Reducing Channel Interaction Through Cochlear Implant Programming May Improve Speech Perception: Current Focusing and Channel Deactivation

Speech perception among cochlear implant (CI) listeners is highly variable. High degrees of channel interaction are associated with poorer speech understanding. Two methods for reducing channel interaction, focusing electrical fields, and deactivating subsets of channels were assessed by the change in vowel and consonant identification scores with different program settings. The main hypotheses were that (a) focused stimulation will improve phoneme recognition and (b) speech perception will improve when channels with high thresholds are deactivated. To select high-threshold channels for deactivation, subjects’ threshold profiles were processed to enhance the peaks and troughs, and then an exclusion or inclusion criterion based on the mean and standard deviation was used. Low-threshold channels were selected manually and matched in number and apex-to-base distribution. Nine ears in eight adult CI listeners with Advanced Bionics HiRes90k devices were tested with six experimental programs. Two, all-channel programs, (a) 14-channel partial tripolar (pTP) and (b) 14-channel monopolar (MP), and four variable-channel programs, derived from these two base programs, (c) pTP with high- and (d) low-threshold channels deactivated, and (e) MP with high- and (f) low-threshold channels deactivated, were created. Across subjects, performance was similar with pTP and MP programs. However, poorer performing subjects (scoring < 62% correct on vowel identification) tended to perform better with the all-channel pTP than with the MP program (1 > 2). These same subjects showed slightly more benefit with the reduced channel MP programs (5 and 6). Subjective ratings were consistent with performance. These finding suggest that reducing channel interaction may benefit poorer performing CI listeners.

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Comparison of Gated Audiovisual Speech Identification in Elderly Hearing Aid Users and Elderly Normal-Hearing Individuals: Effects of Adding Visual Cues to Auditory Speech Stimuli

The present study compared elderly hearing aid (EHA) users (n = 20) with elderly normal-hearing (ENH) listeners (n = 20) in terms of isolation points (IPs, the shortest time required for correct identification of a speech stimulus) and accuracy of audiovisual gated speech stimuli (consonants, words, and final words in highly and less predictable sentences) presented in silence. In addition, we compared the IPs of audiovisual speech stimuli from the present study with auditory ones extracted from a previous study, to determine the impact of the addition of visual cues. Both participant groups achieved ceiling levels in terms of accuracy in the audiovisual identification of gated speech stimuli; however, the EHA group needed longer IPs for the audiovisual identification of consonants and words. The benefit of adding visual cues to auditory speech stimuli was more evident in the EHA group, as audiovisual presentation significantly shortened the IPs for consonants, words, and final words in less predictable sentences; in the ENH group, audiovisual presentation only shortened the IPs for consonants and words. In conclusion, although the audiovisual benefit was greater for EHA group, this group had inferior performance compared with the ENH group in terms of IPs when supportive semantic context was lacking. Consequently, EHA users needed the initial part of the audiovisual speech signal to be longer than did their counterparts with normal hearing to reach the same level of accuracy in the absence of a semantic context.

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Discriminability and Perceptual Saliency of Temporal and Spectral Cues for Final Fricative Consonant Voicing in Simulated Cochlear-Implant and Bimodal Hearing

Multiple redundant acoustic cues can contribute to the perception of a single phonemic contrast. This study investigated the effect of spectral degradation on the discriminability and perceptual saliency of acoustic cues for identification of word-final fricative voicing in "loss" versus "laws", and possible changes that occurred when low-frequency acoustic cues were restored. Three acoustic cues that contribute to the word-final /s/-/z/ contrast (first formant frequency [F1] offset, vowel–consonant duration ratio, and consonant voicing duration) were systematically varied in synthesized words. A discrimination task measured listeners’ ability to discriminate differences among stimuli within a single cue dimension. A categorization task examined the extent to which listeners make use of a given cue to label a syllable as "loss" versus "laws" when multiple cues are available. Normal-hearing listeners were presented with stimuli that were either unprocessed, processed with an eight-channel noise-band vocoder to approximate spectral degradation in cochlear implants, or low-pass filtered. Listeners were tested in four listening conditions: unprocessed, vocoder, low-pass, and a combined vocoder + low-pass condition that simulated bimodal hearing. Results showed a negative impact of spectral degradation on F1 cue discrimination and a trading relation between spectral and temporal cues in which listeners relied more heavily on the temporal cues for "loss-laws" identification when spectral cues were degraded. Furthermore, the addition of low-frequency fine-structure cues in simulated bimodal hearing increased the perceptual saliency of the F1 cue for "loss-laws" identification compared with vocoded speech. Findings suggest an interplay between the quality of sensory input and cue importance.

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Reducing Channel Interaction Through Cochlear Implant Programming May Improve Speech Perception: Current Focusing and Channel Deactivation

Speech perception among cochlear implant (CI) listeners is highly variable. High degrees of channel interaction are associated with poorer speech understanding. Two methods for reducing channel interaction, focusing electrical fields, and deactivating subsets of channels were assessed by the change in vowel and consonant identification scores with different program settings. The main hypotheses were that (a) focused stimulation will improve phoneme recognition and (b) speech perception will improve when channels with high thresholds are deactivated. To select high-threshold channels for deactivation, subjects’ threshold profiles were processed to enhance the peaks and troughs, and then an exclusion or inclusion criterion based on the mean and standard deviation was used. Low-threshold channels were selected manually and matched in number and apex-to-base distribution. Nine ears in eight adult CI listeners with Advanced Bionics HiRes90k devices were tested with six experimental programs. Two, all-channel programs, (a) 14-channel partial tripolar (pTP) and (b) 14-channel monopolar (MP), and four variable-channel programs, derived from these two base programs, (c) pTP with high- and (d) low-threshold channels deactivated, and (e) MP with high- and (f) low-threshold channels deactivated, were created. Across subjects, performance was similar with pTP and MP programs. However, poorer performing subjects (scoring < 62% correct on vowel identification) tended to perform better with the all-channel pTP than with the MP program (1 > 2). These same subjects showed slightly more benefit with the reduced channel MP programs (5 and 6). Subjective ratings were consistent with performance. These finding suggest that reducing channel interaction may benefit poorer performing CI listeners.

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Comparison of Gated Audiovisual Speech Identification in Elderly Hearing Aid Users and Elderly Normal-Hearing Individuals: Effects of Adding Visual Cues to Auditory Speech Stimuli

The present study compared elderly hearing aid (EHA) users (n = 20) with elderly normal-hearing (ENH) listeners (n = 20) in terms of isolation points (IPs, the shortest time required for correct identification of a speech stimulus) and accuracy of audiovisual gated speech stimuli (consonants, words, and final words in highly and less predictable sentences) presented in silence. In addition, we compared the IPs of audiovisual speech stimuli from the present study with auditory ones extracted from a previous study, to determine the impact of the addition of visual cues. Both participant groups achieved ceiling levels in terms of accuracy in the audiovisual identification of gated speech stimuli; however, the EHA group needed longer IPs for the audiovisual identification of consonants and words. The benefit of adding visual cues to auditory speech stimuli was more evident in the EHA group, as audiovisual presentation significantly shortened the IPs for consonants, words, and final words in less predictable sentences; in the ENH group, audiovisual presentation only shortened the IPs for consonants and words. In conclusion, although the audiovisual benefit was greater for EHA group, this group had inferior performance compared with the ENH group in terms of IPs when supportive semantic context was lacking. Consequently, EHA users needed the initial part of the audiovisual speech signal to be longer than did their counterparts with normal hearing to reach the same level of accuracy in the absence of a semantic context.

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Reducing Channel Interaction Through Cochlear Implant Programming May Improve Speech Perception: Current Focusing and Channel Deactivation

Speech perception among cochlear implant (CI) listeners is highly variable. High degrees of channel interaction are associated with poorer speech understanding. Two methods for reducing channel interaction, focusing electrical fields, and deactivating subsets of channels were assessed by the change in vowel and consonant identification scores with different program settings. The main hypotheses were that (a) focused stimulation will improve phoneme recognition and (b) speech perception will improve when channels with high thresholds are deactivated. To select high-threshold channels for deactivation, subjects’ threshold profiles were processed to enhance the peaks and troughs, and then an exclusion or inclusion criterion based on the mean and standard deviation was used. Low-threshold channels were selected manually and matched in number and apex-to-base distribution. Nine ears in eight adult CI listeners with Advanced Bionics HiRes90k devices were tested with six experimental programs. Two, all-channel programs, (a) 14-channel partial tripolar (pTP) and (b) 14-channel monopolar (MP), and four variable-channel programs, derived from these two base programs, (c) pTP with high- and (d) low-threshold channels deactivated, and (e) MP with high- and (f) low-threshold channels deactivated, were created. Across subjects, performance was similar with pTP and MP programs. However, poorer performing subjects (scoring < 62% correct on vowel identification) tended to perform better with the all-channel pTP than with the MP program (1 > 2). These same subjects showed slightly more benefit with the reduced channel MP programs (5 and 6). Subjective ratings were consistent with performance. These finding suggest that reducing channel interaction may benefit poorer performing CI listeners.

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Discriminability and Perceptual Saliency of Temporal and Spectral Cues for Final Fricative Consonant Voicing in Simulated Cochlear-Implant and Bimodal Hearing

Multiple redundant acoustic cues can contribute to the perception of a single phonemic contrast. This study investigated the effect of spectral degradation on the discriminability and perceptual saliency of acoustic cues for identification of word-final fricative voicing in "loss" versus "laws", and possible changes that occurred when low-frequency acoustic cues were restored. Three acoustic cues that contribute to the word-final /s/-/z/ contrast (first formant frequency [F1] offset, vowel–consonant duration ratio, and consonant voicing duration) were systematically varied in synthesized words. A discrimination task measured listeners’ ability to discriminate differences among stimuli within a single cue dimension. A categorization task examined the extent to which listeners make use of a given cue to label a syllable as "loss" versus "laws" when multiple cues are available. Normal-hearing listeners were presented with stimuli that were either unprocessed, processed with an eight-channel noise-band vocoder to approximate spectral degradation in cochlear implants, or low-pass filtered. Listeners were tested in four listening conditions: unprocessed, vocoder, low-pass, and a combined vocoder + low-pass condition that simulated bimodal hearing. Results showed a negative impact of spectral degradation on F1 cue discrimination and a trading relation between spectral and temporal cues in which listeners relied more heavily on the temporal cues for "loss-laws" identification when spectral cues were degraded. Furthermore, the addition of low-frequency fine-structure cues in simulated bimodal hearing increased the perceptual saliency of the F1 cue for "loss-laws" identification compared with vocoded speech. Findings suggest an interplay between the quality of sensory input and cue importance.

