Cure Tinnitus Permanently & Naturally

Can You Really Cure Tinnitus Permanently & Naturally?

Many people are desperately trying to find ways to cure tinnitus permanently & naturally. However, there is no way to naturally and permanently cure tinnitus. Tinnitus is a complex medical problem, and it is not always possible to find the causes of it. That is why there is no way to permanently cure it.

Gingko is often recommended as a natural treatment for tinnitus. However, studies have shown that Gingko does not work. Other alternative treatments, such as homeopathy, zinc supplements and B vitamins, have also been shown to be ineffective.

There is no need to waste time or money using natural treatments that do not work. If you are suffering from tinnitus, then it is best for you to get a treatment recommendation from your doctor.

How To Manage Tinnitus

Despite the fact that there is no way to cure tinnitus permanently & naturally, you can manage it. Tinnitus is often caused by an underlying condition. Most people are able to get relief by treating the medical condition. For example, impacted earwax can cause tinnitus. Removing the impacted ear wax not only improves tinnitus symptoms, but it can also improve hearing.

Tinnitus can also be triggered or worsened by high blood pressure or atherosclerosis. Those conditions are not only linked to tinnitus, but they can also increase the risk of heart disease. That is why it is important to get to those conditions treated as soon as possible.

Certain medications can worsen or trigger tinnitus. Some of those medications include water pills, antibiotics, antidepressants and Aspirin. If you think that your medication is causing tinnitus, then you will need to consult with your doctor. Your physician may adjust your dosage or switch you to an alternative medication.

You may want to consider using a white noise machine. These devices produce environmental sounds, such as ocean waves and falling rain. Researchers believe that white noise helps make the auditory system less sensitive to sound.

There are also medications that can reduce the symptoms of tinnitus. Anti-anxiety medications, such as Xanax, can reduce tinnitus symptoms. However, these medications can be habit-forming. That is why they are usually recommended for short-term use.

Transcranial magnetic stimulation, or TMS therapy, may also be effective for treating tinnitus. It works by using small electric currents to stimulate the brain. This treatment is safe and well-tolerated by most people. However, more studies need to be done in order to see exactly how TMS therapy treats tinnitus.

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Adaptive whitening of ambient ocean noise with narrowband signal preservation

Passive underwater listening devices are often deployed to listen for narrowband signals of interest in time-varying background ocean noise. Such tonals are generated mechanically by ships, submarines, and machines, or acoustically by aquatic wildlife. Quantization of the sensor data for storage or low bit-rate transmission adds white noise which can overwhelm weak narrowband signals if the background noise is sufficiently colored. Whitening the background noise prior to quantization can reduce the detrimental effects, but the whitening process must preserve any tonals in the signal for maximum effectiveness. Existing adaptive whitening techniques make no effort to avoid suppressing tonals in the whitening process, while existing spectral separation methods fail to whiten background noise. The proposed methods perform adaptive whitening of background ambient noise while preserving narrowband tones at their original signal-to-noise ratios. The proposed methods are shown to outperform combinations of existing partial solutions both subjectively and by evaluating the objective criteria introduced. The stability and convergence properties of the proposed algorithms match or surpass those of existing well-known adaptive algorithms.

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Differences in intermittent postural control between normal-weight and obese children

Publication date: Available online 15 June 2016
Source:Gait & Posture
Author(s): Israel Villarrasa-Sapiña, Xavier García-Massó, Pilar Serra-Añó, Consolación Garcia-Lucerga, Luis-Millán Gonzalez, Empar Lurbe
AimThe main objective of this study was to determine differences in postural control between obese and non-obese children.MethodsThe study design was cross-sectional, prospective, between-subjects. Postural control variables were obtained from a group of obese children and a normal-weight control group under two different postural conditions: bipedal standing position with eyes open and bipedal standing with eyes closed. Variables were obtained for each balance condition using time domain and sway-density plot analysis of the center of pressure signals acquired by means of a force plate.ResultsPairwise comparisons revealed significant differences between obese and normal-weight children in mean velocity in antero-posterior and medio-lateral directions, ellipse area and mean distance with both eyes open and eyes closed. Normal-weight subjects obtained lower values in all these variables than obese subjects. Furthermore, there were differences between both groups in mean peaks with eyes open and in mean time with eyes closed.ConclusionAlterations were detected in the intermittent postural control in obese children. According to the results obtained, active anticipatory control produces higher center of pressure displacement responses in obese children and the periods during which balance is maintained by passive control and reflex mechanisms are of shorter duration.



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Lower leg compensatory strategies during performance of a step up and over task in patient six-months after total knee arthroplasty

Publication date: Available online 15 June 2016
Source:Gait & Posture
Author(s): Federico Pozzi, Adam Marmon, Lynn Snyder-Mackler, Joseph Zeni
The purpose of this study was to assess the ankle, knee, and hip joint contributions to the total support moment (TSM) and the activation patterns of muscles in the lower leg in patients after total knee arthroplasty (TKA) and healthy older adults during the step up and over task. Moreover, the relationship between quadriceps strength and knee contribution to TSM was measured. Twenty patients six-months after TKA and twenty healthy controls were recruited for this study. Motion and surface electromyographic (EMG) analyses were performed during a step up and over task. Biomechanics and EMG variables were compared between groups using ANCOVA models with movement speed as covariate. Patients after TKA had reduced contribution to the TSM from the knee joint, and greater contribution from the hip and ankle joints, possibly to compensate for the reduced contribution at the knee. No consistent differences of EMG activation or co-contraction were found between groups. Patients with stronger quadriceps had significantly higher knee contribution to TSM during the lowering phase of the task. The results of this study suggest that patients after TKA may use compensatory strategies at the hip and ankle joints to safely perform the step up and over task. Patients may rely on the force generating ability of the quadriceps during the lowering phase as they are not able to compensate with other joint of the lower extremity during this phase of the task.



