Objective: Compare reconstruction outcomes for various lateral skull base closure techniques. Study Design: Retrospective medical records review. Setting: University-based tertiary referral center. Patients: Patients who underwent resections of tumors involving the lateral skull base requiring reconstruction beyond primary closure. Intervention(s): Reconstructive techniques, from rotational flaps to free tissue transfer. Main Outcome Measure(s): Outcome data including wound complications, cerebrospinal fluid (CSF) leakage, and need for surgical revision were tabulated. Results: Eighty-six patients underwent lateral skull base tumor resection and reconstruction. Procedures were primarily lateral temporal bone resections but also included subtotal temporal bone, total temporal bone, and infratemporal fossa resections. Cutaneous malignancy was the most common resection indication (83%) and the temporalis rotational flap was the most commonly employed reconstructive option (30%). When free tissue transfer techniques were used, the radial forearm, anterolateral thigh, and latissimus dorsi were the most frequent donor sites. Patients with T2 disease were more likely to undergo temporalis flaps, whereas patients with T4 disease were more likely to undergo free flap reconstruction. Major complications were uncommon (~8%), the most frequent being stroke (~3%). The postoperative wound complication rate was approximately 45%. The majority involved minor dehiscences and were managed conservatively. Patients with T4 disease were more likely to have wound complications (p
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Πέμπτη 10 Νοεμβρίου 2016
Transmastoid Endoscopic-Assisted Eustachian Tube Packing After Translabyrinthine Tumor Resection: A Cadaveric Feasibility Study.
Hypothesis: Endoscopically assisted packing of the Eustachian tube (ET) will improve visualization of the protympanic space compared with standard techniques with the microscope. Background: Postoperative cerebrospinal fluid (CSF) leakage after translabyrinthine tumor resection remains a problem. Current techniques of packing the ET are limited by inadequate visualization. The objective of this study is to demonstrate the feasibility and usefulness of transmastoid endoscopic-assisted ET packing during translabyrinthine tumor resection. Methods: Eight human cadaveric temporal bone dissections were performed on four heads to test the visualization that could be obtained of the ET orifice with an endoscope via transmastoid-facial recess approach. The incus body and incus buttress were removed, the aditus ad antrum enlarged, and tensor tympani muscle was cut. The scope was placed where the incus buttress had previously resided. The ET orifice was visualized and subsequently packed. Results: In all eight temporal bones, the endoscope was successfully able to visualize the ET orifice, with improved visualization of the orifice compared with standard techniques. Surgical technique and potential pitfalls are discussed. Conclusions: The transmastoid endoscopic approach for packing the ET improves visualization of the ET orifice. Packing under direct visualization provided greater reassurance that the material entered the true ET lumen as opposed to a false passage. The technique can be performed without any significant changes to standard surgical technique, allowing for a fast and accurate closure of the ET orifice and has application in potentially decreasing postoperative CSF leak rates. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Older Individuals Meeting Medicare Cochlear Implant Candidacy Criteria in Noise but not in Quiet: Are These Patients Improved by Surgery?.
Objective: To investigate postoperative hearing outcomes in older patients who qualified for cochlear implant (CI) by Medicare criteria using AZBio sentence tests performed in noise but not in quiet. Study Design: Review of patient records. Setting: University-based otology/neurotology practice. Patients: The senior author performed 136 CI between January 2013 and September 2015. Starting in 2013, CI candidacy evaluation included AZBio sentence tests performed in quiet and noise. For the current study, older patients with preoperative AZBio scores greater than 40% in quiet but less than 40% in noise (+10 or +5 dB signal to noise ratio [SNR]) and follow up >/=6 months were included. Intervention(s): Cochlear implantation in one ear. Main Outcome Measure(s): Pre- versus postoperative AZBio sentence test scores. Results: Fifteen patients with an average age of 73 years (range, 59-91) met inclusion criteria. Preoperative AZBio scores for the implanted ear averaged 47% points in quiet and 9% points in noise (+10 or +5 dB SNR). Preoperative bilateral AZBio scores averaged 70% points in quiet and 24% points in noise (+10 or +5 dB SNR). Postoperative AZBio scores for the implanted ear improved an average of 71% points in quiet and 51% points in noise. Postoperative bilateral hearing improved 23% points in quiet and 27% points in noise. Conclusion: All patients undergoing CI candidacy testing should be tested in both quiet and noise conditions. For those who qualify only in noise, our results demonstrate that cochlear implantation typically improves hearing both in quiet and noise. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Can Genre Be “Heard” in Scale as Well as Song Tasks? An Exploratory Study of Female Singing in Western Lyric and Musical Theater Styles
Source:Journal of Voice
Author(s): Gillyanne Kayes, Graham F. Welch
ObjectivesUsing an empirical design, this study investigated perceptual and acoustic differences between the recorded vocal products of songs and scales of professional female singers of classical Western Lyric (WL) and non-legit Musical Theater (MT) styles.MethodsA total of 54 audio-recorded samples of songs and scales from professional female singers were rated in a blind randomized testing process by seven expert listeners as being performed by either a WL or MT singer. Songs and scales that were accurately perceived by genre were then analyzed intra- and inter-genre using long-term average spectrum analysis.ResultsA high level of agreement was found between judges in ratings for both songs and scales according to genre (P < 0.0001). Judges were more successful in locating WL than MT, but accuracy was always >50%. For the long-term average spectrum analysis intra-genre, song and scale matched better than chance. The highest spectral peak for the WL singers was at the mean fundamental frequency, whereas this spectral area was weaker for the MT singers, who showed a marked peak at 1 kHz. The other main inter-genre difference appeared in the higher frequency region, with a peak in the MT spectrum between 4 and 5 kHz—the region of the “speaker's formant.”ConclusionsIn comparing female singers of WL and MT styles, scales as well as song tasks appear to be indicative of singer genre behavior. This implied difference in vocal production may be useful to teachers and clinicians dealing with multiple genres. The addition of a scale-in-genre task may be useful in future research seeking to identify genre-distinctive behaviors.
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Prevalence of Hearing Loss in Teachers of Singing and Voice Students
Source:Journal of Voice
Author(s): Mitchell J. Isaac, Deanna H. McBroom, Shaun A. Nguyen, Lucinda A. Halstead
ObjectivesSingers and voice teachers are exposed to a range of noise levels during a normal working day. This study aimed to assess the hearing thresholds in a large sample of generally healthy professional voice teachers and voice students to determine the prevalence of hearing loss in this population.Study DesignA cross-sectional study was carried out.MethodsVoice teachers and vocal students had the option to volunteer for a hearing screening of six standard frequencies in a quiet room with the Shoebox audiometer (Clearwater Clinical Limited) and to fill out a brief survey. Data were analyzed for the prevalence and severity of hearing loss in teachers and students based on several parameters assessed in the surveys. All data were analyzed using Microsoft Excel (Microsoft Corp.) and SPSS Statistics Software (IBM Corp.).ResultsA total of 158 participants were included: 58 self-identified as voice teachers, 106 as voice students, and 6 as both. The 6 participants who identified as both, were included in both categories for statistical purposes. Of the 158 participants, 36 had some level of hearing loss: 51.7% of voice teachers had hearing loss, and 7.5% of voice students had hearing loss. Several parameters of noise exposure were found to positively correlate with hearing loss and tinnitus (P < 0.05). Years as a voice teacher and age were both predictors of hearing loss (P < 0.05).ConclusionsHearing loss in a cohort of voice teachers appears to be more prevalent and severe than previously thought. There is a significant association between years teaching and hearing loss. Raising awareness in this population may prompt teachers and students to adopt strategies to protect their hearing.
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Botulinum Toxin-A Dosing Trends for Adductor Spasmodic Dysphonia at a Single Institution Over 10 Years
Source:Journal of Voice
Author(s): Joseph P. Bradley, Emily M. Barrow, Edie R. Hapner, Adam M. Klein, Michael M. Johns
ObjectivesThis study aimed to identify the changes in dosing of botulinum toxin-A for adductor spasmodic dysphonia (ADSD) over a prolonged period.Study DesignThis is a retrospective chart review.MethodsOne hundred thirteen subjects treated for ADSD from 2003 to 2013 were identified from a clinical database. Subject age, gender, and total injection dose amount were all recorded for all subjects who had at least 10 injections.ResultsFifty-four subjects met criteria for inclusion. There were no age or gender differences in the starting dose for subjects. Dosing decreased significantly compared with the second dose (5.05 ± 1.623 Units), by the sixth dose (4.26 ± 1.698 Units), and continued through the 10th dose (4.08 ± 2.019 Units) (P < 0.005 for all).ConclusionsBotulinum toxin-A dosing for ADSD decreases consistently over subsequent injections after the initial two dose titrations.
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The Effects of Compensatory Auditory Stimulation and High-Definition Transcranial Direct Current Stimulation (HD-tDCS) on Tinnitus Perception – A Randomized Pilot Study
by Simon Henin, Dovid Fein, Eric Smouha, Lucas C. Parra
BackgroundTinnitus correlates with elevated hearing thresholds and reduced cochlear compression. We hypothesized that reduced peripheral input leads to elevated neuronal gain resulting in the perception of a phantom sound.
