Economic Evaluation of Treatments for Pediatric Bilateral Severe to Profound Sensorineural Hearing Loss: An Australian Perspective

Objectives: In Australia, surgical treatment options for children with bilateral severe to profound sensorineural hearing loss exist in a continuum ranging from unilateral cochlear implantation (CI), sequential bilateral CI through to simultaneous bilateral CI, depending on the condition. When treatment options are mutually exclusive, the mean costs and benefits of each treatment group are summed together to obtain the total mean costs and benefits. This enables an incremental analysis of treatment options in the context of the treated populations. The objective was to evaluate the cost-utility of current Australian CI treatment practices in children using domestic costs and consequences when compared with bilateral hearing aids (HAs). Research Design: Economic evaluation including a Markov model based on secondary sources. Setting: The base case modeled a government health payer perspective over a child's lifetime. Primary and secondary school education costs were also assessed. Intervention: Bilateral HAs compared with CI, including unilateral, sequential bilateral, or simultaneous bilateral CI weighted according to treatment. Main Outcome Measures: Incremental costs per quality adjusted life year. Results: Approximately 42% of children in Australia with unilateral CI did not transition to sequential bilateral nor undergo simultaneous bilateral implantation. This differs from previous economic evaluations that assumed 100% of children transitioned to sequential bilateral CI treatment or were treated with simultaneous bilateral CI. The incremental cost utility of unilateral cochlear implantation compared with HAs was AUD 21,947/QALY. The weighted average incremental cost utility of the combined cochlear implantation treatment groups was AUD 31,238/QALY when compared with HAs. Conclusion: Previous economic evaluations of cochlear implantation assumed 100% of unilaterally treated patients would transition to sequential bilateral or be treated with simultaneous bilateral implantation. This approach does not take into account the total treated population, where a proportion of patients are treated with unilateral CI. CI was cost effective when compared with HAs, and included children treated with unilateral, sequential bilateral, and simultaneous bilateral CI. The model was sensitive to the number of assessment and habilitation visits. Alternative health service models with cost efficiencies are needed to reduce after care costs.

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Secondary Endolymphatic Hydrops After Acoustic Trauma

Objective: This study applied an inner ear test battery in patients with secondary hydrops after acoustic trauma to assess the inner ear deficits. Study Design: Retrospective study. Setting: University hospital. Methods: Twenty patients with secondary hydrops after acoustic trauma were assigned to Group A. The interval between noise exposure and the testing time varied from 1 month to 3 years (median 3 months). Another 20 patients without progressive hearing loss for at least 3 years after acoustic trauma were assigned to Group B. There were no significant differences between the two groups in terms of age, sex, laterality, and noise source. Before treatment, all patients received audiometry, and caloric, ocular vestibular-evoked myogenic potential (VEMP), and cervical VEMP (cVEMP) tests. Results: Percentages of abnormal mean hearing level (MHL), cVEMP test, oVEMP test, and caloric test were 75%, 75%, 61%, and 43% in Group A, and 35%, 57%, 61%, and 39% in Group B, respectively. Both groups exhibited a significantly declining sequence in inner ear function. Comparison of the abnormalities in the inner ear test battery between Groups A and B revealed a significant difference in percentages of abnormal MHL, but not in those of abnormal cVEMP, oVEMP, and caloric tests. Conclusion: Secondary hydrops after acoustic trauma occurs mainly on the cochlear part, but less on the vestibular part probably because previous acoustic trauma, i.e., firearms have severely damaged the vestibular partition.

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Click Stimulus Electrocochleography Versus MRI With Intratympanic Contrast in Ménière'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 Ménière'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 Ménière'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 Ménière's disease.

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New Web-based Tool for Generating Scattergrams to Report Hearing Results

No abstract available

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High Frequency Ex Vivo Ultrasound Imaging of the Middle Ear to Show Simulated Ossicular Pathology

Hypothesis: To illustrate the ability of high frequency ultrasound (HFUS) using a transducer array to demonstrate a variety of simulated clinical scenarios involving the ossicular chain. Background: HFUS (>20 MHz) is a relatively new area of ultrasonic imaging that provides an order of magnitude better image resolution than the conventional low-frequency systems. HFUS may be a real-time imaging system that could be used in the clinic and would complement computed tomography (CT) and magnetic resonance imaging (MRI) to enhance the decision-making process for patients with middle ear pathology. Methods: Using a commercially available HFUS scanner, we imaged a variety of simulated clinical scenarios to demonstrate the ability of HFUS to image middle ear pathology. Results: We were able to clearly demonstrate real-time visualization of ossicular pathology in human temporal bones, whereas there are some limitations in the current technique to be addressed before it is used in vivo. Conclusion: HFUS allows excellent visualization of middle ear anatomy and pathology through an intact tympanic membrane (TM), and these experiments go some way towards giving the otologist access to high resolution, real-time imaging of the middle ear in the clinic.

