Objective: To evaluate current trends in managing Meniere's disease (MD) by both general otolaryngologists and otologists/neurotologists and discuss treatment modalities. Study Design: Cross-sectional study. Setting: Survey of physicians. Subjects and Methods: An electronic questionnaire was disseminated to all members of American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). Results: Eight hundred and sixty members replied for a response rate of 14.5% for generalists and 35% for neurotologists. Thirty-nine percent of respondents think that diet and lifestyle changes are effective in controlling symptoms in more than 50% of their MD patients. Overall, 72.8% of respondents used hydrochlorothiazide/triamterene (HCTZ/TAT) "often" or "always" with neurotologists using HCTZ/TAT more often than generalists (p
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Πέμπτη 13 Απριλίου 2017
Clinical Validation of a Sound Processor Upgrade in Direct Acoustic Cochlear Implant Subjects.
Objective: The objectives of the investigation were to evaluate the effect of a sound processor upgrade on the speech reception threshold in noise and to collect long-term safety and efficacy data after 21/2 to 5 years of device use of direct acoustic cochlear implant (DACI) recipients. Study Design: The study was designed as a mono-centric, prospective clinical trial. Setting: Tertiary referral center. Patients: Fifteen patients implanted with a direct acoustic cochlear implant. Intervention: Upgrade with a newer generation of sound processor. Main Outcome Measures: Speech recognition test in quiet and in noise, pure tone thresholds, subject-reported outcome measures. Results: The speech recognition in quiet and in noise is superior after the sound processor upgrade and stable after long-term use of the direct acoustic cochlear implant. The bone conduction thresholds did not decrease significantly after long-term high level stimulation. Conclusions: The new sound processor for the DACI system provides significant benefits for DACI users for speech recognition in both quiet and noise. Especially the noise program with the use of directional microphones (Zoom) allows DACI patients to have much less difficulty when having conversations in noisy environments. Furthermore, the study confirms that the benefits of the sound processor upgrade are available to the DACI recipients even after several years of experience with a legacy sound processor. Finally, our study demonstrates that the DACI system is a safe and effective long-term therapy. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Prevalence and Occupation of Patients Presenting With Dysphonia in the United States
Source:Journal of Voice
Author(s): Michael S. Benninger, Chantal E. Holy, Paul C. Bryson, Claudio F. Milstein
ObjectiveVoice disorders are common conditions that may have a significant impact on patient quality of life, yet their prevalence and epidemiology are poorly documented. In this study, we estimated the prevalence, demographics, and occupation of patients with dysphonia.MethodsUsing the Commercial and Medicare MarketScan databases of 146.7 million lives (2008–2012), the prevalence of dysphonia was estimated. Patient demographics and industry occupation were evaluated. Prevalence estimates overall and by industry were made using Medical Expenditure Panel Survey. Industry estimates were compared with US government employment statistics to assess differences between dysphonia and the general population.ResultsA gradual increase in the diagnosis of dysphonia was noted from 1.3% to 1.7% of the population from 2008 to 2012, with an associated increase in the diagnosis of acute laryngitis, the largest diagnostic category. A strong correlation was present between diagnosis and age, with acute laryngitis more common in the younger populations and malignancies in older ages. Benign neoplasms were more prevalent in the service industry, with 2.6 times increased likelihood compared with the general population, and malignancies were more prevalent in the manufacturing industry, with 1.4 times increased likelihood. Almost 3 million laryngoscopies and stroboscopies were performed with $900 million in costs.ConclusionPrevalence rates of the diagnosis of dysphonia are increasing and are associated with large healthcare costs. Prevalence rates also differ somewhat between industries, and there appears to be a higher percentage of malignant neoplasms in the manufacturing industry and benign neoplasms in the service industry.
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The Effect of Optokinetic Stimulation on Perceptual and Postural Symptoms in Visual Vestibular Mismatch Patients.
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Related Articles |
The Effect of Optokinetic Stimulation on Perceptual and Postural Symptoms in Visual Vestibular Mismatch Patients.
PLoS One. 2016;11(4):e0154528
Authors: Van Ombergen A, Lubeck AJ, Van Rompaey V, Maes LK, Stins JF, Van de Heyning PH, Wuyts FL, Bos JE
Abstract
BACKGROUND: Vestibular patients occasionally report aggravation or triggering of their symptoms by visual stimuli, which is called visual vestibular mismatch (VVM). These patients therefore experience discomfort, disorientation, dizziness and postural unsteadiness.
OBJECTIVE: Firstly, we aimed to get a better insight in the underlying mechanism of VVM by examining perceptual and postural symptoms. Secondly, we wanted to investigate whether roll-motion is a necessary trait to evoke these symptoms or whether a complex but stationary visual pattern equally provokes them.