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Comparison of Gated Audiovisual Speech Identification in Elderly Hearing Aid Users and Elderly Normal-Hearing Individuals: Effects of Adding Visual Cues to Auditory Speech Stimuli

The present study compared elderly hearing aid (EHA) users (n = 20) with elderly normal-hearing (ENH) listeners (n = 20) in terms of isolation points (IPs, the shortest time required for correct identification of a speech stimulus) and accuracy of audiovisual gated speech stimuli (consonants, words, and final words in highly and less predictable sentences) presented in silence. In addition, we compared the IPs of audiovisual speech stimuli from the present study with auditory ones extracted from a previous study, to determine the impact of the addition of visual cues. Both participant groups achieved ceiling levels in terms of accuracy in the audiovisual identification of gated speech stimuli; however, the EHA group needed longer IPs for the audiovisual identification of consonants and words. The benefit of adding visual cues to auditory speech stimuli was more evident in the EHA group, as audiovisual presentation significantly shortened the IPs for consonants, words, and final words in less predictable sentences; in the ENH group, audiovisual presentation only shortened the IPs for consonants and words. In conclusion, although the audiovisual benefit was greater for EHA group, this group had inferior performance compared with the ENH group in terms of IPs when supportive semantic context was lacking. Consequently, EHA users needed the initial part of the audiovisual speech signal to be longer than did their counterparts with normal hearing to reach the same level of accuracy in the absence of a semantic context.

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Discriminability and Perceptual Saliency of Temporal and Spectral Cues for Final Fricative Consonant Voicing in Simulated Cochlear-Implant and Bimodal Hearing

Multiple redundant acoustic cues can contribute to the perception of a single phonemic contrast. This study investigated the effect of spectral degradation on the discriminability and perceptual saliency of acoustic cues for identification of word-final fricative voicing in "loss" versus "laws", and possible changes that occurred when low-frequency acoustic cues were restored. Three acoustic cues that contribute to the word-final /s/-/z/ contrast (first formant frequency [F1] offset, vowel–consonant duration ratio, and consonant voicing duration) were systematically varied in synthesized words. A discrimination task measured listeners’ ability to discriminate differences among stimuli within a single cue dimension. A categorization task examined the extent to which listeners make use of a given cue to label a syllable as "loss" versus "laws" when multiple cues are available. Normal-hearing listeners were presented with stimuli that were either unprocessed, processed with an eight-channel noise-band vocoder to approximate spectral degradation in cochlear implants, or low-pass filtered. Listeners were tested in four listening conditions: unprocessed, vocoder, low-pass, and a combined vocoder + low-pass condition that simulated bimodal hearing. Results showed a negative impact of spectral degradation on F1 cue discrimination and a trading relation between spectral and temporal cues in which listeners relied more heavily on the temporal cues for "loss-laws" identification when spectral cues were degraded. Furthermore, the addition of low-frequency fine-structure cues in simulated bimodal hearing increased the perceptual saliency of the F1 cue for "loss-laws" identification compared with vocoded speech. Findings suggest an interplay between the quality of sensory input and cue importance.

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Tinnitus Screener: Results From the First 100 Participants in an Epidemiology Study

Purpose

In the Noise Outcomes in Servicemembers Epidemiology Study, Veterans recently separated from the military undergo comprehensive assessments to initiate long-term monitoring of their auditory function. We developed the Tinnitus Screener, a four-item algorithmic instrument that determines whether tinnitus is present and, if so, whether it is constant or intermittent, or whether only temporary tinnitus has been experienced. Predictive validity data are presented for the first 100 Noise Outcomes in Servicemembers Epidemiology Study participants.

Method

The Tinnitus Screener was administered to participants by telephone. In lieu of a gold standard for determining tinnitus presence, the predictive validity of the tinnitus category assigned to participants on the basis of the Screener results was assessed when the participants attended audiologic testing.

Results

Of the 100 participants, 67 screened positive for intermittent or constant tinnitus. Three were categorized as “temporary” tinnitus only, and 30 were categorized as “no tinnitus.” Tinnitus categorization was predictively valid with 96 of the 100 participants.

Conclusions

These results provide preliminary evidence that the Screener may be suitable for quickly determining essential parameters of reported tinnitus. We have since revised the instrument to differentiate acute from chronic tinnitus and to identify occasional tinnitus. We are also obtaining measures that will enable assessment of its test-retest reliability.

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Tinnitus Screener: Results From the First 100 Participants in an Epidemiology Study

Purpose

In the Noise Outcomes in Servicemembers Epidemiology Study, Veterans recently separated from the military undergo comprehensive assessments to initiate long-term monitoring of their auditory function. We developed the Tinnitus Screener, a four-item algorithmic instrument that determines whether tinnitus is present and, if so, whether it is constant or intermittent, or whether only temporary tinnitus has been experienced. Predictive validity data are presented for the first 100 Noise Outcomes in Servicemembers Epidemiology Study participants.

Method

The Tinnitus Screener was administered to participants by telephone. In lieu of a gold standard for determining tinnitus presence, the predictive validity of the tinnitus category assigned to participants on the basis of the Screener results was assessed when the participants attended audiologic testing.

Results

Of the 100 participants, 67 screened positive for intermittent or constant tinnitus. Three were categorized as “temporary” tinnitus only, and 30 were categorized as “no tinnitus.” Tinnitus categorization was predictively valid with 96 of the 100 participants.

Conclusions

These results provide preliminary evidence that the Screener may be suitable for quickly determining essential parameters of reported tinnitus. We have since revised the instrument to differentiate acute from chronic tinnitus and to identify occasional tinnitus. We are also obtaining measures that will enable assessment of its test-retest reliability.

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Tinnitus Screener: Results From the First 100 Participants in an Epidemiology Study

Purpose

In the Noise Outcomes in Servicemembers Epidemiology Study, Veterans recently separated from the military undergo comprehensive assessments to initiate long-term monitoring of their auditory function. We developed the Tinnitus Screener, a four-item algorithmic instrument that determines whether tinnitus is present and, if so, whether it is constant or intermittent, or whether only temporary tinnitus has been experienced. Predictive validity data are presented for the first 100 Noise Outcomes in Servicemembers Epidemiology Study participants.

Method

The Tinnitus Screener was administered to participants by telephone. In lieu of a gold standard for determining tinnitus presence, the predictive validity of the tinnitus category assigned to participants on the basis of the Screener results was assessed when the participants attended audiologic testing.

Results

Of the 100 participants, 67 screened positive for intermittent or constant tinnitus. Three were categorized as “temporary” tinnitus only, and 30 were categorized as “no tinnitus.” Tinnitus categorization was predictively valid with 96 of the 100 participants.

Conclusions

These results provide preliminary evidence that the Screener may be suitable for quickly determining essential parameters of reported tinnitus. We have since revised the instrument to differentiate acute from chronic tinnitus and to identify occasional tinnitus. We are also obtaining measures that will enable assessment of its test-retest reliability.

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Gait characteristics, balance performance and falls in ambulant adults with cerebral palsy: An observational study

Publication date: Available online 17 June 2016
Source:Gait & Posture
Author(s): P. Morgan, A. Murphy, A. Opheim, J. McGinley
The relationship between spatiotemporal gait parameters, balance performance and falls history was investigated in ambulant adults with cerebral palsy (CP). Participants completed a single assessment of gait using an instrumented walkway at preferred and fast speeds, balance testing (Balance Evaluation Systems Test; BESTest), and reported falls history. Seventeen ambulatory adults with CP, mean age 37 years, participated. Gait speed was typically slow at both preferred and fast speeds (mean 0.97 and 1.21m/s, respectively), with short stride length and high cadence relative to speed. There was a significant, large positive relationship between preferred gait speed and BESTest total score (rho=0.573; p<0.05) and fast gait speed and BESTest total score (rho=0.647, p<0.01). The stride lengths of fallers at both preferred and fast speeds differed significantly from non-fallers (p=0.032 and p=0.025, respectively), with those with a prior history of falls taking shorter strides. Faster gait speed was associated with better performance on tests of anticipatory and postural response components of the BESTest, suggesting potential therapeutic training targets to address either gait speed or balance performance. Future exploration of the implications of slow walking speed and reduced stride length on falls and community engagement, and the potential prognostic value of stride length on identifying falls risk is recommended.



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Surface effects on dynamic stability and loading during outdoor running using wireless trunk accelerometry

Publication date: July 2016
Source:Gait & Posture, Volume 48
Author(s): Kurt H. Schütte, Jeroen Aeles, Tim Op De Beéck, Babette C. van der Zwaard, Rachel Venter, Benedicte Vanwanseele
Despite frequently declared benefits of using wireless accelerometers to assess running gait in real-world settings, available research is limited. The purpose of this study was to investigate outdoor surface effects on dynamic stability and dynamic loading during running using tri-axial trunk accelerometry. Twenty eight runners (11 highly-trained, 17 recreational) performed outdoor running on three outdoor training surfaces (concrete road, synthetic track and woodchip trail) at self-selected comfortable running speeds. Dynamic postural stability (tri-axial acceleration root mean square (RMS) ratio, step and stride regularity, sample entropy), dynamic loading (impact and breaking peak amplitudes and median frequencies), as well as spatio-temporal running gait measures (step frequency, stance time) were derived from trunk accelerations sampled at 1024Hz. Results from generalized estimating equations (GEE) analysis showed that compared to concrete road, woodchip trail had several significant effects on dynamic stability (higher AP ratio of acceleration RMS, lower ML inter-step and inter-stride regularity), on dynamic loading (downward shift in vertical and AP median frequency), and reduced step frequency (p<0.05). Surface effects were unaffected when both running level and running speed were added as potential confounders. Results suggest that woodchip trails disrupt aspects of dynamic stability and loading that are detectable using a single trunk accelerometer. These results provide further insight into how runners adapt their locomotor biomechanics on outdoor surfaces in situ.

