Τρίτη 28 Μαρτίου 2017

Acute vestibular syndrome in cerebellar stroke : A case report and review of the literature.

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Acute vestibular syndrome in cerebellar stroke : A case report and review of the literature.

HNO. 2017 Mar 07;:

Authors: Volgger V, Gürkov R

Abstract
The current paper reports on a patient with recurrent rotational vertigo and persistent dizziness and imbalance lasting several weeks, who underwent extensive neuro-otological and radiological examinations. Pathological findings initially included right-sided benign paroxysmal positional vertigo (BPPV), persistent horizontal spontaneous nystagmus (SPN) to the left, and a pathological bedside and video head impulse test (HIT) on the left. The pathological HIT on the left and the SPN to the left indicated a central origin. Therefore, cranial magnetic resonance imaging was performed which revealed a left-sided ischemic stroke in the territory of the medial branch of the posterior inferior cerebellar artery (mPICA).

PMID: 28271170 [PubMed - as supplied by publisher]



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Evidence of binaural integration benefits following ARIA training for children and adolescents diagnosed with amblyaudia

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DSL prescriptive targets for bone conduction devices: adaptation and comparison to clinical fittings

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Statistical tool to detect small hearing threshold shifts

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Hearing aid use in the elderly as measured by datalogging and self-report

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The development of the University of Jordan word recognition test

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The parents’ perspective of the early diagnostic period of their child with hearing loss: information and support

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Speech perception in Mandarin-speaking children with cochlear implants: A systematic review

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Selection of test-setup parameters to target specific signal-to-noise regions in speech-on-speech intelligibility testing

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Corrigendum

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Book Review

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Listening to music with personal listening devices: monitoring the noise dose using a smartphone application

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Usefulness of self-report questionnaires for psychological assessment of patients with tinnitus and hyperacusis and patients’ views of the questionnaires

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Cochlear implant effectiveness in postlingual single-sided deaf individuals: what’s the point?

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Promoting global action on hearing loss: World hearing day

Volume 56, Issue 3, March 2017, Page 145-147
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An individualised acoustically transparent earpiece for hearing devices

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Social inequalities in pure-tone hearing assessed using occupational stratification schemes

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Applying Rasch model analysis in the development of the cantonese tone identification test (CANTIT)

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Practical guidelines to minimise language and cognitive confounds in the diagnosis of CAPD: a brief tutorial

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Audiologists’ communication behaviour during hearing device management appointments

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The accuracy of objective threshold determination at low frequencies: comparison of different auditory brainstem response (ABR) and auditory steady state response (ASSR) methods

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Evidence of binaural integration benefits following ARIA training for children and adolescents diagnosed with amblyaudia

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DSL prescriptive targets for bone conduction devices: adaptation and comparison to clinical fittings

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Statistical tool to detect small hearing threshold shifts

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Hearing aid use in the elderly as measured by datalogging and self-report

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The development of the University of Jordan word recognition test

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The parents’ perspective of the early diagnostic period of their child with hearing loss: information and support

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Speech perception in Mandarin-speaking children with cochlear implants: A systematic review

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Selection of test-setup parameters to target specific signal-to-noise regions in speech-on-speech intelligibility testing

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Corrigendum

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Book Review

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Listening to music with personal listening devices: monitoring the noise dose using a smartphone application

.


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Usefulness of self-report questionnaires for psychological assessment of patients with tinnitus and hyperacusis and patients’ views of the questionnaires

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Cochlear implant effectiveness in postlingual single-sided deaf individuals: what’s the point?

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Promoting global action on hearing loss: World hearing day

Volume 56, Issue 3, March 2017, Page 145-147
.


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An individualised acoustically transparent earpiece for hearing devices

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Social inequalities in pure-tone hearing assessed using occupational stratification schemes

.


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Applying Rasch model analysis in the development of the cantonese tone identification test (CANTIT)

.


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Practical guidelines to minimise language and cognitive confounds in the diagnosis of CAPD: a brief tutorial

.


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Audiologists’ communication behaviour during hearing device management appointments

.


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The accuracy of objective threshold determination at low frequencies: comparison of different auditory brainstem response (ABR) and auditory steady state response (ASSR) methods

.


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A novel pore-region mutation, c.887G > A (p.G296D) in KCNQ4, causing hearing loss in a Chinese family with autosomal dominant non-syndromic deafness 2.

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A novel pore-region mutation, c.887G > A (p.G296D) in KCNQ4, causing hearing loss in a Chinese family with autosomal dominant non-syndromic deafness 2.

