2) should perform pneumatic otoscopy to assess for OME in a child with otalgia, hearing loss, or both; (3) should obtain tympanometry in children with suspected OME for whom the diagnosis is uncertain after performing (or attempting) pneumatic otoscopy; (4) should manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known) or 3 months from the date of diagnosis (if onset is unknown); (5) should recommend against using intranasal or systemic steroids for treating OME; (6) should recommend against using systemic antibiotics for treating OME; and (7) should recommend against using antihistamines, decongestants, or both for treating OME.The update group made recommendations that clinicians (1) should document in the medical record counseling of parents of infants with OME who fail a newborn screening regarding the importance of follow-up to ensure that hearing is normal when OME resolves and to exclude an underlying sensorineural hearing loss; (2) should determine if a child with OME is at increased risk for speech, language, or learning problems from middle ear effusion because of baseline sensory, physical, cognitive, or behavioral factors; (3) should evaluate at-risk children for OME at the time of diagnosis of an at-risk condition and at 12 to 18 months of age (if diagnosed as being at risk prior to this time); (4) should not routinely screen children for OME who are not at risk and do not have symptoms that may be attributable to OME, such as hearing difficulties, balance (vestibular) problems, poor school performance, behavioral problems, or ear discomfort; (5) should educate children with OME and their families regarding the natural history of OME, need for follow-up, and the possible sequelae; (6) should obtain an age-appropriate hearing test if OME persists for 3 months or longer OR for OME of any duration in an at-risk child; (7) should counsel families of children with bilateral OME and documented hearing loss about the potential impact on speech and language development; (8) should reevaluate, at 3- to 6-month intervals, children with chronic OME until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected; (9) should recommend tympanostomy tubes when surgery is performed for OME in a child <4 years old; adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); (10) should recommend tympanostomy tubes, adenoidectomy, or both when surgery is performed for OME in a child ≥4 years old; and (11) should document resolution of OME, improved hearing, or improved quality of life when managing a child with OME.

PMID: 26832942 [PubMed - in process]

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Histone deacetylase 1 is required for the development of the zebrafish inner ear.

Related Articles

Histone deacetylase 1 is required for the development of the zebrafish inner ear.

Sci Rep. 2016;6:16535

Authors: He Y, Tang D, Li W, Chai R, Li H

Abstract
Histone deacetylase 1 (HDAC1) has been reported to be important for multiple aspects of normal embryonic development, but little is known about its function in the development of mechanosensory organs. Here, we first confirmed that HDAC1 is expressed in the developing otic vesicles of zebrafish by whole-mount in situ hybridization. Knockdown of HDAC1 using antisense morpholino oligonucleotides in zebrafish embryos induced smaller otic vesicles, abnormal otoliths, malformed or absent semicircular canals, and fewer sensory hair cells. HDAC1 loss of function also caused attenuated expression of a subset of key genes required for otic vesicle formation during development. Morpholino-mediated knockdown of HDAC1 resulted in decreased expression of members of the Fgf family in the otic vesicles, suggesting that HDAC1 is involved in the development of the inner ear through regulation of Fgf signaling pathways. Taken together, our results indicate that HDAC1 plays an important role in otic vesicle formation.

PMID: 26832938 [PubMed - in process]

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Phenotypic Heterogeneity in a DFNA20/26 family segregating a novel ACTG1 mutation.

Related Articles

Phenotypic Heterogeneity in a DFNA20/26 family segregating a novel ACTG1 mutation.

BMC Genet. 2016;17(1):33

Authors: Yuan Y, Gao X, Huang B, Lu J, Wang G, Lin X, Qu Y, Dai P

Abstract
BACKGROUND: Genetic factors play an important role in hearing loss, contributing to approximately 60 % of cases of congenital hearing loss. Autosomal dominant deafness accounts for approximately 20 % of cases of hereditary hearing loss. Diseases with autosomal dominant inheritance often show pleiotropy, different degrees of penetrance, and variable expressivity.
METHODS: A three-generation Chinese family with autosomal dominant nonsyndromic hearing impairment (ADNSHI) was enrolled in this study. Audiometric data and blood samples were collected from the family. In total, 129 known human deafness genes were sequenced using next-generation sequencing (NGS) to identify the responsible gene mutation in the family. Whole Exome Sequencing (WES) was performed to exclude any other variant that cosegregated with the phenotype.
RESULTS: The age of onset of the affected family members was the second decade of life. The condition began with high-frequency hearing impairment in all family members excluding III:2. The novel ACTG1 c.638A > G (p.K213R) mutation was found in all affected family members and was not found in the unaffected family members. A heterozygous c.638A > G mutation in ACTG1 and homozygous c.109G > A (p.V37I) mutation in GJB2 were found in III:2, who was born with hearing loss. The WES result concurred with that of targeted sequencing of known deafness genes.
CONCLUSIONS: The novel mutation p.K213R in ACTG1 was found to be co-segregated with hearing loss and the genetic cause of ADNSHI in this family. A homozygous mutation associated with recessive inheritance only rarely co-acts with a dominant mutation to result in hearing loss in a dominant family. In such cases, the mutations in the two genes, as in ACTG1 and GJB2 in the present study, may result in a more severe phenotype. Targeted sequencing of known deafness genes is one of the best choices to identify the genetic cause in hereditary hearing loss families.

PMID: 26832775 [PubMed - in process]

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Care of Adults With Intellectual and Developmental Disabilities: Down Syndrome.

Related Articles

Care of Adults With Intellectual and Developmental Disabilities: Down Syndrome.

FP Essent. 2015 Dec;439:20-5

Authors: Wilson B, Jones KB, Weedon D, Bilder D

Abstract
Down syndrome (DS) is a genetic disorder involving excess genetic material from chromosome 21. The incidence of DS is increasing, and the life expectancy for individuals with DS has increased to a median age of 55 years. Adults with DS are at increased risk of several conditions, including significant neurologic, cardiovascular, pulmonary, gastrointestinal, musculoskeletal, endocrine, psychiatric, hematologic, and social comorbidities, and additional screening or monitoring may be needed. Additional preventive measures for patients with DS include regular screening for thyroid dysfunction, hearing loss, eye disorders, heart disease, osteoporosis, and dementia, and one-time vaccination with the polyvalent pneumococcal polysaccharide vaccine (PPV23). Quality of life should be the main focus of treatment, with patients being involved in medical decisions as much as possible.

PMID: 26669211 [PubMed - indexed for MEDLINE]

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A Founder Mutation in MYO7A Underlies a Significant Proportion of Usher Syndrome in Indigenous South Africans: Implications for the African Diaspora.

Related Articles

A Founder Mutation in MYO7A Underlies a Significant Proportion of Usher Syndrome in Indigenous South Africans: Implications for the African Diaspora.