METHODS: Nine VVM patients and healthy matched control group were examined by exposing both groups to a stationary stimulus as well as an optokinetic stimulus rotating around the naso-occipital axis for a prolonged period of time. Subjective visual vertical (SVV) measurements, posturography and relevant questionnaires were assessed.
RESULTS: No significant differences between both groups were found for SVV measurements. Patients always swayed more and reported more symptoms than healthy controls. Prolonged exposure to roll-motion caused in patients and controls an increase in postural sway and symptoms. However, only VVM patients reported significantly more symptoms after prolonged exposure to the optokinetic stimulus compared to scores after exposure to a stationary stimulus.
CONCLUSIONS: VVM patients differ from healthy controls in postural and subjective symptoms and motion is a crucial factor in provoking these symptoms. A possible explanation could be a central visual-vestibular integration deficit, which has implications for diagnostics and clinical rehabilitation purposes. Future research should focus on the underlying central mechanism of VVM and the effectiveness of optokinetic stimulation in resolving it.
PMID: 27128970 [PubMed - indexed for MEDLINE]
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The Effect of Optokinetic Stimulation on Perceptual and Postural Symptoms in Visual Vestibular Mismatch Patients.
| |
Related Articles |
The Effect of Optokinetic Stimulation on Perceptual and Postural Symptoms in Visual Vestibular Mismatch Patients.
PLoS One. 2016;11(4):e0154528
Authors: Van Ombergen A, Lubeck AJ, Van Rompaey V, Maes LK, Stins JF, Van de Heyning PH, Wuyts FL, Bos JE
Abstract
BACKGROUND: Vestibular patients occasionally report aggravation or triggering of their symptoms by visual stimuli, which is called visual vestibular mismatch (VVM). These patients therefore experience discomfort, disorientation, dizziness and postural unsteadiness.
OBJECTIVE: Firstly, we aimed to get a better insight in the underlying mechanism of VVM by examining perceptual and postural symptoms. Secondly, we wanted to investigate whether roll-motion is a necessary trait to evoke these symptoms or whether a complex but stationary visual pattern equally provokes them.
METHODS: Nine VVM patients and healthy matched control group were examined by exposing both groups to a stationary stimulus as well as an optokinetic stimulus rotating around the naso-occipital axis for a prolonged period of time. Subjective visual vertical (SVV) measurements, posturography and relevant questionnaires were assessed.
RESULTS: No significant differences between both groups were found for SVV measurements. Patients always swayed more and reported more symptoms than healthy controls. Prolonged exposure to roll-motion caused in patients and controls an increase in postural sway and symptoms. However, only VVM patients reported significantly more symptoms after prolonged exposure to the optokinetic stimulus compared to scores after exposure to a stationary stimulus.
CONCLUSIONS: VVM patients differ from healthy controls in postural and subjective symptoms and motion is a crucial factor in provoking these symptoms. A possible explanation could be a central visual-vestibular integration deficit, which has implications for diagnostics and clinical rehabilitation purposes. Future research should focus on the underlying central mechanism of VVM and the effectiveness of optokinetic stimulation in resolving it.
PMID: 27128970 [PubMed - indexed for MEDLINE]
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Success of sensory cell regeneration raises hope for hearing restoration
In an apparent first, St. Jude Children's Research Hospital investigators have used genetic manipulation to regenerate auditory hair cells in adult mice.
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Success of sensory cell regeneration raises hope for hearing restoration
In an apparent first, St. Jude Children's Research Hospital investigators have used genetic manipulation to regenerate auditory hair cells in adult mice.
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Success of sensory cell regeneration raises hope for hearing restoration
In an apparent first, St. Jude Children's Research Hospital investigators have used genetic manipulation to regenerate auditory hair cells in adult mice.
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A non-toxic dose of cobalt chloride blocks hair cells of the zebrafish lateral line
Source:Hearing Research
Author(s): William J. Stewart, Jacob L. Johansen, James C. Liao
Experiments on the flow-sensitive lateral line system of fishes have provided important insights into the function and sensory transduction of vertebrate hair cells. A common experimental approach has been to pharmacologically block lateral line hair cells and measure how behavior changes. Cobalt chloride (CoCl2) blocks the lateral line by inhibiting calcium movement through the membrane channels of hair cells, but high concentrations can be toxic, making it unclear whether changes in behavior are due to a blocked lateral line or poor health. Here, we identify a non-toxic treatment of cobalt that completely blocks lateral line hair cells. We exposed 5-day post fertilization zebrafish larvae to CoCl2 concentrations ranging from 1-20 mM for 15 minutes and measured 1) the spiking rate of the afferent neurons contacting hair cells and 2) the larvae’s health and long-term survival. Our results show that a 15-minute exposure to 5 mM CoCl2 abolishes both spontaneous and evoked afferent firing. This treatment does not change swimming behavior, and results in >85% survival after 5 days. Weaker treatments of CoCl2 did not eliminate afferent activity, while stronger treatments caused close to 50% mortality. Our work provides a guideline for future zebrafish investigations where physiological confirmation of a blocked lateral line system is required.
