Is Tinnitus Treatable?

Tinnitus is one of the most intrusive disorders known in our modern society. It is far more prevalent today than ever before due to the fact that society is noisier than ever before. Construction workers, factory workers and disc jockeys are probably the three occupations most effected by tinnitus. Loud sounds without proper ear protection can cause tinnitus, and once you have it, it usually does not go away. And while there is no cure currently known, the question is: is tinnitus treatable?

Disc Jockeys Beware

If you are in an otherwise quiet room and you hear a hissing or ringing sound that is not coming from anything discernible, it is probably tinnitus. Some sufferers claim that it literally blocks out other sounds, causing them to be virtually deaf. Unfortunately, contemporary disc jockeys, specifically, generally do not wear ear protection and, essentially, live in a loud music environment. In their youthful exuberance for the music and dancing, they tend to ignore the warnings of experienced individuals. It isn’t too long before tinnitus sets in and will likely only get worse unless precautions are taken.

Psychological Distress and Memory Loss

The tonality, volume and type of ringing or hissing can vary, but the result is the same: partial deafness. The sound may interfere with watching television and listening to music. Even having a conversation can be frustrating with a constant hissing in your ears. At its worst, severe tinnitus can even cause psychological distress, including depression and anxiety. Some sufferers also experience short-term memory loss.

Again, is tinnitus treatable? The simple answer is yes. However, treatment may not work for everybody.

Successful Treatment is Not Guaranteed

As of yet, there is no known, scientifically accepted, definitive cure, just as there is no definitive universal treatment. Even with successful treatment, there is no guarantee that the hissing or ringing will completely dissipate or disappear and not return. So it is wise to look upon ebooks and other sources that claim to alleviate the symptoms of tinnitus with skepticism and concern. The cure may be out there, but it has yet to be discovered.

“Successful” treatments include:

• Tinnitus Restraining Therapy
• Tinnitus Masking
• Meditation
• Medication
• Sound Therapies

The most anticipated cure being examined is stem cell research. Hopefully, the question – “Is tinnitus treatable?” – will be a thing of the past. That being said, it is, in the long run, easier and wiser to prevent tinnitus than to have it treated.

If you have a DJ friend or family member, talk to them; show them this article and other sources that will persuade them to be less careless with their hearing. Their lives will be richer for it.

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Augmented feedback of COM and COP modulates the regulation of quiet human standing relative to the stability boundary

Publication date: Available online 7 April 2016
Source:Gait & Posture
Author(s): Melissa C. Kilby, Semyon M. Slobounov, Karl M. Newell
The experiment manipulated real-time kinematic feedback of the motion of the whole body center of mass (COM) and center of pressure (COP) in anterior-posterior (AP) and medial-lateral (ML) directions to investigate the variables actively controlled in quiet standing of young adults. The feedback reflected the current 2D postural positions within the 2D functional stability boundary that was scaled to 75%, 30% and 12% of its original size. The findings showed that the distance of both COP and COM to the respective stability boundary was greater during the feedback trials compared to a no feedback condition. However, the temporal safety margin of the COP, that is, the virtual time-to-contact (VTC), was higher without feedback. The coupling relation of COP-COM showed stable in-phase synchronization over all of the feedback conditions for frequencies below 1Hz. For higher frequencies (up to 5Hz), there was progressive reduction of COP-COM synchronization and local adaptation under the presence of augmented feedback. The findings show that the augmented feedback of COM and COP motion differentially and adaptively influences spatial and temporal properties of postural motion relative to the stability boundary while preserving the organization of the COM-COP coupling in postural control.



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Augmented feedback of COM and COP modulates the regulation of quiet human standing relative to the stability boundary

Publication date: Available online 7 April 2016
Source:Gait & Posture
Author(s): Melissa C. Kilby, Semyon M. Slobounov, Karl M. Newell
The experiment manipulated real-time kinematic feedback of the motion of the whole body center of mass (COM) and center of pressure (COP) in anterior-posterior (AP) and medial-lateral (ML) directions to investigate the variables actively controlled in quiet standing of young adults. The feedback reflected the current 2D postural positions within the 2D functional stability boundary that was scaled to 75%, 30% and 12% of its original size. The findings showed that the distance of both COP and COM to the respective stability boundary was greater during the feedback trials compared to a no feedback condition. However, the temporal safety margin of the COP, that is, the virtual time-to-contact (VTC), was higher without feedback. The coupling relation of COP-COM showed stable in-phase synchronization over all of the feedback conditions for frequencies below 1Hz. For higher frequencies (up to 5Hz), there was progressive reduction of COP-COM synchronization and local adaptation under the presence of augmented feedback. The findings show that the augmented feedback of COM and COP motion differentially and adaptively influences spatial and temporal properties of postural motion relative to the stability boundary while preserving the organization of the COM-COP coupling in postural control.



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Augmented feedback of COM and COP modulates the regulation of quiet human standing relative to the stability boundary

Publication date: Available online 7 April 2016
Source:Gait & Posture
Author(s): Melissa C. Kilby, Semyon M. Slobounov, Karl M. Newell
The experiment manipulated real-time kinematic feedback of the motion of the whole body center of mass (COM) and center of pressure (COP) in anterior-posterior (AP) and medial-lateral (ML) directions to investigate the variables actively controlled in quiet standing of young adults. The feedback reflected the current 2D postural positions within the 2D functional stability boundary that was scaled to 75%, 30% and 12% of its original size. The findings showed that the distance of both COP and COM to the respective stability boundary was greater during the feedback trials compared to a no feedback condition. However, the temporal safety margin of the COP, that is, the virtual time-to-contact (VTC), was higher without feedback. The coupling relation of COP-COM showed stable in-phase synchronization over all of the feedback conditions for frequencies below 1Hz. For higher frequencies (up to 5Hz), there was progressive reduction of COP-COM synchronization and local adaptation under the presence of augmented feedback. The findings show that the augmented feedback of COM and COP motion differentially and adaptively influences spatial and temporal properties of postural motion relative to the stability boundary while preserving the organization of the COM-COP coupling in postural control.



