Endoscopic Stapes Surgery: A Comparison With Microscopic Surgery.

Objective: To investigate postoperative audiological outcomes and complication rates for fully endoscopic and microscopic stapes surgery carried out by a single surgeon in one center. Patients: All patients having undergone endoscopic and non-endoscopic stapes surgery for otosclerosis from September 2009 to August 2016 under a single surgeon. Intervention(s): Stapedotomy using either an operating microscope or endoscope for visualization. Stapedotomy was carried out using a standard approach. Main Outcome Measure(s): Pre- and postoperative audiometry and complications. Results: Thirty-four patients who underwent endoscopic stapes surgery and 47 patients who underwent non-endoscopic stapes surgery were included in this study. Seventy-nine percent of both endoscopic and non-endoscopic groups had the average air-bone gap closed to less than 10 dBHL, respectively; the difference was not significant (p = 0.940, [chi]2 test). No patients with sensorineural hearing loss, vertigo, or facial nerve paresis were reported. Two of 34 patients (6%) of the endoscopic group had the chorda tympani cut intraoperatively for access compared with 11 of 47 patients (23%) of the non-endoscopic group. Sixteen of 47 patients (34%) required an endaural incision for access in the non-endoscopic group; no endaural incisions were made in the endoscopic group. Conclusion: Air-bone gap closure and patient complications did not vary significantly between endoscopic and non-endoscopic groups in this study of 34 endoscopic procedures. There is a requirement for further studies with larger sample sizes and longer follow-up periods to fully gauge the safety and effectiveness of this technique. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Brainstem Evoked Potential Indices of Subcortical Auditory Processing After Mild Traumatic Brain Injury.

Objectives: The primary aim of this study was to assess subcortical auditory processing in individuals with chronic symptoms after mild traumatic brain injury (mTBI) by measuring auditory brainstem responses (ABRs) to standard click and complex speech stimuli. Consistent with reports in the literature of auditory problems after mTBI (despite normal-hearing thresholds), it was hypothesized that individuals with mTBI would have evidence of impaired neural encoding in the auditory brainstem compared to noninjured controls, as evidenced by delayed latencies and reduced amplitudes of ABR components. We further hypothesized that the speech-evoked ABR would be more sensitive than the click-evoked ABR to group differences because of its complex nature, particularly when recorded in a background noise condition. Design: Click- and speech-ABRs were collected in 32 individuals diagnosed with mTBI in the past 3 to 18 months. All mTBI participants were experiencing ongoing injury symptoms for which they were seeking rehabilitation through a brain injury rehabilitation management program. The same data were collected in a group of 32 age- and gender-matched controls with no history of head injury. ABRs were recorded in both left and right ears for all participants in all conditions. Speech-ABRs were collected in both quiet and in a background of continuous 20-talker babble ipsilateral noise. Peak latencies and amplitudes were compared between groups and across subgroups of mTBI participants categorized by their behavioral auditory test performance. Results: Click-ABR results were not significantly different between the mTBI and control groups. However, when comparing the control group to only those mTBI subjects with measurably decreased performance on auditory behavioral tests, small differences emerged, including delayed latencies for waves I, III, and V. Similarly, few significant group differences were observed for peak amplitudes and latencies of the speech-ABR when comparing at the whole group level but were again observed between controls and those mTBI subjects with abnormal behavioral auditory test performance. These differences were seen for the onset portions of the speech-ABR waveforms in quiet and were close to significant for the onset wave. Across groups, quiet versus noise comparisons were significant for most speech-ABR measures but the noise condition did not reveal more group differences than speech-ABR in quiet, likely because of variability and overall small amplitudes in this condition for both groups. Conclusions: The outcomes of this study indicate that subcortical neural encoding of auditory information is affected in a significant portion of individuals with long-term problems after mTBI. These subcortical differences appear to relate to performance on tests of auditory processing and perception, even in the absence of significant hearing loss on the audiogram. While confounds of age and slight differences in audiometric thresholds cannot be ruled out, these preliminary results are consistent with the idea that mTBI can result in neuronal changes within the subcortical auditory pathway that appear to relate to functional auditory outcomes. Although further research is needed, clinical audiological evaluation of individuals with ongoing post-mTBI symptoms is warranted for identification of individuals who may benefit from auditory rehabilitation as part of their overall treatment plan. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Brainstem Evoked Potential Indices of Subcortical Auditory Processing After Mild Traumatic Brain Injury.

