Audiology by Alexandros G. Sfakianakis: 06/09/16

Πέμπτη 9 Ιουνίου 2016

How Stressful Is “Deep Bubbling”?

Publication date: Available online 9 June 2016
Source:Journal of Voice
Author(s): Jaana Tyrmi, Anne-Maria Laukkanen
ObjectivesWater resistance therapy by phonating through a tube into the water is used to treat dysphonia. Deep submersion (≥10 cm in water, “deep bubbling”) is used for hypofunctional voice disorders. Using it with caution is recommended to avoid vocal overloading. This experimental study aimed to investigate how strenuous “deep bubbling” is.Study DesignFourteen subjects, half of them with voice training, repeated the syllable [pa:] in comfortable speaking pitch and loudness, loudly, and in strained voice. Thereafter, they phonated a vowel-like sound both in comfortable loudness and loudly into a glass resonance tube immersed 10 cm into the water.MethodsOral pressure, contact quotient (CQ, calculated from electroglottographic signal), and sound pressure level were studied. The peak oral pressure P(oral) during [p] and shuttering of the outer end of the tube was measured to estimate the subglottic pressure P(sub) and the mean P(oral) during vowel portions to enable calculation of transglottic pressure P(trans). Sensations during phonation were reported with an open-ended interview.ResultsP(sub) and P(oral) were higher in “deep bubbling” and P(trans) lower than in loud syllable phonation, but the CQ did not differ significantly. Similar results were obtained for the comparison between loud “deep bubbling” and strained phonation, although P(sub) did not differ significantly. Most of the subjects reported “deep bubbling” to be stressful only for respiratory and lip muscles. No big differences were found between trained and untrained subjects.ConclusionsThe CQ values suggest that “deep bubbling” may increase vocal fold loading. Further studies should address impact stress during water resistance exercises.

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Story Goodness in Adolescents With Autism Spectrum Disorder (ASD) and in Optimal Outcomes From ASD

Purpose

This study examined narrative quality of adolescents with autism spectrum disorder (ASD) using a well-studied “story goodness” coding system.

Method

Narrative samples were analyzed for distinct aspects of story goodness and rated by naïve readers on dimensions of story goodness, accuracy, cohesiveness, and oddness. Adolescents with high-functioning ASD were compared with adolescents with typical development (TD; n = 15 per group). A second study compared narratives from adolescents across three groups: ASD, TD, and youths with “optimal outcomes,” who were diagnosed with ASD early in development but no longer meet criteria for ASD and have typical behavioral functioning.

Results

In both studies, the ASD group's narratives had lower composite quality scores compared with peers with typical development. In Study 2, narratives from the optimal outcomes group were intermediate in scores and did not differ significantly from those of either other group. However, naïve raters were able to detect qualitative narrative differences across groups.

Conclusions

Findings indicate that pragmatic deficits in ASD are salient and could have clinical relevance. Furthermore, results indicate subtle differences in pragmatic language skills for individuals with optimal outcomes despite otherwise typical language skills in other domains. These results highlight the need for clinical interventions tailored to the specific deficits of these populations.

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Seeing the Talker's Face Improves Free Recall of Speech for Young Adults With Normal Hearing but Not Older Adults With Hearing Loss

Purpose

Seeing the talker's face improves speech understanding in noise, possibly releasing resources for cognitive processing. We investigated whether it improves free recall of spoken two-digit numbers.

Method

Twenty younger adults with normal hearing and 24 older adults with hearing loss listened to and subsequently recalled lists of 13 two-digit numbers, with alternating male and female talkers. Lists were presented in quiet as well as in stationary and speech-like noise at a signal-to-noise ratio giving approximately 90% intelligibility. Amplification compensated for loss of audibility.

Results

Seeing the talker's face improved free recall performance for the younger but not the older group. Poorer performance in background noise was contingent on individual differences in working memory capacity. The effect of seeing the talker's face did not differ in quiet and noise.

Conclusions

We have argued that the absence of an effect of seeing the talker's face for older adults with hearing loss may be due to modulation of audiovisual integration mechanisms caused by an interaction between task demands and participant characteristics. In particular, we suggest that executive task demands and interindividual executive skills may play a key role in determining the benefit of seeing the talker's face during a speech-based cognitive task.

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The impact of self-efficacy, expectations, and readiness on hearing aid outcomes.

The impact of self-efficacy, expectations, and readiness on hearing aid outcomes.

Int J Audiol. 2016 Jun 7;:1-8

Authors: Ferguson MA, Woolley A, Munro KJ

Abstract
OBJECTIVE: To examine the impact of self-efficacy and expectations for hearing aids, and readiness to improve hearing, on hearing aid outcome measures in first-time adult hearing aid users Design: A prospective, single centre design. Predictor variables measured at the hearing assessment included measures of self-efficacy, expectations and readiness to improve hearing. Outcome measures obtained at six-week follow-up were the Glasgow Hearing Aid Benefit Profile and Satisfaction with Amplification in Daily Life.
STUDY SAMPLE: A sample of 30 first-time adult hearing aid users were recruited through a public-sector funded audiology clinic.
RESULTS: When measured prior to hearing aid fitting, self-efficacy for hearing aids predicted satisfaction with hearing aids but was not related to other hearing aid outcomes. Expectations of hearing aids, in particular positive expectations, and readiness to improve hearing predicted outcomes for hearing aid satisfaction and benefit, although not hearing aid use. Hearing sensitivity was not correlated with hearing aid outcomes.
CONCLUSIONS: These results suggest that assessment of expectations of hearing aids, and readiness to improve hearing, may be useful to help identify individuals attending audiology clinics who would most likely benefit from hearing aid provision.

PMID: 27266542 [PubMed - as supplied by publisher]

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Contemporary surgical issues in paediatric cochlear implantation.

Contemporary surgical issues in paediatric cochlear implantation.

Int J Audiol. 2016 Jun 7;:1-11

Authors: Wasson JD, Briggs RJ

Abstract
OBJECTIVE: To review the contemporary surgical issues in paediatric cochlear implantation (CI) based on published evidence.
DESIGN: Narrative literature review.
RESULTS: Surgical challenges in paediatric CI are discussed, with respect to post meningitic labyrinthitis ossificans; cochlear malformation; cochlear implantation in infants; auditory neuropathy and cochlear nerve deficiency; bilateral cochlear implantation; hearing preservation; otitis media; and device failure.
CONCLUSION: Early CI is recommended if bacterial meningitis causes profound sensorineural hearing loss (SNHL). CI in cochleovestibular malformation requires pre-operative imaging to plan surgical technique, choice of electrode, and to anticipate complication. Children with congenital severe to profound SNHL should undergo early bilateral simultaneous implantation, preferably before 12 months of age, except those with auditory neuropathy spectrum disorder who should be implanted after one year. Soft surgical technique should be deployed in an attempt to preserve any residual hearing. Otitis media with effusion is not a contraindication to cochlear implantation, but active or recurrent acute otitis media requires resolution of infection with grommet insertion pre-operatively. Device failure in CI recipients requires a stepwise audiological, medical, radiological, and device integrity assessment to determine the need for reimplantation.