Graphical abstract

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Gait initiation time is associated with the risk of multiple falls—A population-based study

Publication date: Available online 16 June 2016
Source:Gait & Posture
Author(s): Michele. L Callisaya, Leigh Blizzard, Kara Martin, Velandai K. Srikanth
AimsIn a population-based study of older people to examine whether 1) overall gait initiation (GI) time or its components are associated with falls and 2) GI under dual-task is a stronger predictor of falls risk than under single-task.MethodsParticipants aged 60-85 years were randomly selected from the electoral roll. GI was obtained with a force platform under both single and dual-task conditions. Falls were ascertained prospectively over a 12-month period. Log multinomial regression was used to examine the association between GI time (total and its components) and risk of single and multiple falls. Age, sex and physiological and cognitive falls risk factors were considered as confounders.ResultsThe mean age of the sample (n=124) was 71.0 (SD 6.8) years and 58.9% (n=73) were male. Over 12 months 21.8% (n=27) of participants reported a single fall and 16.1% (n=20) reported multiple falls. Slower overall GI time under both single (RR all per 100ms 1.28, 95%CI 1.03, 1.58) and dual-task (RR 1.14, 95%CI 1.02, 1.27) was associated with increased risk of multiple, but not single falls (p<0.05). Multiple falls were also associated with slower time to first lateral movement under single-task (RR 1.90 95%CI 0.59, 1.51) and swing time under dual-task condition (RR 1.44 95%CI 1.08, 1.94).ConclusionSlower GI time is associated with the risk of multiple falls independent of other risk factors, suggesting it could be used as part of a comprehensive falls assessment. Time to the first lateral movement under single-task may be the best measures of this risk.



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Gait characteristics, balance performance and falls in ambulant adults with cerebral palsy: An observational study

Publication date: Available online 17 June 2016
Source:Gait & Posture
Author(s): P. Morgan, A. Murphy, A. Opheim, J. McGinley
The relationship between spatiotemporal gait parameters, balance performance and falls history was investigated in ambulant adults with cerebral palsy (CP). Participants completed a single assessment of gait using an instrumented walkway at preferred and fast speeds, balance testing (Balance Evaluation Systems Test; BESTest), and reported falls history. Seventeen ambulatory adults with CP, mean age 37 years, participated. Gait speed was typically slow at both preferred and fast speeds (mean 0.97 and 1.21m/s, respectively), with short stride length and high cadence relative to speed. There was a significant, large positive relationship between preferred gait speed and BESTest total score (rho=0.573; p<0.05) and fast gait speed and BESTest total score (rho=0.647, p<0.01). The stride lengths of fallers at both preferred and fast speeds differed significantly from non-fallers (p=0.032 and p=0.025, respectively), with those with a prior history of falls taking shorter strides. Faster gait speed was associated with better performance on tests of anticipatory and postural response components of the BESTest, suggesting potential therapeutic training targets to address either gait speed or balance performance. Future exploration of the implications of slow walking speed and reduced stride length on falls and community engagement, and the potential prognostic value of stride length on identifying falls risk is recommended.



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Surface effects on dynamic stability and loading during outdoor running using wireless trunk accelerometry

Publication date: July 2016
Source:Gait & Posture, Volume 48
Author(s): Kurt H. Schütte, Jeroen Aeles, Tim Op De Beéck, Babette C. van der Zwaard, Rachel Venter, Benedicte Vanwanseele
Despite frequently declared benefits of using wireless accelerometers to assess running gait in real-world settings, available research is limited. The purpose of this study was to investigate outdoor surface effects on dynamic stability and dynamic loading during running using tri-axial trunk accelerometry. Twenty eight runners (11 highly-trained, 17 recreational) performed outdoor running on three outdoor training surfaces (concrete road, synthetic track and woodchip trail) at self-selected comfortable running speeds. Dynamic postural stability (tri-axial acceleration root mean square (RMS) ratio, step and stride regularity, sample entropy), dynamic loading (impact and breaking peak amplitudes and median frequencies), as well as spatio-temporal running gait measures (step frequency, stance time) were derived from trunk accelerations sampled at 1024Hz. Results from generalized estimating equations (GEE) analysis showed that compared to concrete road, woodchip trail had several significant effects on dynamic stability (higher AP ratio of acceleration RMS, lower ML inter-step and inter-stride regularity), on dynamic loading (downward shift in vertical and AP median frequency), and reduced step frequency (p<0.05). Surface effects were unaffected when both running level and running speed were added as potential confounders. Results suggest that woodchip trails disrupt aspects of dynamic stability and loading that are detectable using a single trunk accelerometer. These results provide further insight into how runners adapt their locomotor biomechanics on outdoor surfaces in situ.

Graphical abstract

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Gait initiation time is associated with the risk of multiple falls—A population-based study

Publication date: Available online 16 June 2016
Source:Gait & Posture
Author(s): Michele. L Callisaya, Leigh Blizzard, Kara Martin, Velandai K. Srikanth
AimsIn a population-based study of older people to examine whether 1) overall gait initiation (GI) time or its components are associated with falls and 2) GI under dual-task is a stronger predictor of falls risk than under single-task.MethodsParticipants aged 60-85 years were randomly selected from the electoral roll. GI was obtained with a force platform under both single and dual-task conditions. Falls were ascertained prospectively over a 12-month period. Log multinomial regression was used to examine the association between GI time (total and its components) and risk of single and multiple falls. Age, sex and physiological and cognitive falls risk factors were considered as confounders.ResultsThe mean age of the sample (n=124) was 71.0 (SD 6.8) years and 58.9% (n=73) were male. Over 12 months 21.8% (n=27) of participants reported a single fall and 16.1% (n=20) reported multiple falls. Slower overall GI time under both single (RR all per 100ms 1.28, 95%CI 1.03, 1.58) and dual-task (RR 1.14, 95%CI 1.02, 1.27) was associated with increased risk of multiple, but not single falls (p<0.05). Multiple falls were also associated with slower time to first lateral movement under single-task (RR 1.90 95%CI 0.59, 1.51) and swing time under dual-task condition (RR 1.44 95%CI 1.08, 1.94).ConclusionSlower GI time is associated with the risk of multiple falls independent of other risk factors, suggesting it could be used as part of a comprehensive falls assessment. Time to the first lateral movement under single-task may be the best measures of this risk.



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Gait characteristics, balance performance and falls in ambulant adults with cerebral palsy: An observational study

Publication date: Available online 17 June 2016
Source:Gait & Posture
Author(s): P. Morgan, A. Murphy, A. Opheim, J. McGinley
The relationship between spatiotemporal gait parameters, balance performance and falls history was investigated in ambulant adults with cerebral palsy (CP). Participants completed a single assessment of gait using an instrumented walkway at preferred and fast speeds, balance testing (Balance Evaluation Systems Test; BESTest), and reported falls history. Seventeen ambulatory adults with CP, mean age 37 years, participated. Gait speed was typically slow at both preferred and fast speeds (mean 0.97 and 1.21m/s, respectively), with short stride length and high cadence relative to speed. There was a significant, large positive relationship between preferred gait speed and BESTest total score (rho=0.573; p<0.05) and fast gait speed and BESTest total score (rho=0.647, p<0.01). The stride lengths of fallers at both preferred and fast speeds differed significantly from non-fallers (p=0.032 and p=0.025, respectively), with those with a prior history of falls taking shorter strides. Faster gait speed was associated with better performance on tests of anticipatory and postural response components of the BESTest, suggesting potential therapeutic training targets to address either gait speed or balance performance. Future exploration of the implications of slow walking speed and reduced stride length on falls and community engagement, and the potential prognostic value of stride length on identifying falls risk is recommended.



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Surface effects on dynamic stability and loading during outdoor running using wireless trunk accelerometry

Publication date: July 2016
Source:Gait & Posture, Volume 48
Author(s): Kurt H. Schütte, Jeroen Aeles, Tim Op De Beéck, Babette C. van der Zwaard, Rachel Venter, Benedicte Vanwanseele
Despite frequently declared benefits of using wireless accelerometers to assess running gait in real-world settings, available research is limited. The purpose of this study was to investigate outdoor surface effects on dynamic stability and dynamic loading during running using tri-axial trunk accelerometry. Twenty eight runners (11 highly-trained, 17 recreational) performed outdoor running on three outdoor training surfaces (concrete road, synthetic track and woodchip trail) at self-selected comfortable running speeds. Dynamic postural stability (tri-axial acceleration root mean square (RMS) ratio, step and stride regularity, sample entropy), dynamic loading (impact and breaking peak amplitudes and median frequencies), as well as spatio-temporal running gait measures (step frequency, stance time) were derived from trunk accelerations sampled at 1024Hz. Results from generalized estimating equations (GEE) analysis showed that compared to concrete road, woodchip trail had several significant effects on dynamic stability (higher AP ratio of acceleration RMS, lower ML inter-step and inter-stride regularity), on dynamic loading (downward shift in vertical and AP median frequency), and reduced step frequency (p<0.05). Surface effects were unaffected when both running level and running speed were added as potential confounders. Results suggest that woodchip trails disrupt aspects of dynamic stability and loading that are detectable using a single trunk accelerometer. These results provide further insight into how runners adapt their locomotor biomechanics on outdoor surfaces in situ.