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Reliability and Validity of Edinburgh Visual Gait Score as an Evaluation Tool for Children with Cerebral Palsy

Publication date: Available online 15 June 2016
Source:Gait & Posture
Author(s): Maria del Pilar Duque Orozco, Oussama Abousamra, Church Chris, Lennon Nancy, John Henley, Kenneth J. Rogers, Julieanne P. Sees, Justin Connor, Freeman Miller
Assessment of gait abnormalities in cerebral palsy (CP) is challenging, and access to instrumented gait analysis is not always feasible. Therefore, many observational gait analysis scales have been devised. This study aimed to evaluate the interobserver reliability, intraobserver reliability, and validity of Edinburgh Visual Gait Score (EVGS). Video of 30 children with spastic CP were reviewed by 7 raters (10 children each in GMFCS levels I, II, and III, age 6-12 years). Three observers had high level of experience in gait analysis (10+ years), two had medium level (2-5 years) and two had no previous experience (orthopedic fellows). Interobserver reliability was evaluated using percentage of complete agreement and kappa values. Criterion validity was evaluated by comparing EVGS scores with 3DGA data taken from the same video visit. Interobserver agreement was 60%-90% and Kappa values were 0.18-0.85 for the 17 items in EVGS. Reliability was higher for distal segments (foot/ankle/knee 63-90%; trunk/pelvis/hip 60-76%), with greater experience (high 66-91%, medium 62-90%, no-experience 41-87%), with more EVGS practice (1st 10 videos 52-88%, last 10 videos 64-97%) and when used with higher functioning children (GMFCS I 65-96%, II 58-90%, III 35-65%). Intraobserver agreement was 64%-92%. Agreement between EVGS and 3DGA was 52%-73%. We believe that having EVGS as part of the standardized gait evaluation is helpful in optimizing the visual scoring. EVGS can be a supportive tool that adds quantitative data instead of only qualitative assessment to a video only gait evaluation.



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EFFECT OF DUAL-TASK-INDUCED UNCERTAINTY ON GAIT BIOMECHANICS IN PATIENTS WITH MULTIPLE SCLEROSIS WITH 2 TO 6.5 EDSS GRADE

Publication date: Available online 15 June 2016
Source:Gait & Posture
Author(s): Carmen Gutiérrez Cruz, Juan Carlos Miangolarra, F. Javier Rojas
The goal of this study was to assess the effect that uncertainty induced by dual task conditions has on reaction-response time parameters and gait patterns of patients with multiple sclerosis (MS) with a 2 to 6.5 EDSS grade. The study involved eleven patients −nine women and two men– diagnosed with multiple sclerosis (age, 48±10years; height, 1.65±0.1m; weight, 72±22 Kg) with capacity to walk five meters without any aid or assistance. We employed an intra-group repeated measures design. Each participant was asked to walk with and without task-related uncertainty. Reaction-response and gait cycle times, as well as center of mass (CM) dynamics were measured using three force plates synchronized with a video camera through an electronic device that also controlled the system of uncertainty. The results obtained reveal that uncertainty induced by dual tasking is related to a reduction in the mean stride length and mean displacement and horizontal velocity of the CM in patients with MS. The values obtained for CM parameters indicate that uncertainty affects balance, as compared to no-uncertainty situations. These results confirm the necessity of including controlled dual-task-induced uncertainty in physical training programs for MS patients.



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Differences in intermittent postural control between normal-weight and obese children

Publication date: Available online 15 June 2016
Source:Gait & Posture
Author(s): Israel Villarrasa-Sapiña, Xavier García-Massó, Pilar Serra-Añó, Consolación Garcia-Lucerga, Luis-Millán Gonzalez, Empar Lurbe
AimThe main objective of this study was to determine differences in postural control between obese and non-obese children.MethodsThe study design was cross-sectional, prospective, between-subjects. Postural control variables were obtained from a group of obese children and a normal-weight control group under two different postural conditions: bipedal standing position with eyes open and bipedal standing with eyes closed. Variables were obtained for each balance condition using time domain and sway-density plot analysis of the center of pressure signals acquired by means of a force plate.ResultsPairwise comparisons revealed significant differences between obese and normal-weight children in mean velocity in antero-posterior and medio-lateral directions, ellipse area and mean distance with both eyes open and eyes closed. Normal-weight subjects obtained lower values in all these variables than obese subjects. Furthermore, there were differences between both groups in mean peaks with eyes open and in mean time with eyes closed.ConclusionAlterations were detected in the intermittent postural control in obese children. According to the results obtained, active anticipatory control produces higher center of pressure displacement responses in obese children and the periods during which balance is maintained by passive control and reflex mechanisms are of shorter duration.



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Lower leg compensatory strategies during performance of a step up and over task in patient six-months after total knee arthroplasty

Publication date: Available online 15 June 2016
Source:Gait & Posture
Author(s): Federico Pozzi, Adam Marmon, Lynn Snyder-Mackler, Joseph Zeni
The purpose of this study was to assess the ankle, knee, and hip joint contributions to the total support moment (TSM) and the activation patterns of muscles in the lower leg in patients after total knee arthroplasty (TKA) and healthy older adults during the step up and over task. Moreover, the relationship between quadriceps strength and knee contribution to TSM was measured. Twenty patients six-months after TKA and twenty healthy controls were recruited for this study. Motion and surface electromyographic (EMG) analyses were performed during a step up and over task. Biomechanics and EMG variables were compared between groups using ANCOVA models with movement speed as covariate. Patients after TKA had reduced contribution to the TSM from the knee joint, and greater contribution from the hip and ankle joints, possibly to compensate for the reduced contribution at the knee. No consistent differences of EMG activation or co-contraction were found between groups. Patients with stronger quadriceps had significantly higher knee contribution to TSM during the lowering phase of the task. The results of this study suggest that patients after TKA may use compensatory strategies at the hip and ankle joints to safely perform the step up and over task. Patients may rely on the force generating ability of the quadriceps during the lowering phase as they are not able to compensate with other joint of the lower extremity during this phase of the task.