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Augmented feedback of COM and COP modulates the regulation of quiet human standing relative to the stability boundary

Publication date: Available online 7 April 2016
Source:Gait & Posture
Author(s): Melissa C. Kilby, Semyon M. Slobounov, Karl M. Newell
The experiment manipulated real-time kinematic feedback of the motion of the whole body center of mass (COM) and center of pressure (COP) in anterior-posterior (AP) and medial-lateral (ML) directions to investigate the variables actively controlled in quiet standing of young adults. The feedback reflected the current 2D postural positions within the 2D functional stability boundary that was scaled to 75%, 30% and 12% of its original size. The findings showed that the distance of both COP and COM to the respective stability boundary was greater during the feedback trials compared to a no feedback condition. However, the temporal safety margin of the COP, that is, the virtual time-to-contact (VTC), was higher without feedback. The coupling relation of COP-COM showed stable in-phase synchronization over all of the feedback conditions for frequencies below 1Hz. For higher frequencies (up to 5Hz), there was progressive reduction of COP-COM synchronization and local adaptation under the presence of augmented feedback. The findings show that the augmented feedback of COM and COP motion differentially and adaptively influences spatial and temporal properties of postural motion relative to the stability boundary while preserving the organization of the COM-COP coupling in postural control.



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Minnesota’s Zack LaVine Gives Back to Hard-of-Hearing Community

With all the attention focused on greed and selfishness among pro athletes these days, it’s nice to see one that is positive and addresses the deaf and hard-of-hearing community. The Minnesota Timberwolves’ Zack LaVine, who won the NBA’s slam dunk contest during the NBA All-Star Game last month, has donated time and money to the Metro School for the Deaf in St. Paul.

Tweet

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A Comparison of the Visual Attention Patterns of People With Aphasia and Adults Without Neurological Conditions for Camera-Engaged and Task-Engaged Visual Scenes

Purpose

The purpose of the study was to compare the visual attention patterns of adults with aphasia and adults without neurological conditions when viewing visual scenes with 2 types of engagement.

Method

Eye-tracking technology was used to measure the visual attention patterns of 10 adults with aphasia and 10 adults without neurological conditions. Participants viewed camera-engaged (i.e., human figure facing camera) and task-engaged (i.e., human figure looking at and touching an object) visual scenes.

Results

Participants with aphasia responded to engagement cues by focusing on objects of interest more for task-engaged scenes than camera-engaged scenes; however, the difference in their responses to these scenes were not as pronounced as those observed in adults without neurological conditions. In addition, people with aphasia spent more time looking at background areas of interest and less time looking at person areas of interest for camera-engaged scenes than did control participants.

Conclusions

Results indicate people with aphasia visually attend to scenes differently than adults without neurological conditions. As a consequence, augmentative and alternative communication (AAC) facilitators may have different visual attention behaviors than the people with aphasia for whom they are constructing or selecting visual scenes. Further examination of the visual attention of people with aphasia may help optimize visual scene selection.

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A Comparison of the Visual Attention Patterns of People With Aphasia and Adults Without Neurological Conditions for Camera-Engaged and Task-Engaged Visual Scenes

Purpose

The purpose of the study was to compare the visual attention patterns of adults with aphasia and adults without neurological conditions when viewing visual scenes with 2 types of engagement.

Method

Eye-tracking technology was used to measure the visual attention patterns of 10 adults with aphasia and 10 adults without neurological conditions. Participants viewed camera-engaged (i.e., human figure facing camera) and task-engaged (i.e., human figure looking at and touching an object) visual scenes.

Results

Participants with aphasia responded to engagement cues by focusing on objects of interest more for task-engaged scenes than camera-engaged scenes; however, the difference in their responses to these scenes were not as pronounced as those observed in adults without neurological conditions. In addition, people with aphasia spent more time looking at background areas of interest and less time looking at person areas of interest for camera-engaged scenes than did control participants.

Conclusions

Results indicate people with aphasia visually attend to scenes differently than adults without neurological conditions. As a consequence, augmentative and alternative communication (AAC) facilitators may have different visual attention behaviors than the people with aphasia for whom they are constructing or selecting visual scenes. Further examination of the visual attention of people with aphasia may help optimize visual scene selection.

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A Comparison of the Visual Attention Patterns of People With Aphasia and Adults Without Neurological Conditions for Camera-Engaged and Task-Engaged Visual Scenes

Purpose

The purpose of the study was to compare the visual attention patterns of adults with aphasia and adults without neurological conditions when viewing visual scenes with 2 types of engagement.

Method

Eye-tracking technology was used to measure the visual attention patterns of 10 adults with aphasia and 10 adults without neurological conditions. Participants viewed camera-engaged (i.e., human figure facing camera) and task-engaged (i.e., human figure looking at and touching an object) visual scenes.

Results

Participants with aphasia responded to engagement cues by focusing on objects of interest more for task-engaged scenes than camera-engaged scenes; however, the difference in their responses to these scenes were not as pronounced as those observed in adults without neurological conditions. In addition, people with aphasia spent more time looking at background areas of interest and less time looking at person areas of interest for camera-engaged scenes than did control participants.

Conclusions

Results indicate people with aphasia visually attend to scenes differently than adults without neurological conditions. As a consequence, augmentative and alternative communication (AAC) facilitators may have different visual attention behaviors than the people with aphasia for whom they are constructing or selecting visual scenes. Further examination of the visual attention of people with aphasia may help optimize visual scene selection.

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Middle-aged adults with hearing loss have substantially higher health care costs

In a study published online by JAMA Otolaryngology-Head & Neck Surgery, Annie N. Simpson, Ph.D.

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Middle-aged adults with hearing loss have substantially higher health care costs

In a study published online by JAMA Otolaryngology-Head & Neck Surgery, Annie N. Simpson, Ph.D.

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Vowel-dependent variation in Cantonese /s/ from an individual-difference perspective

Individual variation is ubiquitous in the acoustic realization of human speech; however, little is known about the nature of individual differences in coarticulation. Through an in-depth case study of the temporal dynamics of vocalic influences on the acoustic realization of Cantonese /s/, this study demonstrates that coarticulatory effects may vary by the sex and self-reported autistic-like traits of the individual. These findings have significant implications for research in phonetics, phonology, and sound change.

