[Diagnosis of Cochleovestibular Neurovascular Compression Syndrome:A Scoring System Based on Five Clinical Characteristics].

Related Articles

[Diagnosis of Cochleovestibular Neurovascular Compression Syndrome:A Scoring System Based on Five Clinical Characteristics].

No Shinkei Geka. 2017 Feb;45(2):117-125

Authors: Okamura T, Nishizaki T, Ikeda N, Nakano S, Sakakura T, Fujii N, Okuda T

Abstract
The optimal method for diagnosing cochleovestibular neurovascular compression syndrome(CNVC)remains controversial, and the aim of this study is to develop a standard diagnostic instrument for the condition. The clinical features of 53 sides of 50 patients with a combination of vertigo, tinnitus, and/or hearing loss were retrospectively evaluated. The following five clinical features were evaluated and given a score of 1 or 0:1)a long history of recurrent vertigo, tinnitus, or hearing loss;2)neurological findings related to positional vertigo, nystagmus, tinnitus, or hearing loss;3)neuro-otological findings involving tinnitus, audiometry, or vestibular testing;4)auditory brainstem response(ABR)evaluation with the detection of a low 25-75% II wave amplitude on the contralateral side and delayed interpeak latency in the I-III or I-V waves(usually low II wave amplitude combined with double peaks and a wide-based form)during ABR evaluation using 80 and 90dB clicks;and 5)the detection of vascular contact with the eighth cranial nerve on magnetic resonance imaging-constructive interference in steady state or air computed tomography imaging. Finally, the sum of these scores was evaluated. For cases in which more than one of the features of the items 1), 2), or 3) were present, the score was evaluated based on the most representative of the items.
RESULTS: The patients were divided into those with scores of 4-5 and those with scores of 2-3. All the patients with scores of 4-5 exhibited CNVC, while those with scores of 2-3 had other diseases. Therefore, CNVC should be suspected in patients with scores of 4-5, but can be ruled out in those with scores of 2-3.

PMID: 28202828 [PubMed - in process]

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Population responses in primary auditory cortex simultaneously represent the temporal envelope and periodicity features in natural speech

Publication date: Available online 17 February 2017
Source:Hearing Research
Author(s): Daniel A. Abrams, Trent Nicol, Travis White-Schwoch, Mitra Hartmann, Steven Zecker, Nina Kraus
Speech perception relies on a listener’s ability to simultaneously resolve multiple temporal features in the speech signal. Little is known regarding neural mechanisms that enable the simultaneous coding of concurrent temporal features in the speech signal. Here we show that two categories of temporal features in speech, the low-frequency speech envelope and periodicity cues, are processed by distinct neural mechanisms within the same population of cortical neurons. We measured population activity in primary auditory cortex of anesthetized guinea pig in response to three variants of a naturally produced speech sentence. Results show that the envelope of population responses closely tracks the speech envelope, and this cortical activity more closely reflects wider bandwidths of the speech envelope compared to narrow bands. Additionally, neuronal populations represent the fundamental frequency of speech robustly with phase-locked responses. Importantly, these two temporal features of speech are simultaneously observed within neuronal ensembles in auditory cortex in response to clear, conversation, and compressed speech exemplars. Results show that auditory cortex is adept at simultaneously resolving multiple temporal features in extended speech sentences using discrete coding mechanisms.



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Pitch Ranking with Different Virtual Channel Configurations in Electrical Hearing

Publication date: Available online 17 February 2017
Source:Hearing Research
Author(s): Monica Padilla, Natalia Stupak, David M. Landsberger
Monopolar Virtual Channels (MPVCs) use current steering to increase the number of spectral channels provided to cochlear implant users beyond the physical number of electrodes. The current spread created with a current steered channel is similar to the spread found for monopolar stimulation, and this spread may be one of the bottlenecks for improved performance with an increased number of channels. Quadrupolar Virtual Channels (QPVCs) use current focusing in combination with steering in an attempt to increase the number of channels while reducing channel interaction. However, due to the potentially asymmetric current field generated by QPVCs, there may be distortions in the place pitch representation using this mode. A Virtual Tripole (VTP) is introduced as a current focused virtual channel with a relatively symmetrical electric field distribution. In this study, we looked at pitch ranking in cochlear implant users with QPVC, VTP, and MPVC configurations to determine if place pitch shifts similarly across the cochlea or if any of the stimulation modes shift non-monotonically. Results suggest that MPVC and VTP stimulation provide a consistent monotonic shift across cochlear positions while the place shift provided by QPVCs was more variable. The use of VTP stimulation would be recommended instead of QPVC for a speech processing strategy.



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The pattern and degree of capsular fibrous sheaths surrounding cochlear electrode arrays

Publication date: Available online 17 February 2017
Source:Hearing Research
Author(s): Reuven Ishai, Barbara S. Herrmann, Joseph B. Nadol, Alicia M. Quesnel
An inflammatory tissue reaction around the electrode array of a cochlear implant (CI) is common, in particular at the electrode insertion region (cochleostomy) where mechanical trauma often occurs. However, the factors determining the amount and causes of fibrous reaction surrounding the stimulating electrode, especially medially near the perimodiolar location, are unclear. Temporal bone (TB) specimens from patients who had undergone cochlear implantation during life with either Advanced Bionics (AB) Clarion ^TM or HiRes90K^TM (Sylmar, CA, USA) devices that have a half-band and a pre-curved electrode, or Cochlear ^TM Nucleus (Sydney, Australia) device that have a full-band and a straight electrode were evaluated. The thickness of the fibrous tissue surrounding the electrode array of both types of CI devices at both the lower (LB) and upper (UB) basal turns of the cochlea was quantified at three locations: the medial, inferior, and superior aspects of the sheath. Fracture of the osseous spiral lamina and/or marked displacement of the basilar membrane were interpreted as evidence of intracochlear trauma. In addition, post-operative word recognition scores, duration of implantation, and post-operative programming data were evaluated.Seven TBs from six patients implanted with AB devices and five TBs from five patients implanted with Nucleus devices were included. A fibrous capsule around the stimulating electrode array was present in all twelve specimens. TBs implanted with AB device had a significantly thicker fibrous capsule at the medial aspect than at the inferior or superior aspects at both locations (LB and UB) of the cochlea (Wilcoxon signed-ranks test, p<0.01). TBs implanted with a Nucleus device had no difference in the thickness of the fibrous capsule surrounding the track of the electrode array (Wilcoxon signed-ranks test, p>0.05). Nine of fourteen (64%) basal turns of the cochlea (LB and UB of seven TBs) implanted with AB devices demonstrated intracochlear trauma compared to two of ten (20%) basal turns of the cochlea (LB and UB of five TBs) with Nucleus devices, (Fisher exact test, p<0.05). There was no significant correlation between the thickness of the fibrous tissue and the duration of implantation or the word recognition scores (Spearman rho, p=0.06, p=0.4 respectively). Our outcomes demonstrated the development of a robust fibrous tissue sheath medially closest to the site of electric stimulation in cases implanted with the AB device electrode, but not in cases implanted with the Nucleus device. The cause of the asymmetric fibrous sheath may be multifactorial including insertional trauma, a foreign body response, and/or asymmetric current flow.