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Microsurgical Anatomy of the Internal Acoustic Meatus as Seen Using the Retrosigmoid Approach

Hypothesis: To show via a retrosigmoid approach the bony labyrinth anatomy and its relationship with the internal acoustic meatus so as to provide guidelines for a safer drilling to the fundus using this approach. Background: Few studies deal with the complex anatomy of petrous bone structures as observed by a retrosigmoid approach. Methods: Ten retrosigmoid approaches were performed bilaterally on five fresh cadaveric heads. Afterward high-resolution computed tomographic scans were obtained. Measurements of landmarks and distances between important topographic structures of the pyramid were obtained on its surface using a navigation system. Semicircular canals, vestibular aqueduct, and internal acoustic meatus were dissected to show their anatomy and relationships. Results: The anatomy of the inner ear structures was shown. Opening of the internal acoustic meatus was accomplished without injury to the labyrinth in 9 out of 10 sides. The distance between the drilled bone of the internal acoustic meatus and the vestibule was calculated on the postoperative computed tomographic scan. The mean value was 1.43 mm (SD, 0.30 mm; range, 1.0–1.8 mm). Conclusion: A better knowledge of the anatomy of the semicircular canals and of the vestibular aqueduct as observed by a retrosigmoid approach, together with their relationships to the fundus and other petrous bone landmarks, can be useful to get a general orientation in acoustic neuroma surgery. Using this information together with the neuronavigation, we were able to successfully open the internal acoustic meatus without entering labyrinthine structures in 90% of the study dissections.

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Cadaveric Study of an Endoscopic Keyhole Middle Fossa Craniotomy Approach to the Superior Semicircular Canal

Objective: Demonstrate that an endoscopic keyhole approach to the middle cranial fossa is technically feasible for repair of semicircular canal dehiscence. Study Design: Cadaveric technical feasibility/methods development study. Setting: Tertiary care military medical center. Patients: Three fresh cadaveric heads (six sides). Intervention(s): Endoscopic minimally invasive approach to the middle cranial fossa using the Medtronic Fusion Guidance system. Main Outcome Measure(s): Ability to identify the surgical landmarks of the middle cranial fossa and successfully identify and instrument the superior semicircular canal. Results: In every attempt, the arcuate eminence was successfully identified under endoscopic visualization and with the assistance of surgical navigation. The superior semicircular canal was unroofed, and its location confirmed visually and with the navigation system. The opened canal was then plugged with bone wax, bone pate, and covered with fascia. The 15-mm burr hole craniotomy provided ample room for one working instrument and a 4-mm 0-degree endoscope. Conclusion: The endoscopic keyhole approach to superior semicircular canal dehiscence is technically feasible in a human cadaveric model. Further studies will determine 1) if this approach is possible and safe in vivo, 2) is associated with improved surgical outcomes, and 3) if surgical navigation aids in this approach.

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Controlled Clinical Trial on Bone-anchored Hearing Implants and a Surgical Technique With Soft-tissue Preservation

Objective: To compare the clinical and audiological outcomes after linear incision with soft-tissue preservation and standard linear incision with soft-tissue reduction for placement of percutaneous bone-anchored hearing implants. Study Design: Clinical trial with historical control-group from a previous randomized controlled trial. Setting: Tertiary referral center. Patients and Interventions: Twenty-five patients were enrolled in a prospective cohort of bone-anchored hearing implant placement with linear incision and tissue preservation with a follow-up of 6 months. The control-group consisted of 25 patients from a previous randomized controlled trial in the same tertiary referral center. All sound processors were fitted 3 weeks after surgery. Main Outcome Measures: Numbness around the abutment, length of surgery, soft-tissue reactions according to Holgers’ classification, Patient and Observer Scar Assessment Scale, implant loss, Implant Stability Quotient, and audiological outcome. Results: Tissue preservation resulted in better results on sensibility (mean percentage correct responses 98% [SD 4.4] versus 89% [SD 15.0], p = 0.003), on the Patient and Observer Scar Assessment Scale (mean observer score 15.3 [SD 4.3] versus 19.4 [SD 6.3], p = 0.006), and shorter total surgery time (mean 24.6 min [SD 6.2] versus 31.9 min [SD 6.5], p 

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Emergence of Binaural Summation After Surgical Correction of Unilateral Congenital Aural Atresia