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Diffuse ultrasound monitoring of stress and damage development on a 15-ton concrete beam

This paper describes the use of an ultrasonic imaging technique (Locadiff) for the Non-Destructive Testing & Evaluation of a concrete structure. By combining coda wave interferometry and a sensitivity kernel for diffuse waves, Locadiff can monitor the elastic and structural properties of a heterogeneous material with a high sensitivity, and can map changes of these properties over time when a perturbation occurs in the bulk of the material. The applicability of the technique to life-size concrete structures is demonstrated through the monitoring of a 15-ton reinforced concrete beam subject to a four-point bending test causing cracking. The experimental results show that Locadiff achieved to (1) detect and locate the cracking zones in the core of the concrete beam at an early stage by mapping the changes in the concrete's micro-structure; (2) monitor the internal stress level in both temporal and spatial domains by mapping the variation in velocity caused by the acousto-elasticeffect. The mechanical behavior of the concrete structure is also studied using conventional techniques such as acoustic emission, vibrating wire extensometers, and digital image correlation. The performances of the Locadiff technique in the detection of early stage cracking are assessed and discussed.

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Normal mode solutions for seismo-acoustic propagation resulting from shear and combined wave point sources

Normal modesolutions to range-independent seismo-acoustic problems are benchmarked against elastic parabolic equation solutions and then used to benchmark the shear elastic parabolic equation self-starter [Frank, Odom, and Collis, J. Acoust. Soc. Am. 133, 1358–1367 (2013)]. The Pekeris waveguide with an elastic seafloor is considered for a point source located in the ocean emitting compressional waves, or in the seafloor, emitting both compressional and shear waves. Accurate solutions are obtained when the source is in the seafloor, and when the source is at the interface between the fluid and elastic layers.

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Erratum: On the validity of the effective density fluid model as an approximation of a poroelastic sediment layer [J. Acoust. Soc. Am. 138, 748–757 (2015)]

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Middle-aged adults with hearing loss have substantially higher health care costs

In a study published online by JAMA Otolaryngology-Head & Neck Surgery, Annie N. Simpson, Ph.D.

from #Audiology via xlomafota13 on Inoreader http://ift.tt/23lxatN
via IFTTT

Normal mode solutions for seismo-acoustic propagation resulting from shear and combined wave point sources

Normal modesolutions to range-independent seismo-acoustic problems are benchmarked against elastic parabolic equation solutions and then used to benchmark the shear elastic parabolic equation self-starter [Frank, Odom, and Collis, J. Acoust. Soc. Am. 133, 1358–1367 (2013)]. The Pekeris waveguide with an elastic seafloor is considered for a point source located in the ocean emitting compressional waves, or in the seafloor, emitting both compressional and shear waves. Accurate solutions are obtained when the source is in the seafloor, and when the source is at the interface between the fluid and elastic layers.

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Comparing auditory steady-state responses amplitude evoked by simultaneous air- and bone-conducted stimulation in newborns.

Comparing auditory steady-state responses amplitude evoked by simultaneous air- and bone-conducted stimulation in newborns.

Int J Audiol. 2016 Apr 6;:1-5

Authors: Torres-Fortuny A, Hernández-Pérez H, Ramírez B, Alonso I, Eimil E, Guerrero-Aranda A, Mijares E

Abstract
OBJECTIVE: The aim of this study was to evaluate the potential interactions of the simultaneous presentation of air- and bone-conducted stimuli on auditory steady-state responses (ASSR) amplitude in newborns.
DESIGN: Bone- and air-conducted stimuli were sinusoidal carrier tones of 500 and 2000 Hz respectively modulated in amplitude (95% depth). Air- and bone- conducted stimuli were either simultaneously recorded in the same ear using insert earphones and bone vibrator respectively, or recorded individually (single stimulation).
STUDY SAMPLE: Sixty-nine well babies (135 ears) with ages ranging from 1 to 16 days (mean of 9.2 ± 7.9 days) were tested in this study.
RESULTS: No significant changes in ASSR amplitude by air-conducted stimuli were observed when evoked by simultaneous or single stimulation. The same trend prevailed for ASSR amplitudes evoked by bone-conducted stimuli.
CONCLUSIONS: The results of this study suggest that the simultaneous stimulation of air-and bone-conducted stimuli does not alter ASSR amplitude values in well babies. Therefore, the results support the use of this technique as a potential hearing screening tool to discriminate between conductive and sensorineural hearing loss.

PMID: 27049922 [PubMed - as supplied by publisher]

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Speech recognition outcomes following bilateral cochlear implantation in adults aged over 50 years old.

Speech recognition outcomes following bilateral cochlear implantation in adults aged over 50 years old.

Int J Audiol. 2016 Apr 6;:1-6

Authors: Boisvert I, McMahon CM, Dowell RC

Abstract
OBJECTIVE: To examine the speech recognition benefit of bilateral cochlear implantation over unilateral implantation in adults aged over 50 years old, and to identify potential predictors of successful bilateral implantation in this group.
DESIGN: Retrospective cohort study using data collected during standard clinical practice. Bilateral performance was compared to the unilateral performance with the first and second implanted ear and examined in relation to potential predictive variables.
STUDY SAMPLE: Sixty-seven cochlear implant users who received a second implant after the age of 50 years old.
RESULTS: Participants obtained significantly greater speech recognition scores with the use of bilateral cochlear implants compared to the use of each individual implant. The score obtained with the first implanted ear was the most reliable predictor of the score obtained with the second and with bilateral implants.
CONCLUSIONS: Older adults can obtain speech recognition benefits from sequential bilateral cochlear implantation.

PMID: 27049835 [PubMed - as supplied by publisher]

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Comparing auditory steady-state responses amplitude evoked by simultaneous air- and bone-conducted stimulation in newborns.

Comparing auditory steady-state responses amplitude evoked by simultaneous air- and bone-conducted stimulation in newborns.