Objectives: The primary aim of this study was to assess subcortical auditory processing in individuals with chronic symptoms after mild traumatic brain injury (mTBI) by measuring auditory brainstem responses (ABRs) to standard click and complex speech stimuli. Consistent with reports in the literature of auditory problems after mTBI (despite normal-hearing thresholds), it was hypothesized that individuals with mTBI would have evidence of impaired neural encoding in the auditory brainstem compared to noninjured controls, as evidenced by delayed latencies and reduced amplitudes of ABR components. We further hypothesized that the speech-evoked ABR would be more sensitive than the click-evoked ABR to group differences because of its complex nature, particularly when recorded in a background noise condition. Design: Click- and speech-ABRs were collected in 32 individuals diagnosed with mTBI in the past 3 to 18 months. All mTBI participants were experiencing ongoing injury symptoms for which they were seeking rehabilitation through a brain injury rehabilitation management program. The same data were collected in a group of 32 age- and gender-matched controls with no history of head injury. ABRs were recorded in both left and right ears for all participants in all conditions. Speech-ABRs were collected in both quiet and in a background of continuous 20-talker babble ipsilateral noise. Peak latencies and amplitudes were compared between groups and across subgroups of mTBI participants categorized by their behavioral auditory test performance. Results: Click-ABR results were not significantly different between the mTBI and control groups. However, when comparing the control group to only those mTBI subjects with measurably decreased performance on auditory behavioral tests, small differences emerged, including delayed latencies for waves I, III, and V. Similarly, few significant group differences were observed for peak amplitudes and latencies of the speech-ABR when comparing at the whole group level but were again observed between controls and those mTBI subjects with abnormal behavioral auditory test performance. These differences were seen for the onset portions of the speech-ABR waveforms in quiet and were close to significant for the onset wave. Across groups, quiet versus noise comparisons were significant for most speech-ABR measures but the noise condition did not reveal more group differences than speech-ABR in quiet, likely because of variability and overall small amplitudes in this condition for both groups. Conclusions: The outcomes of this study indicate that subcortical neural encoding of auditory information is affected in a significant portion of individuals with long-term problems after mTBI. These subcortical differences appear to relate to performance on tests of auditory processing and perception, even in the absence of significant hearing loss on the audiogram. While confounds of age and slight differences in audiometric thresholds cannot be ruled out, these preliminary results are consistent with the idea that mTBI can result in neuronal changes within the subcortical auditory pathway that appear to relate to functional auditory outcomes. Although further research is needed, clinical audiological evaluation of individuals with ongoing post-mTBI symptoms is warranted for identification of individuals who may benefit from auditory rehabilitation as part of their overall treatment plan. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Brainstem Evoked Potential Indices of Subcortical Auditory Processing After Mild Traumatic Brain Injury.