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Reliability and Validity of Edinburgh Visual Gait Score as an Evaluation Tool for Children with Cerebral Palsy

Publication date: Available online 15 June 2016
Source:Gait & Posture
Author(s): Maria del Pilar Duque Orozco, Oussama Abousamra, Church Chris, Lennon Nancy, John Henley, Kenneth J. Rogers, Julieanne P. Sees, Justin Connor, Freeman Miller
Assessment of gait abnormalities in cerebral palsy (CP) is challenging, and access to instrumented gait analysis is not always feasible. Therefore, many observational gait analysis scales have been devised. This study aimed to evaluate the interobserver reliability, intraobserver reliability, and validity of Edinburgh Visual Gait Score (EVGS). Video of 30 children with spastic CP were reviewed by 7 raters (10 children each in GMFCS levels I, II, and III, age 6-12 years). Three observers had high level of experience in gait analysis (10+ years), two had medium level (2-5 years) and two had no previous experience (orthopedic fellows). Interobserver reliability was evaluated using percentage of complete agreement and kappa values. Criterion validity was evaluated by comparing EVGS scores with 3DGA data taken from the same video visit. Interobserver agreement was 60%-90% and Kappa values were 0.18-0.85 for the 17 items in EVGS. Reliability was higher for distal segments (foot/ankle/knee 63-90%; trunk/pelvis/hip 60-76%), with greater experience (high 66-91%, medium 62-90%, no-experience 41-87%), with more EVGS practice (1st 10 videos 52-88%, last 10 videos 64-97%) and when used with higher functioning children (GMFCS I 65-96%, II 58-90%, III 35-65%). Intraobserver agreement was 64%-92%. Agreement between EVGS and 3DGA was 52%-73%. We believe that having EVGS as part of the standardized gait evaluation is helpful in optimizing the visual scoring. EVGS can be a supportive tool that adds quantitative data instead of only qualitative assessment to a video only gait evaluation.



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EFFECT OF DUAL-TASK-INDUCED UNCERTAINTY ON GAIT BIOMECHANICS IN PATIENTS WITH MULTIPLE SCLEROSIS WITH 2 TO 6.5 EDSS GRADE

Publication date: Available online 15 June 2016
Source:Gait & Posture
Author(s): Carmen Gutiérrez Cruz, Juan Carlos Miangolarra, F. Javier Rojas
The goal of this study was to assess the effect that uncertainty induced by dual task conditions has on reaction-response time parameters and gait patterns of patients with multiple sclerosis (MS) with a 2 to 6.5 EDSS grade. The study involved eleven patients −nine women and two men– diagnosed with multiple sclerosis (age, 48±10years; height, 1.65±0.1m; weight, 72±22 Kg) with capacity to walk five meters without any aid or assistance. We employed an intra-group repeated measures design. Each participant was asked to walk with and without task-related uncertainty. Reaction-response and gait cycle times, as well as center of mass (CM) dynamics were measured using three force plates synchronized with a video camera through an electronic device that also controlled the system of uncertainty. The results obtained reveal that uncertainty induced by dual tasking is related to a reduction in the mean stride length and mean displacement and horizontal velocity of the CM in patients with MS. The values obtained for CM parameters indicate that uncertainty affects balance, as compared to no-uncertainty situations. These results confirm the necessity of including controlled dual-task-induced uncertainty in physical training programs for MS patients.



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Differences in intermittent postural control between normal-weight and obese children

Publication date: Available online 15 June 2016
Source:Gait & Posture
Author(s): Israel Villarrasa-Sapiña, Xavier García-Massó, Pilar Serra-Añó, Consolación Garcia-Lucerga, Luis-Millán Gonzalez, Empar Lurbe
AimThe main objective of this study was to determine differences in postural control between obese and non-obese children.MethodsThe study design was cross-sectional, prospective, between-subjects. Postural control variables were obtained from a group of obese children and a normal-weight control group under two different postural conditions: bipedal standing position with eyes open and bipedal standing with eyes closed. Variables were obtained for each balance condition using time domain and sway-density plot analysis of the center of pressure signals acquired by means of a force plate.ResultsPairwise comparisons revealed significant differences between obese and normal-weight children in mean velocity in antero-posterior and medio-lateral directions, ellipse area and mean distance with both eyes open and eyes closed. Normal-weight subjects obtained lower values in all these variables than obese subjects. Furthermore, there were differences between both groups in mean peaks with eyes open and in mean time with eyes closed.ConclusionAlterations were detected in the intermittent postural control in obese children. According to the results obtained, active anticipatory control produces higher center of pressure displacement responses in obese children and the periods during which balance is maintained by passive control and reflex mechanisms are of shorter duration.



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Lower leg compensatory strategies during performance of a step up and over task in patient six-months after total knee arthroplasty

Publication date: Available online 15 June 2016
Source:Gait & Posture
Author(s): Federico Pozzi, Adam Marmon, Lynn Snyder-Mackler, Joseph Zeni
The purpose of this study was to assess the ankle, knee, and hip joint contributions to the total support moment (TSM) and the activation patterns of muscles in the lower leg in patients after total knee arthroplasty (TKA) and healthy older adults during the step up and over task. Moreover, the relationship between quadriceps strength and knee contribution to TSM was measured. Twenty patients six-months after TKA and twenty healthy controls were recruited for this study. Motion and surface electromyographic (EMG) analyses were performed during a step up and over task. Biomechanics and EMG variables were compared between groups using ANCOVA models with movement speed as covariate. Patients after TKA had reduced contribution to the TSM from the knee joint, and greater contribution from the hip and ankle joints, possibly to compensate for the reduced contribution at the knee. No consistent differences of EMG activation or co-contraction were found between groups. Patients with stronger quadriceps had significantly higher knee contribution to TSM during the lowering phase of the task. The results of this study suggest that patients after TKA may use compensatory strategies at the hip and ankle joints to safely perform the step up and over task. Patients may rely on the force generating ability of the quadriceps during the lowering phase as they are not able to compensate with other joint of the lower extremity during this phase of the task.