ObjectiveThe purpose of this pilot study was to test whether compensating for this peripheral deficit could reduce the tinnitus percept acutely using customized auditory stimulation. To further enhance the effects of auditory stimulation, this intervention was paired with high-definition transcranial direct current stimulation (HD-tDCS).
MethodsA randomized sham-controlled, single blind study was conducted in a clinical setting on adult participants with chronic tinnitus (n = 14). Compensatory auditory stimulation (CAS) and HD-tDCS were administered either individually or in combination in order to access the effects of both interventions on tinnitus perception. CAS consisted of sound exposure typical to daily living (20-minute sound-track of a TV show), which was adapted with compressive gain to compensate for deficits in each subject's individual audiograms. Minimum masking levels and the visual analog scale were used to assess the strength of the tinnitus percept immediately before and after the treatment intervention.
ResultsCAS reduced minimum masking levels, and visual analog scale trended towards improvement. Effects of HD-tDCS could not be resolved with the current sample size.
ConclusionsThe results of this pilot study suggest that providing tailored auditory stimulation with frequency-specific gain and compression may alleviate tinnitus in a clinical population. Further experimentation with longer interventions is warranted in order to optimize effect sizes.
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The Compound Action Potential in Subjects Receiving a Cochlear Implant
Hypothesis: The compound action potential (CAP) is a purely neural component of the cochlea's response to sound, and may provide information regarding the existing neural substrate in cochlear implant (CI) subjects that can help account for variance in speech perception outcomes. Background: Measurement of the “total response” (TR), or sum of the magnitudes of spectral components in the ongoing responses to tone bursts across frequencies, has been shown to account for 40 to 50% of variance in speech perception outcomes. The ongoing response is composed of both hair cell and neural components. This correlation may be improved with the addition of the CAP. Methods: Intraoperative round window electrocochleography (ECochG) was performed in adult and pediatric CI subjects (n = 238). Stimuli were tones of different frequencies (250 Hz–4 kHz) at 90 dB nHL. The CAP was assessed in two ways, as an amplitude and with a scaling factor derived from a function fitted to the response. The results were correlated with consonant-nucleus-consonant (CNC) word scores at 6 months post-implantation (n = 51). Results: Only about half of the subjects had a measurable CAP at any frequency. The CNC word scores correlated weakly with both amplitude (r2 = 0.20, p from #Audiology via xlomafota13 on Inoreader http://journals.lww.com/otology-neurotology/Fulltext/2016/12000/The_Compound_Action_Potential_in_Subjects.31.aspx
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Temporal Bone Dissection Guide, Second Edition: Howard W. Francis and John K. Niparko; New York: Thieme, 2016.
No abstract available
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The Role of Telemedicine in Auditory Rehabilitation: A Systematic Review
Objective: The purpose of this study was to assess the feasibility and effectiveness of live telemedicine applications in hearing amplification and cochlear implantation. Data Sources and Study Selection: A systematic search was performed in PubMed, MEDLINE, PsychINFO, CINALH, and Web of Science to identify peer-reviewed research. Inclusion criteria were titles containing words from the search terms 1) audiology, otolaryngology, and hearing impairment, 2) rehabilitative methods, and 3) telemedicine. Exclusion criteria were: 1) non-English articles, and 2) non-original research. Data Extraction and Synthesis: Twelve eligible studies were identified. The studies employed a prospective design in nine of the articles and retrospective case series in three. The use of telemedicine for the provision of cochlear implant services was examined in eight of the articles and with hearing aids in four of the articles. The types of services include intraoperative cochlear implant telemetry; implant programming and assessment of electrode-specific measures and speech recognition after implantation. Hearing aid programming and remote gain assessments were also reported. Many studies assess patient and provider satisfaction along with encounter time comparison. The studies occurred from 2009 to 2014 and took place in seven countries. Conclusions: This review examined the feasibility of remote telemedicine connection to provide in auditory rehabilitation services through hearing aids and cochlear implants. There are significant concerns regarding Internet bandwidth limitations for remote clinics. There is a paucity of research examining reimbursement and cost-effectiveness for services. Further prospective research investigating cost-effectiveness and bandwidth limitations is warranted to assess long-term sustainability of remote audiological rehabilitative service delivery.from #Audiology via xlomafota13 on Inoreader http://journals.lww.com/otology-neurotology/Fulltext/2016/12000/The_Role_of_Telemedicine_in_Auditory.2.aspx
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Solitary Plasmacytoma in the Internal Auditory Canal and Cerebellopontine Angle Mimicking Meningioma
No abstract availablefrom #Audiology via xlomafota13 on Inoreader http://journals.lww.com/otology-neurotology/Fulltext/2016/12000/Solitary_Plasmacytoma_in_the_Internal_Auditory.39.aspx
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Clinical Implications of Word Recognition Differences in Earphone and Aided Conditions
Objective: To compare word recognition scores for adults with hearing loss measured using earphones and in the sound field without and with hearing aids (HA). Study Design: Independent review of presurgical audiological data from an active middle ear implant (MEI) FDA clinical trial. Setting: Multicenter prospective FDA clinical trial. Patients: Ninety-four adult HA users. Interventions/Main Outcomes Measured: Preoperative earphone, aided word recognition scores, and speech intelligibility index. Results: We performed an independent review of presurgical audiological data from an MEI FDA trial and compared unaided and aided word recognition scores with participants’ HAs fit according to the NAL-R algorithm. For 52 participants (55.3%), differences in scores between earphone and aided conditions were >10%; for 33 participants (35.1%), earphone scores were higher by 10% or more than aided scores. These participants had significantly higher pure-tone thresholds at 250, 500, and 1000 Hz, higher pure-tone averages, higher speech recognition thresholds (and higher earphone speech levels [p = 0.002]). No significant correlation was observed between word recognition scores measured with earphones and with hearing aids (r = 0.14; p = 0.16), whereas a moderately high positive correlation was observed between unaided and aided word recognition (r = 0.68; p from #Audiology via xlomafota13 on Inoreader http://journals.lww.com/otology-neurotology/Fulltext/2016/12000/Clinical_Implications_of_Word_Recognition.3.aspx
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Middle Cranial Fossa (MCF) Approach Without the Use of Lumbar Drain for the Management of Spontaneous Cerebral Spinal Fluid (CSF) Leaks
Objective: To determine the efficacy and morbidity of repairing spontaneous cerebrospinal fluid (CSF) leaks with the middle cranial fossa (MCF) approach without the use of a lumbar drain (LD), as perioperative use of LD remains controversial. Study Design: Retrospective review from 2003 to 2015. Setting: University of Iowa Hospitals and Clinics and Indiana University Health Center. Patients: Those with a confirmed lateral skull base spontaneous CSF leaks and/or encephaloceles. Intervention: MCF approach for repair of spontaneous CSF leak and/or encephalocele without the use of lumbar drain. Assessment of patient age, sex, body mass index (BMI), and medical comorbidities. Main Outcome Measure: Spontaneous CSF leak patient characteristics (age, sex, BMI, obstructive sleep apnea) were collected. Length of stay (LOS), hospital costs, postoperative complications, CSF leak rate, and need for LD were calculated. Results: Sixty-five operative MCF repairs were performed for spontaneous CSF leaks on 60 patients (five had bilateral CSF leaks). CSF diversion with LD was used in 15 of 60 patients, mostly before 2010. After 2010, only three of 44 patients (6.7%) had postoperative otorrhea requiring LD. The use of LD resulted in significantly longer LOS (3.6 ± 1.6 versus 8.7 ± 2.9 d) and hospital costs ($29,621). There were no postoperative complications in 77% (50 of 65) of cases. Three cases required return to the operating room for complications including frontal subdural hematoma (1), subdural CSF collection (1), and tension pneumocephalus (1). No patients experienced long-term neurologic sequelae or long-term CSF leak recurrence with an average length of follow-up of 19.5 months (range 3–137 mo). The average patient BMI was 37.5 ± 8.6 kg/m2. The average age was 57.5 ± 11.4 years and 68% were female. Obstructive sleep apnea was present in 43.3% (26 of 60) of patients. Conclusion: The morbidity of the MCF craniotomy for repair of spontaneous CSF leaks is low and the long-term efficacy of repair is high. Universal use of perioperative lumbar drain is not indicated and significantly increases length of stay and hospital costs. Obesity and obstructive sleep apnea are highly associated with spontaneous CSF leaks.from #Audiology via xlomafota13 on Inoreader http://journals.lww.com/otology-neurotology/Fulltext/2016/12000/Middle_Cranial_Fossa__MCF__Approach_Without_the.27.aspx
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Minimally Invasive Surgery for the Treatment of Hyperacusis