Int J Audiol. 2016 Apr 6;:1-5

Authors: Torres-Fortuny A, Hernández-Pérez H, Ramírez B, Alonso I, Eimil E, Guerrero-Aranda A, Mijares E

Abstract
OBJECTIVE: The aim of this study was to evaluate the potential interactions of the simultaneous presentation of air- and bone-conducted stimuli on auditory steady-state responses (ASSR) amplitude in newborns.
DESIGN: Bone- and air-conducted stimuli were sinusoidal carrier tones of 500 and 2000 Hz respectively modulated in amplitude (95% depth). Air- and bone- conducted stimuli were either simultaneously recorded in the same ear using insert earphones and bone vibrator respectively, or recorded individually (single stimulation).
STUDY SAMPLE: Sixty-nine well babies (135 ears) with ages ranging from 1 to 16 days (mean of 9.2 ± 7.9 days) were tested in this study.
RESULTS: No significant changes in ASSR amplitude by air-conducted stimuli were observed when evoked by simultaneous or single stimulation. The same trend prevailed for ASSR amplitudes evoked by bone-conducted stimuli.
CONCLUSIONS: The results of this study suggest that the simultaneous stimulation of air-and bone-conducted stimuli does not alter ASSR amplitude values in well babies. Therefore, the results support the use of this technique as a potential hearing screening tool to discriminate between conductive and sensorineural hearing loss.

PMID: 27049922 [PubMed - as supplied by publisher]

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Speech recognition outcomes following bilateral cochlear implantation in adults aged over 50 years old.

Speech recognition outcomes following bilateral cochlear implantation in adults aged over 50 years old.

Int J Audiol. 2016 Apr 6;:1-6

Authors: Boisvert I, McMahon CM, Dowell RC

Abstract
OBJECTIVE: To examine the speech recognition benefit of bilateral cochlear implantation over unilateral implantation in adults aged over 50 years old, and to identify potential predictors of successful bilateral implantation in this group.
DESIGN: Retrospective cohort study using data collected during standard clinical practice. Bilateral performance was compared to the unilateral performance with the first and second implanted ear and examined in relation to potential predictive variables.
STUDY SAMPLE: Sixty-seven cochlear implant users who received a second implant after the age of 50 years old.
RESULTS: Participants obtained significantly greater speech recognition scores with the use of bilateral cochlear implants compared to the use of each individual implant. The score obtained with the first implanted ear was the most reliable predictor of the score obtained with the second and with bilateral implants.
CONCLUSIONS: Older adults can obtain speech recognition benefits from sequential bilateral cochlear implantation.

PMID: 27049835 [PubMed - as supplied by publisher]

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Comparing auditory steady-state responses amplitude evoked by simultaneous air- and bone-conducted stimulation in newborns.

Comparing auditory steady-state responses amplitude evoked by simultaneous air- and bone-conducted stimulation in newborns.

Int J Audiol. 2016 Apr 6;:1-5

Authors: Torres-Fortuny A, Hernández-Pérez H, Ramírez B, Alonso I, Eimil E, Guerrero-Aranda A, Mijares E

Abstract
OBJECTIVE: The aim of this study was to evaluate the potential interactions of the simultaneous presentation of air- and bone-conducted stimuli on auditory steady-state responses (ASSR) amplitude in newborns.
DESIGN: Bone- and air-conducted stimuli were sinusoidal carrier tones of 500 and 2000 Hz respectively modulated in amplitude (95% depth). Air- and bone- conducted stimuli were either simultaneously recorded in the same ear using insert earphones and bone vibrator respectively, or recorded individually (single stimulation).
STUDY SAMPLE: Sixty-nine well babies (135 ears) with ages ranging from 1 to 16 days (mean of 9.2 ± 7.9 days) were tested in this study.
RESULTS: No significant changes in ASSR amplitude by air-conducted stimuli were observed when evoked by simultaneous or single stimulation. The same trend prevailed for ASSR amplitudes evoked by bone-conducted stimuli.
CONCLUSIONS: The results of this study suggest that the simultaneous stimulation of air-and bone-conducted stimuli does not alter ASSR amplitude values in well babies. Therefore, the results support the use of this technique as a potential hearing screening tool to discriminate between conductive and sensorineural hearing loss.

PMID: 27049922 [PubMed - as supplied by publisher]

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Speech recognition outcomes following bilateral cochlear implantation in adults aged over 50 years old.

Speech recognition outcomes following bilateral cochlear implantation in adults aged over 50 years old.

Int J Audiol. 2016 Apr 6;:1-6

Authors: Boisvert I, McMahon CM, Dowell RC

Abstract
OBJECTIVE: To examine the speech recognition benefit of bilateral cochlear implantation over unilateral implantation in adults aged over 50 years old, and to identify potential predictors of successful bilateral implantation in this group.
DESIGN: Retrospective cohort study using data collected during standard clinical practice. Bilateral performance was compared to the unilateral performance with the first and second implanted ear and examined in relation to potential predictive variables.
STUDY SAMPLE: Sixty-seven cochlear implant users who received a second implant after the age of 50 years old.
RESULTS: Participants obtained significantly greater speech recognition scores with the use of bilateral cochlear implants compared to the use of each individual implant. The score obtained with the first implanted ear was the most reliable predictor of the score obtained with the second and with bilateral implants.
CONCLUSIONS: Older adults can obtain speech recognition benefits from sequential bilateral cochlear implantation.

PMID: 27049835 [PubMed - as supplied by publisher]

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Comparing auditory steady-state responses amplitude evoked by simultaneous air- and bone-conducted stimulation in newborns.

Comparing auditory steady-state responses amplitude evoked by simultaneous air- and bone-conducted stimulation in newborns.

Int J Audiol. 2016 Apr 6;:1-5

Authors: Torres-Fortuny A, Hernández-Pérez H, Ramírez B, Alonso I, Eimil E, Guerrero-Aranda A, Mijares E

Abstract
OBJECTIVE: The aim of this study was to evaluate the potential interactions of the simultaneous presentation of air- and bone-conducted stimuli on auditory steady-state responses (ASSR) amplitude in newborns.
DESIGN: Bone- and air-conducted stimuli were sinusoidal carrier tones of 500 and 2000 Hz respectively modulated in amplitude (95% depth). Air- and bone- conducted stimuli were either simultaneously recorded in the same ear using insert earphones and bone vibrator respectively, or recorded individually (single stimulation).
STUDY SAMPLE: Sixty-nine well babies (135 ears) with ages ranging from 1 to 16 days (mean of 9.2 ± 7.9 days) were tested in this study.
RESULTS: No significant changes in ASSR amplitude by air-conducted stimuli were observed when evoked by simultaneous or single stimulation. The same trend prevailed for ASSR amplitudes evoked by bone-conducted stimuli.
CONCLUSIONS: The results of this study suggest that the simultaneous stimulation of air-and bone-conducted stimuli does not alter ASSR amplitude values in well babies. Therefore, the results support the use of this technique as a potential hearing screening tool to discriminate between conductive and sensorineural hearing loss.