PMID: 27266370 [PubMed - as supplied by publisher]

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Story Goodness in Adolescents With Autism Spectrum Disorder (ASD) and in Optimal Outcomes From ASD

Purpose

This study examined narrative quality of adolescents with autism spectrum disorder (ASD) using a well-studied “story goodness” coding system.

Method

Results

Conclusions

Findings indicate that pragmatic deficits in ASD are salient and could have clinical relevance. Furthermore, results indicate subtle differences in pragmatic language skills for individuals with optimal outcomes despite otherwise typical language skills in other domains. These results highlight the need for clinical interventions tailored to the specific deficits of these populations.

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Seeing the Talker's Face Improves Free Recall of Speech for Young Adults With Normal Hearing but Not Older Adults With Hearing Loss

Purpose

Seeing the talker's face improves speech understanding in noise, possibly releasing resources for cognitive processing. We investigated whether it improves free recall of spoken two-digit numbers.

Method

Results

Conclusions

We have argued that the absence of an effect of seeing the talker's face for older adults with hearing loss may be due to modulation of audiovisual integration mechanisms caused by an interaction between task demands and participant characteristics. In particular, we suggest that executive task demands and interindividual executive skills may play a key role in determining the benefit of seeing the talker's face during a speech-based cognitive task.

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The impact of self-efficacy, expectations, and readiness on hearing aid outcomes.

The impact of self-efficacy, expectations, and readiness on hearing aid outcomes.

Int J Audiol. 2016 Jun 7;:1-8

Authors: Ferguson MA, Woolley A, Munro KJ

PMID: 27266542 [PubMed - as supplied by publisher]

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Contemporary surgical issues in paediatric cochlear implantation.

Contemporary surgical issues in paediatric cochlear implantation.

Int J Audiol. 2016 Jun 7;:1-11

Authors: Wasson JD, Briggs RJ

PMID: 27266370 [PubMed - as supplied by publisher]

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Story Goodness in Adolescents With Autism Spectrum Disorder (ASD) and in Optimal Outcomes From ASD

Purpose

This study examined narrative quality of adolescents with autism spectrum disorder (ASD) using a well-studied “story goodness” coding system.

Method

Results

Conclusions

Findings indicate that pragmatic deficits in ASD are salient and could have clinical relevance. Furthermore, results indicate subtle differences in pragmatic language skills for individuals with optimal outcomes despite otherwise typical language skills in other domains. These results highlight the need for clinical interventions tailored to the specific deficits of these populations.

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Seeing the Talker's Face Improves Free Recall of Speech for Young Adults With Normal Hearing but Not Older Adults With Hearing Loss

Purpose

Seeing the talker's face improves speech understanding in noise, possibly releasing resources for cognitive processing. We investigated whether it improves free recall of spoken two-digit numbers.

Method

Results

Conclusions

We have argued that the absence of an effect of seeing the talker's face for older adults with hearing loss may be due to modulation of audiovisual integration mechanisms caused by an interaction between task demands and participant characteristics. In particular, we suggest that executive task demands and interindividual executive skills may play a key role in determining the benefit of seeing the talker's face during a speech-based cognitive task.

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A systematic review and meta-analysis on acoustic voice parameters after uncomplicated thyroidectomy.

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A systematic review and meta-analysis on acoustic voice parameters after uncomplicated thyroidectomy.

Laryngoscope. 2016 Feb;126(2):528-37

Authors: Lang BH, Wong CK, Ma EP

Abstract
BACKGROUND: Postthyroidectomy voice changes are common even without apparent laryngeal nerve injury. Our study evaluated the impact of open cervical thyroidectomy on five acoustic voice parameters in the early (< 3 months) and late (≥ 3 months) postoperative periods.
METHODS: A systematic review was performed to identify studies that quantitatively assessed voice quality by acoustic voice analysis before and after thyroidectomy. Parameters included average fundamental frequency (F0 , Hz), jitter (%), shimmer (%), noise-to-harmonic ratio (NHR), and maximum phonation time (MPT) (in secs). Meta-analysis was performed using both fixed- and random-effects models.
RESULTS: A total of 896 patients were analyzed. Relative to baseline, F0 significantly worsened in the early period (from 194.9 ± 34.9 Hz to 188.0 ± 34.0 Hz, P = 0.001). This was equivalent to a quarter-tone loss (P = 0.004). Shimmer (from 3.15 ± 1.59% to 3.19 ± 1.70%, P = 0.040) and MPT (from 17.9 secs to 16.7 secs, P = 0.046) also worsened in the early period, whereas jitter and NHR remained unchanged in the early and late periods. Males suffered greater deterioration in F0 (from 120.6 ± 18.8 Hz to 111.0 ± 18.5 Hz, P = 0.048) and in NHR (from 0.12 ± 0.02 to 0.16 ± 0.03, P = 0.019) than females in the early period. Four of the five acoustic parameters (F0 , jitter, shimmer, and NHR) significantly worsened after total thyroidectomy (TT) and not after lesser resection.
CONCLUSION: F0 , shimmer, and MPT significantly worsened in the early and not in the late postoperative period. F0 impairment was perceptually significant. Males and those undergoing TT suffered greater voice impairment than their counterparts during the early period.

PMID: 26152841 [PubMed - indexed for MEDLINE]

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Mice Haploinsufficient for Ets1 and Fli1 Display Middle Ear Abnormalities and Model Aspects of Jacobsen Syndrome.

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Mice Haploinsufficient for Ets1 and Fli1 Display Middle Ear Abnormalities and Model Aspects of Jacobsen Syndrome.

Am J Pathol. 2015 Jul;185(7):1867-76

Authors: Carpinelli MR, Kruse EA, Arhatari BD, Debrincat MA, Ogier JM, Bories JC, Kile BT, Burt RA

Abstract
E26 transformation-specific 1 (ETS1) and friend leukemia integration 1 (FLI1) are members of the ETS family of transcription factors, of which there are 28 in humans. Both genes are hemizygous in Jacobsen syndrome, an 11q contiguous gene deletion disorder involving thrombocytopenia, facial dysmorphism, growth and mental retardation, malformation of the heart and other organs, and hearing impairment associated with recurrent ear infections. To determine whether any of these defects are because of hemizygosity for ETS1 and FLI1, we characterized the phenotype of mice heterozygous for mutant alleles of Ets1 and Fli1. Fli1(+/-) mice displayed mild thrombocytopenia, as did Ets1(+/-)Fli1(+/-) animals. Fli1(+/-) and Ets1(+/-)Fli1(+/-) mice also displayed craniofacial abnormalities, including a small middle ear cavity, short nasal bone, and malformed interface between the nasal bone process and cartilaginous nasal septum. They exhibited hearing impairment, otitis media, fusions of ossicles to the middle ear wall, and deformed stapes. Hearing impairment was more penetrant and stapes malformations were more severe in Ets1(+/-)Fli1(+/-) mice than in Fli1(+/-) mice, indicating partial functional redundancy of these transcription factors during auditory development. Our findings indicate that the short nose, otitis media, and hearing impairment in Jacobsen syndrome are likely because of hemizygosity for ETS1 and FLI1.