Objective: To evaluate the efficacy of a minimally invasive surgical procedure in patients with severe hyperacusis. Study Design: Prospective, longitudinal design. Setting: Tertiary referral center. Patients: Adult patients with history of severe hyperacusis. Intervention: Using a transcanal approach, the round and oval window was reinforced with temporalis fascia or tragal perichondrium in six subjects (nine ears) and was subdivided into two groups (unilateral or bilateral reinforcement procedure). Main Outcome Measures: Pre- and postoperative noise tolerance was measured using uncomfortable loudness level (ULL) test scores. In addition, a self-report hyperacusis questionnaire (HQ) was used to assess hypersensitivity to sound before and after the intervention. Results: Analysis of the data reveals improved postoperative mean ULL test scores of 14 dB (confidence interval [CI], 70–98 dB) in the unilateral group. For the bilateral group, improved mean scores were 13 dB (CI, 63–88 dB) in the first ear and 8 dB (CI, 71–86 dB) for the second ear. Further, a negative linear trend was observed in the mean subjective scores for the HQ when both groups measures were analyzed together decreasing from a mean score of 32.0 (standard deviation [SD] = 3.32) preoperative to a mean score of 11.5 (SD = 7.42) after surgery. Postoperatively, the patients reported no change in hearing and improved quality of life after the procedure. Conclusion: The results suggest that reinforcement of the round and oval window with temporalis fascia or tragal perichondrium may offer significant benefit for individuals with severe hyperacusis that has not responded to traditional therapy. ULL scores and self-report measures postoperatively demonstrate improved noise tolerance, high patient satisfaction, and enhanced quality of life.from #Audiology via xlomafota13 on Inoreader http://journals.lww.com/otology-neurotology/Fulltext/2016/12000/Minimally_Invasive_Surgery_for_the_Treatment_of.4.aspx
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Response to Letter to the Editor: “Electrocochleography Versus MRI With Intratympanic Contrast in Ménière's Disease”
No abstract available
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Long-term Incidence and Degree of Sensorineural Hearing Loss in Otosclerosis
Objectives: 1) To evaluate the long-term incidence and degree of the sensorineural component of hearing loss (SNHL) in patients with otosclerosis after accounting for expected age-related hearing loss. 2) To identify variables that might predict development of sensorineural hearing loss due to otosclerosis. Study Design: Retrospective audiometric database and chart review. Setting: Tertiary referral center. Patients: Consecutive patients with otosclerosis observed between 1994 and 2004, with ≥10 years follow-up, excluding patients with postoperative hearing loss or surgery before the initial audiogram. Intervention: Bone conduction (BC) thresholds at 0.5, 1, 2, and 4 kHz and Word Recognition. Main Outcome Measure: BC threshold change (BCTC) over ≥10 years minus estimated age-related threshold change (ARTC) specific to age and sex for each patient (based on ISO 7029 reference population). Results: Three-hundred fifty-seven ears (290 patients) met study criteria, including 217 ears that had undergone stapedectomy during the study period. Mean follow-up was 14.0 years. The average BCTC after subtracting estimated ARTC was 4.6, 2.6, 3, and 2.7 dB for 0.5, 1, 2, and 4 kHz frequencies, respectively. However, 34% of ears (122 ears) had clinically significant progression of SNHL during the study period (>10 dB BCTC beyond expected ARTC at ≥2 frequencies). Multivariate analysis demonstrated that the probability of developing clinically significant SNHL was higher for women (odds ratio 1.86, p = 0.018) and lower for operated patients (odds ratio 0.46, p = 0.002). Conclusion: The average long-term sensorineural hearing loss due to otosclerosis was statistically significantly more than for age alone at each frequency, but these average values (from 2.6 to 4.6 dB for tested frequencies) were clinically insignificant. Approximately one-third of patients with otosclerosis demonstrated a clinically significant progression of the sensorineural component of hearing loss, with the average BCTC above expected age-related changes ranging from 10.2 to 14.6 dB for tested frequencies among this subgroup.from #Audiology via xlomafota13 on Inoreader http://journals.lww.com/otology-neurotology/Fulltext/2016/12000/Long_term_Incidence_and_Degree_of_Sensorineural.5.aspx
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The Stapes Bar: An Unusual Cause of Conductive Hearing Loss With Normal Tympanic Membrane
No abstract availablefrom #Audiology via xlomafota13 on Inoreader http://journals.lww.com/otology-neurotology/Fulltext/2016/12000/The_Stapes_Bar___An_Unusual_Cause_of_Conductive.43.aspx
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The Effect of Piston Diameter in Stapedotomy for Otosclerosis: A Temporal Bone Model
Hypothesis: The use of larger-diameter pistons in stapedotomy leads to better hearing outcomes compared with the use of smaller-diameter pistons. There is an interaction between stapes piston diameter and fenestration diameter. Background: Otosclerosis can be treated surgically by removing part of the stapes and bypassing the stapes footplate with a prosthesis. Available piston shaft diameters range between 0.3 and 0.8 mm. There has been a tendency toward the use of smaller-diameter pistons, because of a suspected decreased risk of cochlear trauma and subsequent sensorineural hearing loss (SNHL) with smaller pistons. However, mathematical models, temporal bone studies, and clinical studies suggest that the use of larger-diameter pistons is associated with better hearing outcomes. Methods: Three fresh-frozen, non-pathologic temporal bones were harvested from human cadaveric donors. Acoustic stimuli in the form of pure tones from 250 to 8000 Hz were generated at 110 dB sound pressure level. A total of 16 frequencies in a 1/3-octave series were used. Stapes and round window velocities in response to the acoustic stimuli were measured at multiple equally spaced points covering the stapes footplate and round window using a scanning laser Doppler interferometry system. Eight sets of measurements were performed in each temporal bone: 1) normal condition (mobile stapes), 2) stapes fixation and stapedotomy followed by insertion of 3) a 0.4-mm-diameter piston in a 0.5-mm-diameter fenestration, 4) a 0.4-mm-diameter piston in a 0.7-mm-diameter fenestration, 5) a 0.4-mm-diameter piston in a 0.9-mm-diameter fenestration, 6) a 0.6-mm-diameter piston in a 0.7-mm-diameter fenestration, 7) a 0.6-mm-diameter piston in a 0.9-mm-diameter fenestration, and 8) a 0.8-mm-diameter piston in a 0.9-mm-diameter fenestration. Results: At midrange frequencies, between 500 and 4000 Hz, round window velocities increased by 2 to 3 dB when using a 0.6-mm-diameter piston compared with a 0.4-mm-diameter piston. Using a 0.8-mm-diameter piston led to a further increase in round window velocities by 2 to 4 dB. Conclusion: Our results suggest a modest effect of piston diameter on hearing results following stapedotomy.from #Audiology via xlomafota13 on Inoreader http://journals.lww.com/otology-neurotology/Fulltext/2016/12000/The_Effect_of_Piston_Diameter_in_Stapedotomy_for.6.aspx
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Serial cVEMP Testing is Sensitive to Disease Progression in Ménière Patients
Objective: To assess the cervical vestibular evoked myogenic potentials (cVEMPs) ability to track disease progression in Ménière's disease patients over time and identify the most sensitive outcome measurement. Study Design: Retrospective. Setting: Large specialty hospital, department of otolaryngology. Subjects: Twenty nine Ménière's patients and seven migraine associated vertigo (MAV) patients. Intervention: All patients underwent two cervical vestibular evoked myogenic potential tests at 250, 500, 750, and 1000 Hz with a minimum test interval of 3 months. Main Outcome Measures: Threshold, peak-to-peak (PP) amplitude, interaural asymmetry ratio, and effect size. Results: In affected Ménière's ears all outcome measures were worse during the second test, for threshold this difference was statistically significant at 750 and 1000 Hz compared with the first test. Compared with young healthy ears the threshold was significantly worse at all frequencies. PP amplitude was significantly decreased at the second test at 750 Hz compared with the first test. In MAV no significant difference between tests was found at any frequency in PP amplitude or threshold. In Ménière's ears, threshold showed a higher first-to-second effect size at 500, 750, and 1000 Hz compared with PP amplitude. Conclusion: cVEMP is able to track progression in Ménière's disease over time. Thresholds were the most effective outcome measure to both track progression and to distinguish between MAV and Ménière's patients.from #Audiology via xlomafota13 on Inoreader http://journals.lww.com/otology-neurotology/Fulltext/2016/12000/Serial_cVEMP_Testing_is_Sensitive_to_Disease.25.aspx
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Clinical Implication of the Threshold Equalizing Noise Test in Patients With Sudden Sensorineural Hearing Loss
Objective: The aims of the present study were to investigate the prevalence of cochlear dead regions (DRs) in patients with sudden sensorineural hearing loss (SSNHL) and compare the hearing outcome according to the presence of DRs. Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients and Methods: The threshold-equalizing noise (HL) test was performed on a total of 112 ears diagnosed with SSNHL. Ears were divided into two groups based on the presence of DRs. Eighty-two ears belonged to the group without DRs and 30 ears belonged to the group with DRs. There was no difference between the two groups with respect to age, sex, side of affected ear, presence of bilateral SSNHL, presence of vertigo, history of treatment, and initial pure-tone thresholds. Pure-tone audiograms were gathered at the time of initial presentation and at 1, 3, and 6 months after onset of symptoms. Results: The prevalence of DRs was observed to be 29% and was found to be prevalent at 1k and 1.5k Hz in patients with SSNHL. When the hearing thresholds over times were compared between the two groups, subjects with DRs showed significantly poorer hearing outcome compared with those without DRs. The improvements in word recognition scores over times were also less in subject with DRs than those without DRs. Conclusion: DRs are associated with worse hearing thresholds at follow-up audiogram and might be associated with unfavorable hearing outcome in patients with SSNHL.from #Audiology via xlomafota13 on Inoreader http://journals.lww.com/otology-neurotology/Fulltext/2016/12000/Clinical_Implication_of_the_Threshold_Equalizing.7.aspx