BMC Med Genet. 2017 Mar 24;18(1):36

Authors: Huang B, Liu Y, Gao X, Xu J, Dai P, Zhu Q, Yuan Y

Abstract
BACKGROUND: Hereditary non-syndromic hearing loss is the most common inherited sensory defect in humans. The KCNQ4 channel belongs to a family of potassium ion channels that play crucial roles in physiology and disease. Mutations in KCNQ4 underlie deafness non-syndromic autosomal dominant 2, a subtype of autosomal dominant, progressive, high-frequency hearing loss.
METHODS: A six-generation Chinese family from Hebei Province with autosomal dominantly inherited, sensorineural, postlingual, progressive hearing loss was enrolled in this study. Mutation screening of 129 genes associated with hearing loss was performed in five family members by next-generation sequencing (NGS). We also carried out variant analysis on DNA from 531 Chinese individuals with normal hearing as controls.
RESULTS: This family exhibits postlingual, progressive, symmetrical, bilateral, non-syndromic sensorineural hearing loss. NGS, bioinformatic analysis, and Sanger sequencing confirmed the co-segregation of a novel mutation [c.887G > A (p.G296D)] in KCNQ4 with the disease phenotype in this family. This mutation leads to a glycine-to-aspartic acid substitution at position 296 in the pore region of the KCNQ4 channel. This mutation affects a highly conserved glutamic acid. NGS is a highly efficient tool for identifying gene mutations causing heritable disease.
CONCLUSIONS: Progressive hearing loss is common in individuals with KCNQ4 mutations. NGS together with Sanger sequencing confirmed that the five affected members of this Chinese family inherited a missense mutation, c.887G > A (p.G296D), in exon 6 of KCNQ4. Our results increase the number of identified KCNQ4 mutations.

PMID: 28340560 [PubMed - in process]



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Novel compound heterozygous mutations in the OTOF Gene identified by whole-exome sequencing in auditory neuropathy spectrum disorder.

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Novel compound heterozygous mutations in the OTOF Gene identified by whole-exome sequencing in auditory neuropathy spectrum disorder.

BMC Med Genet. 2017 Mar 23;18(1):35

Authors: Tang F, Ma D, Wang Y, Qiu Y, Liu F, Wang Q, Lu Q, Shi M, Xu L, Liu M, Liang J

Abstract
BACKGROUND: Many hearing-loss diseases are demonstrated to have Mendelian inheritance caused by mutations in single gene. However, many deaf individuals have diseases that remain genetically unexplained. Auditory neuropathy is a sensorineural deafness in which sounds are able to be transferred into the inner ear normally but the transmission of the signals from inner ear to auditory nerve and brain is injured, also known as auditory neuropathy spectrum disorder (ANSD). The pathogenic mutations of the genes responsible for the Chinese ANSD population remain poorly understood.
METHODS: A total of 127 patients with non-syndromic hearing loss (NSHL) were enrolled in Guangxi Zhuang Autonomous Region. A hereditary deafness gene mutation screening was performed to identify the mutation sites in four deafness-related genes (GJB2, GJB3, 12S rRNA, and SLC26A4). In addition, whole-exome sequencing (WES) was applied to explore unappreciated mutation sites in the cases with the singularity of its phenotype.
RESULTS: Well-characterized mutations were found in only 8.7% (11/127) of the patients. Interestingly, two mutations in the OTOF gene were identified in two affected siblings with ANSD from a Chinese family, including one nonsense mutation c.1273C > T (p.R425X) and one missense mutation c.4994 T > C (p.L1665P). Furthermore, we employed Sanger sequencing to confirm the mutations in each subject. Two compound heterozygous mutations in the OTOF gene were observed in the two affected siblings, whereas the two parents and unaffected sister were heterozygous carriers of c.1273C > T (father and sister) and c.4994 T > C (mother). The nonsense mutation p.R425X, contributes to a premature stop codon, may result in a truncated polypeptide, which strongly suggests its pathogenicity for ANSD. The missense mutation p.L1665P results in a single amino acid substitution in a highly conserved region.
CONCLUSIONS: Two mutations in the OTOF gene in the Chinese deaf population were recognized for the first time. These findings not only extend the OTOF gene mutation spectrum for ANSD but also indicate that whole-exome sequencing is an effective approach to clarify the genetic characteristics in non-syndromic ANSD patients.

PMID: 28335750 [PubMed - in process]



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Associations between childhood hearing loss and behavioural and academic difficulties: A Danish cohort study.

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Associations between childhood hearing loss and behavioural and academic difficulties: A Danish cohort study.

Int J Pediatr Otorhinolaryngol. 2016 Nov;90:91-98

Authors: Niclasen J, Obel C, Guldager C, Pleinert S, Dammeyer J

Abstract
OBJECTIVE: Negative associations between hearing loss (HL) and behavioural and academic difficulties have been reported. However, most studies are based on small clinical samples. The aim of the present study was to investigate such associations using data from a large-scale non-clinical Danish birth cohort controlling for a large number of relevant confounding factors.
METHODS: The study applied data from the Aarhus Birth Cohort's 10-12-year-old follow-up (N = 7599). Associations between parent-reported HL on the one hand, and parent- and teacher-reported behavioural difficulties measured by the Strengths and Difficulties Questionnaire (SDQ) and parent-reported academic difficulties on the other hand, were investigated.
RESULTS: After controlling for relevant confounding factors, significant associations were observed between parent-reported HL and parent- and teacher-reported Externalising scores, and academic difficulties.
CONCLUSIONS: Childhood HL is associated with behavioural and academic difficulties. Parent reported HL in a non-clinical cohort is indicative for academic and behavioural difficulties.