PMID: 26093983 [PubMed - indexed for MEDLINE]

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Postimplantation changes of electrophysiological parameters in patients with cochlear implants.

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Postimplantation changes of electrophysiological parameters in patients with cochlear implants.

Audiol Neurootol. 2015;20(4):222-8

Authors: Molisz A, Zarowski A, Vermeiren A, Theunen T, De Coninck L, Siebert J, Offeciers EF

Abstract
OBJECTIVE: To evaluate the postoperative changes of the basic electrophysiological and psychophysical parameters in cochlear implant (CI) patients: the impedance of the electrode contacts, the electrically-evoked compound action potential (ECAP) thresholds and the T/C levels.
STUDY DESIGN AND SETTING: Retrospective case review in a quaternary otologic referral centre.
MATERIALS AND METHODS: Data on the impedance of the electrode contacts, the ECAP thresholds and the T/C levels were collected in 20 consecutive CI patients divided into 2 groups. Group 1 comprised 10 prelingually deaf children implanted before the age of 18 months, and group 2 comprised 10 postlingually deaf adults (average age of 58 years). All patients were users of the Nucleus 24RECA (Freedom, Contour advance off-stylet electrode) CI.
RESULTS AND CONCLUSIONS: (1) The mid-portion and the apical electrodes showed a decrease in the impedance values between the 1st and the 6th postoperative months and stabilization in the later course. Impedance of the most basal electrodes grew during the first postoperative months and stabilized later on, but remained higher than the impedance of the mid-portion and the apical electrodes. (2) The neural response telemetry threshold values tended to decrease within the first 3 months after surgery to reach a plateau afterwards. (3) The behavioural threshold levels remained generally stable, except for the basal electrodes where a decrease could be observed. The hearing comfort levels showed an increase during the first 6 months of the implant use and remained stable afterwards.

PMID: 25969138 [PubMed - indexed for MEDLINE]

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The impact of self-efficacy, expectations, and readiness on hearing aid outcomes.

The impact of self-efficacy, expectations, and readiness on hearing aid outcomes.

Int J Audiol. 2016 Jun 7;:1-8

Authors: Ferguson MA, Woolley A, Munro KJ

PMID: 27266542 [PubMed - as supplied by publisher]

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Contemporary surgical issues in paediatric cochlear implantation.

Contemporary surgical issues in paediatric cochlear implantation.

Int J Audiol. 2016 Jun 7;:1-11

Authors: Wasson JD, Briggs RJ

PMID: 27266370 [PubMed - as supplied by publisher]

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The impact of self-efficacy, expectations, and readiness on hearing aid outcomes.

The impact of self-efficacy, expectations, and readiness on hearing aid outcomes.

Int J Audiol. 2016 Jun 7;:1-8

Authors: Ferguson MA, Woolley A, Munro KJ

PMID: 27266542 [PubMed - as supplied by publisher]

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Contemporary surgical issues in paediatric cochlear implantation.

Contemporary surgical issues in paediatric cochlear implantation.

Int J Audiol. 2016 Jun 7;:1-11

Authors: Wasson JD, Briggs RJ

PMID: 27266370 [PubMed - as supplied by publisher]

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Reducing Listening Effort via primax Hearing Technology

When listening situations become noisier or more challenging, this is even more important. However, beyond improving speech intelligibility, another indicator of the effectiveness of hearing aid fittings that has sometimes been overlooked is the cognitive demands, or listening effort required for speech understanding to take place. This is why it is important to not only improve speech understanding, but also make speech understanding easy. This is the underlying goal of the new Signia primax™ platform ― to improve speech intelligibility and reduce listening effort for the wearer.

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Reducing Listening Effort via primax Hearing Technology

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Reducing Listening Effort via primax Hearing Technology

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[The differential diagnosis of recurrent episodes of vertigo].

[The differential diagnosis of recurrent episodes of vertigo].

Zh Nevrol Psikhiatr Im S S Korsakova. 2016;116(4):4-9

Authors: Kudryavtseva AS, Amelin AV, Lilenko SV, Skoromets AA

Abstract
Recurrent episodes of vertigo are one of the most frequent reasons of referrals for medical help. In the Russian medicine, the development of vertigo is traditionally associated with a cerebral vascular pathology. It is suggested that correctly planned clinical neurovestibular study may identify the signs of a balance disorder of peripheral and central genesis.
AIM: To increase the effectiveness of the differential diagnosis of peripheral and central vertigo in patients with recurrent episodes of balance disorders using the protocol of neurovestibular examination ALGORITM.
MATERIAL AND METHODS: The study included 120 outpatients with preliminary diagnoses of cerebral ischemia and autonomic vascular dystonia.
RESULTS: Signs of lesion of peripheral and central regions of the vestibular system were found in 43.5 and 17.5% patients, respectively. Benign positional vertigo was the most frequent cause of vertigo while chronic cerebral ischemia was identified in 16.5% of the patients.
CONCLUSION: Neurovestibularexamnation using the protocol ALGORITM is important for assessment of the level of vestibular system lesion. Iitis necessary to use it in complex examination of patients with complaints of vertigo.

PMID: 27240041 [PubMed - as supplied by publisher]

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Right Ventricular Thrombus and Cerebral Artery Aneurysm in a Patient with Behçet's Disease.

Right Ventricular Thrombus and Cerebral Artery Aneurysm in a Patient with Behçet's Disease.

Sultan Qaboos Univ Med J. 2016 May;16(2):e250-3

Authors: Sabzi F, Mirzaei S, Faraji R

Abstract
We report a 35-year-old woman referred to the Imam Ali Hospital, Kermanshah, Iran, in July 2014 for evaluation of postoperative dyspnoea after neurosurgery performed seven days previously for a ruptured cerebral artery aneurysm. She was known to have Behçet's disease with a history of recurrent oral and genital aphthous ulcers and uveitis. At referral, her symptoms included vertigo, dysarthria, palpitations and chest pain. Transthoracic echocardiography (TTE) revealed a large thrombus in her right ventricle outflow tract and open-heart surgery was performed eight days after the previous surgery to remove the clot. The postoperative period was complicated by transient acute renal failure, which resolved spontaneously. The patient was discharged 13 days after the cardiac surgery on warfarin, prednisolone, azathioprine and cyclophosphamide. Cyclophosphamide and azathioprine were discontinued after three months as the symptoms had completely resolved; however, prednisolone was continued due to recurrent uveitis. A 10-month follow-up TTE scan revealed no thrombus recurrence and treatment with warfarin and prednisolone was continued.