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Reliability and Validity of Edinburgh Visual Gait Score as an Evaluation Tool for Children with Cerebral Palsy

Publication date: Available online 15 June 2016
Source:Gait & Posture
Author(s): Maria del Pilar Duque Orozco, Oussama Abousamra, Church Chris, Lennon Nancy, John Henley, Kenneth J. Rogers, Julieanne P. Sees, Justin Connor, Freeman Miller
Assessment of gait abnormalities in cerebral palsy (CP) is challenging, and access to instrumented gait analysis is not always feasible. Therefore, many observational gait analysis scales have been devised. This study aimed to evaluate the interobserver reliability, intraobserver reliability, and validity of Edinburgh Visual Gait Score (EVGS). Video of 30 children with spastic CP were reviewed by 7 raters (10 children each in GMFCS levels I, II, and III, age 6-12 years). Three observers had high level of experience in gait analysis (10+ years), two had medium level (2-5 years) and two had no previous experience (orthopedic fellows). Interobserver reliability was evaluated using percentage of complete agreement and kappa values. Criterion validity was evaluated by comparing EVGS scores with 3DGA data taken from the same video visit. Interobserver agreement was 60%-90% and Kappa values were 0.18-0.85 for the 17 items in EVGS. Reliability was higher for distal segments (foot/ankle/knee 63-90%; trunk/pelvis/hip 60-76%), with greater experience (high 66-91%, medium 62-90%, no-experience 41-87%), with more EVGS practice (1st 10 videos 52-88%, last 10 videos 64-97%) and when used with higher functioning children (GMFCS I 65-96%, II 58-90%, III 35-65%). Intraobserver agreement was 64%-92%. Agreement between EVGS and 3DGA was 52%-73%. We believe that having EVGS as part of the standardized gait evaluation is helpful in optimizing the visual scoring. EVGS can be a supportive tool that adds quantitative data instead of only qualitative assessment to a video only gait evaluation.



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EFFECT OF DUAL-TASK-INDUCED UNCERTAINTY ON GAIT BIOMECHANICS IN PATIENTS WITH MULTIPLE SCLEROSIS WITH 2 TO 6.5 EDSS GRADE

Publication date: Available online 15 June 2016
Source:Gait & Posture
Author(s): Carmen Gutiérrez Cruz, Juan Carlos Miangolarra, F. Javier Rojas
The goal of this study was to assess the effect that uncertainty induced by dual task conditions has on reaction-response time parameters and gait patterns of patients with multiple sclerosis (MS) with a 2 to 6.5 EDSS grade. The study involved eleven patients −nine women and two men– diagnosed with multiple sclerosis (age, 48±10years; height, 1.65±0.1m; weight, 72±22 Kg) with capacity to walk five meters without any aid or assistance. We employed an intra-group repeated measures design. Each participant was asked to walk with and without task-related uncertainty. Reaction-response and gait cycle times, as well as center of mass (CM) dynamics were measured using three force plates synchronized with a video camera through an electronic device that also controlled the system of uncertainty. The results obtained reveal that uncertainty induced by dual tasking is related to a reduction in the mean stride length and mean displacement and horizontal velocity of the CM in patients with MS. The values obtained for CM parameters indicate that uncertainty affects balance, as compared to no-uncertainty situations. These results confirm the necessity of including controlled dual-task-induced uncertainty in physical training programs for MS patients.



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Cytomegalovirus: the stealth virus.

Cytomegalovirus: the stealth virus.

Pract Midwife. 2016 May;19(5):28-9

Authors: Robinson S

Abstract
Cytomegalovirus (CMV) is an infection, part of the herpes family of viruses which, if contracted during pregnancy, cancause devastating effects on the newborn baby. This article is written by the trustee of a volunteer-based charity, mostly run by mothers of CMV children, who are striving to raise awareness of this infection, which is more common than Down's syndrome, listeria and toxoplasmosis, and is theprimary preventable cause of childhood hearing loss.

PMID: 27295757 [PubMed - in process]

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[Phonemic balance of the Freiburg monosyllabic speech test].

[Phonemic balance of the Freiburg monosyllabic speech test].

HNO. 2016 Jun 14;

Authors: Exter M, Winkler A, Holube I

Abstract
BACKGROUND: ISO 8253-3 [4] describes the requirements for speech tests with respect to their phonemic balance. The fulfillment of these requirements by the Freiburg monosyllabic speech test were examined.
METHODS: The Freiburg monosyllables were phonologically transcribed and analyzed with respect to their structural types, vowels and consonants, as well as phonological classes, and compared to reference values.
RESULTS: The phonemic distribution of the Freiburg monosyllables differs slightly from the reference values for the German language. The differences are presumably related to the restriction to monosyllabic substantives. Most test lists (except for 12) contain similar proportions of different phonem classes for vowel and consonants according to Hahlbrock and ISO 8253-3 [4].
CONCLUSION: The deviations of test lists 5, 11, and 15 in a study for perceptual equivalence cannot be explained by phonemic imbalance in comparison to other test lists. Only the lower recognition rates for test list 12 might be explained by its deviant phonemic distribution.

PMID: 27299891 [PubMed - as supplied by publisher]

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Inner ear disorders in 68 pregnant women-A 20-year experience.

Inner ear disorders in 68 pregnant women-A 20-year experience.