PMID: 27729161 [PubMed - indexed for MEDLINE]



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Sagittal plane joint kinetics during stair ascent in patients with peripheral arterial disease and intermittent claudication

Publication date: Available online 28 March 2017
Source:Gait & Posture
Author(s): Stephanie L. King, Natalie Vanicek, Thomas D. O’Brien
Stair negotiation poses a substantial physical demand on the musculoskeletal system and this challenging task can place individuals at risk of falls. Peripheral arterial disease (PAD) can cause intermittent claudication (IC) pain in the calf and results in altered gait mechanics during level walking. However, whether those with PAD-IC adopt alternate strategies to climb stairs is unknown. Twelve participants with PAD-IC (six bilateral and six unilateral) and 10 healthy controls were recruited and instructed to ascend a five-step staircase whilst 3D kinematic data of the lower-limbs were recorded synchronously with kinetic data from force plates embedded into the staircase on steps two and three. Limbs from the unilateral group and both limbs from the bilateral claudicants were categorised as claudicating (N=18), asymptomatic (N=6) and control (N=10). Claudicants walked more slowly than healthy controls (trend; P=<.066). Both claudicating- and asymptomatic-limb groups had reduced propulsive GRF (P=.025 and P=.002, respectively) and vertical GRF (P=.005 and P=.001, respectively) compared to controls. The claudicating-limb group had a reduced knee extensor moment during forward continuance (P=.060), ankle angular velocity at peak moment (P=.039) and ankle power generation (P=.055) compared to the controls. The slower gait speed, irrespective of laterality of symptoms, indicates functional capacity was determined by the limitations of the claudicating limb. Reduced ankle power generation and angular velocity (despite adequate plantarflexor moment) implies velocity-dependent limitations existed in the calf. The lack of notable compensatory strategies indicates reliance on an impaired muscle group to accomplish this potentially hazardous task, highlighting the importance of maintaining plantarflexor strength and power in those with PAD-IC.



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Sagittal plane joint kinetics during stair ascent in patients with peripheral arterial disease and intermittent claudication

Publication date: Available online 28 March 2017
Source:Gait & Posture
Author(s): Stephanie L. King, Natalie Vanicek, Thomas D. O’Brien
Stair negotiation poses a substantial physical demand on the musculoskeletal system and this challenging task can place individuals at risk of falls. Peripheral arterial disease (PAD) can cause intermittent claudication (IC) pain in the calf and results in altered gait mechanics during level walking. However, whether those with PAD-IC adopt alternate strategies to climb stairs is unknown. Twelve participants with PAD-IC (six bilateral and six unilateral) and 10 healthy controls were recruited and instructed to ascend a five-step staircase whilst 3D kinematic data of the lower-limbs were recorded synchronously with kinetic data from force plates embedded into the staircase on steps two and three. Limbs from the unilateral group and both limbs from the bilateral claudicants were categorised as claudicating (N=18), asymptomatic (N=6) and control (N=10). Claudicants walked more slowly than healthy controls (trend; P=<.066). Both claudicating- and asymptomatic-limb groups had reduced propulsive GRF (P=.025 and P=.002, respectively) and vertical GRF (P=.005 and P=.001, respectively) compared to controls. The claudicating-limb group had a reduced knee extensor moment during forward continuance (P=.060), ankle angular velocity at peak moment (P=.039) and ankle power generation (P=.055) compared to the controls. The slower gait speed, irrespective of laterality of symptoms, indicates functional capacity was determined by the limitations of the claudicating limb. Reduced ankle power generation and angular velocity (despite adequate plantarflexor moment) implies velocity-dependent limitations existed in the calf. The lack of notable compensatory strategies indicates reliance on an impaired muscle group to accomplish this potentially hazardous task, highlighting the importance of maintaining plantarflexor strength and power in those with PAD-IC.



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Sagittal plane joint kinetics during stair ascent in patients with peripheral arterial disease and intermittent claudication

Publication date: Available online 28 March 2017
Source:Gait & Posture
Author(s): Stephanie L. King, Natalie Vanicek, Thomas D. O’Brien
Stair negotiation poses a substantial physical demand on the musculoskeletal system and this challenging task can place individuals at risk of falls. Peripheral arterial disease (PAD) can cause intermittent claudication (IC) pain in the calf and results in altered gait mechanics during level walking. However, whether those with PAD-IC adopt alternate strategies to climb stairs is unknown. Twelve participants with PAD-IC (six bilateral and six unilateral) and 10 healthy controls were recruited and instructed to ascend a five-step staircase whilst 3D kinematic data of the lower-limbs were recorded synchronously with kinetic data from force plates embedded into the staircase on steps two and three. Limbs from the unilateral group and both limbs from the bilateral claudicants were categorised as claudicating (N=18), asymptomatic (N=6) and control (N=10). Claudicants walked more slowly than healthy controls (trend; P=<.066). Both claudicating- and asymptomatic-limb groups had reduced propulsive GRF (P=.025 and P=.002, respectively) and vertical GRF (P=.005 and P=.001, respectively) compared to controls. The claudicating-limb group had a reduced knee extensor moment during forward continuance (P=.060), ankle angular velocity at peak moment (P=.039) and ankle power generation (P=.055) compared to the controls. The slower gait speed, irrespective of laterality of symptoms, indicates functional capacity was determined by the limitations of the claudicating limb. Reduced ankle power generation and angular velocity (despite adequate plantarflexor moment) implies velocity-dependent limitations existed in the calf. The lack of notable compensatory strategies indicates reliance on an impaired muscle group to accomplish this potentially hazardous task, highlighting the importance of maintaining plantarflexor strength and power in those with PAD-IC.