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The Human Vestibular Aqueduct: Anatomical Characteristics and Enlargement Criteria
Hypothesis: The human vestibular aqueduct (VA) shows great anatomical variations, and imaging can be difficult, so we need more data on the normal anatomy of the VA for better radiologic evaluation of large vestibular aqueduct syndrome (LVAS). Background: The normal anatomy of the human VA was analyzed in micro-dissected human temporal bones. Methods: The study is based on two sets of human temporal bones. One set of 32 human temporal bones was selected from a collection of 50 micro-dissected specimens. The outline of the intraosseous portion of the VA was drawn and digitized, and dimensions were assessed. The other set of 20 plastic molds were randomly selected from a collection of 324 specimens, and the VA dimensions were assessed. Results: Measurements from this study are presented in means, standard deviations, and ranges. The results from these measurements are considered normal and compared with previously published data. The variations in the normal anatomy of the VA are presented and discussed. Conclusion: The VA courses sagittal in the human skull. Therefore, we recommend the lateral projection (reformatted) to demonstrate the VA in LVAS patients. We advocate assessing: 1) the width (or height) of the external aperture (EA), 2) the width at the half distance between the EA and the common crus (CC), and if possible 3) the width of the proximal portion of the VA. Based on the measurements, our criteria for enlargement are 2.0 mm or greater, 1.5 mm or greater, and more than 1 mm at these sites.from #Audiology via xlomafota13 on Inoreader http://journals.lww.com/otology-neurotology/Fulltext/2016/12000/The_Human_Vestibular_Aqueduct___Anatomical.29.aspx
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Diagnostic Criteria for Detection of Vestibular Schwannomas in the VA Population
Objective: To investigate the prevalence of vestibular schwannoma (VS) and asymmetric sensorineural hearing loss in the Veterans Administration hospital population and analyze a more efficient method of diagnosing VS in a population with significant noise exposure. Study Design: Retrospective review of South Central (VISN 16) Veterans Administration hospitals. Methods: Record query for ICD-9 codes for asymmetric sensorineural hearing loss or VS between 1999 and 2012. Patient demographics, signs and symptoms at presentation, audiogram and imaging data, and management data were collected and analyzed. Audiograms from tumor patients were compared with controls matched for age, sex, combat experience, and medical comorbidity (2:1 control to case ratio). Results: The prevalence of VS was 1 per 1,145 patients in this population, with average age at diagnosis of 62. Patients with VS presented more commonly with unilateral tinnitus, rollover, and absent acoustic reflexes when compared with matched controls, but positive predictive value was low. Published criteria for defining hearing asymmetry showed variable sensitivity (51–89%) and low specificity (0–42%) for the detection of VS in this population. Criteria meeting the definitions of significant asymmetry with specificity for VS of 80% or greater were as follows: >15 dB threshold difference at 3 kHz and unilateral tinnitus, ≥45 dB threshold difference at 3 kHz regardless of tinnitus, or when the word recognition score difference was ≥80%. With serial audiograms 2.5 years apart or greater, a ≥10 dB threshold increase at any frequency between 0.5 and 4 kHz had a 100% sensitivity for tumor and a ≥10 dB increase at 3 kHz had a specificity of 84%. The majority of patients were observed, whereas only 30% had surgery. Patients who were observed were older than those treated with surgery or radiation (p from #Audiology via xlomafota13 on Inoreader http://journals.lww.com/otology-neurotology/Fulltext/2016/12000/Diagnostic_Criteria_for_Detection_of_Vestibular.8.aspx
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Intratympanic Sustained-Exposure Dexamethasone Thermosensitive Gel for Symptoms of Ménière's Disease: Randomized Phase 2b Safety and Efficacy Trial
Objective: To evaluate safety and efficacy of a single intratympanic injection of OTO-104, sustained-exposure dexamethasone, in patients with unilateral Ménière's disease. Study Design: Randomized, double-blind, placebo-controlled, Phase 2b study over 5 months. Setting: Fifty-two academic and community otolaryngology centers. Patients: One hundred fifty four patients (77 per group) aged 18 to 85 years inclusive. Intervention: Single intratympanic injection of OTO-104 (12 mg dexamethasone) or placebo. Main Outcome Measures: Efficacy (vertigo) and safety (adverse events, otoscopy, audiometry, tympanometry). Results: Primary endpoint (change from baseline in vertigo rate at Month 3) was not statistically significant (placebo [−43%], OTO-104 [−61%], P = 0.067). Improvements with OTO-104 were observed in prospectively defined secondary endpoints number of days with definitive vertigo, (Month 2 [P = 0.035], Month 3 [P = 0.030]), vertigo severity (Months 2–3, P = 0.046) and daily vertigo counts (Month 2, P = 0.042), and in some Short Form-36 (SF-36) subscales (Month 2 bodily pain P = 0.039, vitality P = 0.045, social functioning P = 0.025). No difference in tinnitus loudness or tinnitus handicap inventory (THI-25) was observed. OTO-104 was well tolerated; no negative impact on safety compared with placebo. Persistent tympanic membrane perforation was observed in two OTO-104 treated patients at study end. Conclusion: OTO-104 was well-tolerated, did not significantly affect change from baseline in vertigo rate, but did reduce number definitive vertigo days, vertigo severity, and average daily vertigo count compared with placebo during Month 3. Results provide insight into analyzing for a vertigo treatment effect and support advancing OTO-104 into Phase 3 clinical trials for the treatment of Ménière's disease symptoms.from #Audiology via xlomafota13 on Inoreader http://journals.lww.com/otology-neurotology/Fulltext/2016/12000/Intratympanic_Sustained_Exposure_Dexamethasone.33.aspx
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Post Hybrid Cochlear Implant Hearing Loss and Endolymphatic Hydrops
Objective: To evaluate for potential causes of delayed loss of residual hearing that variably occurs with hybrid cochlear implants. Study Design: Histopathological evaluation of 29 human temporal bone (HTB) with cochlear implant (CI). Setting: The Neurotology and House HTB Laboratory of UCLA (House-UCLA). Subjects and Methods: HTB from CI patients from the House-UCLA HTB Laboratory (n = 28) and one courtesy of Massachusetts Eye and Ear Infirmary (MEEI). Histopathological analysis to identify the location of cochleostomy, fibrosis, and bone formation in the scala vestibuli and tympani, and endolymphatic hydrops. Spiral ganglion neuron counts were obtained. Statistical analysis compared presence of cochleostomy and location with the histopathological findings. Results: Seventeen of 29 bones with fibrosis in the scala vestibule (SV) and tympani had evidence of a cochleostomy involving the SV containing the ductus reunions, all of which had hydrops. Ten of 11 bones had no SV fibrosis, and a cochleostomy limited to the scala tympani, of which all had no hydrops. One HTB had moderate SV fibrosis not involving the ductus reuniens, and was without hydrops. One HTB had a SV cochleostomy but the electrode ruptured Reissner's membrane, and was without hydrops. Cochleostomy was significantly associated with SV fibrosis and hydrops (p from #Audiology via xlomafota13 on Inoreader http://journals.lww.com/otology-neurotology/Fulltext/2016/12000/Post_Hybrid_Cochlear_Implant_Hearing_Loss_and.9.aspx
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Traumatic Tympanic Membrane Perforation Repair Using Gelfoam, Ofloxacin Drops, and FGF-2
No abstract available
from #Audiology via xlomafota13 on Inoreader http://journals.lww.com/otology-neurotology/Fulltext/2016/12000/Traumatic_Tympanic_Membrane_Perforation_Repair.37.aspx
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from #Audiology via xlomafota13 on Inoreader http://journals.lww.com/otology-neurotology/Fulltext/2016/12000/Traumatic_Tympanic_Membrane_Perforation_Repair.37.aspx
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The Enigma of Poor Performance by Adults With Cochlear Implants
Objective: Considerable unexplained variability and large individual differences exist in speech recognition outcomes for postlingually deaf adults who use cochlear implants (CIs), and a sizeable fraction of CI users can be considered “poor performers.” This article summarizes our current knowledge of poor CI performance, and provides suggestions to clinicians managing these patients. Method: Studies are reviewed pertaining to speech recognition variability in adults with hearing loss. Findings are augmented by recent studies in our laboratories examining outcomes in postlingually deaf adults with CIs. Results: In addition to conventional clinical predictors of CI performance (e.g., amount of residual hearing, duration of deafness), factors pertaining to both “bottom-up” auditory sensitivity to the spectro-temporal details of speech, and “top-down” linguistic knowledge and neurocognitive functions contribute to CI outcomes. Conclusions: The broad array of factors that contribute to speech recognition performance in adult CI users suggests the potential both for novel diagnostic assessment batteries to explain poor performance, and also new rehabilitation strategies for patients who exhibit poor outcomes. Moreover, this broad array of factors determining outcome performance suggests the need to treat individual CI patients using a personalized rehabilitation approach.