PMID: 27226921 [PubMed]

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Meniere's disease.

Meniere's disease.

Nat Rev Dis Primers. 2016;2:16028

Authors: Nakashima T, Pyykkö I, Arroll MA, Casselbrant ML, Foster CA, Manzoor NF, Megerian CA, Naganawa S, Young YH

Abstract
Meniere's disease (MD) is a disorder of the inner ear that causes vertigo attacks, fluctuating hearing loss, tinnitus and aural fullness. The aetiology of MD is multifactorial. A characteristic sign of MD is endolymphatic hydrops (EH), a disorder in which excessive endolymph accumulates in the inner ear and causes damage to the ganglion cells. In most patients, the clinical symptoms of MD present after considerable accumulation of endolymph has occurred. However, some patients develop symptoms in the early stages of EH. The reason for the variability in the symptomatology is unknown and the relationship between EH and the clinical symptoms of MD requires further study. The diagnosis of MD is based on clinical symptoms but can be complemented with functional inner ear tests, including audiometry, vestibular-evoked myogenic potential testing, caloric testing, electrocochleography or head impulse tests. MRI has been optimized to directly visualize EH in the cochlea, vestibule and semicircular canals, and its use is shifting from the research setting to the clinic. The management of MD is mainly aimed at the relief of acute attacks of vertigo and the prevention of recurrent attacks. Therapeutic options are based on empirical evidence and include the management of risk factors and a conservative approach as the first line of treatment. When medical treatment is unable to suppress vertigo attacks, intratympanic gentamicin therapy or endolymphatic sac decompression surgery is usually considered. This Primer covers the pathophysiology, symptomatology, diagnosis, management, quality of life and prevention of MD.

PMID: 27170253 [PubMed - in process]

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The Neural Correlates of Chronic Symptoms of Vertigo Proneness in Humans.

The Neural Correlates of Chronic Symptoms of Vertigo Proneness in Humans.

PLoS One. 2016;11(4):e0152309

Authors: Alsalman O, Ost J, Vanspauwen R, Blaivie C, De Ridder D, Vanneste S

Abstract
Vestibular signals are of significant importance for variable functions including gaze stabilization, spatial perception, navigation, cognition, and bodily self-consciousness. The vestibular network governs functions that might be impaired in patients affected with vestibular dysfunction. It is currently unclear how different brain regions/networks process vestibular information and integrate the information into a unified spatial percept related to somatosensory awareness and whether people with recurrent balance complaints have a neural signature as a trait affecting their development of chronic symptoms of vertigo. Pivotal evidence points to a vestibular-related brain network in humans that is widely distributed in nature. By using resting state source localized electroencephalography in non-vertiginous state, electrophysiological changes in activity and functional connectivity of 23 patients with balance complaints where chronic symptoms of vertigo and dizziness are among the most common reported complaints are analyzed and compared to healthy subjects. The analyses showed increased alpha2 activity within the posterior cingulate cortex and the precuneues/cuneus and reduced beta3 and gamma activity within the pregenual and subgenual anterior cingulate cortex for the subjects with balance complaints. These electrophysiological variations were correlated with reported chronic symptoms of vertigo intensity. A region of interest analysis found reduced functional connectivity for gamma activity within the vestibular cortex, precuneus, frontal eye field, intra-parietal sulcus, orbitofrontal cortex, and the dorsal anterior cingulate cortex. In addition, there was a positive correlation between chronic symptoms of vertigo intensity and increased alpha-gamma nesting in the left frontal eye field. When compared to healthy subjects, there is evidence of electrophysiological changes in the brain of patients with balance complaints even outside chronic symptoms of vertigo episodes. This suggests that these patients have a neural signature or trait that makes them prone to developing chronic balance problems.

PMID: 27089185 [PubMed - in process]

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Vestibular paroxysmia: a treatable neurovascular cross-compression syndrome.

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Vestibular paroxysmia: a treatable neurovascular cross-compression syndrome.

J Neurol. 2016 Apr;263 Suppl 1:90-6

Authors: Brandt T, Strupp M, Dieterich M

Abstract
The leading symptoms of vestibular paroxysmia (VP) are recurrent, spontaneous, short attacks of spinning or non-spinning vertigo that generally last less than one minute and occur in a series of up to 30 or more per day. VP may manifest when arteries in the cerebellar pontine angle cause a segmental, pressure-induced dysfunction of the eighth nerve. The symptoms are usually triggered by direct pulsatile compression with ephaptic discharges, less often by conduction blocks. MR imaging reveals the neurovascular compression of the eighth nerve (3D constructive interference in steady state and 3D time-of-flight sequences) in more than 95 % of cases. A loop of the anterior inferior cerebellar artery seems to be most often involved, less so the posterior inferior cerebellar artery, the vertebral artery, or a vein. The frequent attacks of vertigo respond to carbamazepine or oxcarbazepine, even in low dosages (200-600 mg/d or 300-900 mg/d, respectively), which have been shown to also be effective in children. Alternative drugs to try are lamotrigine, phenytoin, gabapentin, topiramate or baclofen or other non-antiepileptic drugs used in trigeminal neuralgia. The results of ongoing randomized placebo-controlled treatment studies, however, are not yet available. Surgical microvascular decompression of the eighth nerve is the "ultima ratio" for medically intractable cases or in exceptional cases of non-vascular compression of the eighth nerve by a tumor or cyst. The International Barany Society for Neuro-Otology is currently working on a consensus document on the clinical criteria for establishing a diagnosis of VP as a clinical entity.

PMID: 27083889 [PubMed - in process]

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Next-generation sequencing identifies novel CACNA1A gene mutations in episodic ataxia type 2.

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Next-generation sequencing identifies novel CACNA1A gene mutations in episodic ataxia type 2.

Mol Genet Genomic Med. 2016 Mar;4(2):211-22

Authors: Maksemous N, Roy B, Smith RA, Griffiths LR

Abstract
Episodic Ataxia type 2 (EA2) is a rare autosomal dominantly inherited neurological disorder characterized by recurrent disabling imbalance, vertigo, and episodes of ataxia lasting minutes to hours. EA2 is caused most often by loss of function mutations of the calcium channel gene CACNA1A. In addition to EA2, mutations in CACNA1A are responsible for two other allelic disorders: familial hemiplegic migraine type 1 (FHM1) and spinocerebellar ataxia type 6 (SCA6). Herein, we have utilized next-generation sequencing (NGS) to screen the coding sequence, exon-intron boundaries, and Untranslated Regions (UTRs) of five genes where mutation is known to produce symptoms related to EA2, including CACNA1A. We performed this screening in a group of 31 unrelated patients with EA2 symptoms. Both novel and known mutations were detected through NGS technology, and confirmed through Sanger sequencing. Genetic testing showed in total 15 mutation bearing patients (48%), of which nine were novel mutations (6 missense and 3 small frameshift deletion mutations) and six known mutations (4 missense and 2 nonsense).These results demonstrate the efficiency of our NGS-panel for detecting known and novel mutations for EA2 in the CACNA1A gene, also identifying a novel missense mutation in ATP1A2 which is not a normal target for EA2 screening.