Objective: To investigate the emergence of binaural summation in patients with unilateral congenital aural atresia undergoing surgical correction. Study Design: Preoperative and postoperative audiometric testing in a prospective cohort of 10 patients with unilateral congenital aural atresia. Setting: University-based tertiary care center. Patients: Ten patients (ages 6–53) with an average 69 dB (±9 dB sd) unilateral conductive hearing loss, normal hearing in the nonatretic ear, and normal bone conduction in the atretic ear. Interventions: Pre- and postoperative hearing in noise test in quiet and in noise. Main Outcome Measures: Levels of sentences presented from a single central speaker were adaptively varied to determine a speech reception threshold (SRT), first in quiet and then with simultaneous multitalker babble at 65 dB SPL from the same speaker. Results: Preoperative SRT was worse than normal controls in both quiet (p = 0.001) and in noise (p = 0.05), as expected. Postoperative SRT in quiet improved 3.5 dB (marginally significant with one-tailed p value of 0.05); thresholds in noise improved an insignificant 0.8 dB (one-tailed p = 0.2). Converting results to dB-worse-than normal, atresia patients did better in noise (relative to normal) than in quiet (p = 0.008). Conclusion: The expected summation effect (3 dB) occurs after atresia surgery in quiet but not in noise. Relative to normal, these patients performed better in noise than quiet, perhaps because these patients develop skills attending to threshold-level speech in noise during their years without binaural benefit.

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Correlation of CT, MR, and Histopathology in Incomplete Partition-II Cochlear Anomaly

Objective: To correlate the computed tomography (CT) and magnetic resonance imaging (MR) findings in a patient with incomplete partition-type II (IP-II) anomaly with histopathology in a similar human temporal bone specimen. To discover the histologic correlate of a common finding on MR of an “apparent” interscalar septum (IS). Patients: A patient with sensorineural hearing loss and imaging findings characteristic of IP-II, and a patient with histopathologic IP-II anomaly. Intervention: High-resolution CT, MR, and review of postmortem temporal bone histopathology. Main Outcome Measure: Correlation of temporal bone histopathology with CT and MR findings. Results: Consistent findings of IP-II anomaly on CT, absence of the IS between the more distal turns and flattening of the interscalar ridge between the distal basal turn and the middle turn, were present. The signal void surrounding the cochlea on MR also demonstrated flattening of the interscalar ridge. However, a thin band-like area of low T2 signal was seen, which could be mistaken for an IS. Correlation with temporal bone histopathology revealed that the modiolus was foreshortened, and the spiral ganglion neuron dendritic processes continued toward the upper middle turn through the osseous spiral lamina, likely accounting for the MR finding. Conclusion: Correlation of CT, MR, and histopathology in IP-II shows an “apparent” segmentation representing a continuum of neurosensory elements in approximately the same location of the expected location of a normal IS. Care should be taken when interpreting MR imaging in isolation. Understanding the bony outline of the cochlea on imaging may prove to be complementary.

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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.

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The impact of tinnitus upon cognition in adults: A systematic review.

The impact of tinnitus upon cognition in adults: A systematic review.

Int J Audiol. 2016 May 31;:1-8

Authors: Tegg-Quinn S, Bennett RJ, Eikelboom RH, Baguley DM

Abstract
OBJECTIVE: To systematically review and analyse experimental outcomes of studies exploring the impact of tinnitus upon cognitive function and their implications for clinical management of invasive tinnitus.
DESIGN: A systematic and descriptive review.
STUDY SAMPLE: Eighteen studies were identified investigating the impact of tinnitus on cognitive function.
RESULTS: The 18 studies evaluated cognitive function using 24 different objective behavioural tests, nine electrophysiological recordings, one oculomotor test, and one self-report questionnaire. The studies spanned 18 years and revealed numerous interactions potentially contributing to the cognitive difficulties frequently reported by people with invasive tinnitus. The studies indicate a clear association between tinnitus and aspects of cognitive function, specifically the executive control of attention.
CONCLUSIONS: Tinnitus impairs cognitive function by way of impact upon executive control of attention. Clinical management of patients reporting tinnitus and cognitive difficulties requires an understanding of the reciprocal relationship between tinnitus and cognitive function, with additive effects of anxiety, depression, and somatic cognitive bias. Further study is required to establish the impact of advancing age, hearing loss, anxiety, depression tinnitus duration, and distress upon cognitive function in people with invasive tinnitus.

PMID: 27240696 [PubMed - as supplied by publisher]

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The impact of tinnitus upon cognition in adults: A systematic review.

The impact of tinnitus upon cognition in adults: A systematic review.