from #Audiology via xlomafota13 on Inoreader http://journals.lww.com/otology-neurotology/Fulltext/2016/12000/The_Enigma_of_Poor_Performance_by_Adults_With.10.aspx
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from #Audiology via xlomafota13 on Inoreader http://journals.lww.com/otology-neurotology/Fulltext/2016/12000/The_Enigma_of_Poor_Performance_by_Adults_With.10.aspx
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Safe and Sound
Over time, automobiles have become ever safer. Airbags all around us protect us against impact and crumple zones keep the impact away from the people in the cabin. In more modern developments, automobiles are surrounded by sensors and even cameras to warn the driver about nearby objects and even drifts across traffic lanes. And today’s post-modern vehicles will even apply the brakes upon sensing danger. Even after all of these advancements, accidents happen.
from #Audiology via xlomafota13 on Inoreader http://www.audiology.org/news/safe-and-sound
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Evidence of compensatory joint kinetics during stair ascent and descent in Parkinson’s disease
Publication date: Available online 9 November 2016
Source:Gait & Posture
Author(s): Zachary J. Conway, Peter A. Silburn, Tim D. Blackmore, Michael H. Cole
BackgroundStair ambulation is a challenging activity of daily life that requires larger joint moments than walking. Stabilisation of the body and prevention of lower limb collapse during this task depends upon adequately-sized hip, knee and ankle extensor moments. However, people with Parkinson’s disease (PD) often present with strength deficits that may impair their capacity to control the lower limbs and ultimately increase their falls risk.ObjectiveTo investigate hip, knee and ankle joint moments during stair ascent and descent and determine the contribution of these joints to the body’s support in people with PD.MethodsTwelve PD patients and twelve age-matched controls performed stair ascent and descent trials. Data from an instrumented staircase and a three-dimensional motion analysis system were used to derive sagittal hip, knee and ankle moments. Support moment impulses were calculated by summing all extensor moment impulses and the relative contribution of each joint was calculated.ResultsLinear mixed model analyses indicated that PD patients walked slower and had a reduced cadence relative to controls. Although support moment impulses were typically not different between groups during stair ascent or descent, a reduced contribution by the ankle joint required an increased knee joint contribution for the PD patients.ConclusionsDespite having poorer knee extensor strength, people with PD rely more heavily on these muscles during stair walking. This adaptation could possibly be driven by the somewhat restricted mobility of this joint, which may provide these individuals with an increased sense of stability during these tasks.
from #Audiology via ola Kala on Inoreader http://rss.sciencedirect.com/action/redirectFile?&zone=main¤tActivity=feed&usageType=outward&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%3F_ob%3DGatewayURL%26_origin%3DIRSSSEARCH%26_method%3DcitationSearch%26_piikey%3DS0966636216306476%26_version%3D1%26md5%3D759c5b01807fecb99dca1bc325b02895
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Source:Gait & Posture
Author(s): Zachary J. Conway, Peter A. Silburn, Tim D. Blackmore, Michael H. Cole
BackgroundStair ambulation is a challenging activity of daily life that requires larger joint moments than walking. Stabilisation of the body and prevention of lower limb collapse during this task depends upon adequately-sized hip, knee and ankle extensor moments. However, people with Parkinson’s disease (PD) often present with strength deficits that may impair their capacity to control the lower limbs and ultimately increase their falls risk.ObjectiveTo investigate hip, knee and ankle joint moments during stair ascent and descent and determine the contribution of these joints to the body’s support in people with PD.MethodsTwelve PD patients and twelve age-matched controls performed stair ascent and descent trials. Data from an instrumented staircase and a three-dimensional motion analysis system were used to derive sagittal hip, knee and ankle moments. Support moment impulses were calculated by summing all extensor moment impulses and the relative contribution of each joint was calculated.ResultsLinear mixed model analyses indicated that PD patients walked slower and had a reduced cadence relative to controls. Although support moment impulses were typically not different between groups during stair ascent or descent, a reduced contribution by the ankle joint required an increased knee joint contribution for the PD patients.ConclusionsDespite having poorer knee extensor strength, people with PD rely more heavily on these muscles during stair walking. This adaptation could possibly be driven by the somewhat restricted mobility of this joint, which may provide these individuals with an increased sense of stability during these tasks.
from #Audiology via ola Kala on Inoreader http://rss.sciencedirect.com/action/redirectFile?&zone=main¤tActivity=feed&usageType=outward&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%3F_ob%3DGatewayURL%26_origin%3DIRSSSEARCH%26_method%3DcitationSearch%26_piikey%3DS0966636216306476%26_version%3D1%26md5%3D759c5b01807fecb99dca1bc325b02895
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Under Water Gait Analysis in Parkinson’s disease
Publication date: Available online 10 November 2016
Source:Gait & Posture
Author(s): Daniele Volpe, Davide Pavan, Meg Morris, Annamaria Guiotto, Robert Iansek, Sofia Fortuna, Giuseppe Frazzitta, Zimi Sawacha
Although hydrotherapy is one of the physical therapies adopted to optimize gait rehabilitation in people with Parkinson disease, the quantitative measurement of gait-related outcomes has not been provided yet. This work aims to document the gait improvements in a group of parkinsonians after a hydrotherapy program through 2D and 3D underwater and on land gait analysis. Thirty-four parkinsonians and twenty-two controls were enrolled, divided into two different cohorts. In the first one, 2 groups of patients underwent underwater or land based walking training; controls underwent underwater walking training. Hence pre-treatment 2D underwater and on land gait analysis were performed, together with post-treatment on land gait analysis. Considering that current literature documented a reduced movement amplitude in parkinsonians across all lower limb joints in all movement planes, 3D underwater and on land gait analysis were performed on a second cohort of subjects (10 parkinsonians and 10 controls) who underwent underwater gait training. Baseline land 2D and 3D gait analysis in parkinsonians showed shorter stride length and slower speed than controls, in agreement with previous findings. Comparison between underwater and on land gait analysis showed reduction in stride length, cadence and speed on both parkinsonians and controls. Although patients who underwent underwater treatment exhibited significant changes on spatiotemporal parameters and sagittal plane lower limb kinematics, 3D gait analysis documented a significant (p<0.05) improvement in all movement planes. These data deserve attention for research directions promoting the optimal recovery and maintenance of walking ability.
from #Audiology via ola Kala on Inoreader http://rss.sciencedirect.com/action/redirectFile?&zone=main¤tActivity=feed&usageType=outward&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%3F_ob%3DGatewayURL%26_origin%3DIRSSSEARCH%26_method%3DcitationSearch%26_piikey%3DS0966636216306488%26_version%3D1%26md5%3Dc8ea396c36f5e15f090a56e640bbb415
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Source:Gait & Posture
Author(s): Daniele Volpe, Davide Pavan, Meg Morris, Annamaria Guiotto, Robert Iansek, Sofia Fortuna, Giuseppe Frazzitta, Zimi Sawacha
Although hydrotherapy is one of the physical therapies adopted to optimize gait rehabilitation in people with Parkinson disease, the quantitative measurement of gait-related outcomes has not been provided yet. This work aims to document the gait improvements in a group of parkinsonians after a hydrotherapy program through 2D and 3D underwater and on land gait analysis. Thirty-four parkinsonians and twenty-two controls were enrolled, divided into two different cohorts. In the first one, 2 groups of patients underwent underwater or land based walking training; controls underwent underwater walking training. Hence pre-treatment 2D underwater and on land gait analysis were performed, together with post-treatment on land gait analysis. Considering that current literature documented a reduced movement amplitude in parkinsonians across all lower limb joints in all movement planes, 3D underwater and on land gait analysis were performed on a second cohort of subjects (10 parkinsonians and 10 controls) who underwent underwater gait training. Baseline land 2D and 3D gait analysis in parkinsonians showed shorter stride length and slower speed than controls, in agreement with previous findings. Comparison between underwater and on land gait analysis showed reduction in stride length, cadence and speed on both parkinsonians and controls. Although patients who underwent underwater treatment exhibited significant changes on spatiotemporal parameters and sagittal plane lower limb kinematics, 3D gait analysis documented a significant (p<0.05) improvement in all movement planes. These data deserve attention for research directions promoting the optimal recovery and maintenance of walking ability.