PMID: 27066515 [PubMed]

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A recurrent headache circumscribed in a coronal line-shaped area around the head: a coronal linear headache.

A recurrent headache circumscribed in a coronal line-shaped area around the head: a coronal linear headache.

Springerplus. 2016;5:315

Authors: Wang L, Pan JF, Lu YY, Hu LH, Lu YN, Pan QQ, Wang Y

Abstract
BACKGROUND: Linear headache (LH) has recently been described as a paroxysmal or continuous head pain restricted in a linear trajectory of 5-10 mm in width, linking one endpoint in occipital or occipitocervical region with another endpoint in ipsilateral nasion or forehead region. The sagittal line-shaped pain area of LH is close and parallel to a sagittal venous sinus, the superior sagittal sinus (SSS). For some patients, the LH had some features resembling the pattern of migraine without aura.
CASE DESCRIPTION: A 45 year-old woman complained with a distinct headache for more than half years. The pain trajectory of the headache is confined to a coronal line-shaped area of 5-10 mm in width linking the two points in the bilateral temporal regions with the occipital protuberance. This coronal line-shaped pain area is close and parallel to a coronal cambered venous sinus complex, the combination of the confluences of sinus and the bilateral cavernous sinus (CS), superior petrosal sinus (SPS) linking the CS with transverse sinus (TS) and TS into which the SPS feeds. The patient had a past history of migraine without aura for 10 years and her son had a benign paroxysmal vertigo (BPV) for 12 years. Both of her coronal line-shaped headache and her son's vertigo had well response to sodium valproate.
DISCUSSION AND EVALUATION: Its clinical characteristics were distinctly different from those of other two headache entities defined with topographical criteria, nummular headache and epicrania fugax, and different from other existing headache entities except for migraine without aura.
CONCLUSION: The distinct coronal line-shaped headache is suggestive of a variant of LH, a coronal LH, and probably belongs to a subtype of migraine without aura as proposed for LH. This coronal LH reinforces the proposal of LH as a new headache syndrome or a subtype of a previously known headache syndrome, probably of migraine.

PMID: 27066346 [PubMed]

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Dizziness and vestibular function before and after cochlear implantation.

Dizziness and vestibular function before and after cochlear implantation.

Eur Arch Otorhinolaryngol. 2016 Mar 21;

Authors: Rah YC, Park JH, Park JH, Choi BY, Koo JW

Abstract
Vestibular problems after cochlear implantation (CI) were explored by categorizing them according to clinical course and changes in objective vestibular function. The changes in vestibular function of 62 patients (66 ears) were analyzed and vestibular symptoms were divided into three categories by their time course and nature. Etiologies were determined by analyzing the symptoms in combination with changes in objective vestibular function, measured using the caloric and/or video head impulse test. Before surgery, vestibular function was normal in 31 cases (47.0 %), unilaterally hypofunctional in 14 (21.2 %), and bilaterally hypofunctional in 21 (31.8 %). Eight cases (12.1 %) reported dizziness before surgery. A total of 18 cases (27.3 %) experienced postoperative dizziness. Ten patients experienced immediate transient dizziness (including 2 cases of benign positional paroxysmal vertigo); four experienced immediate prolonged dizziness (including 3 cases of bilateral vestibular hypofunction); and four experienced recurrent episodic dizziness (including 3 cases of suspicious endolymphatic hydrops). The sums of the maximal slow-phase velocities (SPVs) of the implanted ears were changed from 22.70 ± 17.31 to 12.55 ± 12.02°/s after implantation (p = 0.004) with very little changes in the other side (32.65 ± 24.85-31.40 ± 29.10°/s). Careful review of vestibular status is an important step, especially when deciding implantation in the only vestibular functioning ear or bilateral implantation.

PMID: 27001256 [PubMed - as supplied by publisher]

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[Hydropic inner ear disease of the vestibular type].

[Hydropic inner ear disease of the vestibular type].

HNO. 2016 Mar 18;

Authors: Volgger V, Krause E, Ertl-Wagner B, Gürkov R

Abstract
We report the case of a patient with episodic rotational vertigo for years. Ear symptoms were negated. The clinical diagnosis was not clear - Menière's disease, vestibular migraine and recurrent vertigo after vestibular neuritis all qualified for differential diagnoses. A locally enhanced inner-ear MRI established clarity by showing an endolymphatic hydrops in the vestibulum. Besides the classical triad of Menière's disease there are other clinical appearances of endolymphatic hydrops, which can be visualized with inner-ear MRI.

PMID: 26992384 [PubMed - as supplied by publisher]

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Bilateral Vestibular Hypofunction: Insights in Etiologies, Clinical Subtypes, and Diagnostics.

Bilateral Vestibular Hypofunction: Insights in Etiologies, Clinical Subtypes, and Diagnostics.

Front Neurol. 2016;7:26

Authors: Lucieer F, Vonk P, Guinand N, Stokroos R, Kingma H, van de Berg R

Abstract
OBJECTIVE: To evaluate the different etiologies and clinical subtypes of bilateral vestibular hypofunction (BVH) and the value of diagnostic tools in the diagnostic process of BVH.
MATERIALS AND METHODS: A retrospective case review was performed on 154 patients diagnosed with BVH in a tertiary referral center, between 2013 and 2015. Inclusion criteria comprised (1) imbalance and/or oscillopsia during locomotion and (2) summated slow phase velocity of nystagmus of less than 20°/s during bithermal caloric tests.
RESULTS: The definite etiology of BVH was determined in 47% of the cases and the probable etiology in 22%. In 31%, the etiology of BVH remained idiopathic. BVH resulted from more than 20 different etiologies. In the idiopathic group, the percentage of migraine was significantly higher compared to the non-idiopathic group (50 versus 11%, p < 0.001). Among all patients, 23.4% were known with autoimmune disorders in their medical history. All four clinical subtypes (recurrent vertigo with BVH, rapidly progressive BVH, slowly progressive BVH, and slowly progressive BVH with ataxia) were found in this population. Slowly progressive BVH with ataxia comprised only 4.5% of the cases. The head impulse test was abnormal in 94% of the cases. The torsion swing test was abnormal in 66%. Bilateral normal hearing to moderate hearing loss was found in 49%. Blood tests did not often contribute to the determination of the etiology of the disease. Abnormal cerebral imaging was found in 21 patients.
CONCLUSION: BVH is a heterogeneous condition with various etiologies and clinical characteristics. Migraine seems to play a significant role in idiopathic BVH and autoimmunity could be a modulating factor in the development of BVH. The distribution of etiologies of BVH probably depends on the clinical setting. In the diagnostic process of BVH, the routine use of some blood tests can be reconsidered and a low-threshold use of audiometry and cerebral imaging is advised. The torsion swing test is not the "gold standard" for diagnosing BVH due to its lack of sensitivity. Future diagnostic criteria of BVH should consist of standardized vestibular tests combined with a history that is congruent with the vestibular findings.