Int J Audiol. 2016 May 31;:1-8

Authors: Tegg-Quinn S, Bennett RJ, Eikelboom RH, Baguley DM

Abstract
OBJECTIVE: To systematically review and analyse experimental outcomes of studies exploring the impact of tinnitus upon cognitive function and their implications for clinical management of invasive tinnitus.
DESIGN: A systematic and descriptive review.
STUDY SAMPLE: Eighteen studies were identified investigating the impact of tinnitus on cognitive function.
RESULTS: The 18 studies evaluated cognitive function using 24 different objective behavioural tests, nine electrophysiological recordings, one oculomotor test, and one self-report questionnaire. The studies spanned 18 years and revealed numerous interactions potentially contributing to the cognitive difficulties frequently reported by people with invasive tinnitus. The studies indicate a clear association between tinnitus and aspects of cognitive function, specifically the executive control of attention.
CONCLUSIONS: Tinnitus impairs cognitive function by way of impact upon executive control of attention. Clinical management of patients reporting tinnitus and cognitive difficulties requires an understanding of the reciprocal relationship between tinnitus and cognitive function, with additive effects of anxiety, depression, and somatic cognitive bias. Further study is required to establish the impact of advancing age, hearing loss, anxiety, depression tinnitus duration, and distress upon cognitive function in people with invasive tinnitus.

PMID: 27240696 [PubMed - as supplied by publisher]

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Sustained Aftereffect of α-tACS Lasts Up to 70 min after Stimulation.

Sustained Aftereffect of α-tACS Lasts Up to 70 min after Stimulation.

Front Hum Neurosci. 2016;10:245

Authors: Kasten FH, Dowsett J, Herrmann CS

Abstract
Transcranial alternating current stimulation (tACS) has been repeatedly demonstrated to increase power of endogenous brain oscillations in the range of the stimulated frequency after stimulation. In the alpha band this aftereffect has been shown to persist for at least 30 min. However, in most experiments the aftereffect exceeded the duration of the measurement. Thus, it remains unclear how the effect develops beyond these 30 min and when it decays. The current study aimed to extend existing findings by monitoring the physiological aftereffect of tACS in the alpha range for an extended period of 90 min post-stimulation. To this end participants received either 20 min of tACS or sham stimulation with intensities below their individual sensation threshold at the individual alpha frequency (IAF). Electroencephalogram (EEG) was acquired during 3 min before and 90 min after stimulation. Subjects performed a visual vigilance task during the whole measurement. While the enhanced power in the individual alpha band did not return back to pre-stimulation baseline in the stimulation group, the difference between stimulation and sham diminishes after 70 min due to a natural alpha increase of the sham group.

PMID: 27252642 [PubMed]

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Annexin A5 is the Most Abundant Membrane-Associated Protein in Stereocilia but is Dispensable for Hair-Bundle Development and Function.

Annexin A5 is the Most Abundant Membrane-Associated Protein in Stereocilia but is Dispensable for Hair-Bundle Development and Function.

Sci Rep. 2016;6:27221

Authors: Krey JF, Drummond M, Foster S, Porsov E, Vijayakumar S, Choi D, Friderici K, Jones SM, Nuttall AL, Barr-Gillespie PG

Abstract
The phospholipid- and Ca(2+)-binding protein annexin A5 (ANXA5) is the most abundant membrane-associated protein of ~P23 mouse vestibular hair bundles, the inner ear's sensory organelle. Using quantitative mass spectrometry, we estimated that ANXA5 accounts for ~15,000 copies per stereocilium, or ~2% of the total protein there. Although seven other annexin genes are expressed in mouse utricles, mass spectrometry showed that none were present at levels near ANXA5 in bundles and none were upregulated in stereocilia of Anxa5(-/-) mice. Annexins have been proposed to mediate Ca(2+)-dependent repair of membrane lesions, which could be part of the repair mechanism in hair cells after noise damage. Nevertheless, mature Anxa5(-/-) mice not only have normal hearing and balance function, but following noise exposure, they are identical to wild-type mice in their temporary or permanent changes in hearing sensitivity. We suggest that despite the unusually high levels of ANXA5 in bundles, it does not play a role in the bundle's key function, mechanotransduction, at least until after two months of age in the cochlea and six months of age in the vestibular system. These results reinforce the lack of correlation between abundance of a protein in a specific compartment or cellular structure and its functional significance.

PMID: 27251877 [PubMed - in process]

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The Contribution of Hearing and Hearing Loss to Balance Control.

The Contribution of Hearing and Hearing Loss to Balance Control.