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Unilateral Tinnitus Without Hearing Loss

Different disorders are associated with tinnitus. However, it is not unique to have unilateral tinnitus without hearing loss. Nevertheless, the symptoms should be evaluated to rule out possible nerve problems.

Tinnitus Explained

Tinnitus come from the Latin tinnire, which means “a ringing” or “to ring.” The condition causes an unpleasant sound localized in the ear. The severity of unilateral tinnitus without hearing loss varies and may be perceived as a buzzing, clicking, hissing, ringing or roaring sound. While to some the noise represents a minor annoyance, the disruption may cause depression and anxiety in others. Approximately 10 percent of people in the United States live with the disorder. Tinnitus occurs most often in adults between the age of 40 and 70.

The condition is often classified as being objective, subjective, vibratory or non-vibratory. Objective tinnitus can be heard by others when listening through a stethoscope positioned on the head or neck near the affected ear. Subjective is sound only heard by the individual. Vibratory tinnitus occurs from vibrations transmitted to the cochlea from nearby organs or tissues. The non-vibratory form of the condition involves biological or chemical changes that affect auditory nerves.

Basic Causes

Single-sided tinnitus may have a simple explanation. Think about your activity in the 24 hours before the symptom began. The loud noise exposure from attending a rock concert or practicing on a rifle range are sufficient to temporarily damage one or both ears. Especially if safety precautions or hearing protection was not used. Perhaps you drank an excess of coffee, did not drink enough fluid following a workout or took a high dose of aspirin. Maybe you started a new medication. By nightfall, you suffer unilateral tinnitus without hearing loss.

Other possible reasons people experience unilateral tinnitus without hearing loss include blood circulation abnormalities, chemical imbalances, blood pressure which is too high or too low. OTC medications or vitamin deficiencies might also cause the problem.

Avoiding caffeine, getting sufficient sleep, taking a multiple vitamin with complex B vitamins, learning how to manage stress or getting treatment for hypertension can all reduce or alleviate tinnitus symptoms.

More Serious Causes

The condition might be caused by a benign tumor called an acoustic neuroma. The growths spawns from the Schwann cells, which covers a branch of the eight cranial nerve. As the mass grows, it slowly destroys the nerve. Other symptoms also often arise and include dizziness. However, the initial symptoms is typically tinnitus. Unilateral tinnitus without hearing loss may occur for months or even years before the patient experiences dizziness and eventual hearing loss.



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Dynamic Assessment of Narratives: Efficient, Accurate Identification of Language Impairment in Bilingual Students

Purpose
This study investigated the classification accuracy of a concentrated English narrative dynamic assessment (DA) for identifying language impairment (LI).
Method
Forty-two Spanish–English bilingual kindergarten to third-grade children (10 LI and 32 with no LI) were administered two 25-min DA test–teach–test sessions. Pre- and posttest narrative retells were scored in real time. Using a structured intervention approach, examiners taught children missing story grammar elements and subordination. A posttest was administered using a parallel story.
Results
Four classification predictors were analyzed: posttest scores, gain scores, modifiability ratings, and teaching duration. Discriminant function analysis indicated that an overall modifiability rating was the best classifier, with 100% sensitivity and 88% specificity after 1 DA session and 100% sensitivity and specificity after 2 sessions. Any 2 combinations of posttest scores, modifiability ratings, and teaching duration for just 1 session resulted in sensitivity and specificity rates over 90%. Receiver operating characteristic analyses were used to identify clinically usable cutoff points. Post hoc exploration indicated that similar results could be obtained after only one 5–10-min teaching cycle, potentially further abbreviating the DA process.
Conclusion
Concentrated English narrative DA results in high classification accuracy for bilingual children with and without LI. This efficient version of DA is amenable to clinical use.