Clin Otolaryngol. 2016 Jun 14;

Authors: Wu PH, Cheng PW, Young YH

Abstract
Pregnancy itself causes the mothers not only physiological changes in metabolism, hormone status, and autonomic nervous system, but also psychological impacts from emotional stress. These changes may affect the hearing and balance system in pregnant women resulting in a variety of inner ear symptoms i.e. hearing loss, tinnitus, vertigo, etc.(1) However, the clinicians were not so familiar with the management of inner ear disorders in pregnant women. This article is protected by copyright. All rights reserved.

PMID: 27299361 [PubMed - as supplied by publisher]

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Next generation shape memory prosthesis (NiTiBOND) for stapedotomy: Short-term results.

Next generation shape memory prosthesis (NiTiBOND) for stapedotomy: Short-term results.

Laryngoscope. 2016 Jun 14;

Authors: Green JD, McElveen JT

Abstract
OBJECTIVES/HYPOTHESIS: To review hearing results and complications for the NiTiBOND next generation shape memory prosthesis and compare them with results for the current shape memory prosthesis (SMart).
STUDY DESIGN: Retrospective, multicenter chart review.
METHODS: Primary laser stapedotomy was performed using either a NiTiBOND or a SMart prosthesis. Ninety-two ears in 79 patients were included in the study (67.4% female), 52 with the NiTiBOND prosthesis and 40 with the SMart prosthesis. Data collected included demographic variables, pre- and postoperative pure-tone air and bone conduction thresholds, speech discrimination scores, complications, and the need for revision surgery. Pure-tone average (PTA) and PTA air-bone gap (ABG) pre- and postoperative were computed. Success was defined as a postoperative ABG of ≤10 dB.
RESULTS: There were no significant differences between groups in hearing results, including improvement in ABG, change in speech discrimination, change in air or bone PTA, or change in high-frequency bone PTA. Short-term (mean = 4.4 and 4.9 weeks, respectively) success rates for the NiTiBOND and SMart prostheses were 84.6% and 70.0%, respectively, with this difference closing at the most recent test (83.7% and 80.0%, respectively). No revision surgery took place in either group, and there were no differences in complications such as dizziness, tinnitus, or taste disturbance, though the NiTiBOND group tended to have a lower rate of transient or permanent vertigo.
CONCLUSIONS: Compared with the SMart prosthesis, the NiTiBOND prosthesis is a safe prosthesis that achieves at least comparable hearing results and may offer some surgical advantages.
LEVEL OF EVIDENCE: 4 Laryngoscope, 2016.

PMID: 27296859 [PubMed - as supplied by publisher]

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[Phonemic balance of the Freiburg monosyllabic speech test].

[Phonemic balance of the Freiburg monosyllabic speech test].

HNO. 2016 Jun 14;

Authors: Exter M, Winkler A, Holube I

Abstract
BACKGROUND: ISO 8253-3 [4] describes the requirements for speech tests with respect to their phonemic balance. The fulfillment of these requirements by the Freiburg monosyllabic speech test were examined.
METHODS: The Freiburg monosyllables were phonologically transcribed and analyzed with respect to their structural types, vowels and consonants, as well as phonological classes, and compared to reference values.
RESULTS: The phonemic distribution of the Freiburg monosyllables differs slightly from the reference values for the German language. The differences are presumably related to the restriction to monosyllabic substantives. Most test lists (except for 12) contain similar proportions of different phonem classes for vowel and consonants according to Hahlbrock and ISO 8253-3 [4].
CONCLUSION: The deviations of test lists 5, 11, and 15 in a study for perceptual equivalence cannot be explained by phonemic imbalance in comparison to other test lists. Only the lower recognition rates for test list 12 might be explained by its deviant phonemic distribution.

PMID: 27299891 [PubMed - as supplied by publisher]

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Inner ear disorders in 68 pregnant women-A 20-year experience.

Inner ear disorders in 68 pregnant women-A 20-year experience.

Clin Otolaryngol. 2016 Jun 14;

Authors: Wu PH, Cheng PW, Young YH

Abstract
Pregnancy itself causes the mothers not only physiological changes in metabolism, hormone status, and autonomic nervous system, but also psychological impacts from emotional stress. These changes may affect the hearing and balance system in pregnant women resulting in a variety of inner ear symptoms i.e. hearing loss, tinnitus, vertigo, etc.(1) However, the clinicians were not so familiar with the management of inner ear disorders in pregnant women. This article is protected by copyright. All rights reserved.

PMID: 27299361 [PubMed - as supplied by publisher]

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Next generation shape memory prosthesis (NiTiBOND) for stapedotomy: Short-term results.

Next generation shape memory prosthesis (NiTiBOND) for stapedotomy: Short-term results.

Laryngoscope. 2016 Jun 14;

Authors: Green JD, McElveen JT

Abstract
OBJECTIVES/HYPOTHESIS: To review hearing results and complications for the NiTiBOND next generation shape memory prosthesis and compare them with results for the current shape memory prosthesis (SMart).
STUDY DESIGN: Retrospective, multicenter chart review.
METHODS: Primary laser stapedotomy was performed using either a NiTiBOND or a SMart prosthesis. Ninety-two ears in 79 patients were included in the study (67.4% female), 52 with the NiTiBOND prosthesis and 40 with the SMart prosthesis. Data collected included demographic variables, pre- and postoperative pure-tone air and bone conduction thresholds, speech discrimination scores, complications, and the need for revision surgery. Pure-tone average (PTA) and PTA air-bone gap (ABG) pre- and postoperative were computed. Success was defined as a postoperative ABG of ≤10 dB.
RESULTS: There were no significant differences between groups in hearing results, including improvement in ABG, change in speech discrimination, change in air or bone PTA, or change in high-frequency bone PTA. Short-term (mean = 4.4 and 4.9 weeks, respectively) success rates for the NiTiBOND and SMart prostheses were 84.6% and 70.0%, respectively, with this difference closing at the most recent test (83.7% and 80.0%, respectively). No revision surgery took place in either group, and there were no differences in complications such as dizziness, tinnitus, or taste disturbance, though the NiTiBOND group tended to have a lower rate of transient or permanent vertigo.
CONCLUSIONS: Compared with the SMart prosthesis, the NiTiBOND prosthesis is a safe prosthesis that achieves at least comparable hearing results and may offer some surgical advantages.
LEVEL OF EVIDENCE: 4 Laryngoscope, 2016.