Graphical abstract

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Gait initiation time is associated with the risk of multiple falls—A population-based study

Publication date: Available online 16 June 2016
Source:Gait & Posture
Author(s): Michele. L Callisaya, Leigh Blizzard, Kara Martin, Velandai K. Srikanth
AimsIn a population-based study of older people to examine whether 1) overall gait initiation (GI) time or its components are associated with falls and 2) GI under dual-task is a stronger predictor of falls risk than under single-task.MethodsParticipants aged 60-85 years were randomly selected from the electoral roll. GI was obtained with a force platform under both single and dual-task conditions. Falls were ascertained prospectively over a 12-month period. Log multinomial regression was used to examine the association between GI time (total and its components) and risk of single and multiple falls. Age, sex and physiological and cognitive falls risk factors were considered as confounders.ResultsThe mean age of the sample (n=124) was 71.0 (SD 6.8) years and 58.9% (n=73) were male. Over 12 months 21.8% (n=27) of participants reported a single fall and 16.1% (n=20) reported multiple falls. Slower overall GI time under both single (RR all per 100ms 1.28, 95%CI 1.03, 1.58) and dual-task (RR 1.14, 95%CI 1.02, 1.27) was associated with increased risk of multiple, but not single falls (p<0.05). Multiple falls were also associated with slower time to first lateral movement under single-task (RR 1.90 95%CI 0.59, 1.51) and swing time under dual-task condition (RR 1.44 95%CI 1.08, 1.94).ConclusionSlower GI time is associated with the risk of multiple falls independent of other risk factors, suggesting it could be used as part of a comprehensive falls assessment. Time to the first lateral movement under single-task may be the best measures of this risk.



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Therapeutic Value of Ginkgo biloba Extract EGb 761® in an Animal Model (Meriones unguiculatus) for Noise Trauma Induced Hearing Loss and Tinnitus

by Patrick Krauss, Konstantin Tziridis, Stefanie Buerbank, Achim Schilling, Holger Schulze

Noise induced hearing loss (NIHL) is a common disease in modern societies and may lead to maladaptations within the auditory system that finally result in subjective tinnitus. Available therapies may only alleviate the symptoms rather than restore normal hearing. In a previous study we demonstrated that the prophylactic application of Ginkgo biloba extract EGb 761^® significantly reduces NIHL and tinnitus development in our Mongolian gerbil (Meriones unguiculatus) animal model. Here, we tested whether the application of EGb 761^® has beneficial effects after the formation of permanent NIHL and tinnitus. To this end we monitored the therapeutic effects of EGb 761^® on noise trauma-induced changes in signal processing within the auditory system of our animal model by behavioral (acoustic startle response, ASR) and electrophysiological approaches (auditory brainstem responses, ABR). We found that–in contrast to vehicle–three weeks of daily oral EGb 761^® treatment (100 mg/kg body weight) led to a restoration of hearing thresholds back to pre-trauma conditions. In addition, all 9 animals that displayed behavioral signs of subjective tinnitus showed improvement, with 7 of them showing complete relief of tinnitus symptoms during the time of EGb 761^® treatment. After discontinuation of EGb 761^® treatment, tinnitus related behavior reappeared in all but one of these animals while auditory thresholds remained restored. A detailed analysis of ABR waves revealed that EGb 761^® treatment did not simply change auditory processing back to pre-trauma conditions, but led to subtle changes of ABR wave amplitude and latency at different levels of the auditory pathway, with an overall increase of response to low stimulus intensities and a decrease at high intensities. The functional relevance of these changes may be the observed improvement of hearing thresholds while at the same time suppression of responses to high stimulus intensities may point to a global inhibitory mechanism that counteracts tinnitus.

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Do You Think This Is Far-Fetched?

This is the question Gary Jacobson, editor-in-chief of the Journal of the American Academy of Audiology, poses for us. The question is in the context of a newly published article in the journal that explores the perception about Internet -based delivery of hearing aids amongst older adults. The participants in the study were definitely interested but pointed out various road blocks in place today for internet-based hearing aid delivery to be fully satisfactory. Are these road blocks insurmountable, or simply new territories for technological capture.

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Analysis and modeling of infrasound from a four-stage rocket launch

Infrasound from a four-stage sounding rocket was recorded by several arrays within 100 km of the launch pad. Propagation modeling methods have been applied to the known trajectory to predict infrasonic signals at the ground in order to identify what information might be obtained from such observations. There is good agreement between modeled and observed back azimuths, and predicted arrival times for motor ignition signals match those observed. The signal due to the high-altitude stage ignition is found to be low amplitude, despite predictions of weak attenuation. This lack of signal is possibly due to inefficient aeroacoustic coupling in the rarefied upper atmosphere.

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Perception of Small Frequency Differences in Children with Auditory Processing Disorder or Specific Language Impairment.

Perception of Small Frequency Differences in Children with Auditory Processing Disorder or Specific Language Impairment.

J Am Acad Audiol. 2016 Jun;27(6):489-497

Authors: Rota-Donahue C, Schwartz RG, Shafer V, Sussman ES

Abstract
BACKGROUND: Frequency discrimination is often impaired in children developing language atypically. However, findings in the detection of small frequency changes in these children are conflicting. Previous studies on children's auditory perceptual abilities usually involved establishing differential sensitivity thresholds in sample populations who were not tested for auditory deficits. To date, there are no data comparing suprathreshold frequency discrimination ability in children tested for both auditory processing and language skills.
PURPOSE: : This study examined the perception of small frequency differences (∆ƒ) in children with auditory processing disorder (APD) and/or specific language impairment (SLI). The aim was to determine whether children with APD and children with SLI showed differences in their behavioral responses to frequency changes. Results were expected to identify different degrees of impairment and shed some light on the auditory perceptual overlap between pediatric APD and SLI.
RESEARCH DESIGN: An experimental group design using a two-alternative forced-choice procedure was used to determine frequency discrimination ability for three magnitudes of ∆ƒ from the 1000-Hz base frequency.
STUDY SAMPLE: Thirty children between 10 years of age and 12 years, 11 months of age: 17 children with APD and/or SLI, and 13 typically developing (TD) peers participated. The clinical groups included four children with APD only, four children with SLI only, and nine children with both APD and SLI.
DATA COLLECTION AND ANALYSIS: Behavioral data collected using headphone delivery were analyzed using the sensitivity index d', calculated for three ∆ƒ was 2%, 5%, and 15% of the base frequency or 20, 50, and 150 Hz. Correlations between the dependent variable d' and the independent variables measuring auditory processing and language skills were also obtained. A stepwise regression analysis was then performed.
RESULTS: TD children and children with APD and/or SLI differed in the detection of small-tone ∆ƒ. In addition, APD or SLI status affected behavioral results differently. Comparisons between auditory processing test scores or language test scores and the sensitivity index d' showed different strengths of correlation based on the magnitudes of the ∆ƒ. Auditory processing scores showed stronger correlation to the sensitivity index d' for the small ∆ƒ, while language scores showed stronger correlation to the sensitivity index d' for the large ∆ƒ.
CONCLUSION: Although children with APD and/or SLI have difficulty with behavioral frequency discrimination, this difficulty may stem from two different levels: a basic auditory level for children with APD and a higher language processing level for children with SLI; the frequency discrimination performance seemed to be affected by the labeling demands of the same versus different frequency discrimination task for the children with SLI.

PMID: 27310407 [PubMed - as supplied by publisher]

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Factors Affecting Speech Discrimination in Children with Cochlear Implants: Evidence from Early-Implanted Infants.

Factors Affecting Speech Discrimination in Children with Cochlear Implants: Evidence from Early-Implanted Infants.

J Am Acad Audiol. 2016 Jun;27(6):480-488

Authors: Phan J, Houston DM, Ruffin C, Ting J, Holt RF

Abstract
BACKGROUND: To learn words and acquire language, children must be able to discriminate and correctly perceive phonemes. Although there has been much research on the general language outcomes of children with cochlear implants (CIs), little is known about the development of speech perception with regard to specific speech processes, such as speech discrimination.
PURPOSE: The purpose of this study was to investigate the development of speech discrimination in infants with CIs and identify factors that might correlate with speech discrimination skills.
RESEARCH DESIGN: Using a Hybrid Visual Habituation procedure, we tested infants with CIs on their ability to discriminate the vowel contrast /i/-/u/. We also gathered demographic and audiological information about each infant.
STUDY SAMPLE: Children who had received CIs before 2 yr of age served as participants. We tested the children at two post cochlear implantation intervals: 2-4 weeks post CI stimulation (N = 17) and 6-9 mo post CI stimulation (N = 10).
DATA COLLECTION AND ANALYSIS: The infants' mean looking times during the novel versus old trials of the experiment were measured. A linear regression model was used to evaluate the relationship between the normalized looking time difference and the following variables: chronological age, age at CI stimulation, gender, communication mode, and best unaided pure-tone average.
RESULTS: We found that the best unaided pure-tone average predicted speech discrimination at the early interval. In contrast to some previous speech perception studies that included children implanted before 3 yr of age, age at CI stimulation did not predict speech discrimination performance.
CONCLUSIONS: The results suggest that residual acoustic hearing before implantation might facilitate speech discrimination during the early period post cochlear implantation; with more hearing experience, communication mode might have a greater influence on the ability to discriminate speech. This and other studies on age at cochlear implantation suggest that earlier implantation might not have as large an effect on speech perception as it does on other language skills.

PMID: 27310406 [PubMed - as supplied by publisher]

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Investigating the Interaction between Dichotic Deficits and Cognitive Abilities Using the Dichotic Digits difference Test (DDdT) Part 2.

Investigating the Interaction between Dichotic Deficits and Cognitive Abilities Using the Dichotic Digits difference Test (DDdT) Part 2.