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Population responses in primary auditory cortex simultaneously represent the temporal envelope and periodicity features in natural speech

Publication date: Available online 17 February 2017
Source:Hearing Research
Author(s): Daniel A. Abrams, Trent Nicol, Travis White-Schwoch, Mitra Hartmann, Steven Zecker, Nina Kraus
Speech perception relies on a listener’s ability to simultaneously resolve multiple temporal features in the speech signal. Little is known regarding neural mechanisms that enable the simultaneous coding of concurrent temporal features in the speech signal. Here we show that two categories of temporal features in speech, the low-frequency speech envelope and periodicity cues, are processed by distinct neural mechanisms within the same population of cortical neurons. We measured population activity in primary auditory cortex of anesthetized guinea pig in response to three variants of a naturally produced speech sentence. Results show that the envelope of population responses closely tracks the speech envelope, and this cortical activity more closely reflects wider bandwidths of the speech envelope compared to narrow bands. Additionally, neuronal populations represent the fundamental frequency of speech robustly with phase-locked responses. Importantly, these two temporal features of speech are simultaneously observed within neuronal ensembles in auditory cortex in response to clear, conversation, and compressed speech exemplars. Results show that auditory cortex is adept at simultaneously resolving multiple temporal features in extended speech sentences using discrete coding mechanisms.



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Pitch Ranking with Different Virtual Channel Configurations in Electrical Hearing

Publication date: Available online 17 February 2017
Source:Hearing Research
Author(s): Monica Padilla, Natalia Stupak, David M. Landsberger
Monopolar Virtual Channels (MPVCs) use current steering to increase the number of spectral channels provided to cochlear implant users beyond the physical number of electrodes. The current spread created with a current steered channel is similar to the spread found for monopolar stimulation, and this spread may be one of the bottlenecks for improved performance with an increased number of channels. Quadrupolar Virtual Channels (QPVCs) use current focusing in combination with steering in an attempt to increase the number of channels while reducing channel interaction. However, due to the potentially asymmetric current field generated by QPVCs, there may be distortions in the place pitch representation using this mode. A Virtual Tripole (VTP) is introduced as a current focused virtual channel with a relatively symmetrical electric field distribution. In this study, we looked at pitch ranking in cochlear implant users with QPVC, VTP, and MPVC configurations to determine if place pitch shifts similarly across the cochlea or if any of the stimulation modes shift non-monotonically. Results suggest that MPVC and VTP stimulation provide a consistent monotonic shift across cochlear positions while the place shift provided by QPVCs was more variable. The use of VTP stimulation would be recommended instead of QPVC for a speech processing strategy.



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The pattern and degree of capsular fibrous sheaths surrounding cochlear electrode arrays

Publication date: Available online 17 February 2017
Source:Hearing Research
Author(s): Reuven Ishai, Barbara S. Herrmann, Joseph B. Nadol, Alicia M. Quesnel
An inflammatory tissue reaction around the electrode array of a cochlear implant (CI) is common, in particular at the electrode insertion region (cochleostomy) where mechanical trauma often occurs. However, the factors determining the amount and causes of fibrous reaction surrounding the stimulating electrode, especially medially near the perimodiolar location, are unclear. Temporal bone (TB) specimens from patients who had undergone cochlear implantation during life with either Advanced Bionics (AB) Clarion ^TM or HiRes90K^TM (Sylmar, CA, USA) devices that have a half-band and a pre-curved electrode, or Cochlear ^TM Nucleus (Sydney, Australia) device that have a full-band and a straight electrode were evaluated. The thickness of the fibrous tissue surrounding the electrode array of both types of CI devices at both the lower (LB) and upper (UB) basal turns of the cochlea was quantified at three locations: the medial, inferior, and superior aspects of the sheath. Fracture of the osseous spiral lamina and/or marked displacement of the basilar membrane were interpreted as evidence of intracochlear trauma. In addition, post-operative word recognition scores, duration of implantation, and post-operative programming data were evaluated.Seven TBs from six patients implanted with AB devices and five TBs from five patients implanted with Nucleus devices were included. A fibrous capsule around the stimulating electrode array was present in all twelve specimens. TBs implanted with AB device had a significantly thicker fibrous capsule at the medial aspect than at the inferior or superior aspects at both locations (LB and UB) of the cochlea (Wilcoxon signed-ranks test, p<0.01). TBs implanted with a Nucleus device had no difference in the thickness of the fibrous capsule surrounding the track of the electrode array (Wilcoxon signed-ranks test, p>0.05). Nine of fourteen (64%) basal turns of the cochlea (LB and UB of seven TBs) implanted with AB devices demonstrated intracochlear trauma compared to two of ten (20%) basal turns of the cochlea (LB and UB of five TBs) with Nucleus devices, (Fisher exact test, p<0.05). There was no significant correlation between the thickness of the fibrous tissue and the duration of implantation or the word recognition scores (Spearman rho, p=0.06, p=0.4 respectively). Our outcomes demonstrated the development of a robust fibrous tissue sheath medially closest to the site of electric stimulation in cases implanted with the AB device electrode, but not in cases implanted with the Nucleus device. The cause of the asymmetric fibrous sheath may be multifactorial including insertional trauma, a foreign body response, and/or asymmetric current flow.



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Population responses in primary auditory cortex simultaneously represent the temporal envelope and periodicity features in natural speech

Publication date: Available online 17 February 2017
Source:Hearing Research
Author(s): Daniel A. Abrams, Trent Nicol, Travis White-Schwoch, Mitra Hartmann, Steven Zecker, Nina Kraus
Speech perception relies on a listener’s ability to simultaneously resolve multiple temporal features in the speech signal. Little is known regarding neural mechanisms that enable the simultaneous coding of concurrent temporal features in the speech signal. Here we show that two categories of temporal features in speech, the low-frequency speech envelope and periodicity cues, are processed by distinct neural mechanisms within the same population of cortical neurons. We measured population activity in primary auditory cortex of anesthetized guinea pig in response to three variants of a naturally produced speech sentence. Results show that the envelope of population responses closely tracks the speech envelope, and this cortical activity more closely reflects wider bandwidths of the speech envelope compared to narrow bands. Additionally, neuronal populations represent the fundamental frequency of speech robustly with phase-locked responses. Importantly, these two temporal features of speech are simultaneously observed within neuronal ensembles in auditory cortex in response to clear, conversation, and compressed speech exemplars. Results show that auditory cortex is adept at simultaneously resolving multiple temporal features in extended speech sentences using discrete coding mechanisms.



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Pitch Ranking with Different Virtual Channel Configurations in Electrical Hearing

Publication date: Available online 17 February 2017
Source:Hearing Research
Author(s): Monica Padilla, Natalia Stupak, David M. Landsberger
Monopolar Virtual Channels (MPVCs) use current steering to increase the number of spectral channels provided to cochlear implant users beyond the physical number of electrodes. The current spread created with a current steered channel is similar to the spread found for monopolar stimulation, and this spread may be one of the bottlenecks for improved performance with an increased number of channels. Quadrupolar Virtual Channels (QPVCs) use current focusing in combination with steering in an attempt to increase the number of channels while reducing channel interaction. However, due to the potentially asymmetric current field generated by QPVCs, there may be distortions in the place pitch representation using this mode. A Virtual Tripole (VTP) is introduced as a current focused virtual channel with a relatively symmetrical electric field distribution. In this study, we looked at pitch ranking in cochlear implant users with QPVC, VTP, and MPVC configurations to determine if place pitch shifts similarly across the cochlea or if any of the stimulation modes shift non-monotonically. Results suggest that MPVC and VTP stimulation provide a consistent monotonic shift across cochlear positions while the place shift provided by QPVCs was more variable. The use of VTP stimulation would be recommended instead of QPVC for a speech processing strategy.