PMID: 27296859 [PubMed - as supplied by publisher]

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Cochlear Patency After Transmastoid Labyrinthectomy for Meniere's Syndrome.

Objective: Labyrinthectomy is considered the "gold standard" in the treatment of intractable vertigo attacks because of Meniere's Disease (MD) but sacrifices all residual hearing. Interest in auditory rehabilitation has lead to cochlear implantation in some patients. Concern remains that the cochlear lumen may fill with tissue or bone after surgery. This study sought to determine the incidence of obliteration of the cochlea after transmastoid labyrinthectomy. Study Design: Retrospective observational study. Setting: Tertiary referral center. Patients: Eighteen patients with intractable vertigo from MD who underwent surgery. Interventions: Transmastoid labyrinthectomy between 2008 and 2013. Cochleas were imaged with unenhanced, heavily T2-weighted magnetic resonance imaging (MRI). Main Outcome Measure: Presence of symmetrical cochlear fluid signals on MRI. Results: There was no loss of fluid signal in the cochleas of operated ear compared with the contralateral, unoperated ear in any subject an average of 3 years (standard deviation [SD]: 1.2) after surgery. Five of 18 patients had the vestibule blocked with bone wax at the time of surgery. Blocking the vestibule with bone wax did not change the cochlear fluid signal. Conclusion: The risk of cochlear obstruction after labyrinthectomy for MD is very low. The significance of this finding is that patients with MD who undergo labyrinthectomy will likely remain candidates for cochlear implantation in the labyrinthectomized ear long after surgery if this becomes needed. Immediate cochlear implantation or placement of a cochlear lumen keeper during labyrinthectomy for MD is probably not necessary. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Double-Blind Sham-Controlled Crossover Trial of Repetitive Transcranial Magnetic Stimulation for Mal de Debarquement Syndrome

Objective: To determine whether the chronic rocking dizziness that occurs in Mal de Debarquement Syndrome (MdDS) can be suppressed with repetitive transcranial magnetic stimulation (rTMS) beyond the treatment period. Methods: We performed a prospective randomized double-blind sham controlled crossover trial of 5-days of rTMS utilizing high frequency (10 Hz) stimulation over the left dorsolateral prefrontal cortex (DLPFC). Results: Eight right-handed women (44.5 [SD 7.0] yr) with classical motion-triggered MdDS (mean duration 42.1 [SD 13.2] mo) participated. Group level mixed effects repeated measures analysis of variance (ANOVA) showed improvement in our primary outcome measure, the Dizziness Handicap Inventory (DHI) at Post TMS Weeks 1, 3, and 4 (p 

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Functional Testing of Subcutaneous Piezoelectrically Actuated Hearing Aid: Comparison With BAHA and Potential for Treating Single-sided Deafness

Objective: To compare the performance of a subcutaneous piezoelectrically actuated hearing aid (SPAHA) with the bone-anchored hearing aid (BAHA) and assess its effectiveness as a treatment option for conductive loss and single-sided deafness (SSD). Background: To validate the use of the SPAHA as a bone conduction implant, its performance was compared with a widely used bone conduction implant, the BAHA. Maximum dynamic range, power consumed to deliver standard speech signals and total harmonic distortion (THD) was assessed. The transcranial attenuation was also measured to assess the SPAHA's potential to treat SSD. Method: Functional testing of the SPAHA and BAHA was conducted using cadaver heads. Ipsilateral and contralateral promontory velocity and the power consumption by the devices were measured at 111 different frequencies in the range of 200 to 9600 Hz. Performance metrics were derived from these measurements. Result: The maximum dynamic range for SPAHA was within 10 dB of that of BAHA. The THD for the SPAHA was at most 3%, slightly better than the BAHA. The power consumption by the SPAHA, whereas highly variable, was not statistically different than that of the BAHA. Transcranical attenuation in case of SPAHA was 5 to 10 dB across the measured frequency range. Conclusion: From observed dynamic range and THD, the speech quality delivered by the SPAHA should equal or exceed that delivered by the BAHA. To attain equivalent hearing sensation at lower frequencies, the drive voltage for SPAHA would have to be significantly higher than that for BAHA. For typical speech inputs the power consumption requirements of the SPAHA should be roughly equal to those of the BAHA. Given its performance at high frequencies, the SPAHA seems well-suited to treating SSD.

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Measurement of Ototoxicity Following Intracochlear Bisphosphonate Delivery

Hypothesis: Assessing the maximum safe dose for local bisphosphonate delivery to the cochlea enables efficient delivery without ototoxicity. Background: Otosclerosis is a disease of abnormal bone metabolism affecting the otic capsule, which can cause conductive hearing loss. Larger otosclerotic lesions involving the cochlear endosteum and spiral ligament can result in sensorineural hearing loss. Bisphosphonates are used to treat patients with metabolic bone diseases, including otosclerosis. Local delivery is the most efficient way of delivery to the cochlea while avoiding systemic side effects. To attain intracochlear bisphosphonate delivery without ototoxicity, the maximum safe dose of bisphosphonates requires definition. In the present study, we tested increasing concentrations of zoledronate, a third-generation bisphosphonate in an intracochlear delivery system. We measured ototoxicity by monitoring distortion product otoacoustic emissions and compound action potentials. Methods: Artificial perilymph and increasing molar concentrations of zoledronate were administered to the cochlea in guinea pigs via a cochleostomy. Hearing was measured at multiple time points. A fluorescently labeled zoledronate derivative (6-FAM-ZOL) was coadministered as an internal control for drug delivery. Specimens embedded in the resin blocks were ground to a mid-modiolar section and fluorescent photomicrographs were taken. Results: No significant shift in hearing was observed in animals treated either with artificial perilymph or with 4% of the human systemic zoledronate dose. However, compound action potentials thresholds increased during infusion of 8% of the human systemic zoledronate dose, improved 4 hours later, and then increased again 4 weeks later. Using fluorescent photomicrography, intracochlear bisphosphonate delivery up to the apical cochlear turn was confirmed by visualizing 6-FAM-ZOL. Conclusion: These findings provide reference values for intracochlear bisphosphonate delivery in the treatment of cochlear otosclerosis and describe a useful method for tracking cochlear drug delivery.