J Am Acad Audiol. 2016 Jun;27(6):470-479

Authors: Cameron S, Glyde H, Dillon H, Whitfield J

Abstract
BACKGROUND: The Dichotic Digits difference Test (DDdT) was developed to investigate the relationship between dichotic processing and cognitive abilities and, through the use of differential test scores, to provide professionals with a clinical tool that could aid in differentiation of clients with genuine dichotic deficits from those where cognitive disorders affect test performance. The DDdT consists of four subtests: dichotic free recall (FR), dichotic directed left ear, dichotic directed right ear, and diotic. Scores are calculated for six conditions: FR left ear (LE), right ear (RE), and total, as well as the directed left ear, directed right ear, and diotic, and four difference measures: dichotic advantage, RE advantage FR, RE advantage directed, and attention advantage.
PURPOSE: To investigate the role of cognitive abilities on DDdT test performance.
RESEARCH DESIGN: Correlational analysis between the various DDdT conditions and difference measures, as well as between dichotic, diotic, and cognitive factors (memory, intelligence, and attention).
STUDY SAMPLE: Fifty typically developing children (aged 7 yr 0 mo to 12 yr 1 mo, mean = 9 yr 2 mo) and ten children recruited from the Australian Hearing CAPD Service who were diagnosed with a memory or dichotic deficit (aged 7 yr 0 mo to 15 yr 0 mo, mean = 9 yr 5 mo) took part in the study.
DATA COLLECTION AND ANALYSIS: The Pearson product moment correlations were used to determine the strength of relationships between DDdT conditions as well as relationships between scores on these conditions and performance on the various cognitive assessment tools, which included the number memory forward and reversed subtests of the Test of Auditory Processing Skills - Third Edition, IVA + Plus Continuous Performance Test, and the Test of Non-Verbal Intelligence-4 (TONI-4). A parent questionnaire (Fisher's Auditory Checklist) and a participant questionnaire (Listening Inventory for Education) were also administered.
RESULTS: Diotic performance was significantly correlated with performance on all the DDdT dichotic FR conditions (r = 0.6-0.8; p < 0.00001). Further, significant correlations were found between the FR LE, total, and diotic conditions, and the cognitive measures of attention and memory, with r ranging from 0.4 to 0.5 (p < 0.01-0.001). Right-ear performance was not significantly correlated to any cognitive measure, except for FR RE and number memory forward (r = 0.35; p = 0.006). The DDdT dichotic advantage measure was investigated in a subset of clinical children and found to aid in differentiating true dichotic from spurious results.
CONCLUSIONS: As found in the DDdT normative data study that precedes in the companion paper (DDdT Study Part 1; Cameron et al, 2016), the high correlation between dichotic and diotic performances by the clinical and typically developing participants suggests that factors other than dichotic performance play a substantial role in a child's ability to perform a dichotic listening task. Indeed, 61% of the variance in FR total scores for the children in this study was accounted for by factors that do not involve the perception of dichotic stimuli. This view is supported by the correlations between measures of attention and memory and dichotic scores. This result has wide-spread implications in respect to interpretation of central auditory processing disorder test results and further investigation of the use of the DDdT in a clinical population is warranted.

PMID: 27310405 [PubMed - as supplied by publisher]

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The Dichotic Digits difference Test (DDdT): Development, Normative Data, and Test-Retest Reliability Studies Part 1.

The Dichotic Digits difference Test (DDdT): Development, Normative Data, and Test-Retest Reliability Studies Part 1.

J Am Acad Audiol. 2016 Jun;27(6):458-469

Authors: Cameron S, Glyde H, Dillon H, Whitfield J, Seymour J

Abstract
BACKGROUND: The dichotic digits test is one of the most widely used assessment tools for central auditory processing disorder. However, questions remain concerning the impact of cognitive factors on test results.
PURPOSE: To develop the Dichotic Digits difference Test (DDdT), an assessment tool that could differentiate children with cognitive deficits from children with genuine dichotic deficits based on differential test results. The DDdT consists of four subtests: dichotic free recall (FR), dichotic directed left ear (DLE), dichotic directed right ear (DRE), and diotic. Scores for six conditions are calculated (FR left ear [LE], FR right ear [RE], and FR total, as well as DLE, DRE, and diotic). Scores for four difference measures are also calculated: dichotic advantage, right-ear advantage (REA) FR, REA directed, and attention advantage.
RESEARCH DESIGN: Experiment 1 involved development of the DDdT, including error rate analysis. Experiment 2 involved collection of normative and test-retest reliability data.
STUDY SAMPLE: Twenty adults (aged 25 yr 10 mo to 50 yr 7 mo, mean 36 yr 4 mo) took part in the development study; 62 normal-hearing, typically developing, primary-school children (aged 7 yr 1 mo to 11 yr 11 mo, mean 9 yr 4 mo) and 10 adults (aged 25 yr 0 mo to 51 yr 6 mo, mean 34 yr 10 mo) took part in the normative and test-retest reliability study.
DATA COLLECTION AND ANALYSIS: In Experiment 1, error rate analysis was conducted on the 36 digit-pair combinations of the DDdT. Normative data collected in Experiment 2 were arcsine transformed to achieve a distribution that was closer to a normal distribution and z-scores calculated. Pearson product-moment correlations were used to determine the strength of relationships between DDdT conditions.
RESULTS: The development study revealed no significant differences in the adult population between test and retest on any DDdT condition. Error rates on 36 digit pairs ranged from 1.5% to 16.7%. The most and the least error-prone digits were removed before commencement of the normative data study, leaving 25 unique digit pairs. Average z-scores calculated from the arcsine-transformed data collected from the 62 children who took part in the normative data study revealed that FR dichotic processing (LE, RE, and total) was highly correlated with diotic processing (r ranging from 0.5 to 0.6; p < 0.0001). Significant improvements in performance on retest occurred for the FR LE, RE, total, and diotic conditions (p ranging from 0.05 to 0.0004), the conditions that would be expected to improve with practice if the participant's response strategies are better the second time around.
CONCLUSIONS: The addition of a diotic control task-that shares many response demands with the usual dichotic tasks-opens up the possibility of differentiating children who perform below expectations because of poor dichotic processing skills from those who perform poorly because of impaired attention, memory, or other cognitive abilities. The high correlation between dichotic and diotic performance suggests that factors other than dichotic performance play a substantial role in a child's ability to perform a dichotic listening task. This hypothesis is investigated further in the cognitive correlation study that follows in the companion paper (DDdT Study Part 2; Cameron et al, 2016).

PMID: 27310404 [PubMed - as supplied by publisher]

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Perceptions Toward Internet-Based Delivery of Hearing Aids among Older Hearing-Impaired Adults.

Perceptions Toward Internet-Based Delivery of Hearing Aids among Older Hearing-Impaired Adults.

J Am Acad Audiol. 2016 Jun;27(6):441-457

Authors: Chandra N, Searchfield GD

Abstract
BACKGROUND: Despite evidence that hearing aids can improve the social and psychological functioning of older hearing-impaired adults, hearing aid uptake is low. High cost of hearing aids and poor access to audiology services in rural areas are potential barriers to hearing aid acquisition. Methods of hearing aid delivery deviating from the traditional clinician-based model have been available to consumers for many years. One such method is Internet hearing aid sales. However, research exploring Internet-based hearing aid delivery, as a method to improve hearing aid uptake in this population, is limited.
PURPOSE: The purpose of this study was to explore the perceptions of older hearing aid users (aged ≥65 yr) toward Internet-based hearing aid delivery.
RESEARCH DESIGN: A qualitative approach was adopted to investigate older adults' perceptions of buying hearing aids online.
STUDY SAMPLE: The sample consisted of 18 participants aged between 64 and 81 yr. Fourteen men and four women participated in this study. Participants were all experienced hearing aid users.
DATA COLLECTION AND ANALYSIS: Face-to-face semistructured interviews were conducted. An interview schedule guided the interview. Interviews were recorded with a voice recorder and transcribed verbatim. Thematic analysis of the data was carried out.
RESULTS: Seven main themes emerged from the data. A general lack of awareness, but willingness to learn more about Internet hearing aid sales, was found. Two perceived benefits of Internet-based hearing aid delivery were identified: lower cost of hearing aids and greater convenience or physical accessibility. Numerous concerns and limitations were communicated. Concerns regarding the availability of clinical procedures, such as hearing tests, obtaining the correct-sized earmolds, and fine-tuning of hearing aids, were expressed. Participants conveyed distrust in online retailers. However, trust in and a preference for audiologists' expertise, which was not perceived to be available online, was found. Participants further conveyed a preference for face-to-face contact. Finally, in this sample, a general lack of familiarity and confidence in using the Internet was communicated.
CONCLUSIONS: Internet sales of hearing aids is a controversial topic in audiology. Although Internet-based delivery of hearing aids was perceived by older adults to be potentially beneficial, several shortcomings and concerns were conveyed. Irrespective of opinion of the role of Internet sales, audiologists should consider the opinions of the elderly as to how different service models may improve hearing aid uptake.

PMID: 27310403 [PubMed - as supplied by publisher]

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Clinical Outcomes of the Cochlear™ Nucleus(®) 5 Cochlear Implant System and SmartSound™ 2 Signal Processing.

Clinical Outcomes of the Cochlear™ Nucleus(®) 5 Cochlear Implant System and SmartSound™ 2 Signal Processing.