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Lingual–Alveolar Contact Pressure During Speech in Amyotrophic Lateral Sclerosis: Preliminary Findings

Purpose
This preliminary study on lingual–alveolar contact pressures (LACP) in people with amyotrophic lateral sclerosis (ALS) had several aims: (a) to evaluate whether the protocol induced fatigue, (b) to compare LACP during speech (LACP-Sp) and during maximum isometric pressing (LACP-Max) in people with ALS (PALS) versus healthy controls, (c) to compare the percentage of LACP-Max utilized during speech (%Max) for PALS versus controls, and (d) to evaluate relationships between LACP-Sp and LACP-Max with word intelligibility.
Method
Thirteen PALS and 12 healthy volunteers produced /t, d, s, z, l, n/ sounds while LACP-Sp was recorded. LACP-Max was obtained before and after the speech protocol. Word intelligibility was obtained from auditory–perceptual judgments.
Results
LACP-Max values measured before and after completion of the speech protocol did not differ. LACP-Sp and LACP-Max were statistically lower in the ALS bulbar group compared with controls and PALS with only spinal symptoms. There was no statistical difference between groups for %Max. LACP-Sp and LACP-Max were correlated with word intelligibility.
Conclusions
It was feasible to obtain LACP-Sp measures without inducing fatigue. Reductions in LACP-Sp and LACP-Max for bulbar speakers might reflect tongue weakness. Although confirmation of results is needed, the data indicate that individuals with high word intelligibility maintained LACP-Sp at or above 2 kPa and LACP-Max at or above 50 kPa.

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Dynamic Assessment of Narratives: Efficient, Accurate Identification of Language Impairment in Bilingual Students

Purpose
This study investigated the classification accuracy of a concentrated English narrative dynamic assessment (DA) for identifying language impairment (LI).
Method
Forty-two Spanish–English bilingual kindergarten to third-grade children (10 LI and 32 with no LI) were administered two 25-min DA test–teach–test sessions. Pre- and posttest narrative retells were scored in real time. Using a structured intervention approach, examiners taught children missing story grammar elements and subordination. A posttest was administered using a parallel story.
Results
Four classification predictors were analyzed: posttest scores, gain scores, modifiability ratings, and teaching duration. Discriminant function analysis indicated that an overall modifiability rating was the best classifier, with 100% sensitivity and 88% specificity after 1 DA session and 100% sensitivity and specificity after 2 sessions. Any 2 combinations of posttest scores, modifiability ratings, and teaching duration for just 1 session resulted in sensitivity and specificity rates over 90%. Receiver operating characteristic analyses were used to identify clinically usable cutoff points. Post hoc exploration indicated that similar results could be obtained after only one 5–10-min teaching cycle, potentially further abbreviating the DA process.
Conclusion
Concentrated English narrative DA results in high classification accuracy for bilingual children with and without LI. This efficient version of DA is amenable to clinical use.

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Lingual–Alveolar Contact Pressure During Speech in Amyotrophic Lateral Sclerosis: Preliminary Findings

Purpose
This preliminary study on lingual–alveolar contact pressures (LACP) in people with amyotrophic lateral sclerosis (ALS) had several aims: (a) to evaluate whether the protocol induced fatigue, (b) to compare LACP during speech (LACP-Sp) and during maximum isometric pressing (LACP-Max) in people with ALS (PALS) versus healthy controls, (c) to compare the percentage of LACP-Max utilized during speech (%Max) for PALS versus controls, and (d) to evaluate relationships between LACP-Sp and LACP-Max with word intelligibility.
Method
Thirteen PALS and 12 healthy volunteers produced /t, d, s, z, l, n/ sounds while LACP-Sp was recorded. LACP-Max was obtained before and after the speech protocol. Word intelligibility was obtained from auditory–perceptual judgments.
Results
LACP-Max values measured before and after completion of the speech protocol did not differ. LACP-Sp and LACP-Max were statistically lower in the ALS bulbar group compared with controls and PALS with only spinal symptoms. There was no statistical difference between groups for %Max. LACP-Sp and LACP-Max were correlated with word intelligibility.
Conclusions
It was feasible to obtain LACP-Sp measures without inducing fatigue. Reductions in LACP-Sp and LACP-Max for bulbar speakers might reflect tongue weakness. Although confirmation of results is needed, the data indicate that individuals with high word intelligibility maintained LACP-Sp at or above 2 kPa and LACP-Max at or above 50 kPa.

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Dynamic Assessment of Narratives: Efficient, Accurate Identification of Language Impairment in Bilingual Students

Purpose
This study investigated the classification accuracy of a concentrated English narrative dynamic assessment (DA) for identifying language impairment (LI).
Method
Forty-two Spanish–English bilingual kindergarten to third-grade children (10 LI and 32 with no LI) were administered two 25-min DA test–teach–test sessions. Pre- and posttest narrative retells were scored in real time. Using a structured intervention approach, examiners taught children missing story grammar elements and subordination. A posttest was administered using a parallel story.
Results
Four classification predictors were analyzed: posttest scores, gain scores, modifiability ratings, and teaching duration. Discriminant function analysis indicated that an overall modifiability rating was the best classifier, with 100% sensitivity and 88% specificity after 1 DA session and 100% sensitivity and specificity after 2 sessions. Any 2 combinations of posttest scores, modifiability ratings, and teaching duration for just 1 session resulted in sensitivity and specificity rates over 90%. Receiver operating characteristic analyses were used to identify clinically usable cutoff points. Post hoc exploration indicated that similar results could be obtained after only one 5–10-min teaching cycle, potentially further abbreviating the DA process.
Conclusion
Concentrated English narrative DA results in high classification accuracy for bilingual children with and without LI. This efficient version of DA is amenable to clinical use.