from #Audiology via ola Kala on Inoreader http://rss.sciencedirect.com/action/redirectFile?&zone=main¤tActivity=feed&usageType=outward&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%3F_ob%3DGatewayURL%26_origin%3DIRSSSEARCH%26_method%3DcitationSearch%26_piikey%3DS0966636216306488%26_version%3D1%26md5%3Dc8ea396c36f5e15f090a56e640bbb415
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Muscle Activation Patterns of the Lumbo-Pelvic-Hip Complex During Walking Gait Before and After Exercise
Publication date: Available online 9 November 2016
Source:Gait & Posture
Author(s): Mihyang Chang, Lindsay V. Slater, Revay O. Corbett, Joseph M. Hart, Jay Hertel
The lumbo-pelvic-hip core complex consists of musculoskeletal structures that stabilize the spine and pelvis, however fatigue may affect muscle recruitment, active muscle stiffness and trunk kinematics, compromising trunk stability. The purpose of this study was to compare trunk muscle activation patterns, and trunk and lower extremity kinematics during walking gait before and after exercise. Surface electrodes were placed over the rectus abdominis, external oblique, erector spinae, gluteus medius, vastus lateralis, and vastus medialis of twenty-five healthy inidviduals. Means and 95% confidence intervals for muscle amplitude, muscle onsent and kinematics for 0-100% of the gait cycle were compared before and after exercise. Mean differences (MD) and standard deviations were calculated for all significant differences. The amplitude increased in the rectus abdominis during loading (MD=0.67±0.11), midstance (MD=0.75±0.04), terminal stance (MD=0.58±0.04), and late swing (MD=0.75±0.07) after exercise. Amplitude also increased during swing phase in the erector spinae (MD=0.92±0.11), vastus lateralis (MD=1.12±0.30), and vastus medialis (MD=1.80±0.19) after exercise. There was less trunk and hip rotation from initial contact to midstance after exercise. Neuromuscular fatigue significantly influenced the activation patterns of superficial musculature and kinematics of the lumbo-pelvic-hip complex during walking. Increased muscle activation with decreased movement in a fatigued state may represent an effort to increase trunk stiffness to protect lumbo-pelvic-hip structures from overload.
from #Audiology via ola Kala on Inoreader http://rss.sciencedirect.com/action/redirectFile?&zone=main¤tActivity=feed&usageType=outward&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%3F_ob%3DGatewayURL%26_origin%3DIRSSSEARCH%26_method%3DcitationSearch%26_piikey%3DS0966636216306452%26_version%3D1%26md5%3Dab466d55aef52f8856f50d492187df88
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Source:Gait & Posture
Author(s): Mihyang Chang, Lindsay V. Slater, Revay O. Corbett, Joseph M. Hart, Jay Hertel
The lumbo-pelvic-hip core complex consists of musculoskeletal structures that stabilize the spine and pelvis, however fatigue may affect muscle recruitment, active muscle stiffness and trunk kinematics, compromising trunk stability. The purpose of this study was to compare trunk muscle activation patterns, and trunk and lower extremity kinematics during walking gait before and after exercise. Surface electrodes were placed over the rectus abdominis, external oblique, erector spinae, gluteus medius, vastus lateralis, and vastus medialis of twenty-five healthy inidviduals. Means and 95% confidence intervals for muscle amplitude, muscle onsent and kinematics for 0-100% of the gait cycle were compared before and after exercise. Mean differences (MD) and standard deviations were calculated for all significant differences. The amplitude increased in the rectus abdominis during loading (MD=0.67±0.11), midstance (MD=0.75±0.04), terminal stance (MD=0.58±0.04), and late swing (MD=0.75±0.07) after exercise. Amplitude also increased during swing phase in the erector spinae (MD=0.92±0.11), vastus lateralis (MD=1.12±0.30), and vastus medialis (MD=1.80±0.19) after exercise. There was less trunk and hip rotation from initial contact to midstance after exercise. Neuromuscular fatigue significantly influenced the activation patterns of superficial musculature and kinematics of the lumbo-pelvic-hip complex during walking. Increased muscle activation with decreased movement in a fatigued state may represent an effort to increase trunk stiffness to protect lumbo-pelvic-hip structures from overload.
from #Audiology via ola Kala on Inoreader http://rss.sciencedirect.com/action/redirectFile?&zone=main¤tActivity=feed&usageType=outward&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%3F_ob%3DGatewayURL%26_origin%3DIRSSSEARCH%26_method%3DcitationSearch%26_piikey%3DS0966636216306452%26_version%3D1%26md5%3Dab466d55aef52f8856f50d492187df88
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Evidence of compensatory joint kinetics during stair ascent and descent in Parkinson’s disease
Publication date: Available online 9 November 2016
Source:Gait & Posture
Author(s): Zachary J. Conway, Peter A. Silburn, Tim D. Blackmore, Michael H. Cole
BackgroundStair ambulation is a challenging activity of daily life that requires larger joint moments than walking. Stabilisation of the body and prevention of lower limb collapse during this task depends upon adequately-sized hip, knee and ankle extensor moments. However, people with Parkinson’s disease (PD) often present with strength deficits that may impair their capacity to control the lower limbs and ultimately increase their falls risk.ObjectiveTo investigate hip, knee and ankle joint moments during stair ascent and descent and determine the contribution of these joints to the body’s support in people with PD.MethodsTwelve PD patients and twelve age-matched controls performed stair ascent and descent trials. Data from an instrumented staircase and a three-dimensional motion analysis system were used to derive sagittal hip, knee and ankle moments. Support moment impulses were calculated by summing all extensor moment impulses and the relative contribution of each joint was calculated.ResultsLinear mixed model analyses indicated that PD patients walked slower and had a reduced cadence relative to controls. Although support moment impulses were typically not different between groups during stair ascent or descent, a reduced contribution by the ankle joint required an increased knee joint contribution for the PD patients.ConclusionsDespite having poorer knee extensor strength, people with PD rely more heavily on these muscles during stair walking. This adaptation could possibly be driven by the somewhat restricted mobility of this joint, which may provide these individuals with an increased sense of stability during these tasks.
from #Audiology via xlomafota13 on Inoreader http://rss.sciencedirect.com/action/redirectFile?&zone=main¤tActivity=feed&usageType=outward&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%3F_ob%3DGatewayURL%26_origin%3DIRSSSEARCH%26_method%3DcitationSearch%26_piikey%3DS0966636216306476%26_version%3D1%26md5%3D759c5b01807fecb99dca1bc325b02895
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Source:Gait & Posture
Author(s): Zachary J. Conway, Peter A. Silburn, Tim D. Blackmore, Michael H. Cole
BackgroundStair ambulation is a challenging activity of daily life that requires larger joint moments than walking. Stabilisation of the body and prevention of lower limb collapse during this task depends upon adequately-sized hip, knee and ankle extensor moments. However, people with Parkinson’s disease (PD) often present with strength deficits that may impair their capacity to control the lower limbs and ultimately increase their falls risk.ObjectiveTo investigate hip, knee and ankle joint moments during stair ascent and descent and determine the contribution of these joints to the body’s support in people with PD.MethodsTwelve PD patients and twelve age-matched controls performed stair ascent and descent trials. Data from an instrumented staircase and a three-dimensional motion analysis system were used to derive sagittal hip, knee and ankle moments. Support moment impulses were calculated by summing all extensor moment impulses and the relative contribution of each joint was calculated.ResultsLinear mixed model analyses indicated that PD patients walked slower and had a reduced cadence relative to controls. Although support moment impulses were typically not different between groups during stair ascent or descent, a reduced contribution by the ankle joint required an increased knee joint contribution for the PD patients.ConclusionsDespite having poorer knee extensor strength, people with PD rely more heavily on these muscles during stair walking. This adaptation could possibly be driven by the somewhat restricted mobility of this joint, which may provide these individuals with an increased sense of stability during these tasks.
from #Audiology via xlomafota13 on Inoreader http://rss.sciencedirect.com/action/redirectFile?&zone=main¤tActivity=feed&usageType=outward&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%3F_ob%3DGatewayURL%26_origin%3DIRSSSEARCH%26_method%3DcitationSearch%26_piikey%3DS0966636216306476%26_version%3D1%26md5%3D759c5b01807fecb99dca1bc325b02895
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Under Water Gait Analysis in Parkinson’s disease
Publication date: Available online 10 November 2016
Source:Gait & Posture
Author(s): Daniele Volpe, Davide Pavan, Meg Morris, Annamaria Guiotto, Robert Iansek, Sofia Fortuna, Giuseppe Frazzitta, Zimi Sawacha
Although hydrotherapy is one of the physical therapies adopted to optimize gait rehabilitation in people with Parkinson disease, the quantitative measurement of gait-related outcomes has not been provided yet. This work aims to document the gait improvements in a group of parkinsonians after a hydrotherapy program through 2D and 3D underwater and on land gait analysis. Thirty-four parkinsonians and twenty-two controls were enrolled, divided into two different cohorts. In the first one, 2 groups of patients underwent underwater or land based walking training; controls underwent underwater walking training. Hence pre-treatment 2D underwater and on land gait analysis were performed, together with post-treatment on land gait analysis. Considering that current literature documented a reduced movement amplitude in parkinsonians across all lower limb joints in all movement planes, 3D underwater and on land gait analysis were performed on a second cohort of subjects (10 parkinsonians and 10 controls) who underwent underwater gait training. Baseline land 2D and 3D gait analysis in parkinsonians showed shorter stride length and slower speed than controls, in agreement with previous findings. Comparison between underwater and on land gait analysis showed reduction in stride length, cadence and speed on both parkinsonians and controls. Although patients who underwent underwater treatment exhibited significant changes on spatiotemporal parameters and sagittal plane lower limb kinematics, 3D gait analysis documented a significant (p<0.05) improvement in all movement planes. These data deserve attention for research directions promoting the optimal recovery and maintenance of walking ability.