PMID: 26973594 [PubMed]

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Comorbidities and recurrence of benign paroxysmal positional vertigo: personal experience.

Comorbidities and recurrence of benign paroxysmal positional vertigo: personal experience.

Int J Audiol. 2016 May;55(5):279-84

Authors: Picciotti PM, Lucidi D, De Corso E, Meucci D, Sergi B, Paludetti G

Abstract
OBJECTIVE: The aim of this study is to evaluate the correlation between clinical features of benign paroxysmal positional vertigo (BPPV) and age, sex, trauma, presence of one or more comorbidities such as cardiovascular, neurological, endocrinological, metabolic, psychiatric diseases.
DESIGN: Retrospective review of medical records (chart review).
STUDY SAMPLE: A total of 475 patients aged from 14 to 87 years, affected by BPPV.
RESULTS: Recurrence of BPPV occurred in 139/475 patients (29.2%). The recurrence rate was significantly higher in female and older patients. Comorbidities were present in 72.6% of subjects with recurrent BPPV vs. 48.9% of patients with no recurrence (p <0.01). Forty-two patients (8.8%) reported a cranial trauma as a triggering event. Post-traumatic patients showed a significantly higher persistence rate (45.2%) compared to patients affected by non-traumatic BPPV (20.5%). Recurrence rates are overlapping between the two groups.
CONCLUSION: Our results confirm the association between recurrence of BPPV and age, female sex, and presence of comorbidities. The correlation is stronger in patients affected by multiple associated diseases; the most frequently involved pathologies are psychiatric disorders, followed by neurological and vascular diseases. Collecting a complete medical history is important for prognostic stratification and detection of potential underlying pathological conditions.

PMID: 26963274 [PubMed - in process]

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Tilt-table testing of patients with pacemaker and recurrent syncope.

Tilt-table testing of patients with pacemaker and recurrent syncope.

Indian Pacing Electrophysiol J. 2015 Jul-Aug;15(4):193-8

Authors: Haarmark C, Kanters JK, Mehlsen J

Abstract
The diagnosis of recurrent syncope in patients with pacemakers (PM) is quite challenging and the etiology of syncope is often multifactorial. To portray the mechanism of syncope in PM patients, we report the results of head-up tilt table testing (HUT) in a series of patients with PM, originally implanted for reasons other than neurally mediated syncope, referred due to syncope or pre-syncope (aborted syncope, vertigo, suspected orthostatic hypotension). Forty-one patients with PM undergoing a HUT in our syncope unit between January 1st, 2007 and December 31st 2011 were included. A standard HUT protocol with nitroglycerine provocation was used and the test results were classified according to current guidelines. Baseline data were retrieved from the medical records. Overall, 54% of patients had a positive response to HUT. Vasodepressor or orthostatic hypotensive response were the most prevalent responses accounting for 72% of patients with a positive test. There were no differences between groups with positive or negative test result regarding age, gender, resting blood pressure and heart rate, daily fluid intake, pacing mode, pacing indication or pacing rhythm at rest. HUT in patients with pacemakers has a high diagnostic yield. Although, the majority of patients had a vasodepressor or orthostatic hypotensive response, cardioinhibitory response leading to syncope was also seen.

PMID: 26937118 [PubMed]

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Risk factors for falls in older adults in a South African Urban Community.

Risk factors for falls in older adults in a South African Urban Community.

BMC Geriatr. 2016;16(1):51

Authors: Kalula SZ, Ferreira M, Swingler GH, Badri M

Abstract
BACKGROUND: Studies on falls in older adults have mainly been conducted in high income countries. Scant, if any, information exists on risk factors for falls in the older population of sub-Saharan African countries.
METHODS: A cross-sectional survey and a 12-month follow-up study were conducted to determine risk factors for falls in a representative multi-ethnic sample of 837 randomly selected ambulant community-dwelling subjects aged ≥65 years in three suburbs of Cape Town, South Africa. Logistic regression models were fitted to determine the association between (1) falls and (2) recurrent falls occurring during follow-up and their potential socio-demographic, self-reported medical conditions and physical assessment predictors.
RESULTS: Prevalence rates of 26.4 % for falls and 11 % for recurrent falls at baseline and 21.9 % for falls and 6.3 % for recurrent falls during follow-up. In both prospective analyses of falls and recurrent falls, history of previous falls, dizziness/vertigo, ethnicity (white or mixed ancestry vs black African) were significant predictors. However, poor cognitive score was a significant predictor in the falls analysis, and marital status (unmarried vs married) and increased time to perform the timed Up and Go test in the recurrent fall analysis but not in both. Other than the timed Up and Go test in recurrent falls analysis, physical assessment test outcomes were not significant predictors of falls.
CONCLUSION: Our study provides simple criteria based on demographic characteristics, medical and physical assessments to identify older persons at increased risk of falls. History taking remains an important part of medical practice in the determination of a risk of falls in older patients. Physical assessment using tools validated in developed country populations may not produce results needed to predict a risk of falls in a different setting.

PMID: 26912129 [PubMed - in process]

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Falls and fear of falling in vertigo and balance disorders: A controlled cross-sectional study.

http:--ebooks.iospress.nl-content-images

Falls and fear of falling in vertigo and balance disorders: A controlled cross-sectional study.

J Vestib Res. 2016 Jan 28;25(5-6):241-51

Authors: Schlick C, Schniepp R, Loidl V, Wuehr M, Hesselbarth K, Jahn K

Abstract
BACKGROUND: Vertigo and dizziness are among the most prevalent symptoms in neurologic disorders. Although many of these patients suffer from postural instability and gait disturbances, there is only limited data on their risk of falling.
METHODS: We conducted a controlled cross-sectional study at the tertiary care outpatient clinic of the German Center for Vertigo and Balance Disorders using a self-administered questionnaire to assess falls, fall-related injuries, and fear of falling. The recruitment period was 6 months.
RESULTS: A total of 569 patients (mean age 59.6 ± 17.1 years, 55% females) and 100 healthy participants were included (response rate > 90%). Dizzy patients with central balance disorders (Parkinsonian, cerebellar, and brainstem oculomotor syndromes) had the highest fall rates (> 50% recurrent fallers, odds ratio > 10). The rate of recurrent fallers was 30% in bilateral vestibular failure and peripheral neuropathy (odds ratio > 5). Patients with functional dizziness (somatoform or phobic vertigo) were concerned about falling but did not fall more often than healthy controls (odds ratio 0.87).
CONCLUSION: Falls are common in patients presenting to a dizziness unit. Those with central syndromes are at risk of recurrent and injurious falling. Fall rates and fear of falling should be assessed in balance disorders and used to guide the regimen of rehabilitation therapy. The identification of risk factors would help provide protective measures to these groups of patients.