Invest Ophthalmol Vis Sci. 2015 Oct;56(11):6671-8

Authors: Roberts L, George S, Greenberg J, Ramesar RS

Abstract
PURPOSE: Research over the past 25 years at the University of Cape Town has led to the identification of causative mutations in 17% of the 1416 families in the Retinal Degenerative Diseases (RDD) biorepository in South Africa. A low rate of mutation detection has been observed in patients of indigenous African origin, hinting at novel genes and mutations in this population. Recently, however, data from our translational research program showed two unrelated indigenous African families with Usher syndrome (USH), with the same homozygous MYO7A mutation. Therefore, the extent to which this mutation contributes toward the disease burden in South Africa was investigated.
METHODS: Cohorts of unrelated indigenous South African probands with different RDD diagnoses were tested for the MYO7A c.6377delC mutation. Familial cosegregation analysis was performed for homozygous probands, clinical data were evaluated, and SNP haplotypes were analyzed.
RESULTS: This homozygous MYO7A mutation underlies a remarkable 43% of indigenous African USH cases investigated in this study, the majority of which (60%) were diagnosed clinically with Type 2 USH. All homozygotes shared a common haplotype. This mutation does not appear to cause nonsyndromic vision loss.
CONCLUSIONS: Of interest is the origin of this common mutation relevant to the Bantu population migration into southern Africa. Further investigation of the phenotype may elucidate the disease biology, and perhaps reveal a larger cohort with the same mutation, with which to assess the impact of environmental and genetic modifiers and evaluate therapeutic trials.

PMID: 26469752 [PubMed - indexed for MEDLINE]

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Danish reading span data from 283 hearing-aid users, including a sub-group analysis of their relationship to speech-in-noise performance.

Related Articles

Danish reading span data from 283 hearing-aid users, including a sub-group analysis of their relationship to speech-in-noise performance.

Int J Audiol. 2016 Feb 2;:1-8

Authors: Borch Petersen E, Lunner T, Vestergaard MD, Sundewall Thorén E

Abstract
OBJECTIVE: This study provides descriptive statistics of the Danish reading span (RS) test for hearing-impaired adults. The combined effect of hearing loss, RS score, and age on speech-in-noise performance in different spatial settings was evaluated in a subset of participants.
DESIGN: Data from published and unpublished studies were re-analysed. Data regarding speech-in-noise performance with co-located or spatially separated sound sources were available for a subset of participants.
STUDY SAMPLE: RS scores from 283 hearing-impaired participants were extracted from past studies, and 239 of these participants had completed a speech-in-noise test.
RESULTS: RS scores (mean = 41.91%, standard deviation = 11.29%) were related to age (p <0.01), but not pure-tone average (PTA) (p = 0.29). Speech-in-noise performance for co-located sound sources was related to PTA and RS score (both p < 0.01, adjusted R-squared = 0.226). Performance for spatially separated sounds was related to PTA (p < 0.01, adjusted R-squared = 0.10) but not RS score (p = 0.484). We found no differences between the standardized coefficients of the two regression models.
CONCLUSIONS: The distribution of RS scores indicated a high test difficulty. We found that age should be controlled when RS scores are compared across populations. The experimental setup of the speech-in-noise test may influence the relationship between performance and RS score.

PMID: 26836955 [PubMed - as supplied by publisher]

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Danish reading span data from 283 hearing-aid users, including a sub-group analysis of their relationship to speech-in-noise performance.

Related Articles

Danish reading span data from 283 hearing-aid users, including a sub-group analysis of their relationship to speech-in-noise performance.

Int J Audiol. 2016 Feb 2;:1-8

Authors: Borch Petersen E, Lunner T, Vestergaard MD, Sundewall Thorén E

Abstract
OBJECTIVE: This study provides descriptive statistics of the Danish reading span (RS) test for hearing-impaired adults. The combined effect of hearing loss, RS score, and age on speech-in-noise performance in different spatial settings was evaluated in a subset of participants.
DESIGN: Data from published and unpublished studies were re-analysed. Data regarding speech-in-noise performance with co-located or spatially separated sound sources were available for a subset of participants.
STUDY SAMPLE: RS scores from 283 hearing-impaired participants were extracted from past studies, and 239 of these participants had completed a speech-in-noise test.
RESULTS: RS scores (mean = 41.91%, standard deviation = 11.29%) were related to age (p <0.01), but not pure-tone average (PTA) (p = 0.29). Speech-in-noise performance for co-located sound sources was related to PTA and RS score (both p < 0.01, adjusted R-squared = 0.226). Performance for spatially separated sounds was related to PTA (p < 0.01, adjusted R-squared = 0.10) but not RS score (p = 0.484). We found no differences between the standardized coefficients of the two regression models.
CONCLUSIONS: The distribution of RS scores indicated a high test difficulty. We found that age should be controlled when RS scores are compared across populations. The experimental setup of the speech-in-noise test may influence the relationship between performance and RS score.

PMID: 26836955 [PubMed - as supplied by publisher]

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Clinical Practice Guideline: Otitis Media with Effusion (Update).

Related Articles

Clinical Practice Guideline: Otitis Media with Effusion (Update).

Otolaryngol Head Neck Surg. 2016 Feb;154(1 Suppl):S1-S41

Authors: Rosenfeld RM, Shin JJ, Schwartz SR, Coggins R, Gagnon L, Hackell JM, Hoelting D, Hunter LL, Kummer AW, Payne SC, Poe DS, Veling M, Vila PM, Walsh SA, Corrigan MD