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Lingual–Alveolar Contact Pressure During Speech in Amyotrophic Lateral Sclerosis: Preliminary Findings

Purpose
This preliminary study on lingual–alveolar contact pressures (LACP) in people with amyotrophic lateral sclerosis (ALS) had several aims: (a) to evaluate whether the protocol induced fatigue, (b) to compare LACP during speech (LACP-Sp) and during maximum isometric pressing (LACP-Max) in people with ALS (PALS) versus healthy controls, (c) to compare the percentage of LACP-Max utilized during speech (%Max) for PALS versus controls, and (d) to evaluate relationships between LACP-Sp and LACP-Max with word intelligibility.
Method
Thirteen PALS and 12 healthy volunteers produced /t, d, s, z, l, n/ sounds while LACP-Sp was recorded. LACP-Max was obtained before and after the speech protocol. Word intelligibility was obtained from auditory–perceptual judgments.
Results
LACP-Max values measured before and after completion of the speech protocol did not differ. LACP-Sp and LACP-Max were statistically lower in the ALS bulbar group compared with controls and PALS with only spinal symptoms. There was no statistical difference between groups for %Max. LACP-Sp and LACP-Max were correlated with word intelligibility.
Conclusions
It was feasible to obtain LACP-Sp measures without inducing fatigue. Reductions in LACP-Sp and LACP-Max for bulbar speakers might reflect tongue weakness. Although confirmation of results is needed, the data indicate that individuals with high word intelligibility maintained LACP-Sp at or above 2 kPa and LACP-Max at or above 50 kPa.

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Evidence of binaural integration benefits following ARIA training for children and adolescents diagnosed with amblyaudia

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DSL prescriptive targets for bone conduction devices: adaptation and comparison to clinical fittings

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Evidence of binaural integration benefits following ARIA training for children and adolescents diagnosed with amblyaudia

.


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DSL prescriptive targets for bone conduction devices: adaptation and comparison to clinical fittings

.


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Evidence of binaural integration benefits following ARIA training for children and adolescents diagnosed with amblyaudia

.


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DSL prescriptive targets for bone conduction devices: adaptation and comparison to clinical fittings

.


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Round and Oval Window Anatomic Variability: Its Implication for the Vibroplasty Technique.

Objective: The objective of this study is to evaluate the anatomical variability of round and oval window regions and its relationship with their closest structures, to determine its implication on the fitting and stabilization of the middle ear implant Vibrant Soundbridge. Methods: Variations of the anatomy of round and oval window regions were assessed in a total of 85 human dissected temporal bones. Afterward, we evaluated the adaptation and subsequent stabilization of the floating mass transducer (FMT) of the Vibrant Soundbridge in 67 cases in round window (RW) and in 22 cases in oval window (OW), and the influence that the variability of the different anatomical features examined had on this stabilization. We also assessed access and surgeon's view of the RW niche through the facial recess approach. Results: Stabilization of the FMT in the RW was achieved in 53 (79%) of the 67 cases; we found that the less favorable anatomical conditions for stabilization were: membrane smaller than 1.5 mm, presence of a high jugular bulb and a narrow or very narrow RW niche. Frequently, two or more of these conditions happened simultaneously. In seven cases (22%) access to the RW through facial recess approach did not allow positioning the FMT in place. OW stabilization succeeded in 18 (82%) of the 22 cases. Conclusion: Round and oval window vibroplasty are difficult surgical techniques. To place the FMT directly on the OW may be easier as we do not have to drill the niche. In both regions there are some anatomical conditions that hinder fitting the FMT and even make it impossible. Once fitted, the main problem is to achieve good stabilization of the device. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Bilateral Labyrinthine and Internal Auditory Canal Enhancement in an Infant With Severe Labyrinthine Dysplasia: A Previously Unreported Phenomenon.

Objective: To describe a novel case of congenital profound bilateral sensorineural hearing loss in a patient with bilateral nodular internal auditory canal and labyrinthine enhancement and temporal bone dysplasia. Patients: A 76-day-old female was referred to the authors' center for evaluation of congenital deafness. Behavioral observations and objective audiometric evaluation demonstrated bilateral profound sensorineural hearing loss and a comprehensive multidisciplinary evaluation identified compound heterozygous pathogenic variants in MYO7A, a gene associated with Usher Syndrome Type 1B or DFNB2. Computed tomography and contrast-enhanced magnetic resonance imaging studies demonstrated bilateral temporal bone anomalies with unique middle and inner ear malformations, as well as unique contrast enhancement in the membranous labyrinth, internal auditory canals, and cranial nerves, which have not been previously described with MYO7A variants. Interventions: Given the potential risk for progressive bilateral labyrinthitis ossificans, bilateral simultaneous cochlear implantation was performed at 4 months of age. Main Outcome Measures: Subsequent audiologic follow up after implantation shows significantly improved access to auditory information and increased vocalizations. At last testing, speech and language skills for both receptive and expressive language abilities were found to be commensurate with her chronological age. Conclusion: We report a novel presentation and imaging findings of congenital bilateral profound sensorineural hearing loss in a patient with nodular internal auditory canal and labyrinthine enhancement and coexisting inner ear dysplasia. Despite the multiple radiologic abnormalities, the patient has demonstrated good benefit from cochlear implantation. Future study of rare variants of congenital deafness, such as this, is critical toward defining new disease processes and determining optimal treatment. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Comparison of Experts and Residents Performing a Complex Procedure in a Temporal Bone Surgery Simulator.