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Reexamination of Etiology and Surgical Outcome in Patient With Advanced External Auditory Canal Cholesteatoma

Objective: To describe the etiology of advanced cases of external auditory canal (EAC) cholesteatoma (EACC), and to report the surgical management and outcomes based on canalplasty depending on the extent of adjacent structures involvement around the EAC. Study Design: Retrospective case review. Setting: University hospital. Patients: Participants comprised 28 patients (12 males, 16 females) ranging in age from 9 to 86 years old. All patients presented with advanced-stage EACC (Naim's classification: stage III/IV). Intervention: Surgery ranged from simple bony meatoplasty with cartilage graft repair to more enlarged EAC canalplasty combined with tympanoplasty. Result: EACC was categorized as idiopathic in 22 patients and secondary EACC in six patients. Six patients with idiopathic EACC were receiving hemodialysis, one of whom showed bilateral pathology. Particularly in cases with epithelial invasion into the hypotympanum immediately adjacent to the jugular bulb, multi-layered repair including bone paste, post-auricular pedicled musculo-periosteal flap, auto cartilage, and temporalis muscle fascia were required. Five patients required revision surgery (17%), including one case of recurrent (reconstructed) cholesteatoma and three cases of perforation of the tympanic membrane. Conclusion: In the majority of our series, underlying diseases followed with microangiopathy and angiogenesis could be possible candidates in the etiology of EACC. Enlarged bony meatoplasty and multilayered reconstruction surgery brought about self-cleaning and dried the EAC in advanced-stage EACC.

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Prognostic and Evolutive Factors of Tinnitus Triggered by Sudden Sensorineural Hearing Loss

Introduction: The association between sudden sensorineural hearing loss (SSNHL) and tinnitus is frequent. Its correlation with the auditory prognosis remains controversial. The objective of the study is to evaluate tinnitus of which onset is concurrent with SSNHL and analyze it as a prognostic factor and its correlation with hearing recovery. Materials and Methods: A prospective cohort study was conducted with 30 patients with SSNHL. Serial audiometry was performed and the Tinnitus Handicap Inventory (THI) was applied at the initial consultation and after treatment. Results: Tinnitus had an incidence of 93.3%, with an initial mean THI of 63.6%. The mean decrease in THI was significant in all scale domains. However, there was no statistically significant difference between the degrees of tinnitus and hearing loss, as well as between hearing recovery percentage in relation to the degree of tinnitus. The correlation of THI gain with the hearing recovery rate was negative (the greater the decrease in the level of tinnitus discomfort, the greater the hearing recovery rate), being significant only in the emotional domain of THI, but showing a poor correlation. Discussion: There was a reduction in the level of tinnitus discomfort, as measured by THI, after treatment of SSNHL. There is a correlation between tinnitus and hearing improvement in patients with SSNHL only in the emotional domain of THI, but this correlation is considered poor. The degree of tinnitus severity as measured by THI was not proportional to the hearing loss and is not a prognostic factor for hearing improvement.

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Stability of the aVOR to Repeat Head Impulse Testing

Objective: The angular vestibulo-ocular reflex (aVOR) is known to be influenced by factors such as arousal and cognition during traditional vestibular function testing. However, the inherent variability of the aVOR to head impulse testing has not been explicitly examined. The purpose of this study was to determine the variability of the aVOR to active and passive head impulses using the gold standard scleral search coil method to record head and eye rotation. Study Design: Descriptive. Setting: Tertiary referral center. Patients: Twenty six healthy control subjects agreed to active and passive horizontal head impulse testing on at least two separate sessions from two unique institutions. An additional 27 individuals with cochlear implantation (CI) underwent passive horizontal and vertical semicircular canal plane head impulse testing. Test sessions were separated from 3 to 210 days in the normal subjects and from 49 to 537 days in the subjects with CI. Main Outcome Measure(s): Reliability of the angular VOR gain (eye velocity/head velocity) over time. Results: In the healthy control subjects, there was no difference in aVOR gain between right and left ears, between session one and session two, or between active (self-generated, 0.99 ± 0.08) or passive (imposed, 1.0 ± 0.08) head impulses. In the patients, we also found the aVOR gain very stable over time. However, the aVOR gains of the patients were different across the semicircular canal planes tested (p 

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

Objective: To evaluate the characteristics and spontaneous recovery of tinnitus related to idiopathic sudden sensorineural hearing loss (ISSNHL). Study Design: Retrospective analysis from two randomized placebo-controlled clinical trials for treatment of ISSNHL within 48 hours from onset (Study A), or of tinnitus related to ISSNHL within 3 months from onset (Study B). Setting: Forty-eight European sites (academic tertiary referral centers, private ENT practices). Patients: One hundred thirteen adult patients of which 65 with hearing loss ≥30 dB (Study A) and 48 with persistent acute tinnitus (Study B) at baseline. Interventions: Intratympanic (i.t.) injection of placebo gel in single dose or in triple dose during 3 consecutive days. Main Outcome Measures: Frequency of tinnitus, subjective tinnitus loudness, rates of complete tinnitus remission, and complete hearing recovery during 3 months follow-up. Results: In acute ISSNHL, tinnitus loudness decreased rapidly in cases of mild-moderate hearing loss, and tinnitus had completely resolved in two-thirds of patients after 3 months. Hearing recovery preceded tinnitus resolution. When associated with severe-profound hearing loss, tinnitus improved significantly less. Complete hearing recovery and full tinnitus remission were both about three times more frequent in mild-moderate hearing loss patients than in severe-profound cases. Improvement in tinnitus loudness over time can be approximated by a negative exponential function. Conclusions: Prognosis for ISSNHL-related tinnitus is relatively poor in case of severe-profound hearing loss and the longer it has persisted. Alleviation or management of tinnitus should be a key therapeutic objective especially in pronounced ISSNHL cases.