Audiol Neurootol. 2016 Jun 2;21(4):195-202

Authors: Vitkovic J, Le C, Lee SL, Clark RA

Abstract
This study investigated the hypothesis that a hearing 'map' of our surroundings is used to maintain balance control. We investigated the effects of sound on postural sway using centre of pressure analysis in 50 subjects with normal hearing, 28 with hearing loss and 19 with vestibular dysfunction. The acoustic environments utilized sound cues that were either present or absent. It was found that auditory cues are utilized by subjects with normal hearing to improve postural sway. The ability to utilize sound for postural control is diminished when there is a hearing loss, but this appears to be overcome by the use of a hearing aid. Patients with additional vestibular deficits exploit auditory cues to a greater degree, suggesting that sensory weighting to enhance the use of auditory cues may be applied when there is diminished sensory redundancy.

PMID: 27251708 [PubMed - as supplied by publisher]

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Sustained Aftereffect of α-tACS Lasts Up to 70 min after Stimulation.

Sustained Aftereffect of α-tACS Lasts Up to 70 min after Stimulation.

Front Hum Neurosci. 2016;10:245

Authors: Kasten FH, Dowsett J, Herrmann CS

Abstract
Transcranial alternating current stimulation (tACS) has been repeatedly demonstrated to increase power of endogenous brain oscillations in the range of the stimulated frequency after stimulation. In the alpha band this aftereffect has been shown to persist for at least 30 min. However, in most experiments the aftereffect exceeded the duration of the measurement. Thus, it remains unclear how the effect develops beyond these 30 min and when it decays. The current study aimed to extend existing findings by monitoring the physiological aftereffect of tACS in the alpha range for an extended period of 90 min post-stimulation. To this end participants received either 20 min of tACS or sham stimulation with intensities below their individual sensation threshold at the individual alpha frequency (IAF). Electroencephalogram (EEG) was acquired during 3 min before and 90 min after stimulation. Subjects performed a visual vigilance task during the whole measurement. While the enhanced power in the individual alpha band did not return back to pre-stimulation baseline in the stimulation group, the difference between stimulation and sham diminishes after 70 min due to a natural alpha increase of the sham group.

PMID: 27252642 [PubMed]

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Annexin A5 is the Most Abundant Membrane-Associated Protein in Stereocilia but is Dispensable for Hair-Bundle Development and Function.

Annexin A5 is the Most Abundant Membrane-Associated Protein in Stereocilia but is Dispensable for Hair-Bundle Development and Function.

Sci Rep. 2016;6:27221

Authors: Krey JF, Drummond M, Foster S, Porsov E, Vijayakumar S, Choi D, Friderici K, Jones SM, Nuttall AL, Barr-Gillespie PG

Abstract
The phospholipid- and Ca(2+)-binding protein annexin A5 (ANXA5) is the most abundant membrane-associated protein of ~P23 mouse vestibular hair bundles, the inner ear's sensory organelle. Using quantitative mass spectrometry, we estimated that ANXA5 accounts for ~15,000 copies per stereocilium, or ~2% of the total protein there. Although seven other annexin genes are expressed in mouse utricles, mass spectrometry showed that none were present at levels near ANXA5 in bundles and none were upregulated in stereocilia of Anxa5(-/-) mice. Annexins have been proposed to mediate Ca(2+)-dependent repair of membrane lesions, which could be part of the repair mechanism in hair cells after noise damage. Nevertheless, mature Anxa5(-/-) mice not only have normal hearing and balance function, but following noise exposure, they are identical to wild-type mice in their temporary or permanent changes in hearing sensitivity. We suggest that despite the unusually high levels of ANXA5 in bundles, it does not play a role in the bundle's key function, mechanotransduction, at least until after two months of age in the cochlea and six months of age in the vestibular system. These results reinforce the lack of correlation between abundance of a protein in a specific compartment or cellular structure and its functional significance.

PMID: 27251877 [PubMed - in process]

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The Contribution of Hearing and Hearing Loss to Balance Control.

The Contribution of Hearing and Hearing Loss to Balance Control.

Audiol Neurootol. 2016 Jun 2;21(4):195-202

Authors: Vitkovic J, Le C, Lee SL, Clark RA

Abstract
This study investigated the hypothesis that a hearing 'map' of our surroundings is used to maintain balance control. We investigated the effects of sound on postural sway using centre of pressure analysis in 50 subjects with normal hearing, 28 with hearing loss and 19 with vestibular dysfunction. The acoustic environments utilized sound cues that were either present or absent. It was found that auditory cues are utilized by subjects with normal hearing to improve postural sway. The ability to utilize sound for postural control is diminished when there is a hearing loss, but this appears to be overcome by the use of a hearing aid. Patients with additional vestibular deficits exploit auditory cues to a greater degree, suggesting that sensory weighting to enhance the use of auditory cues may be applied when there is diminished sensory redundancy.

PMID: 27251708 [PubMed - as supplied by publisher]

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The impact of tinnitus upon cognition in adults: A systematic review.