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The pattern and degree of capsular fibrous sheaths surrounding cochlear electrode arrays

Publication date: Available online 17 February 2017
Source:Hearing Research
Author(s): Reuven Ishai, Barbara S. Herrmann, Joseph B. Nadol, Alicia M. Quesnel
An inflammatory tissue reaction around the electrode array of a cochlear implant (CI) is common, in particular at the electrode insertion region (cochleostomy) where mechanical trauma often occurs. However, the factors determining the amount and causes of fibrous reaction surrounding the stimulating electrode, especially medially near the perimodiolar location, are unclear. Temporal bone (TB) specimens from patients who had undergone cochlear implantation during life with either Advanced Bionics (AB) Clarion ^TM or HiRes90K^TM (Sylmar, CA, USA) devices that have a half-band and a pre-curved electrode, or Cochlear ^TM Nucleus (Sydney, Australia) device that have a full-band and a straight electrode were evaluated. The thickness of the fibrous tissue surrounding the electrode array of both types of CI devices at both the lower (LB) and upper (UB) basal turns of the cochlea was quantified at three locations: the medial, inferior, and superior aspects of the sheath. Fracture of the osseous spiral lamina and/or marked displacement of the basilar membrane were interpreted as evidence of intracochlear trauma. In addition, post-operative word recognition scores, duration of implantation, and post-operative programming data were evaluated.Seven TBs from six patients implanted with AB devices and five TBs from five patients implanted with Nucleus devices were included. A fibrous capsule around the stimulating electrode array was present in all twelve specimens. TBs implanted with AB device had a significantly thicker fibrous capsule at the medial aspect than at the inferior or superior aspects at both locations (LB and UB) of the cochlea (Wilcoxon signed-ranks test, p<0.01). TBs implanted with a Nucleus device had no difference in the thickness of the fibrous capsule surrounding the track of the electrode array (Wilcoxon signed-ranks test, p>0.05). Nine of fourteen (64%) basal turns of the cochlea (LB and UB of seven TBs) implanted with AB devices demonstrated intracochlear trauma compared to two of ten (20%) basal turns of the cochlea (LB and UB of five TBs) with Nucleus devices, (Fisher exact test, p<0.05). There was no significant correlation between the thickness of the fibrous tissue and the duration of implantation or the word recognition scores (Spearman rho, p=0.06, p=0.4 respectively). Our outcomes demonstrated the development of a robust fibrous tissue sheath medially closest to the site of electric stimulation in cases implanted with the AB device electrode, but not in cases implanted with the Nucleus device. The cause of the asymmetric fibrous sheath may be multifactorial including insertional trauma, a foreign body response, and/or asymmetric current flow.



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Two Turkish siblings with MEGDEL syndrome due to novel SERAC1 gene mutation.

Related Articles

Two Turkish siblings with MEGDEL syndrome due to novel SERAC1 gene mutation.

Turk J Pediatr. 2015 Jul-Aug;57(4):388-393

Authors: Ünal Ö, Özgül RK, Yücel D, Yalnızoğlu D, Tokatlı A, Sivri HS, Hişmi B, Coşkun T, Dursun A

Abstract
Association of 3-methylglutaconic aciduria with impaired oxidative phosphorylation, deafness, encephalopathy, leigh-like lesions on brain imaging, progressive spasticity and dystonia defined as a distinct entity under the name of MEGDEL syndrome. It is an autosomal recessive disorder due to mutation in the serine active site-containing protein 1 (SERAC1). SERAC1 is localized at the interface between the mitochondria and the endoplasmic reticulum in the mitochondria-associated membrane fraction that is essential for phospholipid exchange. It was identified as a key player in the phosphatidylglycerol remodeling that is essential for both mitochondrial function and intracellular cholesterol trafficking. Here we report two new Turkish sibling patients affected with MEGDEL syndrome due to SERAC1 gene mutation. The patients were presented with 3-methylglutaconic acid and 3-methylglutaric aciduria, microcephaly, growth retardation, dysmorphic features, severe sensorineural deafness, progressive spasticity, dystonia, seizures, basal ganglia involvement. Metabolic acidosis, mild hyperammonemia and lactic acidemia were accompanied with clinical findings in newborn period.

PMID: 27186703 [PubMed - indexed for MEDLINE]

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Letter to the Editor Regarding Oyewumi M Wolter NE, Heon E, Gordon KA, Papsin BC, Cushing SL. "Using Balance Function to Screen for Vestibular Impairment in Children With Sensorineural Hearing Loss and Cochlear Implants".

Letter to the Editor Regarding Oyewumi M Wolter NE, Heon E, Gordon KA, Papsin BC, Cushing SL. "Using Balance Function to Screen for Vestibular Impairment in Children With Sensorineural Hearing Loss and Cochlear Implants".

Otol Neurotol. 2017 Feb 15;:

Authors: Mierzwiński J, Drela M

PMID: 28207627 [PubMed - as supplied by publisher]

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Independent prescriber physiotherapist led balance clinic: the Southport and Ormskirk pathway.

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Independent prescriber physiotherapist led balance clinic: the Southport and Ormskirk pathway.

J Laryngol Otol. 2017 Feb 16;:1-8

Authors: Burrows L, Lesser TH, Kasbekar AV, Roland N, Billing M

Abstract
OBJECTIVE: To report the introduction and impact of non-medical prescribing, initiated to improve patient pathways for those presenting with dizziness and balance disorders.
METHODS: The Southport and Ormskirk physiotherapy-led vestibular clinic sees and treats all patients with dizziness and balance disorders referred to the ENT department. Letters are triaged by an audiologist, who also performs an otological examination and hearing test; this is followed by an assessment with the independent prescriber physiotherapist. An ENT consultant is nearby if joint consultation is needed. Diagnoses, treatments and patient satisfaction were studied, with an analysis of the impact of medication management (stopping or starting medicines) on patients and service.
RESULTS: In 12 months, 413 new patients with dizziness and balance disorders had appointments. The most common diagnoses were benign paroxysmal positional vertigo and vestibular migraine. Eighty-four per cent of patients required self-management strategies, 50 per cent exercise therapy, 48 per cent medication management and 24 per cent a particle repositioning manoeuvre. Patient satisfaction was high (99 per cent).
CONCLUSION: Having an independent prescriber physiotherapist leading the balance clinic has reduced the number of hospital visits and onward referrals. Nearly half of all patients required medication management as part of their dizziness or balance treatment.

PMID: 28202097 [PubMed - as supplied by publisher]

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Letter to the Editor Regarding Oyewumi M Wolter NE, Heon E, Gordon KA, Papsin BC, Cushing SL. "Using Balance Function to Screen for Vestibular Impairment in Children With Sensorineural Hearing Loss and Cochlear Implants".

Letter to the Editor Regarding Oyewumi M Wolter NE, Heon E, Gordon KA, Papsin BC, Cushing SL. "Using Balance Function to Screen for Vestibular Impairment in Children With Sensorineural Hearing Loss and Cochlear Implants".

Otol Neurotol. 2017 Feb 15;:

Authors: Mierzwiński J, Drela M

PMID: 28207627 [PubMed - as supplied by publisher]

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Independent prescriber physiotherapist led balance clinic: the Southport and Ormskirk pathway.

Related Articles

Independent prescriber physiotherapist led balance clinic: the Southport and Ormskirk pathway.