Abstract
OBJECTIVE: This update of a 2004 guideline codeveloped by the American Academy of Otolaryngology-Head and Neck Surgery Foundation, the American Academy of Pediatrics, and the American Academy of Family Physicians, provides evidence-based recommendations to manage otitis media with effusion (OME), defined as the presence of fluid in the middle ear without signs or symptoms of acute ear infection. Changes from the prior guideline include consumer advocates added to the update group, evidence from 4 new clinical practice guidelines, 20 new systematic reviews, and 49 randomized control trials, enhanced emphasis on patient education and shared decision making, a new algorithm to clarify action statement relationships, and new and expanded recommendations for the diagnosis and management of OME.
PURPOSE: The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing OME and to create explicit and actionable recommendations to implement these opportunities in clinical practice. Specifically, the goals are to improve diagnostic accuracy, identify children who are most susceptible to developmental sequelae from OME, and educate clinicians and patients regarding the favorable natural history of most OME and the clinical benefits for medical therapy (eg, steroids, antihistamines, decongestants). Additional goals relate to OME surveillance, hearing and language evaluation, and management of OME detected by newborn screening. The target patient for the guideline is a child aged 2 months through 12 years with OME, with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The guideline is intended for all clinicians who are likely to diagnose and manage children with OME, and it applies to any setting in which OME would be identified, monitored, or managed. This guideline, however, does not apply to patients <2 months or >12 years old.
ACTION STATEMENTS: The update group made strong recommendations that clinicians (1) should document the presence of middle ear effusion with pneumatic otoscopy when diagnosing OME in a child; (2) should perform pneumatic otoscopy to assess for OME in a child with otalgia, hearing loss, or both; (3) should obtain tympanometry in children with suspected OME for whom the diagnosis is uncertain after performing (or attempting) pneumatic otoscopy; (4) should manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known) or 3 months from the date of diagnosis (if onset is unknown); (5) should recommend against using intranasal or systemic steroids for treating OME; (6) should recommend against using systemic antibiotics for treating OME; and (7) should recommend against using antihistamines, decongestants, or both for treating OME.The update group made recommendations that clinicians (1) should document in the medical record counseling of parents of infants with OME who fail a newborn screening regarding the importance of follow-up to ensure that hearing is normal when OME resolves and to exclude an underlying sensorineural hearing loss; (2) should determine if a child with OME is at increased risk for speech, language, or learning problems from middle ear effusion because of baseline sensory, physical, cognitive, or behavioral factors; (3) should evaluate at-risk children for OME at the time of diagnosis of an at-risk condition and at 12 to 18 months of age (if diagnosed as being at risk prior to this time); (4) should not routinely screen children for OME who are not at risk and do not have symptoms that may be attributable to OME, such as hearing difficulties, balance (vestibular) problems, poor school performance, behavioral problems, or ear discomfort; (5) should educate children with OME and their families regarding the natural history of OME, need for follow-up, and the possible sequelae; (6) should obtain an age-appropriate hearing test if OME persists for 3 months or longer OR for OME of any duration in an at-risk child; (7) should counsel families of children with bilateral OME and documented hearing loss about the potential impact on speech and language development; (8) should reevaluate, at 3- to 6-month intervals, children with chronic OME until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected; (9) should recommend tympanostomy tubes when surgery is performed for OME in a child <4 years old; adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); (10) should recommend tympanostomy tubes, adenoidectomy, or both when surgery is performed for OME in a child ≥4 years old; and (11) should document resolution of OME, improved hearing, or improved quality of life when managing a child with OME.

PMID: 26832942 [PubMed - in process]

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Toxicity of silver nanoparticle in rat ear and BALB/c 3T3 cell line.

Related Articles

Toxicity of silver nanoparticle in rat ear and BALB/c 3T3 cell line.

J Nanobiotechnology. 2014;12:52

Authors: Zou J, Feng H, Mannerström M, Heinonen T, Pyykkö I

Abstract
BACKGROUND: Silver nanoparticles (AgNPs) displayed strong activities in anti-bacterial, anti-viral, and anti-fungal studies and was reportedly efficient in treating otitis media .The potential impact of AgNPs on the inner ear was missing.
OBJECTIVE: Attempted to evaluate the potential toxicity of AgNPs in the inner ear, middle ear, and external ear canal after transtympanic injection in rats.
RESULTS: In in vitro studies, the IC50 for AgNPs in neutral red uptake assay was lower than that in NAD(P)H-dependent cellular oxidoreductase enzyme assay (WST-1) and higher than that in total cellular ATP and nuclear membrane integrity (propidium iodide) assessments. In in vivo experiments, magnetic resonance imaging (MRI) showed that significant changes in the permeability of biological barriers occurred in the middle ear mucosa, the skin of the external ear canal, and the inner ear at 5 h post-transtympanic injection of AgNPs at concentrations ranging from 20 μg/ml to 4000 μg/ml. The alterations in permeability showed a dosage-response relationship, and were reversible. The auditory brainstem response showed that 4000 μg/ml AgNPs induced hearing loss with partial recovery at 7 d, whereas 20 μg/ml caused reversible hearing loss. The functional change in auditory system was in line with the histology results. In general, the BALB/c 3T3 cell line is more than 1000 times more sensitive than the in vivo studies. Impairment of the mitochondrial function was indicated to be the mechanism of toxicity of AgNPs.
CONCLUSION: These results suggest that AgNPs caused significant, dose-dependent changes in the permeability of biological barriers in the middle ear mucosa, the skin of the external ear canal, and the inner ear. In general, the BALB/c 3T3 cell line is more than 1000 times more sensitive than the in vivo studies. The rat ear model might be expended to other engineered nanomaterials in nanotoxicology study.

PMID: 25467963 [PubMed - indexed for MEDLINE]

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Clinical Practice Guideline: Otitis Media with Effusion (Update).

Related Articles

Clinical Practice Guideline: Otitis Media with Effusion (Update).

Otolaryngol Head Neck Surg. 2016 Feb;154(1 Suppl):S1-S41

Authors: Rosenfeld RM, Shin JJ, Schwartz SR, Coggins R, Gagnon L, Hackell JM, Hoelting D, Hunter LL, Kummer AW, Payne SC, Poe DS, Veling M, Vila PM, Walsh SA, Corrigan MD

Abstract
OBJECTIVE: This update of a 2004 guideline codeveloped by the American Academy of Otolaryngology-Head and Neck Surgery Foundation, the American Academy of Pediatrics, and the American Academy of Family Physicians, provides evidence-based recommendations to manage otitis media with effusion (OME), defined as the presence of fluid in the middle ear without signs or symptoms of acute ear infection. Changes from the prior guideline include consumer advocates added to the update group, evidence from 4 new clinical practice guidelines, 20 new systematic reviews, and 49 randomized control trials, enhanced emphasis on patient education and shared decision making, a new algorithm to clarify action statement relationships, and new and expanded recommendations for the diagnosis and management of OME.
PURPOSE: The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing OME and to create explicit and actionable recommendations to implement these opportunities in clinical practice. Specifically, the goals are to improve diagnostic accuracy, identify children who are most susceptible to developmental sequelae from OME, and educate clinicians and patients regarding the favorable natural history of most OME and the clinical benefits for medical therapy (eg, steroids, antihistamines, decongestants). Additional goals relate to OME surveillance, hearing and language evaluation, and management of OME detected by newborn screening. The target patient for the guideline is a child aged 2 months through 12 years with OME, with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The guideline is intended for all clinicians who are likely to diagnose and manage children with OME, and it applies to any setting in which OME would be identified, monitored, or managed. This guideline, however, does not apply to patients <2 months or >12 years old.
ACTION STATEMENTS: The update group made strong recommendations that clinicians (1) should document the presence of middle ear effusion with pneumatic otoscopy when diagnosing OME in a child; (2) should perform pneumatic otoscopy to assess for OME in a child with otalgia, hearing loss, or both; (3) should obtain tympanometry in children with suspected OME for whom the diagnosis is uncertain after performing (or attempting) pneumatic otoscopy; (4) should manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known) or 3 months from the date of diagnosis (if onset is unknown); (5) should recommend against using intranasal or systemic steroids for treating OME; (6) should recommend against using systemic antibiotics for treating OME; and (7) should recommend against using antihistamines, decongestants, or both for treating OME.The update group made recommendations that clinicians (1) should document in the medical record counseling of parents of infants with OME who fail a newborn screening regarding the importance of follow-up to ensure that hearing is normal when OME resolves and to exclude an underlying sensorineural hearing loss; (2) should determine if a child with OME is at increased risk for speech, language, or learning problems from middle ear effusion because of baseline sensory, physical, cognitive, or behavioral factors; (3) should evaluate at-risk children for OME at the time of diagnosis of an at-risk condition and at 12 to 18 months of age (if diagnosed as being at risk prior to this time); (4) should not routinely screen children for OME who are not at risk and do not have symptoms that may be attributable to OME, such as hearing difficulties, balance (vestibular) problems, poor school performance, behavioral problems, or ear discomfort; (5) should educate children with OME and their families regarding the natural history of OME, need for follow-up, and the possible sequelae; (6) should obtain an age-appropriate hearing test if OME persists for 3 months or longer OR for OME of any duration in an at-risk child; (7) should counsel families of children with bilateral OME and documented hearing loss about the potential impact on speech and language development; (8) should reevaluate, at 3- to 6-month intervals, children with chronic OME until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected; (9) should recommend tympanostomy tubes when surgery is performed for OME in a child <4 years old; adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); (10) should recommend tympanostomy tubes, adenoidectomy, or both when surgery is performed for OME in a child ≥4 years old; and (11) should document resolution of OME, improved hearing, or improved quality of life when managing a child with OME.