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Lateral Semicircular Canal–enlarged Vestibular Aqueduct Fistula Associated With Paroxysmal Positional Nystagmus

No abstract available

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Cochlear Histopathology as Observed in Two Patients With a Cochlear Implant Electrode With Positioner

Hypothesis: This study reports the cochlear histopathology of two patients who during life underwent cochlear implantation with a positioner. Background: A silastic positioner introduced by the Advanced Bionics Corporation in 1999 was designed to position the electrode of the cochlear implant close to the modiolus. The positioner was recalled in the United States in July 2002 because of an apparent higher incidence of bacterial meningitis in patients in whom the positioner had been placed. Methods: Four celloidin-embedded temporal bones from two patients with cochlear implants with a positioner from the temporal bone collection of the Massachusetts Eye and Ear Infirmary were included in the study. In a previous study, we reported histopathologic findings in Patient 1, and in this report, we present the findings in a second case in a 94-year-old woman (Patient 2), and the similarities and differences between the two patients. All four specimens were prepared for histologic study by conventional techniques and 2-D reconstruction. Results: Evidence of insertion trauma was observed in all three implanted specimens. More significant trauma was found in Patient 2 than in Patient 1 including disruption of the osseous spiral lamina and the basilar membrane. In addition, there was more new fibrous tissue and bone in Patient 2 than in Patient 1. There was a large fluid space in all three implanted temporal bones around the electrode and positioner. Conclusion: The findings observed in the two patients may help to explain the increased risk of meningitis in patients implanted with a positioner.

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Sudden Pediatric Hearing Loss: Comparing the Results of Combined Treatment (Intratympanic Dexamethasone and Systemic Steroids) With Systemic Steroid Treatment Alone

Objective: The aim of the present study was to compare hearing improvements obtained with combined intratympanic and systemic steroid therapy, and systemic steroid therapy alone in pediatric patients with idiopathic sudden sensorineural hearing loss (SSHL). Study Design: Retrospective. Setting: Tertiary referral hospital. Patients: Pediatric patients with SSHL. Interventions: The patients were divided into two groups, based on the method of steroid administration: Group 1 (systemic therapy group, n = 23) was treated with oral methylprednisolone alone whereas Group 2 (combination therapy group, n = 26) was treated with combination of oral methylprednisolone and intratympanic dexamethasone injections. Main Outcome Measures: Pre- and post-treatment audiograms were compared with pure-tone averages (PTAs) in each group. Two treatment groups were also compared. The final hearing assessment was performed 4 weeks after completion of the treatment. Results: The mean PTAs before and after the treatment were 61.86 ± 23.99 and 42.65 ± 32.69 dB in Group 1 (p = 0.001), and 70.07 ± 29.74 and 38.85 ± 32.28 dB in Group 2 (p = 0.001). Pure-tone gain was 20.00 ± 15.02 dB in Group 1, and 31.69 ± 28.29 dB in Group 2. Comparison of two groups for post-treatment PTA and pure-tone gains did not yield any statistically significant differences (p = 0.388 and p = 0.132, respectively). Conclusion: Significant hearing improvement may be obtained with use of systemic steroids alone, or simultaneous administration of systemic and intratympanic steroids in pediatric patients with SSHL. Although we did not have a control group, two treatment options appear to offer similar hearing improvements in the pediatric age group higher than the rates obtained with placebo when previous studies in the literature are taken into account.

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Cochlear Implantation in Patients With Intracochlear and Intralabyrinthine Schwannomas

Objective: Schwannomas may arise primarily within the inner ear, or invade the cochlea or labyrinth from the distal internal auditory canal through transmodiolar or transmacular extension, respectively. To date, very limited data exists regarding cochlear implant (CI) outcomes in this unique population. Study Design: Retrospective case review. Patients: Ten ears (nine patients) with inner ear schwannomas that underwent CI at a single tertiary referral center. Intervention(s): Cochlear implantation. Main Outcome Measure(s): Surgical approach, CI performance. Results: Ten ears (nine patients) were implanted with conventional CI arrays. Three cases had primary inner ear schwannomas, while seven were in patients with neurofibromatosis type 2 (NF2) having transmodiolar invasion of the inner ear from a vestibular schwannoma (VS). In all cases, intracochlear tumor was left in situ to preserve cochlear anatomy and a full electrode insertion was achieved. Use of a styleted electrode with late deployment aided advancement through the intracochlear tumor. In all cases, the ipsilateral internal auditory canal and inner ear could be visualized on postoperative magnetic resonance imaging (MRI) for tumor surveillance. Eight ears achieved good open-set word recognition (median, Consonant-Nucleus-Consonant [CNC] 50% [range, 28–88%], median, AzBio 73% [range, 60–91%]); two patients with NF2 and prolonged deafness (15 and 22 years) received limited benefit. Conclusions: Cochlear implantation in patients with inner ear schwannomas and an intact cochlear nerve is feasible. Leaving intracochlear schwannoma in situ preserves cochlear architecture and use of a styleted electrode may aid in achieving a full insertion when obstructing tumor is present. Postoperative MRI surveillance is still adequate after CI and a high percentage of patients achieve good open-set speech perception performance.

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