J Am Acad Audiol. 2016 Jun;27(6):425-440

Authors: Runge CL, Henion K, Tarima S, Beiter A, Zwolan TA

Abstract
BACKGROUND: While published data exist regarding cochlear implant (CI) outcomes from large academic programs, evidence of benefit based on national, multicenter clinical trials is needed for information regarding typical patient outcomes of devices implanted by U.S. centers representing larger academic to smaller hospital-based programs.
PURPOSE: This nationwide trial evaluated outcomes in a group of newly implanted adult recipients of the Cochlear™ Nucleus(®) 5 CI system and SmartSound™ 2 signal processing. Unlike previous clinical trials, the AzBio sentence test was used and represents recent transition in our field to use of more challenging test materials. It was hypothesized that (1) speech perception scores in quiet with SmartSound™ 2 signal processing would not be statistically different from previous-generation devices; (2) speech perception scores in noise with SmartSound™ 2 signal processing would be better with enhanced microphone directionality; (3) speech perception scores in noise will be better with the preferred SmartSound™ 2 program for listening in noise; and (4) cochlear implantation would improve quality of life as assessed by the updated Health Utility Index Mark 3 (HUI3). A secondary purpose was to examine the relationships among the current and previously used speech perception tests of the Minimum Speech Test Battery (MSTB). It was hypothesized that speech perception scores within the same test interval would show predictive relationships.
RESEARCH DESIGN: Prospective, single-arm, repeated-measures study across 13 CI centers in the United States between February 2010 and June 2012. The participating centers ranged from larger academic to smaller hospital-based programs to accurately represent the diversity of programs in the United States.
STUDY SAMPLE: Participants were 38 postlingually deafened adult CI candidates.
DATA COLLECTION AND ANALYSIS: Primary measures were Consonant-Nucleus-Consonant (CNC) words in quiet and the AzBio Sentence Test in Quiet (AzBioQ) and in Noise (AzBioN) tested at preoperative, and 3-, 6-, and 12-mo postactivation intervals. Quality of life was measured with the HUI3. For the secondary objective, statistical analyses were performed to investigate the predictive properties between current and previously used MSTB tests.
RESULTS: Mean CNC scores were significantly higher compared to the Nucleus(®) 24 Contour™ at 3 mo (p < 0.05) postactivation and showed no difference compared to the Nucleus(®) Freedom™ at 6 mo postactivation. Both SmartSound™ 2 FOCUS and NOISE programs provided significant improvements in performance in noise over the EVERYDAY program (p < 0.001), and performance with the FOCUS program was significantly better compared to the NOISE program (p < 0.001). Speech perception in noise was not related to patients' subjective program preferences. Quality-of-life outcomes showed significant improvements from the preoperative to 6-mo postactivation interval (p < 0.05-0.001). Strong and significant correlations were found between preoperative CNC and AzBioQ and preoperative Hearing-in-Noise Test sentences in Quiet (HINTQ) and AzBioQ. At 12-mo postactivation, there were strong and highly significant correlations between CNC and AzBioQ, HINTQ and AzBioQ, and Hearing-in-Noise Test sentences in Noise and AzBioN (all p < 0.001).
CONCLUSIONS: Results of this national clinical trial showed significant improvements in speech perception and quality of life following cochlear implantation. SmartSound™ 2 signal processing features showed a significant benefit of FOCUS when listening in noise, although preference of signal processing feature did not correlate with performance. Significant correlations were observed between speech perception tests. The findings of this study can be applied in clinical assessment, programming, and follow-up for CI candidates and recipients.

PMID: 27310402 [PubMed - as supplied by publisher]

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Perceptions of Internet Delivery of Hearing Aids.

Perceptions of Internet Delivery of Hearing Aids.

J Am Acad Audiol. 2016 Jun;27(6):424

Authors: Jacobson GP

PMID: 27310401 [PubMed - as supplied by publisher]

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Perception of Small Frequency Differences in Children with Auditory Processing Disorder or Specific Language Impairment.

Perception of Small Frequency Differences in Children with Auditory Processing Disorder or Specific Language Impairment.

J Am Acad Audiol. 2016 Jun;27(6):489-497

Authors: Rota-Donahue C, Schwartz RG, Shafer V, Sussman ES

Abstract
BACKGROUND: Frequency discrimination is often impaired in children developing language atypically. However, findings in the detection of small frequency changes in these children are conflicting. Previous studies on children's auditory perceptual abilities usually involved establishing differential sensitivity thresholds in sample populations who were not tested for auditory deficits. To date, there are no data comparing suprathreshold frequency discrimination ability in children tested for both auditory processing and language skills.
PURPOSE: : This study examined the perception of small frequency differences (∆ƒ) in children with auditory processing disorder (APD) and/or specific language impairment (SLI). The aim was to determine whether children with APD and children with SLI showed differences in their behavioral responses to frequency changes. Results were expected to identify different degrees of impairment and shed some light on the auditory perceptual overlap between pediatric APD and SLI.
RESEARCH DESIGN: An experimental group design using a two-alternative forced-choice procedure was used to determine frequency discrimination ability for three magnitudes of ∆ƒ from the 1000-Hz base frequency.
STUDY SAMPLE: Thirty children between 10 years of age and 12 years, 11 months of age: 17 children with APD and/or SLI, and 13 typically developing (TD) peers participated. The clinical groups included four children with APD only, four children with SLI only, and nine children with both APD and SLI.
DATA COLLECTION AND ANALYSIS: Behavioral data collected using headphone delivery were analyzed using the sensitivity index d', calculated for three ∆ƒ was 2%, 5%, and 15% of the base frequency or 20, 50, and 150 Hz. Correlations between the dependent variable d' and the independent variables measuring auditory processing and language skills were also obtained. A stepwise regression analysis was then performed.
RESULTS: TD children and children with APD and/or SLI differed in the detection of small-tone ∆ƒ. In addition, APD or SLI status affected behavioral results differently. Comparisons between auditory processing test scores or language test scores and the sensitivity index d' showed different strengths of correlation based on the magnitudes of the ∆ƒ. Auditory processing scores showed stronger correlation to the sensitivity index d' for the small ∆ƒ, while language scores showed stronger correlation to the sensitivity index d' for the large ∆ƒ.
CONCLUSION: Although children with APD and/or SLI have difficulty with behavioral frequency discrimination, this difficulty may stem from two different levels: a basic auditory level for children with APD and a higher language processing level for children with SLI; the frequency discrimination performance seemed to be affected by the labeling demands of the same versus different frequency discrimination task for the children with SLI.

PMID: 27310407 [PubMed - as supplied by publisher]

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Factors Affecting Speech Discrimination in Children with Cochlear Implants: Evidence from Early-Implanted Infants.

Factors Affecting Speech Discrimination in Children with Cochlear Implants: Evidence from Early-Implanted Infants.

J Am Acad Audiol. 2016 Jun;27(6):480-488

Authors: Phan J, Houston DM, Ruffin C, Ting J, Holt RF

Abstract
BACKGROUND: To learn words and acquire language, children must be able to discriminate and correctly perceive phonemes. Although there has been much research on the general language outcomes of children with cochlear implants (CIs), little is known about the development of speech perception with regard to specific speech processes, such as speech discrimination.
PURPOSE: The purpose of this study was to investigate the development of speech discrimination in infants with CIs and identify factors that might correlate with speech discrimination skills.
RESEARCH DESIGN: Using a Hybrid Visual Habituation procedure, we tested infants with CIs on their ability to discriminate the vowel contrast /i/-/u/. We also gathered demographic and audiological information about each infant.
STUDY SAMPLE: Children who had received CIs before 2 yr of age served as participants. We tested the children at two post cochlear implantation intervals: 2-4 weeks post CI stimulation (N = 17) and 6-9 mo post CI stimulation (N = 10).
DATA COLLECTION AND ANALYSIS: The infants' mean looking times during the novel versus old trials of the experiment were measured. A linear regression model was used to evaluate the relationship between the normalized looking time difference and the following variables: chronological age, age at CI stimulation, gender, communication mode, and best unaided pure-tone average.
RESULTS: We found that the best unaided pure-tone average predicted speech discrimination at the early interval. In contrast to some previous speech perception studies that included children implanted before 3 yr of age, age at CI stimulation did not predict speech discrimination performance.
CONCLUSIONS: The results suggest that residual acoustic hearing before implantation might facilitate speech discrimination during the early period post cochlear implantation; with more hearing experience, communication mode might have a greater influence on the ability to discriminate speech. This and other studies on age at cochlear implantation suggest that earlier implantation might not have as large an effect on speech perception as it does on other language skills.

PMID: 27310406 [PubMed - as supplied by publisher]

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Investigating the Interaction between Dichotic Deficits and Cognitive Abilities Using the Dichotic Digits difference Test (DDdT) Part 2.

Investigating the Interaction between Dichotic Deficits and Cognitive Abilities Using the Dichotic Digits difference Test (DDdT) Part 2.

J Am Acad Audiol. 2016 Jun;27(6):470-479

Authors: Cameron S, Glyde H, Dillon H, Whitfield J

Abstract
BACKGROUND: The Dichotic Digits difference Test (DDdT) was developed to investigate the relationship between dichotic processing and cognitive abilities and, through the use of differential test scores, to provide professionals with a clinical tool that could aid in differentiation of clients with genuine dichotic deficits from those where cognitive disorders affect test performance. The DDdT consists of four subtests: dichotic free recall (FR), dichotic directed left ear, dichotic directed right ear, and diotic. Scores are calculated for six conditions: FR left ear (LE), right ear (RE), and total, as well as the directed left ear, directed right ear, and diotic, and four difference measures: dichotic advantage, RE advantage FR, RE advantage directed, and attention advantage.
PURPOSE: To investigate the role of cognitive abilities on DDdT test performance.
RESEARCH DESIGN: Correlational analysis between the various DDdT conditions and difference measures, as well as between dichotic, diotic, and cognitive factors (memory, intelligence, and attention).
STUDY SAMPLE: Fifty typically developing children (aged 7 yr 0 mo to 12 yr 1 mo, mean = 9 yr 2 mo) and ten children recruited from the Australian Hearing CAPD Service who were diagnosed with a memory or dichotic deficit (aged 7 yr 0 mo to 15 yr 0 mo, mean = 9 yr 5 mo) took part in the study.
DATA COLLECTION AND ANALYSIS: The Pearson product moment correlations were used to determine the strength of relationships between DDdT conditions as well as relationships between scores on these conditions and performance on the various cognitive assessment tools, which included the number memory forward and reversed subtests of the Test of Auditory Processing Skills - Third Edition, IVA + Plus Continuous Performance Test, and the Test of Non-Verbal Intelligence-4 (TONI-4). A parent questionnaire (Fisher's Auditory Checklist) and a participant questionnaire (Listening Inventory for Education) were also administered.
RESULTS: Diotic performance was significantly correlated with performance on all the DDdT dichotic FR conditions (r = 0.6-0.8; p < 0.00001). Further, significant correlations were found between the FR LE, total, and diotic conditions, and the cognitive measures of attention and memory, with r ranging from 0.4 to 0.5 (p < 0.01-0.001). Right-ear performance was not significantly correlated to any cognitive measure, except for FR RE and number memory forward (r = 0.35; p = 0.006). The DDdT dichotic advantage measure was investigated in a subset of clinical children and found to aid in differentiating true dichotic from spurious results.
CONCLUSIONS: As found in the DDdT normative data study that precedes in the companion paper (DDdT Study Part 1; Cameron et al, 2016), the high correlation between dichotic and diotic performances by the clinical and typically developing participants suggests that factors other than dichotic performance play a substantial role in a child's ability to perform a dichotic listening task. Indeed, 61% of the variance in FR total scores for the children in this study was accounted for by factors that do not involve the perception of dichotic stimuli. This view is supported by the correlations between measures of attention and memory and dichotic scores. This result has wide-spread implications in respect to interpretation of central auditory processing disorder test results and further investigation of the use of the DDdT in a clinical population is warranted.