J Laryngol Otol. 2017 Feb 16;:1-8

Authors: Burrows L, Lesser TH, Kasbekar AV, Roland N, Billing M

Abstract
OBJECTIVE: To report the introduction and impact of non-medical prescribing, initiated to improve patient pathways for those presenting with dizziness and balance disorders.
METHODS: The Southport and Ormskirk physiotherapy-led vestibular clinic sees and treats all patients with dizziness and balance disorders referred to the ENT department. Letters are triaged by an audiologist, who also performs an otological examination and hearing test; this is followed by an assessment with the independent prescriber physiotherapist. An ENT consultant is nearby if joint consultation is needed. Diagnoses, treatments and patient satisfaction were studied, with an analysis of the impact of medication management (stopping or starting medicines) on patients and service.
RESULTS: In 12 months, 413 new patients with dizziness and balance disorders had appointments. The most common diagnoses were benign paroxysmal positional vertigo and vestibular migraine. Eighty-four per cent of patients required self-management strategies, 50 per cent exercise therapy, 48 per cent medication management and 24 per cent a particle repositioning manoeuvre. Patient satisfaction was high (99 per cent).
CONCLUSION: Having an independent prescriber physiotherapist leading the balance clinic has reduced the number of hospital visits and onward referrals. Nearly half of all patients required medication management as part of their dizziness or balance treatment.

PMID: 28202097 [PubMed - as supplied by publisher]

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Is child walking conditioned by gender? Surface EMG patterns in female and male children

Publication date: Available online 16 February 2017
Source:Gait & Posture
Author(s): Francesco di Nardo, Giulio Laureati, Annachiara Strazza, Alessandro Mengarelli, Laura Burattini, Valentina Agostini, Alberto Nascimbeni, Marco Knaflitz, Sandro Fioretti
EMG-based differences between females and males during walking are generally acknowledged in adults. Aim of the study was the quantification of possible gender differences in myoelectric activity of gastrocnemius lateralis (GL) and tibialis anterior (TA) during walking in school-age children. Gender-related comparison with adults was also provided to get possible novel insight in maturation of gait. To this aim, Statistical gait analysis, a recent methodology performing a statistical characterization of gait by averaging spatial-temporal and surface-EMG-based parameters over hundreds of strides, was performed in100 healthy school-age children (C-group) and in 33 healthy young adults (YA-group). On average, 301±110 consecutive strides were analyzed for each subject. In C-group, no significant differences (p>0.05) were observed between females and males in GL and TA, considering mean onset/offset instants of activation and occurrence frequency. Stratifying the C-group for age, small differences between females and males in occurrence frequency of GL arose in oldest children. In YA-group, females showed a significant propensity for a more complex recruitment of TA and GL (higher number of activations during gait cycle, quantified by occurrence frequency) compared to males. These outcomes suggest that gender-related differences in sEMG parameters do not characterize the recruitment of GL and TA during child walking in early years (6-8 years), start occurring when adolescence is approaching (10-12 years), and are acknowledged in both ankle muscles only in adults. Present findings seem to support previous studies on maturation of gait which indicate adolescence as the time-range where gait is completing its maturation path.



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Is child walking conditioned by gender? Surface EMG patterns in female and male children

Publication date: Available online 16 February 2017
Source:Gait & Posture
Author(s): Francesco di Nardo, Giulio Laureati, Annachiara Strazza, Alessandro Mengarelli, Laura Burattini, Valentina Agostini, Alberto Nascimbeni, Marco Knaflitz, Sandro Fioretti
EMG-based differences between females and males during walking are generally acknowledged in adults. Aim of the study was the quantification of possible gender differences in myoelectric activity of gastrocnemius lateralis (GL) and tibialis anterior (TA) during walking in school-age children. Gender-related comparison with adults was also provided to get possible novel insight in maturation of gait. To this aim, Statistical gait analysis, a recent methodology performing a statistical characterization of gait by averaging spatial-temporal and surface-EMG-based parameters over hundreds of strides, was performed in100 healthy school-age children (C-group) and in 33 healthy young adults (YA-group). On average, 301±110 consecutive strides were analyzed for each subject. In C-group, no significant differences (p>0.05) were observed between females and males in GL and TA, considering mean onset/offset instants of activation and occurrence frequency. Stratifying the C-group for age, small differences between females and males in occurrence frequency of GL arose in oldest children. In YA-group, females showed a significant propensity for a more complex recruitment of TA and GL (higher number of activations during gait cycle, quantified by occurrence frequency) compared to males. These outcomes suggest that gender-related differences in sEMG parameters do not characterize the recruitment of GL and TA during child walking in early years (6-8 years), start occurring when adolescence is approaching (10-12 years), and are acknowledged in both ankle muscles only in adults. Present findings seem to support previous studies on maturation of gait which indicate adolescence as the time-range where gait is completing its maturation path.



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Is child walking conditioned by gender? Surface EMG patterns in female and male children

Publication date: Available online 16 February 2017
Source:Gait & Posture
Author(s): Francesco di Nardo, Giulio Laureati, Annachiara Strazza, Alessandro Mengarelli, Laura Burattini, Valentina Agostini, Alberto Nascimbeni, Marco Knaflitz, Sandro Fioretti
EMG-based differences between females and males during walking are generally acknowledged in adults. Aim of the study was the quantification of possible gender differences in myoelectric activity of gastrocnemius lateralis (GL) and tibialis anterior (TA) during walking in school-age children. Gender-related comparison with adults was also provided to get possible novel insight in maturation of gait. To this aim, Statistical gait analysis, a recent methodology performing a statistical characterization of gait by averaging spatial-temporal and surface-EMG-based parameters over hundreds of strides, was performed in100 healthy school-age children (C-group) and in 33 healthy young adults (YA-group). On average, 301±110 consecutive strides were analyzed for each subject. In C-group, no significant differences (p>0.05) were observed between females and males in GL and TA, considering mean onset/offset instants of activation and occurrence frequency. Stratifying the C-group for age, small differences between females and males in occurrence frequency of GL arose in oldest children. In YA-group, females showed a significant propensity for a more complex recruitment of TA and GL (higher number of activations during gait cycle, quantified by occurrence frequency) compared to males. These outcomes suggest that gender-related differences in sEMG parameters do not characterize the recruitment of GL and TA during child walking in early years (6-8 years), start occurring when adolescence is approaching (10-12 years), and are acknowledged in both ankle muscles only in adults. Present findings seem to support previous studies on maturation of gait which indicate adolescence as the time-range where gait is completing its maturation path.



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Musculoskeletal Pain and Occupational Variables in Teachers With Voice Disorders and in Those With Healthy Voices—A Pilot Study

Publication date: Available online 16 February 2017
Source:Journal of Voice
Author(s): Jhonatan da Silva Vitor, Larissa Thaís Donalonso Siqueira, Vanessa Veis Ribeiro, Janine Santos Ramos, Alcione Ghedini Brasolotto, Kelly Cristina Alves Silverio
PurposeThis study aimed to compare musculoskeletal pain perception in teachers with voice disorders and in those with healthy voices, and to investigate the relationship between musculoskeletal pain and occupational variables (ie, work journey per week and working period).MethodForty-three classroom teachers were divided into two groups: dysphonic group (DG), 32 classroom teachers with voice complaints and voice disorders; and non-DG, 11 classroom teachers without voice complaints and who are vocally healthy. The musculoskeletal pain investigation survey was used to investigate the frequency and intensity of the pain. Occupational variables, such as work journey per week and working period, were investigated by the Voice Production Condition—Teacher questionnaire. The statistical tests used were the Spearman correlation (P ≤ 0.05) and the Mann-Whitney U test (P ≤ 0.05).ResultsThere was no difference between the frequency and the intensity of musculoskeletal pain regarding dysphonia. Work journey per week was positively related to the frequency and the intensity of laryngeal pain in the DG. The working period had a negative relationship to the frequency and the intensity of musculoskeletal pain in the submandibular region in the DG.ConclusionClassroom teachers with voice disorders and those with healthy voices do not have differences regarding the frequency and the intensity of musculoskeletal pain. Besides dysphonia the pain is an important symptom to be considered in classroom teachers. The occupational variables contributed to the presence of musculoskeletal pain in the region near the larynx, which appears to be directly proportional to work journey per week and inversely proportional to the working period.