PMID: 27049922 [PubMed - as supplied by publisher]

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Speech recognition outcomes following bilateral cochlear implantation in adults aged over 50 years old.

Speech recognition outcomes following bilateral cochlear implantation in adults aged over 50 years old.

Int J Audiol. 2016 Apr 6;:1-6

Authors: Boisvert I, McMahon CM, Dowell RC

Abstract
OBJECTIVE: To examine the speech recognition benefit of bilateral cochlear implantation over unilateral implantation in adults aged over 50 years old, and to identify potential predictors of successful bilateral implantation in this group.
DESIGN: Retrospective cohort study using data collected during standard clinical practice. Bilateral performance was compared to the unilateral performance with the first and second implanted ear and examined in relation to potential predictive variables.
STUDY SAMPLE: Sixty-seven cochlear implant users who received a second implant after the age of 50 years old.
RESULTS: Participants obtained significantly greater speech recognition scores with the use of bilateral cochlear implants compared to the use of each individual implant. The score obtained with the first implanted ear was the most reliable predictor of the score obtained with the second and with bilateral implants.
CONCLUSIONS: Older adults can obtain speech recognition benefits from sequential bilateral cochlear implantation.

PMID: 27049835 [PubMed - as supplied by publisher]

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Brain responses found to originate from previously unknown source

Discovery will inform further research into hearing disorders and brain training.

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Brain responses found to originate from previously unknown source

Discovery will inform further research into hearing disorders and brain training.

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Brain responses found to originate from previously unknown source

Discovery will inform further research into hearing disorders and brain training.

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Comparing auditory steady-state responses amplitude evoked by simultaneous air- and bone-conducted stimulation in newborns

10.3109/14992027.2016.1159341<br/>Alejandro Torres-Fortuny

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Speech recognition outcomes following bilateral cochlear implantation in adults aged over 50 years old

10.3109/14992027.2016.1152403<br/>Isabelle Boisvert

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Comparing auditory steady-state responses amplitude evoked by simultaneous air- and bone-conducted stimulation in newborns

10.3109/14992027.2016.1159341<br/>Alejandro Torres-Fortuny

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Speech recognition outcomes following bilateral cochlear implantation in adults aged over 50 years old

10.3109/14992027.2016.1152403<br/>Isabelle Boisvert

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Comparing auditory steady-state responses amplitude evoked by simultaneous air- and bone-conducted stimulation in newborns

10.3109/14992027.2016.1159341<br/>Alejandro Torres-Fortuny

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Speech recognition outcomes following bilateral cochlear implantation in adults aged over 50 years old

10.3109/14992027.2016.1152403<br/>Isabelle Boisvert

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Reflectance Measures from Infant Ears with Normal Hearing and Transient Conductive Hearing Loss.

Objective: The objective is to develop methods to utilize newborn reflectance measures for the identification of middle-ear transient conditions (e.g., middle-ear fluid) during the newborn period and ultimately during the first few months of life. Transient middle-ear conditions are a suspected source of failure to pass a newborn hearing screening. The ability to identify a conductive loss during the screening procedure could enable the referred ear to be either (1) cleared of a middle-ear condition and recommended for more extensive hearing assessment as soon as possible, or (2) suspected of a transient middle-ear condition, and if desired, be rescreened before more extensive hearing assessment. Design: Reflectance measurements are reported from full-term, healthy, newborn babies in which one ear referred and one ear passed an initial auditory brainstem response newborn hearing screening and a subsequent distortion product otoacoustic emission screening on the same day. These same subjects returned for a detailed follow-up evaluation at age 1 month (range 14 to 35 days). In total, measurements were made on 30 subjects who had a unilateral refer near birth (during their first 2 days of life) and bilateral normal hearing at follow-up (about 1 month old). Three specific comparisons were made: (1) Association of ear's state with power reflectance near birth (referred versus passed ear), (2) Changes in power reflectance of normal ears between newborn and 1 month old (maturation effects), and (3) Association of ear's newborn state (referred versus passed) with ear's power reflectance at 1 month. In addition to these measurements, a set of preliminary data selection criteria were developed to ensure that analyzed data were not corrupted by acoustic leaks and other measurement problems. Results: Within 2 days of birth, the power reflectance measured in newborn ears with transient middle-ear conditions (referred newborn hearing screening and passed hearing assessment at age 1 month) was significantly greater than power reflectance on newborn ears that passed the newborn hearing screening across all frequencies (500 to 6000 Hz). Changes in power reflectance in normal ears from newborn to 1 month appear in approximately the 2000 to 5000 Hz range but are not present at other frequencies. The power reflectance at age 1 month does not depend significantly on the ear's state near birth (refer or pass hearing screening) for frequencies above 700 Hz; there might be small differences at lower frequencies. Conclusions: Power reflectance measurements are significantly different for ears that pass newborn hearing screening and ears that refer with middle-ear transient conditions. At age 1 month, about 90% of ears that referred at birth passed an auditory brainstem response hearing evaluation; within these ears the power reflectance at 1 month did not differ between the ear that initially referred at birth and the ear that passed the hearing screening at birth for frequencies above 700 Hz. This study also proposes a preliminary set of criteria for determining when reflectance measures on young babies are corrupted by acoustic leaks, probes against the ear canal, or other measurement problems. Specifically proposed are "data selection criteria" that depend on the power reflectance, impedance magnitude, and impedance angle. Additional data collected in the future are needed to improve and test these proposed criteria. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Reflectance Measures from Infant Ears with Normal Hearing and Transient Conductive Hearing Loss.