Objective: To investigate the use of automated metrics from a virtual reality (VR) temporal bone surgery simulator to determine how the performance of experts and trainees differs when performing a complex otological procedure (mastoidectomy with posterior tympanotomy and cochleostomy). Study Design: Cohort study. Methods: Using the University of Melbourne VR temporal bone surgery simulator, seven ENT consultants and seven ENT residents performed two trials of the surgical approach to cochlear implantation on a virtual temporal bone. Simulator recordings were used to calculate a range of automated metrics for each stage of the procedure, capturing efficiency, technique characteristics, drilled bone regions, and damage to vital anatomical structures. Results: Results confirm that experts drilled more efficiently than residents. Experts generally used larger burrs and applied higher forces, resulting in faster material removal. However, they exercised more caution when drilling close to anatomical structures. Residents opened the temporal bone more widely, but neglected important steps in obtaining a clear view toward the round window, such as thinning the external ear canal wall and skeletonizing the medial aspect of the facial nerve. Residents used higher magnification and reoriented the temporal bone more often than experts. Conclusion: VR simulation provides metrics that allow the objective analysis of surgical technique, and identification of differences between the performance of surgical residents and their senior colleagues. The performance of residents could be improved with more guidance regarding how much force they should apply, what burr size they should use, how they should orient the bone, and for cochlear implant surgery guidance regarding anatomical regions requiring particular attention, to visualize the round window. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Diagnosis and Treatment of Vestibular Neuritis/Neuronitis or Peripheral Vestibulopathy (PVP)? Open Questions and Possible Answers.

The acute vestibular syndrome is a clinically defined entity consisting of vertigo or dizziness that develops acutely over minutes to hours and is accompanied by nausea/vomiting, gait instability, head motion intolerance, and nystagmus, while persisting over a day or more. When it is caused by a peripheral vestibular lesion and is not associated with clinically manifest auditory deficits, it is mostly labeled vestibular neuritis/neuronitis/neuropathy or sometimes peripheral vestibulopathy. Here, we propose hypotheses and discuss current research advances on viral or vascular factors in the pathogenesis, the recurrence, the site of lesion, old and new treatment options, contraindicated measures, the differential diagnosis, and the prognosis of vestibular neuritis/neuronitis/neuropathy or vestibulopathy. Possibly, other structures than the vestibular nerve are also involved in the pathogenetic process and the label peripheral vestibulopathy would be more apt. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Endoscopic Ear Surgery for External Auditory Canal Cholesteatoma.

Background: Treatment of external auditory canal cholesteatoma (EACC) has been a question of debate. To our knowledge and according to a systematic review of endoscopic ear surgery (EES) in 2015, this study describes for the first time the technique and outcome by solely transcanal EES for EACC. Study Method: Retrospective case series, level of evidence IV. Methods: Between October 2014 and December 2016, nine patients with unilateral EACC have been treated by EES. Using a bimanual technique, canaloplasty has been performed using tragal perichondrium, cartilage, or artificial bone. Symptoms, signs, and reconstruction technique have been assessed and the primary endpoint: healing time was compared with benchmark values in the literature. Results: During the 26 months study period all of our nine Naim stage III EACCs were successfully treated by EES with median healing time of 23.8 days. EACC limited to the external auditory canal (Naim stage III) represented an ideal target for EES minimizing tissue damage and thus median healing time compared with retroauricular (42-56 d) or endaural (59 d) surgical techniques. Discussion: Shorter healing time helped to reduce skepticism toward a surgical treatment of EACC from the patient's perspective. Moreover, EES relied on reduced bulky equipment, dressing time, and complex maintenance compared with microscopic techniques. Conclusion: Transcanal endoscopic surgery is a valid treatment option for EACC up to Naim stage III. Moreover, the described procedure fosters in our eyes the teaching of our residence to get familiar with the basic steps of EES. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Insights Into the Role of Collagen in Vocal Fold Health and Disease

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Publication date: Available online 27 March 2017
Source:Journal of Voice
Author(s): Sharon S. Tang, Vidisha Mohad, Madhu Gowda, Susan L. Thibeault
As one of the key fibrous proteins in the extracellular matrix, collagen plays a significant role in the structural and biomechanical characteristics of the vocal fold. Anchored fibrils of collagen create secure structural regions within the vocal folds and are strong enough to sustain vibratory impact and stretch during phonation. This contributes tensile strength, density, and organization to the vocal folds and influences health and pathogenesis. This review offers a comprehensive summary for a current understanding of collagen within normal vocal fold tissues throughout the life span as well as vocal pathology and wound repair. Further, collagen's molecular structure and biosynthesis are discussed. Finally, collagen alterations in tissue injury and repair and the incorporation of collagen-based biomaterials as a method of treating voice disorders are reviewed.