The impact of tinnitus upon cognition in adults: A systematic review.

Int J Audiol. 2016 May 31;:1-8

Authors: Tegg-Quinn S, Bennett RJ, Eikelboom RH, Baguley DM

Abstract
OBJECTIVE: To systematically review and analyse experimental outcomes of studies exploring the impact of tinnitus upon cognitive function and their implications for clinical management of invasive tinnitus.
DESIGN: A systematic and descriptive review.
STUDY SAMPLE: Eighteen studies were identified investigating the impact of tinnitus on cognitive function.
RESULTS: The 18 studies evaluated cognitive function using 24 different objective behavioural tests, nine electrophysiological recordings, one oculomotor test, and one self-report questionnaire. The studies spanned 18 years and revealed numerous interactions potentially contributing to the cognitive difficulties frequently reported by people with invasive tinnitus. The studies indicate a clear association between tinnitus and aspects of cognitive function, specifically the executive control of attention.
CONCLUSIONS: Tinnitus impairs cognitive function by way of impact upon executive control of attention. Clinical management of patients reporting tinnitus and cognitive difficulties requires an understanding of the reciprocal relationship between tinnitus and cognitive function, with additive effects of anxiety, depression, and somatic cognitive bias. Further study is required to establish the impact of advancing age, hearing loss, anxiety, depression tinnitus duration, and distress upon cognitive function in people with invasive tinnitus.

PMID: 27240696 [PubMed - as supplied by publisher]

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The impact of tinnitus upon cognition in adults: A systematic review.

The impact of tinnitus upon cognition in adults: A systematic review.

Int J Audiol. 2016 May 31;:1-8

Authors: Tegg-Quinn S, Bennett RJ, Eikelboom RH, Baguley DM

Abstract
OBJECTIVE: To systematically review and analyse experimental outcomes of studies exploring the impact of tinnitus upon cognitive function and their implications for clinical management of invasive tinnitus.
DESIGN: A systematic and descriptive review.
STUDY SAMPLE: Eighteen studies were identified investigating the impact of tinnitus on cognitive function.
RESULTS: The 18 studies evaluated cognitive function using 24 different objective behavioural tests, nine electrophysiological recordings, one oculomotor test, and one self-report questionnaire. The studies spanned 18 years and revealed numerous interactions potentially contributing to the cognitive difficulties frequently reported by people with invasive tinnitus. The studies indicate a clear association between tinnitus and aspects of cognitive function, specifically the executive control of attention.
CONCLUSIONS: Tinnitus impairs cognitive function by way of impact upon executive control of attention. Clinical management of patients reporting tinnitus and cognitive difficulties requires an understanding of the reciprocal relationship between tinnitus and cognitive function, with additive effects of anxiety, depression, and somatic cognitive bias. Further study is required to establish the impact of advancing age, hearing loss, anxiety, depression tinnitus duration, and distress upon cognitive function in people with invasive tinnitus.

PMID: 27240696 [PubMed - as supplied by publisher]

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Identification of a novel mutation in SLC26A4 gene in a Chinese family with enlarged vestibular aqueduct syndrome.

Identification of a novel mutation in SLC26A4 gene in a Chinese family with enlarged vestibular aqueduct syndrome.

Int J Pediatr Otorhinolaryngol. 2016 Jun;85:75-9

Authors: Zhang F, Bai X, Xiao Y, Zhang X, Zhang G, Li J, Xu L, Wang H

Abstract
OBJECTIVE: To investigate the genetic causes of hearing loss in a two generation Chinese family with enlarged vestibular aqueduct syndrome (EVAS).
METHODS: Clinical and genetic evaluations were conducted in a deaf proband and her normal-hearing parents. Sanger sequencing analysis of all the 21 exons, the exon-intron boundaries and the promoter in SLC26A4 gene was performed to detect the pathogenic mutations. PCR-restricted fragment length polymorphism (PCR-RFLP) was used to further identify the mutation. Phylogenetic analysis was carried out with multiple sequence alignment using BioEdit software. Three-dimensional (3D) modeling of the human wild-type and mutant SLC26A4 (NP_000432.1) was carried out using I-TASSER (http://ift.tt/1roobKN).
RESULTS: Clinical examinations showed that the proband suffered from typical features of sensorineural hearing loss with enlarged vestibular aqueduct. A novel nonsense mutation c.2118C>A (p.C706X) in exon 19 was identified in compound heterozygosity with the splice-site mutation c.919-2A>G in the proband by using Sanger sequencing. The mother was a heterozygous carrier of c.919-2A>G in intron 7, while the father was a heterozygous carrier of c.2118C>A. The mutation c.2118C>A was not found in 200 unrelated controls using Sanger sequencing. PCR-RFLP showed the PCR product of the proband was not digested at 2110 by Fau I because of the c.2118C>A mutation. 3D-structure modeling indicated that the mutation c.2118C>A resulted in a truncate Pendrin protein. Protein alignment indicated high conservation of p.C706 residue in healthy Homo, Nomascus, Pan, Macaca, Canis, Sus, Mus, Rattus, Cricetulus and Xenopus.
CONCLUSIONS: This study revealed a novel heterozygous mutation c.2118C>A (p.C706X) compound with c.919-2A>G in SLC26A4 gene in a patient with EVAS.