Objective: The objective is to develop methods to utilize newborn reflectance measures for the identification of middle-ear transient conditions (e.g., middle-ear fluid) during the newborn period and ultimately during the first few months of life. Transient middle-ear conditions are a suspected source of failure to pass a newborn hearing screening. The ability to identify a conductive loss during the screening procedure could enable the referred ear to be either (1) cleared of a middle-ear condition and recommended for more extensive hearing assessment as soon as possible, or (2) suspected of a transient middle-ear condition, and if desired, be rescreened before more extensive hearing assessment. Design: Reflectance measurements are reported from full-term, healthy, newborn babies in which one ear referred and one ear passed an initial auditory brainstem response newborn hearing screening and a subsequent distortion product otoacoustic emission screening on the same day. These same subjects returned for a detailed follow-up evaluation at age 1 month (range 14 to 35 days). In total, measurements were made on 30 subjects who had a unilateral refer near birth (during their first 2 days of life) and bilateral normal hearing at follow-up (about 1 month old). Three specific comparisons were made: (1) Association of ear's state with power reflectance near birth (referred versus passed ear), (2) Changes in power reflectance of normal ears between newborn and 1 month old (maturation effects), and (3) Association of ear's newborn state (referred versus passed) with ear's power reflectance at 1 month. In addition to these measurements, a set of preliminary data selection criteria were developed to ensure that analyzed data were not corrupted by acoustic leaks and other measurement problems. Results: Within 2 days of birth, the power reflectance measured in newborn ears with transient middle-ear conditions (referred newborn hearing screening and passed hearing assessment at age 1 month) was significantly greater than power reflectance on newborn ears that passed the newborn hearing screening across all frequencies (500 to 6000 Hz). Changes in power reflectance in normal ears from newborn to 1 month appear in approximately the 2000 to 5000 Hz range but are not present at other frequencies. The power reflectance at age 1 month does not depend significantly on the ear's state near birth (refer or pass hearing screening) for frequencies above 700 Hz; there might be small differences at lower frequencies. Conclusions: Power reflectance measurements are significantly different for ears that pass newborn hearing screening and ears that refer with middle-ear transient conditions. At age 1 month, about 90% of ears that referred at birth passed an auditory brainstem response hearing evaluation; within these ears the power reflectance at 1 month did not differ between the ear that initially referred at birth and the ear that passed the hearing screening at birth for frequencies above 700 Hz. This study also proposes a preliminary set of criteria for determining when reflectance measures on young babies are corrupted by acoustic leaks, probes against the ear canal, or other measurement problems. Specifically proposed are "data selection criteria" that depend on the power reflectance, impedance magnitude, and impedance angle. Additional data collected in the future are needed to improve and test these proposed criteria. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Reflectance Measures from Infant Ears with Normal Hearing and Transient Conductive Hearing Loss.

Objective: The objective is to develop methods to utilize newborn reflectance measures for the identification of middle-ear transient conditions (e.g., middle-ear fluid) during the newborn period and ultimately during the first few months of life. Transient middle-ear conditions are a suspected source of failure to pass a newborn hearing screening. The ability to identify a conductive loss during the screening procedure could enable the referred ear to be either (1) cleared of a middle-ear condition and recommended for more extensive hearing assessment as soon as possible, or (2) suspected of a transient middle-ear condition, and if desired, be rescreened before more extensive hearing assessment. Design: Reflectance measurements are reported from full-term, healthy, newborn babies in which one ear referred and one ear passed an initial auditory brainstem response newborn hearing screening and a subsequent distortion product otoacoustic emission screening on the same day. These same subjects returned for a detailed follow-up evaluation at age 1 month (range 14 to 35 days). In total, measurements were made on 30 subjects who had a unilateral refer near birth (during their first 2 days of life) and bilateral normal hearing at follow-up (about 1 month old). Three specific comparisons were made: (1) Association of ear's state with power reflectance near birth (referred versus passed ear), (2) Changes in power reflectance of normal ears between newborn and 1 month old (maturation effects), and (3) Association of ear's newborn state (referred versus passed) with ear's power reflectance at 1 month. In addition to these measurements, a set of preliminary data selection criteria were developed to ensure that analyzed data were not corrupted by acoustic leaks and other measurement problems. Results: Within 2 days of birth, the power reflectance measured in newborn ears with transient middle-ear conditions (referred newborn hearing screening and passed hearing assessment at age 1 month) was significantly greater than power reflectance on newborn ears that passed the newborn hearing screening across all frequencies (500 to 6000 Hz). Changes in power reflectance in normal ears from newborn to 1 month appear in approximately the 2000 to 5000 Hz range but are not present at other frequencies. The power reflectance at age 1 month does not depend significantly on the ear's state near birth (refer or pass hearing screening) for frequencies above 700 Hz; there might be small differences at lower frequencies. Conclusions: Power reflectance measurements are significantly different for ears that pass newborn hearing screening and ears that refer with middle-ear transient conditions. At age 1 month, about 90% of ears that referred at birth passed an auditory brainstem response hearing evaluation; within these ears the power reflectance at 1 month did not differ between the ear that initially referred at birth and the ear that passed the hearing screening at birth for frequencies above 700 Hz. This study also proposes a preliminary set of criteria for determining when reflectance measures on young babies are corrupted by acoustic leaks, probes against the ear canal, or other measurement problems. Specifically proposed are "data selection criteria" that depend on the power reflectance, impedance magnitude, and impedance angle. Additional data collected in the future are needed to improve and test these proposed criteria. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Patterns of Long-term Hearing Loss in Hearing Preservation Cochlear Implant Surgery.

Objective: To describe patterns of hearing loss in patients with low-frequency residual hearing after cochlear implantation. Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: Cochlear implant candidates with immediate postoperative residual low-frequency hearing. Interventions: Hybrid or traditional cochlear implant. Main Outcome Measure: Audiograms to measure postoperative hearing. Results: Of the 166 patients reviewed, 17 ears met the inclusion criteria. The age ranged from 3 years 2 months to 86 years. Etiology was unknown (n = 6), presbycusis (n = 5), genetic (n = 4), acoustic trauma (n = 1), and measles virus (n = 1). The Nucleus Hybrid S8 and S12 (n = 7) was the most common electrode array, and then Nucleus 422 (n = 6), Nucleus Contour Advance (n = 2), Med-El Flex 28 (n = 2), and Advanced Bionics Mid Scala (n = 1). Cochleostomy was performed in nine, and round window approach in nine patients. Average follow-up was 28 months (2-68 mo). Postoperative loss was mixed in eight and purely sensorineural in eight. The most common patterns of hearing loss were gradual decline (n = 7), and then fluctuating hearing (n = 6), stable (n = 3), and sudden loss (n = 1). One patient only had one postoperative audiogram. Conclusion: Some long-term hearing preservation was achieved in 94% of patients with immediate postoperative hearing preservation. Patients developed both mixed and sensorineural loss postoperatively. A majority of patients with mixed hearing loss had a supra-preoperative bone curve. Gradual decline and fluctuating hearing loss were the most common patterns of hearing loss; few patients had stable hearing and one had a sudden loss. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Cochlear Implant Outcomes in Cochlea Nerve Aplasia and Hypoplasia.