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Effect of Hormonal Replacement Therapy on Voice

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Publication date: Available online 27 March 2017
Source:Journal of Voice
Author(s): Abdul-Latif Hamdan, Georges Tabet, Ghina Fakhri, Doja Sarieddine, Rachel Btaiche, Muhieddine Seoud
ObjectiveThis study aimed to investigate the effect of hormonal therapy (HRT) on voice in a group of menopausal women, taking into consideration body mass index (BMI) as a confounding factor and its potential role as a substitute for HRT.Subjects and MethodsA total of 53 menopausal women, 34 not on HRT and 19 on HRT, were recruited. Demographic variables included age, gender, smoking, and BMI. All subjects were asked about the presence or absence of the following symptoms: hoarseness, deepening of the voice, pitch breaks, throat clearing, dryness in the throat, and vocal fatigue. Acoustic analysis was performed, and Voice Handicap Index-10 was also completed.ResultsThe mean BMI was 25.90 ± 5.39 and 25.77 ± 4.26 in patients on HRT and not on HRT, respectively. There was no statistical difference in the Voice Handicap Index-10 score and the prevalence of any of the phonatory symptoms in menopausal women not on HRT compared with menopausal women on HRT. However, menopausal women not on HRT had significantly lower habitual pitch than those on HRT (P value of 0.022). On the other hand, the jitter was significantly higher in those on HRT (P value of 0.033).ConclusionHormonal therapy has an impact on the habitual pith in menopausal women with comparable BMI. Those on HRT have a higher habitual pitch than those not on HRT.



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The “Overdrive” Mode in the “Complete Vocal Technique”: A Preliminary Study

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Publication date: Available online 27 March 2017
Source:Journal of Voice
Author(s): Johan Sundberg, Maddalena Bitelli, Annika Holmberg, Ville Laaksonen
“Complete Vocal Technique,” or CVT, is an internationally widespread method for teaching voice. It classifies voicing into four types, referred to as “vocal modes,” one of which is called “Overdrive.” The physiological correlates of these types are unclear. This study presents an attempt to analyze its voice source and formant frequency characteristics. A male and a female expert of CVT sang a set of “Overdrive” and falsetto tones on the syllable /pᴂ/. The voice source could be analyzed by inverse filtering in the case of the male subject. Results showed that subglottal pressure, measured as the oral pressure during /p/ occlusion, was low in falsetto and high in “Overdrive”, and it was strongly correlated with each of the voice source parameters. These correlations could be described in terms of equations. The deviations from these equations of the different voice source parameters for the various voice samples suggested that “Overdrive” phonation was produced with stronger vocal fold adduction than the falsetto tones. Further, the subject was also found to tune the first formant to the second partial in “Overdrive” tones. The results support the conclusion that the method used, to compensate for the influence of subglottal pressure on the voice source, seems promising to use for analyses of other CVT vocal modes and also for other types of phonation.



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Sensorimotor Mismapping in Poor-pitch Singing

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Publication date: Available online 27 March 2017
Source:Journal of Voice
Author(s): Hao He, Wei-dong Zhang
ObjectiveThis study proposes that there are two types of sensorimotor mismapping in poor-pitch singing: erroneous mapping and no mapping. We created operational definitions for the two types of mismapping based on the precision of pitch-matching and predicted that in the two types of mismapping, phonation differs in terms of accuracy and the dependence on the articulation consistency between the target and the intended vocal action. The study aimed to test this hypothesis by examining the reliability and criterion-related validity of the operational definitions.Study DesignA within-subject design was used in this study.MethodsThirty-two participants identified as poor-pitch singers were instructed to vocally imitate pure tones and to imitate their own vocal recordings with the same articulation as self-targets and with different articulation from self-targets.ResultsDefinitions of the types of mismapping were demonstrated to be reliable with the split-half approach and to have good criterion-related validity with findings that pitch-matching with no mapping was less accurate and more dependent on the articulation consistency between the target and the intended vocal action than pitch-matching with erroneous mapping was. Furthermore, the precision of pitch-matching was positively associated with its accuracy and its dependence on articulation consistency when mismapping was analyzed on a continuum. Additionally, the data indicated that the self-imitation advantage was a function of articulation consistency.ConclusionTypes of sensorimotor mismapping lead to pitch-matching that differs in accuracy and its dependence on the articulation consistency between the target and the intended vocal action. Additionally, articulation consistency produces the self-advantage.



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