from #Audiology via xlomafota13 on Inoreader http://rss.sciencedirect.com/action/redirectFile?&zone=main¤tActivity=feed&usageType=outward&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%3F_ob%3DGatewayURL%26_origin%3DIRSSSEARCH%26_method%3DcitationSearch%26_piikey%3DS0966636216306488%26_version%3D1%26md5%3Dc8ea396c36f5e15f090a56e640bbb415
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Source:Gait & Posture
Author(s): Daniele Volpe, Davide Pavan, Meg Morris, Annamaria Guiotto, Robert Iansek, Sofia Fortuna, Giuseppe Frazzitta, Zimi Sawacha
Although hydrotherapy is one of the physical therapies adopted to optimize gait rehabilitation in people with Parkinson disease, the quantitative measurement of gait-related outcomes has not been provided yet. This work aims to document the gait improvements in a group of parkinsonians after a hydrotherapy program through 2D and 3D underwater and on land gait analysis. Thirty-four parkinsonians and twenty-two controls were enrolled, divided into two different cohorts. In the first one, 2 groups of patients underwent underwater or land based walking training; controls underwent underwater walking training. Hence pre-treatment 2D underwater and on land gait analysis were performed, together with post-treatment on land gait analysis. Considering that current literature documented a reduced movement amplitude in parkinsonians across all lower limb joints in all movement planes, 3D underwater and on land gait analysis were performed on a second cohort of subjects (10 parkinsonians and 10 controls) who underwent underwater gait training. Baseline land 2D and 3D gait analysis in parkinsonians showed shorter stride length and slower speed than controls, in agreement with previous findings. Comparison between underwater and on land gait analysis showed reduction in stride length, cadence and speed on both parkinsonians and controls. Although patients who underwent underwater treatment exhibited significant changes on spatiotemporal parameters and sagittal plane lower limb kinematics, 3D gait analysis documented a significant (p<0.05) improvement in all movement planes. These data deserve attention for research directions promoting the optimal recovery and maintenance of walking ability.
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Muscle Activation Patterns of the Lumbo-Pelvic-Hip Complex During Walking Gait Before and After Exercise
Publication date: Available online 9 November 2016
Source:Gait & Posture
Author(s): Mihyang Chang, Lindsay V. Slater, Revay O. Corbett, Joseph M. Hart, Jay Hertel
The lumbo-pelvic-hip core complex consists of musculoskeletal structures that stabilize the spine and pelvis, however fatigue may affect muscle recruitment, active muscle stiffness and trunk kinematics, compromising trunk stability. The purpose of this study was to compare trunk muscle activation patterns, and trunk and lower extremity kinematics during walking gait before and after exercise. Surface electrodes were placed over the rectus abdominis, external oblique, erector spinae, gluteus medius, vastus lateralis, and vastus medialis of twenty-five healthy inidviduals. Means and 95% confidence intervals for muscle amplitude, muscle onsent and kinematics for 0-100% of the gait cycle were compared before and after exercise. Mean differences (MD) and standard deviations were calculated for all significant differences. The amplitude increased in the rectus abdominis during loading (MD=0.67±0.11), midstance (MD=0.75±0.04), terminal stance (MD=0.58±0.04), and late swing (MD=0.75±0.07) after exercise. Amplitude also increased during swing phase in the erector spinae (MD=0.92±0.11), vastus lateralis (MD=1.12±0.30), and vastus medialis (MD=1.80±0.19) after exercise. There was less trunk and hip rotation from initial contact to midstance after exercise. Neuromuscular fatigue significantly influenced the activation patterns of superficial musculature and kinematics of the lumbo-pelvic-hip complex during walking. Increased muscle activation with decreased movement in a fatigued state may represent an effort to increase trunk stiffness to protect lumbo-pelvic-hip structures from overload.
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Source:Gait & Posture
Author(s): Mihyang Chang, Lindsay V. Slater, Revay O. Corbett, Joseph M. Hart, Jay Hertel
The lumbo-pelvic-hip core complex consists of musculoskeletal structures that stabilize the spine and pelvis, however fatigue may affect muscle recruitment, active muscle stiffness and trunk kinematics, compromising trunk stability. The purpose of this study was to compare trunk muscle activation patterns, and trunk and lower extremity kinematics during walking gait before and after exercise. Surface electrodes were placed over the rectus abdominis, external oblique, erector spinae, gluteus medius, vastus lateralis, and vastus medialis of twenty-five healthy inidviduals. Means and 95% confidence intervals for muscle amplitude, muscle onsent and kinematics for 0-100% of the gait cycle were compared before and after exercise. Mean differences (MD) and standard deviations were calculated for all significant differences. The amplitude increased in the rectus abdominis during loading (MD=0.67±0.11), midstance (MD=0.75±0.04), terminal stance (MD=0.58±0.04), and late swing (MD=0.75±0.07) after exercise. Amplitude also increased during swing phase in the erector spinae (MD=0.92±0.11), vastus lateralis (MD=1.12±0.30), and vastus medialis (MD=1.80±0.19) after exercise. There was less trunk and hip rotation from initial contact to midstance after exercise. Neuromuscular fatigue significantly influenced the activation patterns of superficial musculature and kinematics of the lumbo-pelvic-hip complex during walking. Increased muscle activation with decreased movement in a fatigued state may represent an effort to increase trunk stiffness to protect lumbo-pelvic-hip structures from overload.
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Evidence of compensatory joint kinetics during stair ascent and descent in Parkinson’s disease
Publication date: Available online 9 November 2016
Source:Gait & Posture
Author(s): Zachary J. Conway, Peter A. Silburn, Tim D. Blackmore, Michael H. Cole
BackgroundStair ambulation is a challenging activity of daily life that requires larger joint moments than walking. Stabilisation of the body and prevention of lower limb collapse during this task depends upon adequately-sized hip, knee and ankle extensor moments. However, people with Parkinson’s disease (PD) often present with strength deficits that may impair their capacity to control the lower limbs and ultimately increase their falls risk.ObjectiveTo investigate hip, knee and ankle joint moments during stair ascent and descent and determine the contribution of these joints to the body’s support in people with PD.MethodsTwelve PD patients and twelve age-matched controls performed stair ascent and descent trials. Data from an instrumented staircase and a three-dimensional motion analysis system were used to derive sagittal hip, knee and ankle moments. Support moment impulses were calculated by summing all extensor moment impulses and the relative contribution of each joint was calculated.ResultsLinear mixed model analyses indicated that PD patients walked slower and had a reduced cadence relative to controls. Although support moment impulses were typically not different between groups during stair ascent or descent, a reduced contribution by the ankle joint required an increased knee joint contribution for the PD patients.ConclusionsDespite having poorer knee extensor strength, people with PD rely more heavily on these muscles during stair walking. This adaptation could possibly be driven by the somewhat restricted mobility of this joint, which may provide these individuals with an increased sense of stability during these tasks.
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Source:Gait & Posture
Author(s): Zachary J. Conway, Peter A. Silburn, Tim D. Blackmore, Michael H. Cole
BackgroundStair ambulation is a challenging activity of daily life that requires larger joint moments than walking. Stabilisation of the body and prevention of lower limb collapse during this task depends upon adequately-sized hip, knee and ankle extensor moments. However, people with Parkinson’s disease (PD) often present with strength deficits that may impair their capacity to control the lower limbs and ultimately increase their falls risk.ObjectiveTo investigate hip, knee and ankle joint moments during stair ascent and descent and determine the contribution of these joints to the body’s support in people with PD.MethodsTwelve PD patients and twelve age-matched controls performed stair ascent and descent trials. Data from an instrumented staircase and a three-dimensional motion analysis system were used to derive sagittal hip, knee and ankle moments. Support moment impulses were calculated by summing all extensor moment impulses and the relative contribution of each joint was calculated.ResultsLinear mixed model analyses indicated that PD patients walked slower and had a reduced cadence relative to controls. Although support moment impulses were typically not different between groups during stair ascent or descent, a reduced contribution by the ankle joint required an increased knee joint contribution for the PD patients.ConclusionsDespite having poorer knee extensor strength, people with PD rely more heavily on these muscles during stair walking. This adaptation could possibly be driven by the somewhat restricted mobility of this joint, which may provide these individuals with an increased sense of stability during these tasks.