PMID: 27310405 [PubMed - as supplied by publisher]

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The Dichotic Digits difference Test (DDdT): Development, Normative Data, and Test-Retest Reliability Studies Part 1.

The Dichotic Digits difference Test (DDdT): Development, Normative Data, and Test-Retest Reliability Studies Part 1.

J Am Acad Audiol. 2016 Jun;27(6):458-469

Authors: Cameron S, Glyde H, Dillon H, Whitfield J, Seymour J

Abstract
BACKGROUND: The dichotic digits test is one of the most widely used assessment tools for central auditory processing disorder. However, questions remain concerning the impact of cognitive factors on test results.
PURPOSE: To develop the Dichotic Digits difference Test (DDdT), an assessment tool that could differentiate children with cognitive deficits from children with genuine dichotic deficits based on differential test results. The DDdT consists of four subtests: dichotic free recall (FR), dichotic directed left ear (DLE), dichotic directed right ear (DRE), and diotic. Scores for six conditions are calculated (FR left ear [LE], FR right ear [RE], and FR total, as well as DLE, DRE, and diotic). Scores for four difference measures are also calculated: dichotic advantage, right-ear advantage (REA) FR, REA directed, and attention advantage.
RESEARCH DESIGN: Experiment 1 involved development of the DDdT, including error rate analysis. Experiment 2 involved collection of normative and test-retest reliability data.
STUDY SAMPLE: Twenty adults (aged 25 yr 10 mo to 50 yr 7 mo, mean 36 yr 4 mo) took part in the development study; 62 normal-hearing, typically developing, primary-school children (aged 7 yr 1 mo to 11 yr 11 mo, mean 9 yr 4 mo) and 10 adults (aged 25 yr 0 mo to 51 yr 6 mo, mean 34 yr 10 mo) took part in the normative and test-retest reliability study.
DATA COLLECTION AND ANALYSIS: In Experiment 1, error rate analysis was conducted on the 36 digit-pair combinations of the DDdT. Normative data collected in Experiment 2 were arcsine transformed to achieve a distribution that was closer to a normal distribution and z-scores calculated. Pearson product-moment correlations were used to determine the strength of relationships between DDdT conditions.
RESULTS: The development study revealed no significant differences in the adult population between test and retest on any DDdT condition. Error rates on 36 digit pairs ranged from 1.5% to 16.7%. The most and the least error-prone digits were removed before commencement of the normative data study, leaving 25 unique digit pairs. Average z-scores calculated from the arcsine-transformed data collected from the 62 children who took part in the normative data study revealed that FR dichotic processing (LE, RE, and total) was highly correlated with diotic processing (r ranging from 0.5 to 0.6; p < 0.0001). Significant improvements in performance on retest occurred for the FR LE, RE, total, and diotic conditions (p ranging from 0.05 to 0.0004), the conditions that would be expected to improve with practice if the participant's response strategies are better the second time around.
CONCLUSIONS: The addition of a diotic control task-that shares many response demands with the usual dichotic tasks-opens up the possibility of differentiating children who perform below expectations because of poor dichotic processing skills from those who perform poorly because of impaired attention, memory, or other cognitive abilities. The high correlation between dichotic and diotic performance suggests that factors other than dichotic performance play a substantial role in a child's ability to perform a dichotic listening task. This hypothesis is investigated further in the cognitive correlation study that follows in the companion paper (DDdT Study Part 2; Cameron et al, 2016).

PMID: 27310404 [PubMed - as supplied by publisher]

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Perceptions Toward Internet-Based Delivery of Hearing Aids among Older Hearing-Impaired Adults.

Perceptions Toward Internet-Based Delivery of Hearing Aids among Older Hearing-Impaired Adults.

J Am Acad Audiol. 2016 Jun;27(6):441-457

Authors: Chandra N, Searchfield GD

Abstract
BACKGROUND: Despite evidence that hearing aids can improve the social and psychological functioning of older hearing-impaired adults, hearing aid uptake is low. High cost of hearing aids and poor access to audiology services in rural areas are potential barriers to hearing aid acquisition. Methods of hearing aid delivery deviating from the traditional clinician-based model have been available to consumers for many years. One such method is Internet hearing aid sales. However, research exploring Internet-based hearing aid delivery, as a method to improve hearing aid uptake in this population, is limited.
PURPOSE: The purpose of this study was to explore the perceptions of older hearing aid users (aged ≥65 yr) toward Internet-based hearing aid delivery.
RESEARCH DESIGN: A qualitative approach was adopted to investigate older adults' perceptions of buying hearing aids online.
STUDY SAMPLE: The sample consisted of 18 participants aged between 64 and 81 yr. Fourteen men and four women participated in this study. Participants were all experienced hearing aid users.
DATA COLLECTION AND ANALYSIS: Face-to-face semistructured interviews were conducted. An interview schedule guided the interview. Interviews were recorded with a voice recorder and transcribed verbatim. Thematic analysis of the data was carried out.
RESULTS: Seven main themes emerged from the data. A general lack of awareness, but willingness to learn more about Internet hearing aid sales, was found. Two perceived benefits of Internet-based hearing aid delivery were identified: lower cost of hearing aids and greater convenience or physical accessibility. Numerous concerns and limitations were communicated. Concerns regarding the availability of clinical procedures, such as hearing tests, obtaining the correct-sized earmolds, and fine-tuning of hearing aids, were expressed. Participants conveyed distrust in online retailers. However, trust in and a preference for audiologists' expertise, which was not perceived to be available online, was found. Participants further conveyed a preference for face-to-face contact. Finally, in this sample, a general lack of familiarity and confidence in using the Internet was communicated.
CONCLUSIONS: Internet sales of hearing aids is a controversial topic in audiology. Although Internet-based delivery of hearing aids was perceived by older adults to be potentially beneficial, several shortcomings and concerns were conveyed. Irrespective of opinion of the role of Internet sales, audiologists should consider the opinions of the elderly as to how different service models may improve hearing aid uptake.

PMID: 27310403 [PubMed - as supplied by publisher]

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Clinical Outcomes of the Cochlear™ Nucleus(®) 5 Cochlear Implant System and SmartSound™ 2 Signal Processing.

Clinical Outcomes of the Cochlear™ Nucleus(®) 5 Cochlear Implant System and SmartSound™ 2 Signal Processing.

J Am Acad Audiol. 2016 Jun;27(6):425-440

Authors: Runge CL, Henion K, Tarima S, Beiter A, Zwolan TA

Abstract
BACKGROUND: While published data exist regarding cochlear implant (CI) outcomes from large academic programs, evidence of benefit based on national, multicenter clinical trials is needed for information regarding typical patient outcomes of devices implanted by U.S. centers representing larger academic to smaller hospital-based programs.
PURPOSE: This nationwide trial evaluated outcomes in a group of newly implanted adult recipients of the Cochlear™ Nucleus(®) 5 CI system and SmartSound™ 2 signal processing. Unlike previous clinical trials, the AzBio sentence test was used and represents recent transition in our field to use of more challenging test materials. It was hypothesized that (1) speech perception scores in quiet with SmartSound™ 2 signal processing would not be statistically different from previous-generation devices; (2) speech perception scores in noise with SmartSound™ 2 signal processing would be better with enhanced microphone directionality; (3) speech perception scores in noise will be better with the preferred SmartSound™ 2 program for listening in noise; and (4) cochlear implantation would improve quality of life as assessed by the updated Health Utility Index Mark 3 (HUI3). A secondary purpose was to examine the relationships among the current and previously used speech perception tests of the Minimum Speech Test Battery (MSTB). It was hypothesized that speech perception scores within the same test interval would show predictive relationships.
RESEARCH DESIGN: Prospective, single-arm, repeated-measures study across 13 CI centers in the United States between February 2010 and June 2012. The participating centers ranged from larger academic to smaller hospital-based programs to accurately represent the diversity of programs in the United States.
STUDY SAMPLE: Participants were 38 postlingually deafened adult CI candidates.
DATA COLLECTION AND ANALYSIS: Primary measures were Consonant-Nucleus-Consonant (CNC) words in quiet and the AzBio Sentence Test in Quiet (AzBioQ) and in Noise (AzBioN) tested at preoperative, and 3-, 6-, and 12-mo postactivation intervals. Quality of life was measured with the HUI3. For the secondary objective, statistical analyses were performed to investigate the predictive properties between current and previously used MSTB tests.
RESULTS: Mean CNC scores were significantly higher compared to the Nucleus(®) 24 Contour™ at 3 mo (p < 0.05) postactivation and showed no difference compared to the Nucleus(®) Freedom™ at 6 mo postactivation. Both SmartSound™ 2 FOCUS and NOISE programs provided significant improvements in performance in noise over the EVERYDAY program (p < 0.001), and performance with the FOCUS program was significantly better compared to the NOISE program (p < 0.001). Speech perception in noise was not related to patients' subjective program preferences. Quality-of-life outcomes showed significant improvements from the preoperative to 6-mo postactivation interval (p < 0.05-0.001). Strong and significant correlations were found between preoperative CNC and AzBioQ and preoperative Hearing-in-Noise Test sentences in Quiet (HINTQ) and AzBioQ. At 12-mo postactivation, there were strong and highly significant correlations between CNC and AzBioQ, HINTQ and AzBioQ, and Hearing-in-Noise Test sentences in Noise and AzBioN (all p < 0.001).
CONCLUSIONS: Results of this national clinical trial showed significant improvements in speech perception and quality of life following cochlear implantation. SmartSound™ 2 signal processing features showed a significant benefit of FOCUS when listening in noise, although preference of signal processing feature did not correlate with performance. Significant correlations were observed between speech perception tests. The findings of this study can be applied in clinical assessment, programming, and follow-up for CI candidates and recipients.