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Relationship Between Peripheral and Psychophysical Measures of Amplitude Modulation Detection in Cochlear Implant Users.

Objective: This study investigates the relationship between electrophysiological and psychophysical measures of amplitude modulation (AM) detection. Prior studies have reported both measures of AM detection recorded separately from cochlear implant (CI) users and acutely deafened animals, but no study has made both measures in the same CI users. Animal studies suggest a progressive loss of high-frequency encoding as one ascends the auditory pathway from the auditory nerve to the cortex. Because the CI speech processor uses the envelope of an ongoing acoustic signal to modulate pulse trains that are subsequently delivered to the intracochlear electrodes, it is of interest to explore auditory nerve responses to modulated stimuli. In addition, psychophysical AM detection abilities have been correlated with speech perception outcomes. Thus, the goal was to explore how the auditory nerve responds to AM stimuli and to relate those physiologic measures to perception. Design: Eight patients using Cochlear Ltd. Implants participated in this study. Electrically evoked compound action potentials (ECAPs) were recorded using a 4000 pps pulse train that was sinusoidally amplitude modulated at 125, 250, 500, and 1000 Hz rates. Responses were measured for each pulse over at least one modulation cycle for an apical, medial, and basal electrode. Psychophysical modulation detection thresholds (MDTs) were also measured via a three-alternative forced choice, two-down, one-up adaptive procedure using the same modulation frequencies and electrodes. Results: ECAPs were recorded from individual pulses in the AM pulse train. ECAP amplitudes varied sinusoidally, reflecting the sinusoidal variation in the stimulus. A modulated response amplitude (MRA) metric was calculated as the difference in the maximal and minimum ECAP amplitudes over the modulation cycles. MRA increased as modulation frequency increased, with no apparent cutoff (up to 1000 Hz). In contrast, MDTs increased as the modulation frequency increased. This trend is inconsistent with the physiologic measures. For a fixed modulation frequency, correlations were observed between MDTs and MRAs; this trend was evident at all frequencies except 1000 Hz (although only statistically significant for 250 and 500 Hz AM rates), possibly an indication of central limitations in processing of high modulation frequencies. Finally, peripheral responses were larger and psychophysical thresholds were lower in the apical electrodes relative to basal and medial electrodes, which may reflect better cochlear health and neural survival evidenced by lower preoperative low-frequency audiometric thresholds and steeper growth of neural responses in ECAP amplitude growth functions for apical electrodes. Conclusions: Robust ECAPs were recorded for all modulation frequencies tested. ECAP amplitudes varied sinusoidally, reflecting the periodicity of the modulated stimuli. MRAs increased as the modulation frequency increased, a trend we attribute to neural adaptation. For low modulation frequencies, there are multiple current steps between the peak and valley of the modulation cycle, which means successive stimuli are more similar to one another and neural responses are more likely to adapt. Higher MRAs were correlated with lower psychophysical thresholds at low modulation frequencies but not at 1000 Hz, implying a central limitation to processing of modulated stimuli. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Letter to the Editor: Reporting of Data to Inform the Design of a Definitive Trial Re: Henry, J.A., Frederick, M., Sell, S., Griest, S., Abrams, H. (2015). Validation of a Novel Combination Hearing Aid and Tinnitus Therapy Device, Ear Hear, 36, 42-52.

No abstract available

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The Impact of a Cochlear Implant Electrode Array on the Middle Ear Transfer Function.

Objectives: As a treatment for partial deafness with residual hearing in the lower frequency range, the combined acoustic and electric stimulation of the cochlea has become widespread. Acoustic stimulation is provided by a hearing aid's airborne sound and the electric stimulation by a cochlear implant electrode array, which may be inserted through the round window or a cochleostomy. To take advantage of that concept, it is essential to preserve residual hearing after surgery. Therefore, the intracochlear electrode array should not compromise the middle ear vibration transmission. This study investigates the influence of different electrode types and insertion paths on the middle ear transfer function and the inner ear fluid dynamics. Design: Sound-induced oval and round window net volume velocities were calculated from vibration measurements with laser vibrometers on six nonfixated human temporal bones. After baseline measurements in the "natural" condition, a cochleostomy was drilled and closed with connective tissue. Then, four different electrode arrays were inserted through the cochleostomy. Afterwards, they were inserted through the round window while the cochleostomy was patched again with connective tissue. Results: After having drilled a cochleostomy and electrode insertion, no systematic trends in the changes of oval and round window volume velocities were observed. Nearly all changes of middle ear transfer functions, as well as oval and round window volume velocity ratios, were statistically insignificant. Conclusions: Intracochlear electrode arrays do not significantly increase cochlear input impedance immediately after insertion. Any changes that may occur seem to be independent of electrode array type and insertion path. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Expansion of Prosodic Abilities at the Transition From Babble to Words: A Comparison Between Children With Cochlear Implants and Normally Hearing Children.

Objectives: This longitudinal study examined the effect of emerging vocabulary production on the ability to produce the phonetic cues to prosodic prominence in babbled and lexical disyllables of infants with cochlear implants (CI) and normally hearing (NH) infants. Current research on typical language acquisition emphasizes the importance of vocabulary development for phonological and phonetic acquisition. Children with CI experience significant difficulties with the perception and production of prosody, and the role of possible top-down effects is, therefore, particularly relevant for this population. Design: Isolated disyllabic babble and first words were identified and segmented in longitudinal audio-video recordings and transcriptions for nine NH infants and nine infants with CI interacting with their parents. Monthly recordings were included from the onset of babbling until children had reached a cumulative vocabulary of 200 words. Three cues to prosodic prominence, fundamental frequency (f0), intensity, and duration, were measured in the vocalic portions of stand-alone disyllables. To represent the degree of prosodic differentiation between two syllables in an utterance, the raw values for intensity and duration were transformed to ratios, and for f0, a measure of the perceptual distance in semitones was derived. The degree of prosodic differentiation for disyllabic babble and words for each cue was compared between groups. In addition, group and individual tendencies on the types of stress patterns for babble and words were also examined. Results: The CI group had overall smaller pitch and intensity distances than the NH group. For the NH group, words had greater pitch and intensity distances than babbled disyllables. Especially for pitch distance, this was accompanied by a shift toward a more clearly expressed stress pattern that reflected the influence of the ambient language. For the CI group, the same expansion in words did not take place for pitch. For intensity, the CI group gave evidence of some increase of prosodic differentiation. The results for the duration measure showed evidence of utterance final lengthening in both groups. In words, the CI group significantly reduced durational differences between syllables so that a more even-timed, less differentiated pattern emerged. Conclusions: The onset of vocabulary production did not have the same facilitatory effect for the CI infants on the production of phonetic cues for prosody, especially for pitch. It was argued that the results for duration may reflect greater articulatory difficulties in words for the CI group than the NH group. It was suggested that the lack of clear top-down effects of the vocabulary in the CI group may be because of a lag in development caused by an initial lack of auditory stimulation, possibly compounded by the absence of auditory feedback during the babble phase. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Response to Letter to the Editor: RE: Henry, J.A., Frederick, M., Sell, S, Griest, S., Abrams, H. (2015) Validation of a Novel Combination Hearing Aid and Tinnitus Therapy Device, Ear and Hear, 36, 42-52.