Objective: To assess cochlear implant (CI) outcomes, and factors affecting outcomes, for children with aplasia/ hypoplasia of the cochlea nerve. We also developed a new grading system for the nerves of the internal auditory meatus (IAM) and cochlea nerve classification. Study Design: Retrospective patient review. Setting: Tertiary referral hospital and cochlear implant program. Patients: Children 0 to 16 years inclusive with a CI who had absent/hypoplastic cochlea nerve on magnetic resonance imaging (MRI). Intervention: Cochlear implant. Main Outcome Measures: MRI, trans-tympanic electrical auditory brainstem response, intraoperative electrical auditory brainstem response, Neural Response Telemetry, Categories of Auditory Perception score, Main mode of communication. Results: Fifty CI recipients (26 males and 24 females) were identified, 21 had bilateral CIs, 27 had developmental delay. MRI showed cochlea nerve aplasia in 64 ears, hypoplasia in 25 ears, and a normal nerve in 11 ears. Main mode of communication was analyzed for 41 children: 21 (51%) used verbal language (15 speech alone, 5 speech plus some sign, 1 bilingual in speech and sign), and 20 (49%) used sign language (10 sign alone, 9 sign plus some speech, 1 tactile sign). Seventy-three percent of children used some verbal language. Cochlea nerve aplasia/ hypoplasia and developmental delay were both significant factors affecting main mode of communication. Categories of Auditory Performance scores were available for 59 CI ears; 47% with CN Aplasia (IAM nerve grades 0-III) and 89% with CN hypoplasia (IAM nerve grade IV) achieved Categories of Auditory Performance scores of 5 to 7 (some verbal understanding) (p = 0.003). Conclusion: Our results are encouraging and useful when counselling families regarding the likelihood of language outcomes and auditory understanding. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Vascular and Neuroepithelial Histopathology of the Saccule in Humans With Diabetes Mellitus.

Hypothesis: This study aimed to determine if there are quantitative differences in the neuroepithelium and microvasculature of the saccule between subjects with and without diabetes mellitus (DM). Background: Histopathologic changes that may underlie the association between DM and vestibular dysfunction have not been characterized in humans. Methods: Human temporal bones (HTBs) from 39 subjects with DM (n = 16 type I DM [T1DM], n = 23 type II DM [T2DM]) were compared with 40 group age-matched controls. Vessel wall thickness was measured from the saccular arteriole. Type I and type II vestibular hair cell (VHC) counts were performed on perpendicularly oriented saccular maculae using differential interference contrast microscopy (T1DM: 5HTB/3 subjects; T2DM: 9HTB/8 subjects; controls: 25HTB/20 subjects). Results: The mean density of type I VHCs was 16 to 17% lower in the DM groups compared to controls (T1DM 52.21 [4.26], T2DM 53.3 [5.34], control 63.14 [2.49] cells/mm2, p = 0.02). There were no differences between T1DM, T2DM, and control groups in type II VHC density (T1DM 40.89 [5.17], T2DM 40.44 [6.93], control 42.80 [1.79] cells/mm2, p = 0.92) or in mean vessel wall thickness (T1DM 2.23 [0.62], T2DM 2.18 [0.53], control 2.00 [0.53] [mu]m, p = 0.26). Conclusion: Neuroepithelial pathology, manifested as lower density of type I VHCs, was observed in the saccules of subjects with DM. Saccular microangiopathy, expressed as alterations in arteriole thickness, was not observed. These findings are consistent with histologic observations in animals with experimentally induced diabetes. DM may have a selective and deleterious effect on human vestibular sensory epithelia. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Cochlear Histopathologic Findings in Patients With Systemic Lupus Erythematosus: A Human Temporal Bone Study.

Hypothesis: We hypothesized that, in archived human temporal bone samples from patients with systemic lupus erythematosus (SLE), a pathologic condition exists in the stria vascularis and cochlear hair cells. Background: Sensorineural hearing loss is a common feature in SLE patients. However, the pathophysiologic mechanism of cochlear dysfunction is unclear. Methods: We examined 15 temporal bone samples from 8 SLE patients, along with 17 samples from 10 age-matched healthy control patients. The samples were serially sectioned in the horizontal plane and stained with hematoxylin and eosin. We determined the area of the stria vascularis in a midmodiolar section of each cochlear turn. Then, we made cytocochleograms and calculated the percentage of missing inner and outer hair cells. Results: The area of the stria vascularis in our SLE group was significantly smaller than in our control group. The number of remaining inner hair cells in our SLE group was smaller than in our control group; however, the difference did not reach statistical significance. The loss of outer hair cells in our SLE group was significantly higher than in our control group. There was a tendency toward a positive correlation between the loss of cochlear hair cells and the duration of SLE. Conclusion: The stria vascularis and cochlear hair cells are affected in SLE patients. Our findings could provide the histopathologic basis for the cochlear dysfunction, including sensorineural hearing loss, experienced by SLE patients. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Health-related Quality of Life of Individuals With Neurofibromatosis Type 2: Results From the NF2 Natural History Study.