PMID: 26832942 [PubMed - in process]

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Toxicity of silver nanoparticle in rat ear and BALB/c 3T3 cell line.

Related Articles

Toxicity of silver nanoparticle in rat ear and BALB/c 3T3 cell line.

J Nanobiotechnology. 2014;12:52

Authors: Zou J, Feng H, Mannerström M, Heinonen T, Pyykkö I

Abstract
BACKGROUND: Silver nanoparticles (AgNPs) displayed strong activities in anti-bacterial, anti-viral, and anti-fungal studies and was reportedly efficient in treating otitis media .The potential impact of AgNPs on the inner ear was missing.
OBJECTIVE: Attempted to evaluate the potential toxicity of AgNPs in the inner ear, middle ear, and external ear canal after transtympanic injection in rats.
RESULTS: In in vitro studies, the IC50 for AgNPs in neutral red uptake assay was lower than that in NAD(P)H-dependent cellular oxidoreductase enzyme assay (WST-1) and higher than that in total cellular ATP and nuclear membrane integrity (propidium iodide) assessments. In in vivo experiments, magnetic resonance imaging (MRI) showed that significant changes in the permeability of biological barriers occurred in the middle ear mucosa, the skin of the external ear canal, and the inner ear at 5 h post-transtympanic injection of AgNPs at concentrations ranging from 20 μg/ml to 4000 μg/ml. The alterations in permeability showed a dosage-response relationship, and were reversible. The auditory brainstem response showed that 4000 μg/ml AgNPs induced hearing loss with partial recovery at 7 d, whereas 20 μg/ml caused reversible hearing loss. The functional change in auditory system was in line with the histology results. In general, the BALB/c 3T3 cell line is more than 1000 times more sensitive than the in vivo studies. Impairment of the mitochondrial function was indicated to be the mechanism of toxicity of AgNPs.
CONCLUSION: These results suggest that AgNPs caused significant, dose-dependent changes in the permeability of biological barriers in the middle ear mucosa, the skin of the external ear canal, and the inner ear. In general, the BALB/c 3T3 cell line is more than 1000 times more sensitive than the in vivo studies. The rat ear model might be expended to other engineered nanomaterials in nanotoxicology study.

PMID: 25467963 [PubMed - indexed for MEDLINE]

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Immediate and One Week Effects of Laterally Wedge Insoles on Gait Biomechanics in Healthy Females

Publication date: Available online 3 February 2016
Source:Gait & Posture
Author(s): Joshua T. Weinhandl, Sarah E. Sudheimer, Bonnie L. Van Lunen, Kimberly Stewart, Matthew C. Hoch
It is estimated that approximately 45% of the U.S. population will develop knee osteoarthritis, a disease that creates significant economic burdens in both direct and indirect costs. Laterally wedged insoles have been frequently recommended to reduce knee abduction moments and to manage knee osteoarthritis. However, it remains unknown whether the lateral wedge will reduce knee abduction moments over a prolonged period of time. Thus, the purposes of this study were to 1) examine the immediate effects of a laterally wedged insole in individuals normally aligned knees and 2) determine prolonged effects after the insole was worn for one week. Gait analysis was performed on ten women with and without a laterally wedged insole. After participants wore the wedges for a week, a second gait analysis was performed with and without the insole. The wedged insole did not affect peak knee abduction moment, although there was a significant increase in knee abduction angular impulse after wearing the insoles for one week. Furthermore, there was a significant increase in vertical ground reaction force at the instance of peak knee abduction moment with the wedges. While the laterally wedged insole used in the current study did not alter knee abduction moments as expected, other studies have shown alterations. Future studies should also examine a longer acclimation period, the influence of gait speed, and the effect of different shoe types with the insole.



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Immediate and One Week Effects of Laterally Wedge Insoles on Gait Biomechanics in Healthy Females

Publication date: Available online 3 February 2016
Source:Gait & Posture
Author(s): Joshua T. Weinhandl, Sarah E. Sudheimer, Bonnie L. Van Lunen, Kimberly Stewart, Matthew C. Hoch
It is estimated that approximately 45% of the U.S. population will develop knee osteoarthritis, a disease that creates significant economic burdens in both direct and indirect costs. Laterally wedged insoles have been frequently recommended to reduce knee abduction moments and to manage knee osteoarthritis. However, it remains unknown whether the lateral wedge will reduce knee abduction moments over a prolonged period of time. Thus, the purposes of this study were to 1) examine the immediate effects of a laterally wedged insole in individuals normally aligned knees and 2) determine prolonged effects after the insole was worn for one week. Gait analysis was performed on ten women with and without a laterally wedged insole. After participants wore the wedges for a week, a second gait analysis was performed with and without the insole. The wedged insole did not affect peak knee abduction moment, although there was a significant increase in knee abduction angular impulse after wearing the insoles for one week. Furthermore, there was a significant increase in vertical ground reaction force at the instance of peak knee abduction moment with the wedges. While the laterally wedged insole used in the current study did not alter knee abduction moments as expected, other studies have shown alterations. Future studies should also examine a longer acclimation period, the influence of gait speed, and the effect of different shoe types with the insole.