Objectives: The primary aim of this study was to assess subcortical auditory processing in individuals with chronic symptoms after mild traumatic brain injury (mTBI) by measuring auditory brainstem responses (ABRs) to standard click and complex speech stimuli. Consistent with reports in the literature of auditory problems after mTBI (despite normal-hearing thresholds), it was hypothesized that individuals with mTBI would have evidence of impaired neural encoding in the auditory brainstem compared to noninjured controls, as evidenced by delayed latencies and reduced amplitudes of ABR components. We further hypothesized that the speech-evoked ABR would be more sensitive than the click-evoked ABR to group differences because of its complex nature, particularly when recorded in a background noise condition. Design: Click- and speech-ABRs were collected in 32 individuals diagnosed with mTBI in the past 3 to 18 months. All mTBI participants were experiencing ongoing injury symptoms for which they were seeking rehabilitation through a brain injury rehabilitation management program. The same data were collected in a group of 32 age- and gender-matched controls with no history of head injury. ABRs were recorded in both left and right ears for all participants in all conditions. Speech-ABRs were collected in both quiet and in a background of continuous 20-talker babble ipsilateral noise. Peak latencies and amplitudes were compared between groups and across subgroups of mTBI participants categorized by their behavioral auditory test performance. Results: Click-ABR results were not significantly different between the mTBI and control groups. However, when comparing the control group to only those mTBI subjects with measurably decreased performance on auditory behavioral tests, small differences emerged, including delayed latencies for waves I, III, and V. Similarly, few significant group differences were observed for peak amplitudes and latencies of the speech-ABR when comparing at the whole group level but were again observed between controls and those mTBI subjects with abnormal behavioral auditory test performance. These differences were seen for the onset portions of the speech-ABR waveforms in quiet and were close to significant for the onset wave. Across groups, quiet versus noise comparisons were significant for most speech-ABR measures but the noise condition did not reveal more group differences than speech-ABR in quiet, likely because of variability and overall small amplitudes in this condition for both groups. Conclusions: The outcomes of this study indicate that subcortical neural encoding of auditory information is affected in a significant portion of individuals with long-term problems after mTBI. These subcortical differences appear to relate to performance on tests of auditory processing and perception, even in the absence of significant hearing loss on the audiogram. While confounds of age and slight differences in audiometric thresholds cannot be ruled out, these preliminary results are consistent with the idea that mTBI can result in neuronal changes within the subcortical auditory pathway that appear to relate to functional auditory outcomes. Although further research is needed, clinical audiological evaluation of individuals with ongoing post-mTBI symptoms is warranted for identification of individuals who may benefit from auditory rehabilitation as part of their overall treatment plan. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Changes in Swallowing After Anterior Cervical Discectomy and Fusion With Instrumentation: A Presurgical Versus Postsurgical Videofluoroscopic Comparison

Purpose

The purpose of this study was to explore the impact of anterior cervical discectomy and fusion (ACDF) with anterior instrumentation on swallowing function and physiology as measured on videofluoroscopic swallowing studies.

Method

We retrospectively analyzed both functional measures (penetration-aspiration, residue) and physiological/anatomical measures (hyoid excursion, posterior pharyngeal wall thickness) in a series of 17 patients (8 men, 9 women, mean age 54 years). These measures were extracted from calibrated 5-ml boluses of thin radio-opaque liquids on both pre-ACDF and post-ACDF videofluoroscopies, thus controlling for individual variation and protocol variation.

Results

After ACDF surgery, we found significant within-subject worsening of Penetration-Aspiration Scale (Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996) scores, vallecular (but not piriform sinus) residue, superior (but not anterior) hyoid excursion, and posterior pharyngeal wall thickness. Results are discussed in the context of previous literature.

Conclusions

ACDF surgery can affect both physiological/anatomical and functional measures of swallowing. Future research should expand to other biomechanical and temporal variables, as well as greater bolus volumes and a wider array of viscosities and textures.

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Characterizing Articulation in Apraxic Speech Using Real-Time Magnetic Resonance Imaging

Purpose

Real-time magnetic resonance imaging (MRI) and accompanying analytical methods are shown to capture and quantify salient aspects of apraxic speech, substantiating and expanding upon evidence provided by clinical observation and acoustic and kinematic data. Analysis of apraxic speech errors within a dynamic systems framework is provided and the nature of pathomechanisms of apraxic speech discussed.

Method

One adult male speaker with apraxia of speech was imaged using real-time MRI while producing spontaneous speech, repeated naming tasks, and self-paced repetition of word pairs designed to elicit speech errors. Articulatory data were analyzed, and speech errors were detected using time series reflecting articulatory activity in regions of interest.

Results

Real-time MRI captured two types of apraxic gestural intrusion errors in a word pair repetition task. Gestural intrusion errors in nonrepetitive speech, multiple silent initiation gestures at the onset of speech, and covert (unphonated) articulation of entire monosyllabic words were also captured.