No abstract available

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Health-Related Quality of Life Among Young Children With Cochlear Implants and Developmental Disabilities.

Objective: The present study examined differences in health-related quality of life (HRQoL) between deaf children with cochlear implants (CI) with and without developmental disabilities (DD) and differences across HRQoL domains within both groups of children. Methods: Ninety-two parents of children with CI aged 3-7 years participated in this cross-sectional study. Of these children, 43 had DD (i.e., CI-DD group) and 49 had no DD or chronic illness, demonstrating overall typical development (i.e., CI-TD group). Parents of children in both groups completed the KINDLR, a generic HRQoL questionnaire. Parents also provided anecdotal comments to open-ended questions, and parent comments were evaluated on a CI benefits scale to assess parent-perceived benefits of CI for the deaf children with and without disabilities. Results: Children in the CI-DD group had significantly lower HRQoL compared to children in the CI-TD group, including lower scores on the self-esteem, friend, school, and family HRQoL subscales. No significant differences among groups were found on the physical well-being and emotional well-being subscales. For the CI-TD group, age at implantation correlated negatively with self-esteem and school HRQoL subscales. In the CI-DD group, children's current age correlated negatively with family and with the total HRQoL scores. Parent anecdotal comments and scores on the CI-benefits scale indicated strong parent perceptions of benefits of implantation for children in both groups. Conclusion: Based on parents' proxy report, findings suggest that having DD affects multiple domains of HRQoL among young children with CIs above and beyond that of the CI itself. Parents of deaf children with DD may need greater support through the CI process and follow-up than parents of deaf children without DD. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Relationship Between Peripheral and Psychophysical Measures of Amplitude Modulation Detection in Cochlear Implant Users.

Objective: This study investigates the relationship between electrophysiological and psychophysical measures of amplitude modulation (AM) detection. Prior studies have reported both measures of AM detection recorded separately from cochlear implant (CI) users and acutely deafened animals, but no study has made both measures in the same CI users. Animal studies suggest a progressive loss of high-frequency encoding as one ascends the auditory pathway from the auditory nerve to the cortex. Because the CI speech processor uses the envelope of an ongoing acoustic signal to modulate pulse trains that are subsequently delivered to the intracochlear electrodes, it is of interest to explore auditory nerve responses to modulated stimuli. In addition, psychophysical AM detection abilities have been correlated with speech perception outcomes. Thus, the goal was to explore how the auditory nerve responds to AM stimuli and to relate those physiologic measures to perception. Design: Eight patients using Cochlear Ltd. Implants participated in this study. Electrically evoked compound action potentials (ECAPs) were recorded using a 4000 pps pulse train that was sinusoidally amplitude modulated at 125, 250, 500, and 1000 Hz rates. Responses were measured for each pulse over at least one modulation cycle for an apical, medial, and basal electrode. Psychophysical modulation detection thresholds (MDTs) were also measured via a three-alternative forced choice, two-down, one-up adaptive procedure using the same modulation frequencies and electrodes. Results: ECAPs were recorded from individual pulses in the AM pulse train. ECAP amplitudes varied sinusoidally, reflecting the sinusoidal variation in the stimulus. A modulated response amplitude (MRA) metric was calculated as the difference in the maximal and minimum ECAP amplitudes over the modulation cycles. MRA increased as modulation frequency increased, with no apparent cutoff (up to 1000 Hz). In contrast, MDTs increased as the modulation frequency increased. This trend is inconsistent with the physiologic measures. For a fixed modulation frequency, correlations were observed between MDTs and MRAs; this trend was evident at all frequencies except 1000 Hz (although only statistically significant for 250 and 500 Hz AM rates), possibly an indication of central limitations in processing of high modulation frequencies. Finally, peripheral responses were larger and psychophysical thresholds were lower in the apical electrodes relative to basal and medial electrodes, which may reflect better cochlear health and neural survival evidenced by lower preoperative low-frequency audiometric thresholds and steeper growth of neural responses in ECAP amplitude growth functions for apical electrodes. Conclusions: Robust ECAPs were recorded for all modulation frequencies tested. ECAP amplitudes varied sinusoidally, reflecting the periodicity of the modulated stimuli. MRAs increased as the modulation frequency increased, a trend we attribute to neural adaptation. For low modulation frequencies, there are multiple current steps between the peak and valley of the modulation cycle, which means successive stimuli are more similar to one another and neural responses are more likely to adapt. Higher MRAs were correlated with lower psychophysical thresholds at low modulation frequencies but not at 1000 Hz, implying a central limitation to processing of modulated stimuli. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Letter to the Editor: Reporting of Data to Inform the Design of a Definitive Trial Re: Henry, J.A., Frederick, M., Sell, S., Griest, S., Abrams, H. (2015). Validation of a Novel Combination Hearing Aid and Tinnitus Therapy Device, Ear Hear, 36, 42-52.

No abstract available

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The Impact of a Cochlear Implant Electrode Array on the Middle Ear Transfer Function.

Objectives: As a treatment for partial deafness with residual hearing in the lower frequency range, the combined acoustic and electric stimulation of the cochlea has become widespread. Acoustic stimulation is provided by a hearing aid's airborne sound and the electric stimulation by a cochlear implant electrode array, which may be inserted through the round window or a cochleostomy. To take advantage of that concept, it is essential to preserve residual hearing after surgery. Therefore, the intracochlear electrode array should not compromise the middle ear vibration transmission. This study investigates the influence of different electrode types and insertion paths on the middle ear transfer function and the inner ear fluid dynamics. Design: Sound-induced oval and round window net volume velocities were calculated from vibration measurements with laser vibrometers on six nonfixated human temporal bones. After baseline measurements in the "natural" condition, a cochleostomy was drilled and closed with connective tissue. Then, four different electrode arrays were inserted through the cochleostomy. Afterwards, they were inserted through the round window while the cochleostomy was patched again with connective tissue. Results: After having drilled a cochleostomy and electrode insertion, no systematic trends in the changes of oval and round window volume velocities were observed. Nearly all changes of middle ear transfer functions, as well as oval and round window volume velocity ratios, were statistically insignificant. Conclusions: Intracochlear electrode arrays do not significantly increase cochlear input impedance immediately after insertion. Any changes that may occur seem to be independent of electrode array type and insertion path. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Expansion of Prosodic Abilities at the Transition From Babble to Words: A Comparison Between Children With Cochlear Implants and Normally Hearing Children.