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Immediate and One Week Effects of Laterally Wedge Insoles on Gait Biomechanics in Healthy Females

Publication date: Available online 3 February 2016
Source:Gait & Posture
Author(s): Joshua T. Weinhandl, Sarah E. Sudheimer, Bonnie L. Van Lunen, Kimberly Stewart, Matthew C. Hoch
It is estimated that approximately 45% of the U.S. population will develop knee osteoarthritis, a disease that creates significant economic burdens in both direct and indirect costs. Laterally wedged insoles have been frequently recommended to reduce knee abduction moments and to manage knee osteoarthritis. However, it remains unknown whether the lateral wedge will reduce knee abduction moments over a prolonged period of time. Thus, the purposes of this study were to 1) examine the immediate effects of a laterally wedged insole in individuals normally aligned knees and 2) determine prolonged effects after the insole was worn for one week. Gait analysis was performed on ten women with and without a laterally wedged insole. After participants wore the wedges for a week, a second gait analysis was performed with and without the insole. The wedged insole did not affect peak knee abduction moment, although there was a significant increase in knee abduction angular impulse after wearing the insoles for one week. Furthermore, there was a significant increase in vertical ground reaction force at the instance of peak knee abduction moment with the wedges. While the laterally wedged insole used in the current study did not alter knee abduction moments as expected, other studies have shown alterations. Future studies should also examine a longer acclimation period, the influence of gait speed, and the effect of different shoe types with the insole.



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Cochlear Implant Access in Six Developed Countries

Background: Access to cochlear implantation varies greatly around the world. It is affected by factors that are specific to each country's health care system, by awareness, and by societal attitudes regarding deafness. Methods: Cochlear implant clinicians and researchers from six countries explored and discussed these variations and their likely causes: Robert Briggs from Australia; Wolfe-Dieter Baumgartner from Austria; Thomas Lenarz from Germany; Eva Koltharp from Sweden; Christopher Raine from the United Kingdom, and Craig Buchman, Donna Sorkin, and Christine Yoshinago from the United States. Results: Utilization rates are quite different for the pediatric and adult demographics in all six countries. Pediatric utilization ranges in the six countries (all in the developed world) ranged from a low of 50% in the United States to a high of 97% in Australia. Adult utilization is less than 10% everywhere in the world. Conclusions: Pediatric access to care was excellent for children with the exception of Germany and the United States where there is an inadequate referral system. Adult utilization was low everywhere because of the lack of screening for adults and the fact that primary care physicians and even audiologists are unfamiliar with CI candidacy criteria and outcomes, and hence typically do not make patient referrals.

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Single-sided Deafness Cochlear Implantation: Candidacy, Evaluation, and Outcomes in Children and Adults

Objectives: Although there are various available treatment options for unilateral severe-to-profound hearing loss, these options do not provide the benefits of binaural hearing since sound is directed from the poorer ear to the better ear. The purpose of this investigation was to review our center's experience with cochlear implantation in such patients in providing improved auditory benefits and useful binaural hearing. Study Design: Retrospective chart review. Methods: Twelve adult patients and four pediatric patients with unilateral severe-to-profound hearing loss received an implant in the poorer ear. Outcome measures performed preoperatively on each ear and binaurally included consonant–nucleus–consonant (CNC) monosyllabic words and sentences in noise. The mean pure-tune average in the better ear was within normal range. Results: Test scores revealed a significant improvement in CNC and sentence in noise test scores from the preoperative to most recent postoperative evaluation in the isolated implant ear. All adult subjects use the device full-time. Conclusions: The data reveal significant improvement in speech perception performance in quiet and in noise in patients with single-sided deafness after implantation. Performance might depend on factors including length of hearing loss, age at implantation, and device usage.

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Using the Implant Electrode Array to Conduct Real-time Intraoperative Hearing Monitoring During Pediatric Cochlear Implantation: Preliminary Experiences

Objectives: To present the preliminary experiences and findings from a pilot study evaluating a novel technique for monitoring cochlear electrophysiological function during electrode insertion in cochlear implantation surgery. Study Design: Prospective pilot cohort study. Setting: Tertiary academic neuro-otology center. Patients: Pediatric patients with residual hearing undergoing hearing preservation cochlear implant surgery. Intervention: Monitoring of intraoperative cochlear microphonics during cochlear implant surgery. Main Outcome Measure: Intraoperative intracochlear microphonic measurement, preservation of these responses postoperatively and preservation of hearing as measured by audiometry. Results: Intracochlear microphonics could be identified in both patients presented and were preserved during the surgical procedure and postoperatively. The preservation of intracochlear microphonics correlates with preservation of hearing. Conclusion: The novel approach using the electrode array to detect and measure intracochlear microphonics during cochlear implantation surgery shows promise as an instrument to alert the operating surgeon to hair cell damage during electrode insertion. Further refinement of the technique is required to better understand the measurements and correlate these with pre- and postoperative hearing and risk of hearing loss from surgery. Improvements in the software algorithm will reduce the time required for each measurement, leading to the development a more real-time monitoring technique.

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Music Perception of Adolescents Using Electroacoustic Hearing

Background: Preserved residual hearing in adult recipients of short electrode cochlear implants (CIs) contributes to improve perception of speech in noise as well as music. Recently, children and adolescents with sufficient low-frequency hearing but profound loss at higher frequencies enrolled in a FDA trial intended to evaluate the benefit of a short electrode device on the maintenance of residual hearing. This article reports on the perception of several music listening tasks by adolescents using electroacoustic hearing. Methods: Five adolescents (13–18 yr) with 18–24 months of electroacoustic experience, 73 children (LEC) and adolescents (LEA) who use traditional implants, and 87 children with normal hearing (NH) tested on 3 measures of music perception: Complex Pitch Ranking (PR-C); Melodic Error Detection (MED); Melody Recognition X Information Cue (MRIC). The participants with ipsilateral residual hearing were tested preoperatively at intervals up to 24 months. Results: Pitch ranking scores for the electroacoustic group were significantly better than the LEC and LEA (p 

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Measuring Success: Cost-Effectiveness and Expanding Access to Cochlear Implantation

Only a small fraction of patients with profound sensorineural hearing loss have access to cochlear implantation with the majority of these affected people living in developing countries. Cost effectiveness analysis (CEA) is an important tool to demonstrate the value of this technology to healthcare policy makers. This approach requires that hearing healthcare professionals incorporate methods of assessing long-term benefits of cochlear implantation that include psychosocial, quality of life, and disability outcomes. This review explores different aspects of CEA methodology relevant to cochlear implants and discusses ways that we can improve global access by addressing factors that influence cost-effectiveness.