Conclusion

Real-time MRI and accompanying analytical methods capture and quantify many features of apraxic speech that have been previously observed using other modalities while offering high spatial resolution. This patient's apraxia of speech affected the ability to select only the appropriate vocal tract gestures for a target utterance, suppressing others, and to coordinate them in time.

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Changes in Swallowing After Anterior Cervical Discectomy and Fusion With Instrumentation: A Presurgical Versus Postsurgical Videofluoroscopic Comparison

Purpose

The purpose of this study was to explore the impact of anterior cervical discectomy and fusion (ACDF) with anterior instrumentation on swallowing function and physiology as measured on videofluoroscopic swallowing studies.

Method

We retrospectively analyzed both functional measures (penetration-aspiration, residue) and physiological/anatomical measures (hyoid excursion, posterior pharyngeal wall thickness) in a series of 17 patients (8 men, 9 women, mean age 54 years). These measures were extracted from calibrated 5-ml boluses of thin radio-opaque liquids on both pre-ACDF and post-ACDF videofluoroscopies, thus controlling for individual variation and protocol variation.

Results

After ACDF surgery, we found significant within-subject worsening of Penetration-Aspiration Scale (Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996) scores, vallecular (but not piriform sinus) residue, superior (but not anterior) hyoid excursion, and posterior pharyngeal wall thickness. Results are discussed in the context of previous literature.

Conclusions

ACDF surgery can affect both physiological/anatomical and functional measures of swallowing. Future research should expand to other biomechanical and temporal variables, as well as greater bolus volumes and a wider array of viscosities and textures.

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Characterizing Articulation in Apraxic Speech Using Real-Time Magnetic Resonance Imaging

Purpose

Real-time magnetic resonance imaging (MRI) and accompanying analytical methods are shown to capture and quantify salient aspects of apraxic speech, substantiating and expanding upon evidence provided by clinical observation and acoustic and kinematic data. Analysis of apraxic speech errors within a dynamic systems framework is provided and the nature of pathomechanisms of apraxic speech discussed.

Method

One adult male speaker with apraxia of speech was imaged using real-time MRI while producing spontaneous speech, repeated naming tasks, and self-paced repetition of word pairs designed to elicit speech errors. Articulatory data were analyzed, and speech errors were detected using time series reflecting articulatory activity in regions of interest.

Results

Real-time MRI captured two types of apraxic gestural intrusion errors in a word pair repetition task. Gestural intrusion errors in nonrepetitive speech, multiple silent initiation gestures at the onset of speech, and covert (unphonated) articulation of entire monosyllabic words were also captured.

Conclusion

Real-time MRI and accompanying analytical methods capture and quantify many features of apraxic speech that have been previously observed using other modalities while offering high spatial resolution. This patient's apraxia of speech affected the ability to select only the appropriate vocal tract gestures for a target utterance, suppressing others, and to coordinate them in time.

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Changes in Swallowing After Anterior Cervical Discectomy and Fusion With Instrumentation: A Presurgical Versus Postsurgical Videofluoroscopic Comparison

Purpose

The purpose of this study was to explore the impact of anterior cervical discectomy and fusion (ACDF) with anterior instrumentation on swallowing function and physiology as measured on videofluoroscopic swallowing studies.

Method

We retrospectively analyzed both functional measures (penetration-aspiration, residue) and physiological/anatomical measures (hyoid excursion, posterior pharyngeal wall thickness) in a series of 17 patients (8 men, 9 women, mean age 54 years). These measures were extracted from calibrated 5-ml boluses of thin radio-opaque liquids on both pre-ACDF and post-ACDF videofluoroscopies, thus controlling for individual variation and protocol variation.

Results

After ACDF surgery, we found significant within-subject worsening of Penetration-Aspiration Scale (Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996) scores, vallecular (but not piriform sinus) residue, superior (but not anterior) hyoid excursion, and posterior pharyngeal wall thickness. Results are discussed in the context of previous literature.