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Under Water Gait Analysis in Parkinson’s disease
Publication date: Available online 10 November 2016
Source:Gait & Posture
Author(s): Daniele Volpe, Davide Pavan, Meg Morris, Annamaria Guiotto, Robert Iansek, Sofia Fortuna, Giuseppe Frazzitta, Zimi Sawacha
Although hydrotherapy is one of the physical therapies adopted to optimize gait rehabilitation in people with Parkinson disease, the quantitative measurement of gait-related outcomes has not been provided yet. This work aims to document the gait improvements in a group of parkinsonians after a hydrotherapy program through 2D and 3D underwater and on land gait analysis. Thirty-four parkinsonians and twenty-two controls were enrolled, divided into two different cohorts. In the first one, 2 groups of patients underwent underwater or land based walking training; controls underwent underwater walking training. Hence pre-treatment 2D underwater and on land gait analysis were performed, together with post-treatment on land gait analysis. Considering that current literature documented a reduced movement amplitude in parkinsonians across all lower limb joints in all movement planes, 3D underwater and on land gait analysis were performed on a second cohort of subjects (10 parkinsonians and 10 controls) who underwent underwater gait training. Baseline land 2D and 3D gait analysis in parkinsonians showed shorter stride length and slower speed than controls, in agreement with previous findings. Comparison between underwater and on land gait analysis showed reduction in stride length, cadence and speed on both parkinsonians and controls. Although patients who underwent underwater treatment exhibited significant changes on spatiotemporal parameters and sagittal plane lower limb kinematics, 3D gait analysis documented a significant (p<0.05) improvement in all movement planes. These data deserve attention for research directions promoting the optimal recovery and maintenance of walking ability.
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Source:Gait & Posture
Author(s): Daniele Volpe, Davide Pavan, Meg Morris, Annamaria Guiotto, Robert Iansek, Sofia Fortuna, Giuseppe Frazzitta, Zimi Sawacha
Although hydrotherapy is one of the physical therapies adopted to optimize gait rehabilitation in people with Parkinson disease, the quantitative measurement of gait-related outcomes has not been provided yet. This work aims to document the gait improvements in a group of parkinsonians after a hydrotherapy program through 2D and 3D underwater and on land gait analysis. Thirty-four parkinsonians and twenty-two controls were enrolled, divided into two different cohorts. In the first one, 2 groups of patients underwent underwater or land based walking training; controls underwent underwater walking training. Hence pre-treatment 2D underwater and on land gait analysis were performed, together with post-treatment on land gait analysis. Considering that current literature documented a reduced movement amplitude in parkinsonians across all lower limb joints in all movement planes, 3D underwater and on land gait analysis were performed on a second cohort of subjects (10 parkinsonians and 10 controls) who underwent underwater gait training. Baseline land 2D and 3D gait analysis in parkinsonians showed shorter stride length and slower speed than controls, in agreement with previous findings. Comparison between underwater and on land gait analysis showed reduction in stride length, cadence and speed on both parkinsonians and controls. Although patients who underwent underwater treatment exhibited significant changes on spatiotemporal parameters and sagittal plane lower limb kinematics, 3D gait analysis documented a significant (p<0.05) improvement in all movement planes. These data deserve attention for research directions promoting the optimal recovery and maintenance of walking ability.
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Muscle Activation Patterns of the Lumbo-Pelvic-Hip Complex During Walking Gait Before and After Exercise
Publication date: Available online 9 November 2016
Source:Gait & Posture
Author(s): Mihyang Chang, Lindsay V. Slater, Revay O. Corbett, Joseph M. Hart, Jay Hertel
The lumbo-pelvic-hip core complex consists of musculoskeletal structures that stabilize the spine and pelvis, however fatigue may affect muscle recruitment, active muscle stiffness and trunk kinematics, compromising trunk stability. The purpose of this study was to compare trunk muscle activation patterns, and trunk and lower extremity kinematics during walking gait before and after exercise. Surface electrodes were placed over the rectus abdominis, external oblique, erector spinae, gluteus medius, vastus lateralis, and vastus medialis of twenty-five healthy inidviduals. Means and 95% confidence intervals for muscle amplitude, muscle onsent and kinematics for 0-100% of the gait cycle were compared before and after exercise. Mean differences (MD) and standard deviations were calculated for all significant differences. The amplitude increased in the rectus abdominis during loading (MD=0.67±0.11), midstance (MD=0.75±0.04), terminal stance (MD=0.58±0.04), and late swing (MD=0.75±0.07) after exercise. Amplitude also increased during swing phase in the erector spinae (MD=0.92±0.11), vastus lateralis (MD=1.12±0.30), and vastus medialis (MD=1.80±0.19) after exercise. There was less trunk and hip rotation from initial contact to midstance after exercise. Neuromuscular fatigue significantly influenced the activation patterns of superficial musculature and kinematics of the lumbo-pelvic-hip complex during walking. Increased muscle activation with decreased movement in a fatigued state may represent an effort to increase trunk stiffness to protect lumbo-pelvic-hip structures from overload.
from #Audiology via ola Kala on Inoreader http://rss.sciencedirect.com/action/redirectFile?&zone=main¤tActivity=feed&usageType=outward&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%3F_ob%3DGatewayURL%26_origin%3DIRSSSEARCH%26_method%3DcitationSearch%26_piikey%3DS0966636216306452%26_version%3D1%26md5%3Dab466d55aef52f8856f50d492187df88
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Source:Gait & Posture
Author(s): Mihyang Chang, Lindsay V. Slater, Revay O. Corbett, Joseph M. Hart, Jay Hertel
The lumbo-pelvic-hip core complex consists of musculoskeletal structures that stabilize the spine and pelvis, however fatigue may affect muscle recruitment, active muscle stiffness and trunk kinematics, compromising trunk stability. The purpose of this study was to compare trunk muscle activation patterns, and trunk and lower extremity kinematics during walking gait before and after exercise. Surface electrodes were placed over the rectus abdominis, external oblique, erector spinae, gluteus medius, vastus lateralis, and vastus medialis of twenty-five healthy inidviduals. Means and 95% confidence intervals for muscle amplitude, muscle onsent and kinematics for 0-100% of the gait cycle were compared before and after exercise. Mean differences (MD) and standard deviations were calculated for all significant differences. The amplitude increased in the rectus abdominis during loading (MD=0.67±0.11), midstance (MD=0.75±0.04), terminal stance (MD=0.58±0.04), and late swing (MD=0.75±0.07) after exercise. Amplitude also increased during swing phase in the erector spinae (MD=0.92±0.11), vastus lateralis (MD=1.12±0.30), and vastus medialis (MD=1.80±0.19) after exercise. There was less trunk and hip rotation from initial contact to midstance after exercise. Neuromuscular fatigue significantly influenced the activation patterns of superficial musculature and kinematics of the lumbo-pelvic-hip complex during walking. Increased muscle activation with decreased movement in a fatigued state may represent an effort to increase trunk stiffness to protect lumbo-pelvic-hip structures from overload.
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Linguistically guided adaptation to foreign-accented speech
Adaptation to foreign-accented sentences can be guided by knowledge of the lexical content of those sentences, which, being an exact match for the target, provides feedback on all linguistic levels. The extent to which this feedback needs to match the accented sentence was examined by manipulating the degree of match on different linguistic dimensions, including sub-lexical, lexical, and syntactic levels. Conditions where target-feedback sentence pairs matched and mismatched generated greater transcription improvement over non-English speech feedback, indicating listeners can draw upon sources of linguistic information beyond matching lexical items, such as sub- and supra-lexical information, during adaptation.
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Unilateral Hearing Loss: Understanding Speech Recognition and Localization Variability-Implications for Cochlear Implant Candidacy.
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Sequential Bilateral Cochlear Implantation in Children: Outcome of the Second Implant and Long-Term Use.
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Unilateral Hearing Loss: Understanding Speech Recognition and Localization Variability-Implications for Cochlear Implant Candidacy.
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Sequential Bilateral Cochlear Implantation in Children: Outcome of the Second Implant and Long-Term Use.
from #Audiology via ola Kala on Inoreader http://pdfs.journals.lww.com/ear-hearing/9000/00000/Sequential_Bilateral_Cochlear_Implantation_in.99139.pdf
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Unilateral Hearing Loss: Understanding Speech Recognition and Localization Variability-Implications for Cochlear Implant Candidacy.
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Sequential Bilateral Cochlear Implantation in Children: Outcome of the Second Implant and Long-Term Use.
from #Audiology via xlomafota13 on Inoreader http://pdfs.journals.lww.com/ear-hearing/9000/00000/Sequential_Bilateral_Cochlear_Implantation_in.99139.pdf
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