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A Comprehensive Study on the Etiology of Patients Receiving Cochlear Implantation With Special Emphasis on Genetic Epidemiology

Objective: Cochlear implantation is the most important treatment currently available for profound sensorineural hearing loss. The aim of this study was to investigate the etiology of hearing loss in patients with cochlear implantation, and to compare outcomes. Methods: Japanese hearing loss patients who received cochlear implants (CIs) or electric acoustic stimulation (EAS) in Shinshu University hospital (n = 173, prelingual onset: 92, postlingual onset: 81) participated in this study. Invader assay followed by the targeted exon-sequencing of 63 deafness genes using Massively parallel DNA sequencing (MPS) was applied. For prelingual patients, additional imaging examination, cCMV screening, and pediatric examination were performed for precise diagnosis. Results: Genetic screening successfully identified the causative mutation in 60% of patients with prelingual onset hearing loss and in 36% of those with postlingual hearing loss. Differences in the kinds of genes identified were observed between the two groups. Although there were marked variations in the outcome of cochlear implantation, patients with specific deafness gene mutations showed relatively good results. Conclusion: The present study showed genetic etiology is a major cause of hearing loss in CI/EAS patients. Patients possessing mutations in a number of deafness genes known to be expressed within inner ear have achieved satisfactory auditory performance, suggesting that the identification of the genetic background facilitates the prediction of post-CI performance. MPS is a powerful tool for the identification of causative deafness genes in patients receiving cochlear implantation. Therefore, determination of the involved region inside/outside of the cochlea by identification of the responsible gene is essential.

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Outcomes of Adolescents With a Short Electrode Cochlear Implant With Preserved Residual Hearing

Objective: The purpose of this study was to determine if adolescents with preserved residual low-frequency hearing can develop improved speech perception and maintain localization abilities by combining their acoustic hearing with electrical processing from a short electrode cochlear implant. Study Design: Repeated-measure, single-subject experiment. Setting: Research hospital. Patients: Adolescents with sensorineural hearing loss with a pure-tone average (PTA) between 60 and 90 dB HL between 125 and 1500 Hz and profound loss at higher frequencies. Intervention(s): rehabilitative. Main Outcome Measure(s): Five adolescents received a short electrode cochlear implant in their poorer ear. Audiometric, speech perception in quiet (CNC words), localization, speech production, and language outcomes were collected pre- and postoperatively at 4, 8, 12, and 24 months. Results: Functional hearing preservation was accomplished in all subjects at initial activation and was maintained through 24 months. In the Combined and Hybrid conditions, all subjects showed significant improvements by 4 months postimplantation, with exception of Subject 2 in the Combined condition, who showed a significant improvement by 8 months postimplantation. Results also indicated that all subjects continue to have localization abilities postimplantation. Conclusions: All of the subjects have benefitted from the combined electric and acoustic processing for speech perception abilities. The results from this study suggest that it could be worthwhile to consider acoustic and electric hearing in the adolescent population that have some low-frequency residual hearing and are struggling with hearing aids.

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Project ASPIRE: Spoken Language Intervention Curriculum for Parents of Low-socioeconomic Status and Their Deaf and Hard-of-Hearing Children

Objective: To investigate the impact of a spoken language intervention curriculum aiming to improve the language environments caregivers of low socioeconomic status (SES) provide for their D/HH children with CI & HA to support children's spoken language development. Study Design: Quasiexperimental. Setting: Tertiary. Patients: Thirty-two caregiver–child dyads of low-SES (as defined by caregiver education ≤ MA/MS and the income proxies = Medicaid or WIC/LINK) and children aged 

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The Utility of a Predictive Model for Cochlear Implant Operating Time

Objective: This study analyzes multiple factors and their significance in determining the operative timing for cochlear implants at one institution over a 10-year period. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: All patients including both adult and pediatric undergoing cochlear implantation from 2002 through January 2012. Intervention(s): Cochlear implantation. Main Outcome Measure(s): The overall operative room time and surgical duration for patients undergoing cochlear implantation. Individual factors analyzed for influence on timing included center experience, surgeon experience, location (main OR, children's OR, outpatient OR), patient age, patient sex, bilaterality, anatomical consideration, complications, and the involvement of residents and fellows. Results: ANOVA analysis of individual factors. Factors associated with increased surgical duration included bilateral implants, abnormal inner ear anatomy, and intraoperative complications. Factors associated with time outside the operation included surgical duration, the surgical suite type, and the availability of a fellow. Total operating room time was significantly reduced in an outpatient setting and in quicker performed procedures. Conclusions: The influence of factors affecting both surgical duration and time in the operating room can be predicted and used to provide more accurate estimates of operating room time.

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Bilateral Sequential Cochlear Implantation in Patients With Enlarged Vestibular Aqueduct (EVA) Syndrome

Objectives: To analyze audiometric outcomes after bilateral cochlear implantation in patients with isolated enlarged vestibular aqueduct (EVA) syndrome and associated incomplete partition (IP) malformations. Secondary objective was to analyze rate of cerebrospinal fluid (CSF) gusher in patients with IP-EVA spectrum deformities and compare this with the existing literature. Study Design: Retrospective chart review. Methods: Thirty-two patients with EVA syndrome who received unilateral or bilateral cochlear implants between June 1999 and January 2014 were identified in the University Hospitals Case Medical Center cochlear implant database. Isolated EVA (IEVA) and Incomplete Partition Type II (IP-II) malformations were identified by reviewing high-resolution computed tomography (HRCT) imaging. Demographic information, age at implantation, surgical details, postimplantation audiometric data including speech reception thresholds (SRT), word, and sentence scores were reviewed and analyzed. Intra- and postoperative complications were analyzed as well and compared with the literature. Results: Seventeen patients (32 implanted ears) had pediatric cochlear implantation for EVA-associated hearing loss. Data from 16 controls (32 implanted ears) were used to compare audiometric and speech outcomes of EVA cohort. Mean age at implantation was 6.8 years for EVA cohort and 6.0 years for controls. There was no statistically significant difference in long-term postoperative SRT, monaurally aided word scores, and binaurally tested word scores between pediatric EVA group and controls. The EVA patients had a long-term mean sentence score of 85.92%. A subset of EVA patients implanted at mean age of 3.18 years (n = 15 ears) had similar audiometric outcomes to another control group with Connexin 26 mutations (n = 20 ears) implanted at a similar age. Further subset analysis revealed no significant differences in age at implantation, SRT, and word scores in patients with IEVA and IP-II malformation. There was no significant association between size of vestibular aqueduct and age at implantation. There was no CSF gusher or other intra- or postoperative complications reported in our series. Conclusion: Bilateral sequential cochlear implantation can be performed safely in patients with EVA. Audiometric outcomes are excellent and comparable to pediatric cochlear implant patients with no malformations. CSF gusher rates can be minimized by trans-round window approach. Further long-term studies are needed to identify differences within IP-EVA spectrum deformities, audiometric outcomes, and proportions of EVA patients who will need cochlear implantation for hearing rehabilitation.