PMID: 26890425 [PubMed - in process]

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[Cinical and genetic characteristics of familial Meniere's disease: three families report].

[Cinical and genetic characteristics of familial Meniere's disease: three families report].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Nov;50(11):915-24

Authors: Gao Y, Wang D, Wang H, Guan J, Lan L, Wu Z, Xie L, Yu L, Zhang S, Shan X, Wang Q

Abstract
OBJECTIVE: To investigate the clinical and genetic characteristics of three Chinese Meniere's disease (MD) families and decipher the mechanism of MD further.
METHODS: Personal and family medical evidence of hearing loss, vestibular symptoms, and other clinical abnormalities of the participants were identified, clinical and genetic features were analyzed. Targeted 307 genes capture and high-throughput sequencing were performed on the two ascertained members of family 1007184.
RESULTS: Eight patients from these three families showed post-lingual sensorineural hearing loss, six women and two men were involved. Age of onset in these affected members concentrated in the middle age, with the average age of 39.3 years old. Among them, patients from 1407278 were accompanied by migraine. All of the three probands presented as recurrent vertigo firstly, and then fluctuated hearing loss showed up, accompanying by tinnitus and ear fullness feeling. The hearing loss manifested as late-onset, low frequency-involved pattern, with subsequent gradual progression from moderate to severe level. Some of the patients progressed to severe level involving all frequencies at higher ages. In addition, most of the cases showed revitalization. Four cases received vestibular function tests, three of which had varying dysfunction of vestibular function, while the other one had normal vestibular function. Patients who had abnormal vestibular function showed much more severe hearing impairment. The three-generation family 1007193 had an autosomal recessive genetic characteristics, family 1007184 showed autosomal dominant inheritance of characteristics, family 1407278 were either autosomal dominant or X-linked dominant pattern. Through target genes capture high-throughput sequencing technology, we identified two candidate variants in the two members of family 1007184, named c. 2057G>A in EGFLAM and c. 1961C>T in ITGA8.
CONCLUSION: Meniere's disease has some genetic and familial aggregation in Chinese population, but its complex genetic pathogenic mechanisms need further study.

PMID: 26887996 [PubMed - in process]

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Evaluation of the utricular and saccular function using oVEMPs and cVEMPs in BPPV patients.

Evaluation of the utricular and saccular function using oVEMPs and cVEMPs in BPPV patients.

J Otolaryngol Head Neck Surg. 2016;45:12

Authors: Xu H, Liang FY, Chen L, Song XC, Tong MC, Thong JF, Zhang QQ, Sun Y

Abstract
BACKGROUND: It is well-known that ocular vestibular evoked myogenic potentials (oVEMPs) predominantly reflect utricular function whilst cervical vestibular evoked myogenic potentials (cVEMPs) reflect saccular function. To date, there are no published reports on the systemic evaluation of utricular and saccular function in benign paroxysmal positional vertigo (BPPV), nor are there any reports on the differences in VEMPs between patients with recurrent and non-recurrent BPPV. The aim of this study was to evaluate the difference in cervical and ocular (c/o)VEMPs between patients with BPPV and normal controls, as well as between patients with recurrent and non-recurrent BPPV.
METHODS: Thirty patients with posterior canal BPPV and 30 healthy subjects (as normal controls) were prospectively enrolled. cVEMP and oVEMP testing using 500 Hz tone-burst stimuli were performed on all. VEMP tests were repeated 3 times on each subject to ensure reliability and reproducibility of responses. VEMPs were defined as present or absent. Abnormal VEMP was defined by lack of VEMP response.
RESULTS: In the control group, abnormal cVEMPs responses were detected in 6.67% and abnormal oVEMPs responses were detected in 3.34%. In BPPV patients (10 with recurrent BPPV, 20 with non-recurrent BPPV), abnormal cVEMPs responses were detected in 30% and abnormal oVEMPs responses were detected in 56.7%. More patients with BPPV showed abnormal responses in c/oVEMPs as compared to the control group (p < 0.05). oVEMPs was more often abnormal as compared to cVEMPs in BPPV patients (p < 0.05). There was no statistical difference between abnormal cVEMP responses in non-recurrent BPPV patients (25%) and recurrent BPPV patients (40%) (p > 0.05). Differences in abnormal oVEMP responses (non-recurrent BPPV, 40%; recurrent BPPV, 90%) were significant (p < 0.05).
CONCLUSION: An increased occurrence of abnormal c/oVEMP recordings appeared in BPPV patients, possibly as a result of degeneration of the otolith macula. oVEMPs were more often abnormal in BPPV patients as compared to cVEMPs, suggesting that utricular dysfunction may be more common than saccular dysfunction. Furthermore, oVEMP abnormalities in the recurrent BPPV group were significantly higher than those in the non-recurrent BPPV group. Assessment of c/oVEMPs in BPPV patients may therefore be of prognostic value in predicting likelihood of BPPV recurrence.

PMID: 26857819 [PubMed - in process]

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[The roles of otolith organs in the recurrence primary benign paroxysmal positional vertigo].

[The roles of otolith organs in the recurrence primary benign paroxysmal positional vertigo].

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Sep;29(18):1641-4

Authors: Zhou X, Yu Y, Wu Z, Liu X, Chen X

Abstract
OBJECTIVE: To explore the roles of otolith organs in the occurrence and recurrence of primary benign paroxysmal positional vertigo (BPPV) by vestibular evoked myogenic potential (VEMP) test.
METHOD: We enrolled 17 recurrent primary BPPV patients and 42 non-recurrent primary BPPV patients between September 2014 and November 2014. All patients underwent VEMP tests, including cervical vestibular evoked myogenic potential (cVEMP and ocular vestibular evoked myogenic potential (oVEMP) tests. The abnormal case was defined as non-elicitation or asymmetry rate between bilateral sides is larger than 29%.
RESULT: Significant difference was found in abnormal rate between cVEMP and oVEMP (P < 0.05 ) in BPPV patients. The abnormal rate of oVEMP was higher than that of cVEMP. Significant difference was found in abnormal rate in oVEMP test between recurrent and non-recurrent groups (P < 0.01) but not in cVEMP( P > 0.05). No significant difference was found in sex and age between recurrent and non-recurrent groups (P > 0.05).
CONCLUSION: The impairment of otolith organs, especially the utricle, is related to primary BPPV. Dysfunction of utricle may play a role in recurrence of BPPV. Recurrence of BPPV is not correlated with sex and age.