Objectives: This longitudinal study examined the effect of emerging vocabulary production on the ability to produce the phonetic cues to prosodic prominence in babbled and lexical disyllables of infants with cochlear implants (CI) and normally hearing (NH) infants. Current research on typical language acquisition emphasizes the importance of vocabulary development for phonological and phonetic acquisition. Children with CI experience significant difficulties with the perception and production of prosody, and the role of possible top-down effects is, therefore, particularly relevant for this population. Design: Isolated disyllabic babble and first words were identified and segmented in longitudinal audio-video recordings and transcriptions for nine NH infants and nine infants with CI interacting with their parents. Monthly recordings were included from the onset of babbling until children had reached a cumulative vocabulary of 200 words. Three cues to prosodic prominence, fundamental frequency (f0), intensity, and duration, were measured in the vocalic portions of stand-alone disyllables. To represent the degree of prosodic differentiation between two syllables in an utterance, the raw values for intensity and duration were transformed to ratios, and for f0, a measure of the perceptual distance in semitones was derived. The degree of prosodic differentiation for disyllabic babble and words for each cue was compared between groups. In addition, group and individual tendencies on the types of stress patterns for babble and words were also examined. Results: The CI group had overall smaller pitch and intensity distances than the NH group. For the NH group, words had greater pitch and intensity distances than babbled disyllables. Especially for pitch distance, this was accompanied by a shift toward a more clearly expressed stress pattern that reflected the influence of the ambient language. For the CI group, the same expansion in words did not take place for pitch. For intensity, the CI group gave evidence of some increase of prosodic differentiation. The results for the duration measure showed evidence of utterance final lengthening in both groups. In words, the CI group significantly reduced durational differences between syllables so that a more even-timed, less differentiated pattern emerged. Conclusions: The onset of vocabulary production did not have the same facilitatory effect for the CI infants on the production of phonetic cues for prosody, especially for pitch. It was argued that the results for duration may reflect greater articulatory difficulties in words for the CI group than the NH group. It was suggested that the lack of clear top-down effects of the vocabulary in the CI group may be because of a lag in development caused by an initial lack of auditory stimulation, possibly compounded by the absence of auditory feedback during the babble phase. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Response to Letter to the Editor: RE: Henry, J.A., Frederick, M., Sell, S, Griest, S., Abrams, H. (2015) Validation of a Novel Combination Hearing Aid and Tinnitus Therapy Device, Ear and Hear, 36, 42-52.

No abstract available

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Health-Related Quality of Life Among Young Children With Cochlear Implants and Developmental Disabilities.

Objective: The present study examined differences in health-related quality of life (HRQoL) between deaf children with cochlear implants (CI) with and without developmental disabilities (DD) and differences across HRQoL domains within both groups of children. Methods: Ninety-two parents of children with CI aged 3-7 years participated in this cross-sectional study. Of these children, 43 had DD (i.e., CI-DD group) and 49 had no DD or chronic illness, demonstrating overall typical development (i.e., CI-TD group). Parents of children in both groups completed the KINDLR, a generic HRQoL questionnaire. Parents also provided anecdotal comments to open-ended questions, and parent comments were evaluated on a CI benefits scale to assess parent-perceived benefits of CI for the deaf children with and without disabilities. Results: Children in the CI-DD group had significantly lower HRQoL compared to children in the CI-TD group, including lower scores on the self-esteem, friend, school, and family HRQoL subscales. No significant differences among groups were found on the physical well-being and emotional well-being subscales. For the CI-TD group, age at implantation correlated negatively with self-esteem and school HRQoL subscales. In the CI-DD group, children's current age correlated negatively with family and with the total HRQoL scores. Parent anecdotal comments and scores on the CI-benefits scale indicated strong parent perceptions of benefits of implantation for children in both groups. Conclusion: Based on parents' proxy report, findings suggest that having DD affects multiple domains of HRQoL among young children with CIs above and beyond that of the CI itself. Parents of deaf children with DD may need greater support through the CI process and follow-up than parents of deaf children without DD. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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A Three-Dimensional Geometric-Morphometric Study to Quantify Temporal Bone Growth and its Consequences for the Success of Implanting Bone Anchored Hearing Devices.

Objective: A computed tomography (CT)-based morphological-investigation to describe temporal bone growth and to devise a predictive test of the likely success of Bonebridge implantation into the growing mastoid region of the temporal bone in young patients. Study Design: Retrospective cross-sectional study. Setting: University Hospital Halle (Saale), Germany. Patients: Two cohorts participated. This first, of patients aged less than 21 years, comprised 42 men, and 33 women patients. The second cohort, for those aged more than or equal to 21 years, comprised 17 men, and 20 women patients. Intervention: One hundred eighty three three-dimensional (3-D) reconstructions of the mastoid portion of the temporal bone without malformations or chronic middle ear disease were created on the base of high resolution computer tomography. The 3-D-reconstructions were analyzed using 13 linear measurements and volumetry. Primary Outcome Measure: A CT/3-D model derived metric with which to best estimate the likely success of fitting a Bonebridge. Results: Volume increase stagnated at, on average, 15.6 years of age (men), or 17.5 years (women). The most obvious extent of growth was observed in the craniocaudal direction from the middle cranial fossa to the tip of the mastoid process (total height). This growth is highly correlated with the increase of the mastoid volume (r = 0.938) and thus represents the most influential factor on mastoid volume increase. The total height of the mastoid portion can be used to usefully predict the chance of successful Bonebridge implantation. The depth of the mastoid almost doubled its size from birth (8.93 mm) to adulthood (16.34 mm) and also strongly affects the mastoid volume (r = 0.912). That portion between the external auditory canal (EAC) and the sigmoid sinus showed a lower growth capacity. Conclusions: The highly significant correlations between CT derived linear parameters and Bonebridge fitting (p

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Combined Intratympanic and Systemic Use of Steroids as a First-Line Treatment for Sudden Sensorineural Hearing Loss: A Meta-Analysis of Randomized, Controlled Trials.

Objective: To compare the efficacy of combination therapy (combined intratympanic and systemic use of steroids, CT) with systemic steroid therapy (SST) as a primary treatment for sudden sensorineural hearing loss (SSNHL). Methods: An electronic database search (PubMed, Embase, Cochrane Library, and CNKI databases) was performed. Review Manger 5.3 was used for data synthesis. Data were collected on the following outcomes of interest: the proportion of patients with hearing improvement, changes in pure tone averages (PTA), and speech discrimination score (SDS). Results: A total of 14 RCTs including 756 subjects allocated to CT and 638 to SST were selected. The proportion of patients with hearing improvement as outcome measure was observed in 13 studies, which resulted in an odds ratio (OR) of 2.50 (95% confidence interval [CI]: 1.95-2.1). The PTA changes (in dB) as outcome measure was observed in 12 studies, which resulted in mean difference (MD) 13 (95% CI: 9.24-16.77). SDS changes (in %) as outcome measure were reported in five studies, which resulted in MD 15.72 (95% CI: 5.11-26.33). Conclusion: CT seems to confer a certain degree of benefit as a primary treatment of SSNHL as compared with SST. Further validation based on high quality studies is required. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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RESPONSE TO LETTER TO THE EDITOR.

No abstract available

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Letter to the Editor Regarding Oyewumi M Wolter NE, Heon E, Gordon KA, Papsin BC, Cushing SL. "Using Balance Function to Screen for Vestibular Impairment in Children With Sensorineural Hearing Loss and Cochlear Implants".

No abstract available

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Relationship Between Peripheral and Psychophysical Measures of Amplitude Modulation Detection in Cochlear Implant Users.