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Long-term Communication Outcomes for Children Receiving Cochlear Implants Younger Than 12 Months: A Multicenter Study

Objective: Examine the influence of age at implant on speech perception, language, and speech production outcomes in a large unselected paediatric cohort. Study Design: This study pools available assessment data (collected prospectively and entered into respective databases from 1990 to 2014) from three Australian centers. Patients: Children (n = 403) with congenital bilateral severe to profound hearing loss who received cochlear implants under 6 years of age (excluding those with acquired onset of profound hearing loss after 12 mo, those with progressive hearing loss and those with mild/moderate/severe additional cognitive delay/disability). Main Outcome Measure(s): Speech perception; open-set words (scored for words and phonemes correct) and sentence understanding at school entry and late primary school time points. Language; PLS and PPVT standard score equivalents at school entry, CELF standard scores. Speech Production; DEAP percentage accuracy of vowels, consonants, phonemes-total and clusters, and percentage word-intelligibility at school entry. Results: Regression analysis indicated a significant effect for age-at-implant for all outcome measures. Cognitive skills also accounted for significant variance in all outcome measures except open-set phoneme scores. ANOVA with Tukey pairwise comparisons examined group differences for children implanted younger than 12 months (Group 1), between 13 and 18 months (Group 2), between 19 and 24 months (Group 3), between 25 and 42 months (Group 4), and between 43 and 72 months (Group 5). Open-set speech perception scores for Groups 1, 2, and 3 were significantly higher than Groups 4 and 5. Language standard scores for Group 1 were significantly higher than Groups 2, 3, 4, and 5. Speech production outcomes for Group 1 were significantly higher than scores obtained for Groups 2, 3, and 4 combined. Cross tabulation and χ2 tests supported the hypothesis that a greater percentage of Group 1 children (than Groups 2, 3, 4, or 5) demonstrated language performance within the normative range by school entry. Conclusions: Results support provision of cochlear implants younger than 12 months of age for children with severe to profound hearing loss to optimize speech perception and subsequent language acquisition and speech production accuracy.

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Sentence Recognition in Quiet and Noise by Pediatric Cochlear Implant Users: Relationships to Spoken Language

Objective: We investigated associations between sentence recognition and spoken language for children with cochlear implants (CI) enrolled in the Childhood Development after Cochlear Implantation (CDaCI) study. Study Design: In a prospective longitudinal study, sentence recognition percent-correct scores and language standard scores were correlated at 48-, 60-, and 72-months post-CI activation. Setting: Six tertiary CI centers in the United States. Patients: Children with CIs participating in the CDaCI study. Intervention (s): Cochlear implantation. Main Outcome Measure (s): Sentence recognition was assessed using the Hearing In Noise Test for Children (HINT-C) in quiet and at +10, +5, and 0 dB signal-to-noise ratio (S/N). Spoken language was assessed using the Clinical Assessment of Spoken Language (CASL) core composite and the antonyms, paragraph comprehension (syntax comprehension), syntax construction (expression), and pragmatic judgment tests. Results: Positive linear relationships were found between CASL scores and HINT-C sentence scores when the sentences were delivered in quiet and at +10 and +5 dB S/N, but not at 0 dB S/N. At 48 months post-CI, sentence scores at +10 and +5 dB S/N were most strongly associated with CASL antonyms. At 60 and 72 months, sentence recognition in noise was most strongly associated with paragraph comprehension and syntax construction. Conclusions: Children with CIs learn spoken language in a variety of acoustic environments. Despite the observed inconsistent performance in different listening situations and noise-challenged environments, many children with CIs are able to build lexicons and learn the rules of grammar that enable recognition of sentences.

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Method of Speech Stimulus Presentation Impacts Pediatric Speech Recognition: Monitored Live Voice Versus Recorded Speech

Objective: To characterize the potential differences in speech understanding performance on word and sentence tests assessed using live voice and recorded speech measures for pediatric cochlear implant (CI) recipients. Study Design: This clinical study used a combination of retrospective and prospective study designs exploring within-subject performance for recorded versus monitored-live-voice presentation methods on pediatric word and sentence measures. Methods: Word and/or sentence recognition was obtained for 29 pediatric CI recipients using both recorded stimuli and monitored-live-voice (MLV) within a single-test session with a single experimenter for each session. The difference score was calculated for word and sentence measures allowing a comparison across conditions. Setting: Ambulatory. Patients: Pediatric patients aged 4 to 17 years. Intervention(s): Cochlear implants. Main Outcome Measure(s): Speech recognition testing. Results: There was a significant difference between recorded and MLV speech understanding with mean recorded word scores being 13-percentage points lower than those obtained via MLV. Conclusions: The results of this project suggest that the use of MLV for the assessment of speech perception in the pediatric Audiology clinic may overinflate children's performance and thereby runs the risk of failing to identify poorer or at-risk performance.

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Initial Results With Image-guided Cochlear Implant Programming in Children

Hypothesis: Image-guided cochlear implant (CI) programming can improve hearing outcomes for pediatric CI recipients. Background: CIs have been highly successful for children with severe-to-profound hearing loss, offering potential for mainstreamed education and auditory-oral communication. Despite this, a significant number of recipients still experience poor speech understanding, language delay, and, even among the best performers, restoration to normal auditory fidelity is rare. Although significant research efforts have been devoted to improving stimulation strategies, few developments have led to significant hearing improvement over the past two decades. Recently introduced techniques for image-guided CI programming (IGCIP) permit creating patient-customized CI programs by making it possible, for the first time, to estimate the position of implanted CI electrodes relative to the nerves they stimulate using CT images. This approach permits identification of electrodes with high levels of stimulation overlap and to deactivate them from a patient's map. Previous studies have shown that IGCIP can significantly improve hearing outcomes for adults with CIs. Methods: The IGCIP technique was tested for 21 ears of 18 pediatric CI recipients. Participants had long-term experience with their CI (5 mo to 13 yr) and ranged in age from 5 to 17 years old. Speech understanding was assessed after approximately 4 weeks of experience with the IGCIP map. Results: Using a two-tailed Wilcoxon signed-rank test, statistically significant improvement (p 

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Language Development in the First Year of Life: What Deaf Children Might Be Missing Before Cochlear Implantation

Objectives: Language development is a multifaceted, dynamic process involving the discovery of complex patterns, and the refinement of native language competencies in the context of communicative interactions. This process is already advanced by the end of the first year of life for hearing children, but prelingually deaf children who initially lack a language model may miss critical experiences during this early window. The purpose of this review is twofold. First, we examine the published literature on language development during the first 12 months in typically developing children. Second, we use this literature to inform our understanding of the language outcomes of prelingually deaf children who receive cochlear implants (CIs), and therefore language input, either before or after the first year. Conclusions: During the first 12 months, typically developing infants exhibit advances in speech segmentation, word learning, syntax acquisition, and communication, both verbal and nonverbal. Infants and their caregivers coconstruct a communication foundation during this time, supporting continued language growth. The language outcomes of hearing children are robustly predicted by their experiences and acquired competencies during the first year; yet these predictive links are absent among prelingually deaf infants lacking a language model (i.e., those without exposure to sign). For deaf infants who receive a CI, implantation timing is crucial. Children receiving CIs before 12 months frequently catch up with their typically developing peers, whereas those receiving CIs later do not. Explanations for the language difficulties of late-implanted children are discussed.