Conclusions

ACDF surgery can affect both physiological/anatomical and functional measures of swallowing. Future research should expand to other biomechanical and temporal variables, as well as greater bolus volumes and a wider array of viscosities and textures.

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Characterizing Articulation in Apraxic Speech Using Real-Time Magnetic Resonance Imaging

Purpose

Real-time magnetic resonance imaging (MRI) and accompanying analytical methods are shown to capture and quantify salient aspects of apraxic speech, substantiating and expanding upon evidence provided by clinical observation and acoustic and kinematic data. Analysis of apraxic speech errors within a dynamic systems framework is provided and the nature of pathomechanisms of apraxic speech discussed.

Method

One adult male speaker with apraxia of speech was imaged using real-time MRI while producing spontaneous speech, repeated naming tasks, and self-paced repetition of word pairs designed to elicit speech errors. Articulatory data were analyzed, and speech errors were detected using time series reflecting articulatory activity in regions of interest.

Results

Real-time MRI captured two types of apraxic gestural intrusion errors in a word pair repetition task. Gestural intrusion errors in nonrepetitive speech, multiple silent initiation gestures at the onset of speech, and covert (unphonated) articulation of entire monosyllabic words were also captured.

Conclusion

Real-time MRI and accompanying analytical methods capture and quantify many features of apraxic speech that have been previously observed using other modalities while offering high spatial resolution. This patient's apraxia of speech affected the ability to select only the appropriate vocal tract gestures for a target utterance, suppressing others, and to coordinate them in time.

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Towards a Unified Testing Framework for Single-Sided Deafness Studies: A Consensus Paper

Background: While hearing aids for a contralateral routing of signals (CROS-HA) and bone conduction devices have been the traditional treatment for single-sided deafness (SSD) and asymmetric hearing loss (AHL), in recent years, cochlear implants (CIs) have increasingly become a viable treatment choice, particularly in countries where regulatory approval and reimbursement schemes are in place. Part of the reason for this shift is that the CI is the only device capable of restoring bilateral input to the auditory system and hence of possibly reinstating binaural hearing. Although several studies have independently shown that the CI is a safe and effective treatment for SSD and AHL, clinical outcome measures in those studies and across CI centers vary greatly. Only with a consistent use of defined and agreed-upon outcome measures across centers can high-level evidence be generated to assess the safety and efficacy of CIs and alternative treatments in recipients with SSD and AHL. Methods: This paper presents a comparative study design and minimum outcome measures for the assessment of current treatment options in patients with SSD/AHL. The protocol was developed, discussed, and eventually agreed upon by expert panels that convened at the 2015 APSCI conference in Beijing, China, and at the CI 2016 conference in Toronto, Canada. Results: A longitudinal study design comparing CROS-HA, BCD, and CI treatments is proposed. The recommended outcome measures include (1) speech in noise testing, using the same set of 3 spatial configurations to compare binaural benefits such as summation, squelch, and head shadow across devices; (2) localization testing, using stimuli that rove in both level and spectral content; (3) questionnaires to collect quality of life measures and the frequency of device use; and (4) questionnaires for assessing the impact of tinnitus before and after treatment, if applicable. Conclusion: A protocol for the assessment of treatment options and outcomes in recipients with SSD and AHL is presented. The proposed set of minimum outcome measures aims at harmonizing assessment methods across centers and thus at generating a growing body of high-level evidence for those treatment options.
Audiol Neurotol 2016;21:391-398

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58 million Americans are exposed to loud, frequent noises, including firearms, at work and home

Loud noise exposure is a common environmental hazard in the United States that can lead to hearing loss and other conditions such as sleep disturbance, cardiovascular disease and diabetes.

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58 million Americans are exposed to loud, frequent noises, including firearms, at work and home

Loud noise exposure is a common environmental hazard in the United States that can lead to hearing loss and other conditions such as sleep disturbance, cardiovascular disease and diabetes.

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58 million Americans are exposed to loud, frequent noises, including firearms, at work and home

Loud noise exposure is a common environmental hazard in the United States that can lead to hearing loss and other conditions such as sleep disturbance, cardiovascular disease and diabetes.

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