PMID: 27310402 [PubMed - as supplied by publisher]

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Perceptions of Internet Delivery of Hearing Aids.

Perceptions of Internet Delivery of Hearing Aids.

J Am Acad Audiol. 2016 Jun;27(6):424

Authors: Jacobson GP

PMID: 27310401 [PubMed - as supplied by publisher]

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Association of TMTC2 With Human Nonsyndromic Sensorineural Hearing Loss.

Association of TMTC2 With Human Nonsyndromic Sensorineural Hearing Loss.

JAMA Otolaryngol Head Neck Surg. 2016 Jun 16;

Authors: Runge CL, Indap A, Zhou Y, Kent JW, King E, Erbe CB, Cole R, Littrell J, Merath K, James R, Rüschendorf F, Kerschner JE, Marth G, Hübner N, Göring HH, Friedland DR, Kwok WM, Olivier M

Abstract
Importance: Sensorineural hearing loss (SNHL) is commonly caused by conditions that affect cochlear structures or the auditory nerve, and the genes identified as causing SNHL to date only explain a fraction of the overall genetic risk for this debilitating disorder. It is likely that other genes and mutations also cause SNHL.
Objective: To identify a candidate gene that causes bilateral, symmetric, progressive SNHL in a large multigeneration family of Northern European descent.
Design, Setting, and Participants: In this prospective genotype and phenotype study performed from January 1, 2006, through April 1, 2016, a 6-generation family of Northern European descent with 19 individuals having reported early-onset hearing loss suggestive of an autosomal dominant inheritance were studied at a tertiary academic medical center. In addition, 179 unrelated adult individuals with SNHL and 186 adult individuals reporting nondeafness were examined.
Main Outcomes and Measures: Sensorineural hearing loss.
Results: Nine family members (5 women [55.6%]) provided clinical audiometric and medical records that documented hearing loss. The hearing loss is characterized as bilateral, symmetric, progressive SNHL that reached severe to profound loss in childhood. Audiometric configurations demonstrated a characteristic dip at 1000 to 2000 Hz. All affected family members wear hearing aids or have undergone cochlear implantation. Exome sequencing and linkage and association analyses identified a fully penetrant sequence variant (rs35725509) on chromosome 12q21 (logarithm of odds, 3.3) in the TMTC2 gene region that segregates with SNHL in this family. This gene explains the SNHL occurrence in this family. The variant is also associated with SNHL in a cohort of 363 unrelated individuals (179 patients with confirmed SNHL and 184 controls, P = 7 × 10-4).
Conclusions and Relevance: A previously uncharacterized gene, TMTC2, has been identified as a candidate for causing progressive SNHL in humans. This finding identifies a novel locus that causes autosomal dominant SNHL and therefore a more detailed understanding of the genetic basis of SNHL. Because TMTC2 has not been previously reported to regulate auditory function, the discovery reveals a potentially new, uncharacterized mechanism of hearing loss.

PMID: 27311106 [PubMed - as supplied by publisher]

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[Protective effect of peperphentonamine injection through the otocyst against gentamicin- induced cochlear damage in guinea pigs].

Related Articles

[Protective effect of peperphentonamine injection through the otocyst against gentamicin- induced cochlear damage in guinea pigs].

Nan Fang Yi Ke Da Xue Xue Bao. 2016 Apr;36(4):557-61

Authors: Li BB, Wu J, Chen J, Chen H, Li YH

Abstract
OBJECTIVE: To explore the relationship of gentamicin-induced cochlear damage with autophagy-related protein LC3, beclin1, Na(+-)K(+-)2Cl(-) cotransporter (NKCC1) mRNA and endothelin-1 (ET-1), and investigate the protective mechanism of PPTA against gentamicin-induced cochlear damage.
METHODS: Sixty guinea pigs were randomly divided into control group (with saline and artificial perilymph injections), model group (with gentamicin and artificial perilymph injections), concurrent treatment group (with gentamicin and PPTA injections), model control group (with artificial perilymph injection 7 days after gentamicin injection) and delayed treatment group (with PPTA injection 7 days after gentamicin injection). Saline and gentamicin (160 mg/kg) were injected intraperitoneally, and artificial perilymph and PPTA were injected into the otocysts on a daily basis for 7 consecutive days. Hearing impairment of the guinea pigs was analyzed with ABR, and the protein expressions of beclin1 and LC3 in cochlear tissue were tested. The expression of NKCC1 mRNA was detected with RT-PCR, and the expression of ET-1 was detected immunohistochemically.
RESULTS: The ABR thresholds in the model group and model control group were similar (P>0.05) , but significantly higher than those in the other 3 groups (P<0.05); the threshold was significantly lower in concurrent treatment group than in delayed treatment group (P<0.05). Compared with those in the other 4 groups, the expressions of LC3 II, beclin1, and NKCC1 mRNA were significantly increased in the model group (P<0.05); and those in delayed treatment group were significantly lower than those in the model control group (P<0.05). The expressions of ET-1 in the Corti organ, striavascularis and spiral ganglion were significantly higher in the model group but significantly lower in the control group than those in the other 4 groups; ET-1 expression was significantly lower in delayed treatment group than in the model control group.
CONCLUSION: PPTA offers protection against gantamicin-induced cochlear damage in guinea pigs by inhibiting cell autophagy and suppressing of NKCC1 and ET-1 expressions. Early intervention with PPTA produces better therapeutic effect, suggesting that gantamicin causes irreversible injury of the auditory cells.

PMID: 27113187 [PubMed - indexed for MEDLINE]

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Comprehensive handbook of pediatric audiology - second edition.

Comprehensive handbook of pediatric audiology - second edition.

Int J Audiol. 2016 Jun 16;:1-2

Authors: Flynn T

PMID: 27309404 [PubMed - as supplied by publisher]

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Comprehensive handbook of pediatric audiology - second edition

10.1080/14992027.2016.1195020<br/>Traci Flynn

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Comprehensive handbook of pediatric audiology - second edition.

Comprehensive handbook of pediatric audiology - second edition.

Int J Audiol. 2016 Jun 16;:1-2

Authors: Flynn T

PMID: 27309404 [PubMed - as supplied by publisher]

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Comprehensive handbook of pediatric audiology - second edition.

Comprehensive handbook of pediatric audiology - second edition.

Int J Audiol. 2016 Jun 16;:1-2

Authors: Flynn T

PMID: 27309404 [PubMed - as supplied by publisher]

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Comprehensive handbook of pediatric audiology - second edition

10.1080/14992027.2016.1195020<br/>Traci Flynn

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Comprehensive handbook of pediatric audiology - second edition.

Comprehensive handbook of pediatric audiology - second edition.

Int J Audiol. 2016 Jun 16;:1-2

Authors: Flynn T

PMID: 27309404 [PubMed - as supplied by publisher]

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Comprehensive handbook of pediatric audiology - second edition

10.1080/14992027.2016.1195020<br/>Traci Flynn

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Comprehensive handbook of pediatric audiology - second edition

10.1080/14992027.2016.1195020<br/>Traci Flynn

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Comprehensive handbook of pediatric audiology - second edition

10.1080/14992027.2016.1195020<br/>Traci Flynn

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Therapy of Vestibular Paroxysmia, Superior Oblique Myokymia, and Ocular Neuromyotonia.

Therapy of Vestibular Paroxysmia, Superior Oblique Myokymia, and Ocular Neuromyotonia.

Curr Treat Options Neurol. 2016 Jul;18(7):34

Authors: Strupp M, Dieterich M, Brandt T, Feil K

Abstract
OPINION STATEMENT: Neurovascular compression syndromes are characterized by recurrent attacks of neurological symptoms and clinical signs depending on the cranial nerve affected. It is assumed that pulsatile compression of the nerve is caused mainly by an artery. The result is segmental demyelination of the transition zone or the central part of the cranial nerve, which is covered by oligodendrocytes, and subsequent ephaptic axonal transmission. Compression of the vestibular nerve can cause attacks of spinning or non-spinning vertigo: vestibular paroxysmia. Compression of the trochlear nerve is characterized by attacks of monocular oscillopsia: superior oblique myokymia. Damage to ocular motor nerves due to local radiation or rarely neurovascular compression can also lead to oscillopsia and double vision precipitated by sustained excentric gaze: ocular neuromyotonia. It is important to note that controlled trials have so far not been performed for any of these three syndromes, mainly because of their low prevalence. Therefore, treatment recommendations are based on single cases or small case series and thus have the lowest level of evidence. The sodium channel blockers carbamazepine (50 to 200 mg tid) or oxcarbazepine (100 to 300 mg tid) are evidently effective in most of the patients who have these three syndromes. However, one should always keep in mind the contraindications, side effects, and interactions with other drugs of carbamazepine ( http://ift.tt/1Ou1j6T ) All patients require regular laboratory examinations. Alternatives are other sodium channel blockers such as phenytoin (100 to 300 mg tid), gabapentin (100 to 600 mg tid), or valproic acid (100 to 300 mg tid). Furthermore, there are also few reports on the effects of beta blockers, which may be explained by their reduction of the amplitude of blood pressure. Patients who do not respond to pharmacotherapy require further diagnostics to determine the possibility of other etiologies. Some of these patients benefit from surgical decompression of the affected nerve.

PMID: 27306762 [PubMed]

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