PMID: 27240500 [PubMed - in process]

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Trials of a Contralateral Hearing Aid After Long-Term Unilateral Cochlear Implant Use in Early-Onset Deafness

Purpose

The purpose of this study was to evaluate the practicability of binaural hearing by adding a contralateral hearing aid (HA) after long-term cochlear implant (CI) use in prelingually deaf adults.

Method

Five individuals with 1 CI volunteered for a 3-week bimodal (CI + HA) trial. HA gain was set low until sound was tolerable, then increased as listeners acclimated. Participants logged their daily listening experiences and were closely monitored by the audiologist. Measures included pre- and posttrial consonant-nucleus-consonant (CNC) word and phoneme scores and self-reports of satisfaction and listening ability in difficult situations.

Results

Acoustic stimulation was initially unpleasant, but approached comfort at target gain within the 3-week period. Benefit was demonstrated in continued voluntary HA use and higher bimodal phoneme scores compared to CI alone (8%–31% increases) for 4 of the participants.

Conclusions

When a second CI is not a consideration, a contralateral HA should be pursued as the standard of care for prelingually deaf adults despite substantial auditory deprivation in the previously unaided ear, unpleasant sensations at initial HA fit, or lack of dramatic objective test gains. Frequent audiologist contact, repeated HA adjustments, and client journals are valuable in promoting favorable outcomes with bimodal hearing (adaptation, acceptance, and benefit) for this population.

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An Application of Item Response Theory and the Rasch Model in Speech Recognition Test Materials

Purpose

The purpose of this study was to describe an attempt to apply item-response theory (IRT) and the Rasch model to construction of speech-recognition tests. A set of word-recognition test items applicable to children as young as 3 years old—with any level of hearing sensitivity, with or without using hearing devices—was developed.

Method

Test items were constructed through expert consultation and by reference to some established language corpora, validated with 121 participants with various degrees of hearing loss and 255 with typical hearing. IRT and the Rasch model were applied to evaluate item quality.

Results

Eighty disyllabic word items were selected in accordance with IRT. The speech-recognition abilities of the 376 young participants are reported. The IRT analyses on this set of data are also discussed.

Conclusions

A new set of speech-recognition test materials in Cantonese Chinese has been developed. Construction of short equivalent lists may be performed in accordance with IRT item qualities. Clinical applications of this test tool in the particular language population are discussed.

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Trials of a Contralateral Hearing Aid After Long-Term Unilateral Cochlear Implant Use in Early-Onset Deafness

Purpose

The purpose of this study was to evaluate the practicability of binaural hearing by adding a contralateral hearing aid (HA) after long-term cochlear implant (CI) use in prelingually deaf adults.

Method

Five individuals with 1 CI volunteered for a 3-week bimodal (CI + HA) trial. HA gain was set low until sound was tolerable, then increased as listeners acclimated. Participants logged their daily listening experiences and were closely monitored by the audiologist. Measures included pre- and posttrial consonant-nucleus-consonant (CNC) word and phoneme scores and self-reports of satisfaction and listening ability in difficult situations.

Results

Acoustic stimulation was initially unpleasant, but approached comfort at target gain within the 3-week period. Benefit was demonstrated in continued voluntary HA use and higher bimodal phoneme scores compared to CI alone (8%–31% increases) for 4 of the participants.

Conclusions

When a second CI is not a consideration, a contralateral HA should be pursued as the standard of care for prelingually deaf adults despite substantial auditory deprivation in the previously unaided ear, unpleasant sensations at initial HA fit, or lack of dramatic objective test gains. Frequent audiologist contact, repeated HA adjustments, and client journals are valuable in promoting favorable outcomes with bimodal hearing (adaptation, acceptance, and benefit) for this population.

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Trials of a Contralateral Hearing Aid After Long-Term Unilateral Cochlear Implant Use in Early-Onset Deafness

Purpose

The purpose of this study was to evaluate the practicability of binaural hearing by adding a contralateral hearing aid (HA) after long-term cochlear implant (CI) use in prelingually deaf adults.