Objective: This study investigates the relationship between electrophysiological and psychophysical measures of amplitude modulation (AM) detection. Prior studies have reported both measures of AM detection recorded separately from cochlear implant (CI) users and acutely deafened animals, but no study has made both measures in the same CI users. Animal studies suggest a progressive loss of high-frequency encoding as one ascends the auditory pathway from the auditory nerve to the cortex. Because the CI speech processor uses the envelope of an ongoing acoustic signal to modulate pulse trains that are subsequently delivered to the intracochlear electrodes, it is of interest to explore auditory nerve responses to modulated stimuli. In addition, psychophysical AM detection abilities have been correlated with speech perception outcomes. Thus, the goal was to explore how the auditory nerve responds to AM stimuli and to relate those physiologic measures to perception. Design: Eight patients using Cochlear Ltd. Implants participated in this study. Electrically evoked compound action potentials (ECAPs) were recorded using a 4000 pps pulse train that was sinusoidally amplitude modulated at 125, 250, 500, and 1000 Hz rates. Responses were measured for each pulse over at least one modulation cycle for an apical, medial, and basal electrode. Psychophysical modulation detection thresholds (MDTs) were also measured via a three-alternative forced choice, two-down, one-up adaptive procedure using the same modulation frequencies and electrodes. Results: ECAPs were recorded from individual pulses in the AM pulse train. ECAP amplitudes varied sinusoidally, reflecting the sinusoidal variation in the stimulus. A modulated response amplitude (MRA) metric was calculated as the difference in the maximal and minimum ECAP amplitudes over the modulation cycles. MRA increased as modulation frequency increased, with no apparent cutoff (up to 1000 Hz). In contrast, MDTs increased as the modulation frequency increased. This trend is inconsistent with the physiologic measures. For a fixed modulation frequency, correlations were observed between MDTs and MRAs; this trend was evident at all frequencies except 1000 Hz (although only statistically significant for 250 and 500 Hz AM rates), possibly an indication of central limitations in processing of high modulation frequencies. Finally, peripheral responses were larger and psychophysical thresholds were lower in the apical electrodes relative to basal and medial electrodes, which may reflect better cochlear health and neural survival evidenced by lower preoperative low-frequency audiometric thresholds and steeper growth of neural responses in ECAP amplitude growth functions for apical electrodes. Conclusions: Robust ECAPs were recorded for all modulation frequencies tested. ECAP amplitudes varied sinusoidally, reflecting the periodicity of the modulated stimuli. MRAs increased as the modulation frequency increased, a trend we attribute to neural adaptation. For low modulation frequencies, there are multiple current steps between the peak and valley of the modulation cycle, which means successive stimuli are more similar to one another and neural responses are more likely to adapt. Higher MRAs were correlated with lower psychophysical thresholds at low modulation frequencies but not at 1000 Hz, implying a central limitation to processing of modulated stimuli. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Letter to the Editor: Reporting of Data to Inform the Design of a Definitive Trial Re: Henry, J.A., Frederick, M., Sell, S., Griest, S., Abrams, H. (2015). Validation of a Novel Combination Hearing Aid and Tinnitus Therapy Device, Ear Hear, 36, 42-52.

No abstract available

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The Impact of a Cochlear Implant Electrode Array on the Middle Ear Transfer Function.

Objectives: As a treatment for partial deafness with residual hearing in the lower frequency range, the combined acoustic and electric stimulation of the cochlea has become widespread. Acoustic stimulation is provided by a hearing aid's airborne sound and the electric stimulation by a cochlear implant electrode array, which may be inserted through the round window or a cochleostomy. To take advantage of that concept, it is essential to preserve residual hearing after surgery. Therefore, the intracochlear electrode array should not compromise the middle ear vibration transmission. This study investigates the influence of different electrode types and insertion paths on the middle ear transfer function and the inner ear fluid dynamics. Design: Sound-induced oval and round window net volume velocities were calculated from vibration measurements with laser vibrometers on six nonfixated human temporal bones. After baseline measurements in the "natural" condition, a cochleostomy was drilled and closed with connective tissue. Then, four different electrode arrays were inserted through the cochleostomy. Afterwards, they were inserted through the round window while the cochleostomy was patched again with connective tissue. Results: After having drilled a cochleostomy and electrode insertion, no systematic trends in the changes of oval and round window volume velocities were observed. Nearly all changes of middle ear transfer functions, as well as oval and round window volume velocity ratios, were statistically insignificant. Conclusions: Intracochlear electrode arrays do not significantly increase cochlear input impedance immediately after insertion. Any changes that may occur seem to be independent of electrode array type and insertion path. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Expansion of Prosodic Abilities at the Transition From Babble to Words: A Comparison Between Children With Cochlear Implants and Normally Hearing Children.

Objectives: This longitudinal study examined the effect of emerging vocabulary production on the ability to produce the phonetic cues to prosodic prominence in babbled and lexical disyllables of infants with cochlear implants (CI) and normally hearing (NH) infants. Current research on typical language acquisition emphasizes the importance of vocabulary development for phonological and phonetic acquisition. Children with CI experience significant difficulties with the perception and production of prosody, and the role of possible top-down effects is, therefore, particularly relevant for this population. Design: Isolated disyllabic babble and first words were identified and segmented in longitudinal audio-video recordings and transcriptions for nine NH infants and nine infants with CI interacting with their parents. Monthly recordings were included from the onset of babbling until children had reached a cumulative vocabulary of 200 words. Three cues to prosodic prominence, fundamental frequency (f0), intensity, and duration, were measured in the vocalic portions of stand-alone disyllables. To represent the degree of prosodic differentiation between two syllables in an utterance, the raw values for intensity and duration were transformed to ratios, and for f0, a measure of the perceptual distance in semitones was derived. The degree of prosodic differentiation for disyllabic babble and words for each cue was compared between groups. In addition, group and individual tendencies on the types of stress patterns for babble and words were also examined. Results: The CI group had overall smaller pitch and intensity distances than the NH group. For the NH group, words had greater pitch and intensity distances than babbled disyllables. Especially for pitch distance, this was accompanied by a shift toward a more clearly expressed stress pattern that reflected the influence of the ambient language. For the CI group, the same expansion in words did not take place for pitch. For intensity, the CI group gave evidence of some increase of prosodic differentiation. The results for the duration measure showed evidence of utterance final lengthening in both groups. In words, the CI group significantly reduced durational differences between syllables so that a more even-timed, less differentiated pattern emerged. Conclusions: The onset of vocabulary production did not have the same facilitatory effect for the CI infants on the production of phonetic cues for prosody, especially for pitch. It was argued that the results for duration may reflect greater articulatory difficulties in words for the CI group than the NH group. It was suggested that the lack of clear top-down effects of the vocabulary in the CI group may be because of a lag in development caused by an initial lack of auditory stimulation, possibly compounded by the absence of auditory feedback during the babble phase. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Response to Letter to the Editor: RE: Henry, J.A., Frederick, M., Sell, S, Griest, S., Abrams, H. (2015) Validation of a Novel Combination Hearing Aid and Tinnitus Therapy Device, Ear and Hear, 36, 42-52.

No abstract available

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Health-Related Quality of Life Among Young Children With Cochlear Implants and Developmental Disabilities.

Objective: The present study examined differences in health-related quality of life (HRQoL) between deaf children with cochlear implants (CI) with and without developmental disabilities (DD) and differences across HRQoL domains within both groups of children. Methods: Ninety-two parents of children with CI aged 3-7 years participated in this cross-sectional study. Of these children, 43 had DD (i.e., CI-DD group) and 49 had no DD or chronic illness, demonstrating overall typical development (i.e., CI-TD group). Parents of children in both groups completed the KINDLR, a generic HRQoL questionnaire. Parents also provided anecdotal comments to open-ended questions, and parent comments were evaluated on a CI benefits scale to assess parent-perceived benefits of CI for the deaf children with and without disabilities. Results: Children in the CI-DD group had significantly lower HRQoL compared to children in the CI-TD group, including lower scores on the self-esteem, friend, school, and family HRQoL subscales. No significant differences among groups were found on the physical well-being and emotional well-being subscales. For the CI-TD group, age at implantation correlated negatively with self-esteem and school HRQoL subscales. In the CI-DD group, children's current age correlated negatively with family and with the total HRQoL scores. Parent anecdotal comments and scores on the CI-benefits scale indicated strong parent perceptions of benefits of implantation for children in both groups. Conclusion: Based on parents' proxy report, findings suggest that having DD affects multiple domains of HRQoL among young children with CIs above and beyond that of the CI itself. Parents of deaf children with DD may need greater support through the CI process and follow-up than parents of deaf children without DD. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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