Objective: To explore health-related quality of life (HRQoL) reported by individuals with neurofibromatosis type 2 (NF2) and to assess for correlations between HRQoL and objective measures of disease manifestations. Study Design: Prospective observational study. Setting: Seven international NF2 centers. Subjects: Eighty-one individuals with NF2, 73 adults (>18 years) and 8 children/adolescents (10-17 years). Outcome Measures: Quality of life was measured by Short Form-36 (SF-36) norm-based scores. Objective clinical measures were hearing (categorized by word-recognition scores), facial function (categorized by the House-Brackmann scale) and the volume of subjects' larger vestibular schwannoma (VS). Results: At baseline, adults showed significant deficits in all but two subscales of the SF-36 compared with age- and gender-adjusted United States population norms. In linear regression models including age, gender, inheritance status, hearing, facial weakness and VS volume, demographic and functional measures showed no relationship to any SF-36 subscale. Larger baseline VS volume was significantly related to reduced physical role performance, reduced mental health, and increased pain (p

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Click Stimulus Electrocochleography Versus MRI With Intratympanic Contrast in Meniere's Disease: A Systematic Review.

Objective: To evaluate the diagnostic value of electrocochleography compared with magnetic resonance imaging (MRI) with intratympanic gadolinium administration to diagnose endolymphatic hydrops in patients with Meniere's disease. Data Sources: An electronic search was performed in the PubMed, EMBASE, and Cochrane databases on September 15, 2015. A systematic search was conducted. Articles were included if written in English, Dutch, German, or French language. Study Selection: Original studies reporting on the diagnostic value of electrocochleography compared with MRI with intratympanic gadolinium administration, were included. Data Extraction: The methodological quality of the studies was independently assessed by two reviewers using an adjusted version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. The results of the diagnostic values of both tests were extracted. Data Synthesis: We performed analyses for the sensitivity, specificity, positive predictive value, and negative predictive value of compared electrocochleography with MRI with intratympanic gadolinium administration in patients with definite Meniere's disease. Conclusion: The results of this systematic review, based on a very low number of patients, show there is a relative low sensitivity and negative predictive value for click stimulus electrocochleography compared with MRI with intratympanic gadolinium administration for detecting endolymphatic hydrops in patients with definite Meniere's disease. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Craniocervical Pneumatization: Estimation of Prevalence and Imaging of Treatment Response.

Objective: Estimate the prevalence of craniocervical pneumatization (CCP) and describe successful treatment of this condition with clinical and radiologic correlation. Patients: Individuals with documented CCP on computed tomography (CT). Intervention(s): CT scans of the head, temporal bone, face, neck, and cervical spine. Cessation of habitual Valsalva maneuver (VM) and insertion of pressure-equalization (PE) tubes. Main Outcome Measure: The prevalence of CCP on CT examinations performed during two decades in a large academic healthcare system. Documentation of symptomatic and imaging improvement following treatment of CCP. Results: Radiology database review identified two cases of CCP out of a total of 636,854 head and neck CT scans (0.00031%) or 43,553 temporal bone CT scans (0.0046%). Both CCP patients were symptomatic (aural fullness, hearing loss, vertigo) and practiced habitual VM. One patient showed decreased CCP 4 months following cessation of VM, whereas the other patient improved symptomatically and demonstrated reversion of CCP to normal bone on magnetic resonance imaging (MRI) within 3 years following PE tube placement. Conclusions: Acquired CCP is exceedingly rare and, when successfully treated, reversion to normal bone may accompany symptom resolution. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Diffusion-weighted Magnetic Resonance Imaging as a Novel Imaging Modality in Assessing Treatment Response in Necrotizing Otitis Externa.

Objective: To report our initial experience of diffusion-weighted magnetic resonance imaging (DW-MRI) as a novel imaging tool for assessing and monitoring treatment response in necrotizing otitis externa (NOE). Patients: Seven adults with a diagnosis of NOE on both clinical and computed tomography (CT) criteria who were subsequently monitored with at least two echoplanar DW-MRI investigations were included in this retrospective longitudinal observational study. Intervention: Patients underwent magnetic resonance imaging (MRI), including echoplanar diffusion-weighted sequences, within 2 weeks of diagnosis of NOE to determine the extent of infection and to provide a baseline scan for monitoring response to treatment. Repeated imaging was undertaken after the agreed initial course of antimicrobial therapy was completed. Main Outcome Measure: The primary outcome measure for complete treatment response was complete resolution of high inflammatory signal on the DW-MRI apparent diffusion coefficient (ADC) map. This was correlated to clinical, biochemical, and other MRI measures of disease resolution. Results: Baseline DW-MRI was carried out in all but one patient within 2 weeks of the initial diagnostic CT scan. Patients had between one and three further DW-MRI scans, at a mean interval of 4.4 months from the initial scan (range, 2-8 months). The decision to terminate or continue therapy correlated with ADC signal findings on DW-MRI in all cases. In comparison, conventional MRI sequences performed less well, as there was some degree of persistent residual soft tissue changes in all cases. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Effect of Round Window Reinforcement on Hearing: A Temporal Bone Study With Clinical Implications for Surgical Reinforcement of the Round Window.

Hypothesis: Round window reinforcement leads to conductive hearing loss. Background: The round window is stiffened surgically as therapy for various conditions, including perilymphatic fistula and superior semicircular canal dehiscence. Round window reinforcement reduces symptoms in these patients. However, it also reduces fluid displacement in the cochlea and might therefore increase conductive hearing loss. Methods: Perichondrium was applied to the round window membrane in nine fresh-frozen, nonpathologic temporal bones. In four temporal bones cartilage was applied subsequently. Acoustic stimuli in the form of frequency sweeps from 250 to 8000 Hz were generated at 110 dB sound pressure level. A total of 16 frequencies in a 1/3-octave series were used. Stapes velocities in response to the acoustic stimuli were measured at equally spaced multiple points covering the stapes footplate using a scanning laser Doppler interferometry system. Measurements were made at baseline, after applying perichondrium, and after applying cartilage. Results: At frequencies up to 1000 Hz perichondrium reinforcement decreased stapes velocities by 1.5 to 2.9 dB compared with no reinforcement (p value = 0.003). Reinforcement with cartilage led to a further deterioration of stapes velocities by 2.6 to 4.2 dB at frequencies up to 1000 Hz (p value = 0.050). The higher frequencies were not affected by perichondrium reinforcement (p value = 0.774) or cartilage reinforcement (p value = 0.644). Conclusion: Our results seem to suggest a modest, clinically negligible effect of reinforcement with perichondrium. Placing cartilage on the round window resulted in a graded effect on stapes velocities in keeping with the increased stiffness of cartilage compared with perichondrium. Even so, the effect was relatively small. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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