PMID: 26790267 [PubMed - in process]

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Adrenal adenocarcinoma with Kartagener's syndrome: A case report.

Adrenal adenocarcinoma with Kartagener's syndrome: A case report.

Oncol Lett. 2015 Dec;10(6):3635-3638

Authors: Hu W, Cheng L, Cheng B, Zhang P, Xiao HE, Wu W, Wang X

Abstract
The present study reports the case of a 44-year-old woman with an adrenal tumor, complicated by Kartagener's syndrome (KS). The patient was admitted to Zhongnan Hospital (Wuhan, China), and presented with an 8-week history of vertigo and extended history of a recurrent cough, accompanied by sputum and a congested nose. Computed tomography indicated a mass on the right adrenal gland and situs inversus. A right adrenal tumor combined with KS was diagnosed, and resection of the tumor was performed following relief of respiratory symptoms and control of blood pressure. During six months of follow up the patient recovered well from surgery and blood pressure remained stable. This case revealed that patients exhibiting KS may suffer from serious respiratory infections as a result of impaired defense mechanisms against microbes in the airway. Therefore, comprehensive management of infection, safe anesthesia and appropriate surgical procedures for the avoidance of inflammation and trauma are the most significant factors required for the success of the treatment.

PMID: 26788182 [PubMed - as supplied by publisher]

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Lifestyle Factors and Migraine in Childhood.

Lifestyle Factors and Migraine in Childhood.

Curr Pain Headache Rep. 2016 Feb;20(2):9

Authors: Russo A, Bruno A, Trojsi F, Tessitore A, Tedeschi G

Abstract
Migraine is one of the most common pain symptoms in children. Indeed, a high percentage of adult migraine patients report to have suffered from recurrent headache during the childhood. In particular, children could experience the so-called childhood periodic syndromes (such as cyclic vomiting, abdominal migraine, and benign paroxysmal vertigo) that have been usually considered precursors of migraine or they could develop overt migraine headaches. However, typical cohort of migraine symptoms could be absent and children could not achieve all clinical features necessary for a migraine attack diagnosis according to classification criteria. Nevertheless, migraine is characterized also in childhood by a significant negative impact on the quality of life and a high risk of developing chronic and persistent headache in adulthood. Several studies have emphasized the role of different risk factors for migraine in children. Among these, obesity and overweight, particular food or the regular consumption of alcohol or caffeine, dysfunctional family situation, low level of physical activity, physical or emotional abuse, bullying by peers, unfair treatment in school, and insufficient leisure time seem to be strictly related to migraine onset or progression. Consequently, both identification and avoidance of triggers seem to be mandatory in children with migraine and could represent an alternative approach to the treatment of migraine abstaining from pharmacologic therapies.

PMID: 26757711 [PubMed - in process]

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Puerperal Extracranial Vertebral Artery Dissection and Nonaneurysmal Subarachnoid Hemorrhage.

Puerperal Extracranial Vertebral Artery Dissection and Nonaneurysmal Subarachnoid Hemorrhage.

J Stroke Cerebrovasc Dis. 2016 Feb;25(2):e12-4

Authors: Garrard JW, Simm RF, Bor-Seng-Shu E, Nogueira RC

Abstract
Previously reported only a few times before, we present a case of extracranial vertebral dissection and spontaneous frontoparietal subarachnoid hemorrhage (SAH) in the puerperium, discussing possible mechanisms and difficulties in management. A 35-year-old woman presented 10 days postcaesarean section with neck pain and vertigo with normal initial investigations. Following recurrent vertigo, headache, and ataxia, imaging revealed a frontoparietal SAH and vertebral artery dissection. The patient was consequently treated with aspirin, and then following a return of symptoms 3 weeks later, warfarin therapy was continued for 6 months. The possible underlying mechanisms for this case are discussed, including reversible cervical vasoconstriction syndrome and posterior reversible encephalopathy syndrome, although neither was identified. The small SAH alongside recurrent posterior circulation symptoms resulted in the initiation of antithrombotic therapy. This report supports studies demonstrating higher incidence of cervicocephalic arterial dissection in the puerperium. Moreover, the heterogeneous presentation and manifestations of such cases require individualized treatment, and warrant studies into underlying mechanisms behind extracranial dissection and nonaneurysmal SAH.

PMID: 26696611 [PubMed - in process]

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Postnatal maturation of auditory-nerve response heterogeneity as seen in spatial gradients of synapse morphology in the inner hair cell area

Publication date: Available online 8 June 2016
Source:Hearing Research
Author(s): Leslie D. Liberman, M. Charles Liberman
Auditory nerve fibers in the adult ear are divided into functional subgroups according to spontaneous rate (SR) and threshold sensitivity. The high-threshold, low-SR fibers are morphologically and spatially distinct from the low-threshold high-SR fibers at their synaptic contacts with inner hair cells. This distinction between SR groups in the adult ear is visible in confocal microscopy as complementary size gradients of presynaptic ribbons and post-synaptic glutamate receptor patches across the modiolar-pillar and habenular-cuticular axes in the inner hair cell area. The aim of the present study was to track the post-natal development of this morphological gradient, in mouse, to determine the earliest age at which this important aspect of cochlear organization is fully mature. Here we show, using morphometric analysis of the organ of Corti immunostained for pre- and post-synaptic markers of efferent and afferent innervation, that this SR-based morphological gradient is not fully established until postnatal day 28, well after other features, such as synaptic counts and efferent innervation density in both the inner and outer hair cell areas, appear fully mature.

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Postnatal maturation of auditory-nerve response heterogeneity as seen in spatial gradients of synapse morphology in the inner hair cell area

Publication date: Available online 8 June 2016
Source:Hearing Research
Author(s): Leslie D. Liberman, M. Charles Liberman
Auditory nerve fibers in the adult ear are divided into functional subgroups according to spontaneous rate (SR) and threshold sensitivity. The high-threshold, low-SR fibers are morphologically and spatially distinct from the low-threshold high-SR fibers at their synaptic contacts with inner hair cells. This distinction between SR groups in the adult ear is visible in confocal microscopy as complementary size gradients of presynaptic ribbons and post-synaptic glutamate receptor patches across the modiolar-pillar and habenular-cuticular axes in the inner hair cell area. The aim of the present study was to track the post-natal development of this morphological gradient, in mouse, to determine the earliest age at which this important aspect of cochlear organization is fully mature. Here we show, using morphometric analysis of the organ of Corti immunostained for pre- and post-synaptic markers of efferent and afferent innervation, that this SR-based morphological gradient is not fully established until postnatal day 28, well after other features, such as synaptic counts and efferent innervation density in both the inner and outer hair cell areas, appear fully mature.

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Πληροφορίες

Πέμπτη 9 Ιουνίου 2016