Method

Five individuals with 1 CI volunteered for a 3-week bimodal (CI + HA) trial. HA gain was set low until sound was tolerable, then increased as listeners acclimated. Participants logged their daily listening experiences and were closely monitored by the audiologist. Measures included pre- and posttrial consonant-nucleus-consonant (CNC) word and phoneme scores and self-reports of satisfaction and listening ability in difficult situations.

Results

Acoustic stimulation was initially unpleasant, but approached comfort at target gain within the 3-week period. Benefit was demonstrated in continued voluntary HA use and higher bimodal phoneme scores compared to CI alone (8%–31% increases) for 4 of the participants.

Conclusions

When a second CI is not a consideration, a contralateral HA should be pursued as the standard of care for prelingually deaf adults despite substantial auditory deprivation in the previously unaided ear, unpleasant sensations at initial HA fit, or lack of dramatic objective test gains. Frequent audiologist contact, repeated HA adjustments, and client journals are valuable in promoting favorable outcomes with bimodal hearing (adaptation, acceptance, and benefit) for this population.

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An Application of Item Response Theory and the Rasch Model in Speech Recognition Test Materials

Purpose

The purpose of this study was to describe an attempt to apply item-response theory (IRT) and the Rasch model to construction of speech-recognition tests. A set of word-recognition test items applicable to children as young as 3 years old—with any level of hearing sensitivity, with or without using hearing devices—was developed.

Method

Test items were constructed through expert consultation and by reference to some established language corpora, validated with 121 participants with various degrees of hearing loss and 255 with typical hearing. IRT and the Rasch model were applied to evaluate item quality.

Results

Eighty disyllabic word items were selected in accordance with IRT. The speech-recognition abilities of the 376 young participants are reported. The IRT analyses on this set of data are also discussed.

Conclusions

A new set of speech-recognition test materials in Cantonese Chinese has been developed. Construction of short equivalent lists may be performed in accordance with IRT item qualities. Clinical applications of this test tool in the particular language population are discussed.

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An Application of Item Response Theory and the Rasch Model in Speech Recognition Test Materials

Purpose

The purpose of this study was to describe an attempt to apply item-response theory (IRT) and the Rasch model to construction of speech-recognition tests. A set of word-recognition test items applicable to children as young as 3 years old—with any level of hearing sensitivity, with or without using hearing devices—was developed.

Method

Test items were constructed through expert consultation and by reference to some established language corpora, validated with 121 participants with various degrees of hearing loss and 255 with typical hearing. IRT and the Rasch model were applied to evaluate item quality.

Results

Eighty disyllabic word items were selected in accordance with IRT. The speech-recognition abilities of the 376 young participants are reported. The IRT analyses on this set of data are also discussed.

Conclusions

A new set of speech-recognition test materials in Cantonese Chinese has been developed. Construction of short equivalent lists may be performed in accordance with IRT item qualities. Clinical applications of this test tool in the particular language population are discussed.

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NAS Report on Hearing Care for Adults

On June 2, 2016, the National Academy of Sciences, Engineering, and Medicine (NAS; formerly the Institute of Medicine) issued a report on the access and affordability of hearing care for adults. This report is the output of a 17-member scientific and professional committee, and it is NOT the same as the 2015 report issued by the President’s Council of Advisors on Science and Technology (PCAST). 

Today’s NAS report presents 12 recommendations for improving access to hearing health care.

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Scattering of guided waves at delaminations in composite plates

Carbon fiber laminate composites are increasingly employed for aerospace structures as they offer advantages, such as a good strength to weight ratio. However, impact during the operation and servicing of the aircraft can lead to barely visible and difficult to detect damage. Depending on the severity of the impact, fiber and matrix breakage or delaminations can occur, reducing the load carrying capacity of the structure. Efficient nondestructive testing and structural health monitoring of composite panels can be achieved using guided ultrasonic waves propagating along the structure. The scattering of the A0 Lamb wave mode at delaminations was investigated using a full three-dimensional (3D) finite element (FE) analysis. The influence of the delamination geometry (size and depth) was systematically evaluated. In addition to the depth dependency, a significant influence of the delamination width due to sideways reflection of the guided waves within the delamination area was found. Mixed-mode defects were simulated using a combined model of delamination with localized material degradation. The guided wave scattering at cross-ply composite plates with impact damage was measured experimentally using a non-contact laser interferometer. Good agreement between experiments and FE predictions using the mixed-mode model for an approximation of the impact damage was found.

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Erratum: Relative sound localisation abilities in human listeners [J. Acoust. Soc. Am. 138, 674–686 (2015)]

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REVIEWS OF ACOUSTICAL PATENTS

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