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Speech Recognition of Bimodal Cochlear Implant Recipients Using a Wireless Audio Streaming Accessory for the Telephone

Objective: The goals of the present investigation were (1) to evaluate recognition of recorded speech presented over a mobile telephone for a group of adult bimodal cochlear implant users, and (2) to measure the potential benefits of wireless hearing assistance technology (HAT) for mobile telephone speech recognition using bimodal stimulation (i.e., a cochlear implant in one ear and a hearing aid on the other ear). Study Design: A three-by-two-way repeated measures design was used to evaluate mobile telephone sentence-recognition performance differences obtained in quiet and in noise with and without the wireless HAT accessory coupled to the hearing aid alone, CI sound processor alone, and in the bimodal condition. Setting: Outpatient cochlear implant clinic. Subjects: Sixteen bimodal users with Nucleus 24, Freedom, CI512, or CI422 cochlear implants participated in this study. Intervention (s): Performance was measured with and without the use of a wireless HAT for the telephone used with the hearing aid alone, CI alone, and bimodal condition. Main Outcome Measure(s): CNC word recognition in quiet and in noise with and without the use of a wireless HAT telephone accessory in the hearing aid alone, CI alone, and bimodal conditions. Results: Results suggested that the bimodal condition gave significantly better speech recognition on the mobile telephone with the wireless HAT. Conclusions: A wireless HAT for the mobile telephone provides bimodal users with significant improvement in word recognition in quiet and in noise over the mobile telephone.

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Speech Understanding in Children With Normal Hearing: Sound Field Normative Data for BabyBio, BKB-SIN, and QuickSIN

Objective: The primary goal was to establish normative data for the Pediatric AzBio “BabyBio,” QuickSIN, and BKB-SIN measures in the sound field for children with normal hearing. Setting: Tertiary care hospital; cochlear implant (CI) program. Patients: Forty-one children with normal hearing were recruited across four age groups (5–6, 7–8, 9–10, and 11–12 yr). Interventions: Sentence recognition testing was assessed at four different signal-to-noise ratios (SNRs, +10, +5, 0, and −5 dB) for BabyBio sentences as well as for the BKB-SIN and QuickSIN tests. All measures were presented in the sound field at 60 dBA except QuickSIN, which was presented at 70 dBA. Main Outcome Measures: BabyBio sentence recognition, BKB-SIN SNR-50, and QuickSIN SNR-50 were analyzed to establish sound field norms. Results: BabyBio sentence recognition approached ceiling at all SNRs with mean scores ranging from 86% at −5 dB SNR to 99.3% at +10 dB SNR. Mean QuickSIN SNR-50 was 6.6 dB. Mean BKB-SIN SNR-50 was 1.6 dB with sound field data being consistent with insert earphone normative data in the BKB-SIN manual. Performance for all measures improved with age. Conclusion: Children with normal hearing achieve ceiling-level performance for BabyBio sentence recognition at SNRs used for clinical CI testing (≥0 dB SNR) and approach ceiling level even at −5 dB SNR. Consistent with previous reports, speech recognition in noise improved with age from 5 to 12 years in children with normal hearing. Thus, speech recognition in noise might also increase in the CI population across the same age range warranting age-specific norms for CI recipients. Last, the QuickSIN test could be substituted for the BKB-SIN test with appropriate age-normative data.

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Does Bilateral Experience Lead to Improved Spatial Unmasking of Speech in Children Who Use Bilateral Cochlear Implants?

Hypothesis: In children with bilateral cochlear implants (BiCIs), experience over a 1 to 3-year period can improve speech understanding and spatial unmasking of speech. Background: One reason for providing children with BiCIs is to improve spatial hearing abilities. Little is known about changes in performance with added bilateral experience, and the relation between sound localization and spatial unmasking of speech. Methods: Twenty children with BiCIs participated. Testing was conducted typically within a year of bilateral activation, and at 1, 2, or 3 follow-up annual intervals. All testing was done while children listened with both devices activated. Target speech was presented from front (co-located); interfering speech was from front, right (asymmetrical), or right and left (symmetrical). Speech reception thresholds (SRTs) were measured in each condition. Spatial release from masking (SRM) was quantified as the difference in SRTs between conditions with interferers at 0 degrees and 90 degrees. For 11 of the children, data are also compared with sound localization measures obtained on the same visit to the laboratory but published elsewhere. Results: Change in SRM with bilateral experience varied; some children showed improvement and others did not. Regression analyses identified relationships between SRTs and SRM. Comparison of the SRM with localization data suggests little evidence for correlations between the two spatial tasks. Conclusion: In children with BiCIs spatial hearing mechanisms involved in SRM and sound localization may be different. Reasons for reduced SRM include asymmetry between the ears, and individual differences in the ability to inhibit interfering information, switch and/or sustain attention.

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Beyond Early Intervention: Supporting Children With CIs Through Elementary School

Background: The development of cochlear implants (CIs) and the broader availability of early intervention, made possible by newborn hearing screening, have raised prospects that deaf children can be mainstreamed at the start of elementary school and fare well with minimal support. This report examines the veracity of that perspective. Methods: This report specifically: (1) reviews progress made by deaf children in spoken language acquisition over the past 25 years; (2) presents data collected from 104 children in the early elementary grades (49 with normal hearing (NH) and 55 with severe-to-profound hearing loss who use CIs); (3) describes language acquisition that typically occurs in elementary school; and (4) highlights intervention strategies for school-age deaf children with CIs. Results: The spoken language skills of deaf children have improved thanks to CIs and early intervention, but remain below those of children with NH. The amount of deficit varies across the language construct examined, with the greatest deficit found for skills dependent upon phonological (speech-sound) sensitivity, and the mildest associated with morphosyntactic (grammatical) skills. There is substantial development in both phonological and morphosyntactic skills that typically occurs during the elementary school years. Conclusion: Both the data and theoretical models of language acquisition indicate that even with the availability of CIs and early intervention, deaf children are behind their peers with NH when they enter school. And there is much language learning that lies ahead for them. Thus, there is a need for us to enhance our intervention with deaf children during the early elementary grades.

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Drawing Attention to Global Care

No abstract available

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