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Delayed Changes in Auditory Status in Cochlear Implant Users with Preserved Acoustic Hearing
Source:Hearing Research
Author(s): Rachel A. Scheperle, Viral D. Tejani, Julia K. Omtvedt, Carolyn J. Brown, Paul J. Abbas, Marlan R. Hansen, Bruce J. Gantz, Jacob J. Oleson, Marie V. Ozanne
This retrospective review explores delayed-onset hearing loss in 85 individuals receiving cochlear implants designed to preserve acoustic hearing at the University of Iowa Hospitals and Clinics between 2001 and 2015. Repeated measures of unaided behavioral audiometric thresholds, electrode impedance, and electrically evoked compound action potential (ECAP) amplitude growth functions were used to characterize longitudinal changes in auditory status. Participants were grouped into two primary categories according to changes in unaided behavioral thresholds: (1) stable hearing or symmetrical hearing loss and (2) delayed loss of hearing in the implanted ear. Thirty-eight percent of this sample presented with delayed-onset hearing loss of various degrees and rates of change. Neither array type nor insertion approach (round window or cochleostomy) had a significant effect on prevalence. Electrode impedance increased abruptly for many individuals exhibiting precipitous hearing loss; the increase was often transient. The impedance increases were significantly larger than the impedance changes observed for individuals with stable or symmetrical hearing loss. Moreover, the impedance changes were associated with changes in behavioral thresholds for individuals with a precipitous drop in behavioral thresholds. These findings suggest a change in the electrode environment coincident with the change in auditory status. Changes in ECAP thresholds, growth function slopes, and suprathreshold amplitudes were not correlated with changes in behavioral thresholds, suggesting that neural responsiveness in the region excited by the implant is relatively stable. Further exploration into etiology of delayed-onset hearing loss post implantation is needed, with particular interest in mechanisms associated with changes in the intracochlear environment.
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A non-toxic dose of cobalt chloride blocks hair cells of the zebrafish lateral line
Source:Hearing Research
Author(s): William J. Stewart, Jacob L. Johansen, James C. Liao
Experiments on the flow-sensitive lateral line system of fishes have provided important insights into the function and sensory transduction of vertebrate hair cells. A common experimental approach has been to pharmacologically block lateral line hair cells and measure how behavior changes. Cobalt chloride (CoCl2) blocks the lateral line by inhibiting calcium movement through the membrane channels of hair cells, but high concentrations can be toxic, making it unclear whether changes in behavior are due to a blocked lateral line or poor health. Here, we identify a non-toxic treatment of cobalt that completely blocks lateral line hair cells. We exposed 5-day post fertilization zebrafish larvae to CoCl2 concentrations ranging from 1-20 mM for 15 minutes and measured 1) the spiking rate of the afferent neurons contacting hair cells and 2) the larvae’s health and long-term survival. Our results show that a 15-minute exposure to 5 mM CoCl2 abolishes both spontaneous and evoked afferent firing. This treatment does not change swimming behavior, and results in >85% survival after 5 days. Weaker treatments of CoCl2 did not eliminate afferent activity, while stronger treatments caused close to 50% mortality. Our work provides a guideline for future zebrafish investigations where physiological confirmation of a blocked lateral line system is required.
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Delayed Changes in Auditory Status in Cochlear Implant Users with Preserved Acoustic Hearing
Source:Hearing Research
Author(s): Rachel A. Scheperle, Viral D. Tejani, Julia K. Omtvedt, Carolyn J. Brown, Paul J. Abbas, Marlan R. Hansen, Bruce J. Gantz, Jacob J. Oleson, Marie V. Ozanne
This retrospective review explores delayed-onset hearing loss in 85 individuals receiving cochlear implants designed to preserve acoustic hearing at the University of Iowa Hospitals and Clinics between 2001 and 2015. Repeated measures of unaided behavioral audiometric thresholds, electrode impedance, and electrically evoked compound action potential (ECAP) amplitude growth functions were used to characterize longitudinal changes in auditory status. Participants were grouped into two primary categories according to changes in unaided behavioral thresholds: (1) stable hearing or symmetrical hearing loss and (2) delayed loss of hearing in the implanted ear. Thirty-eight percent of this sample presented with delayed-onset hearing loss of various degrees and rates of change. Neither array type nor insertion approach (round window or cochleostomy) had a significant effect on prevalence. Electrode impedance increased abruptly for many individuals exhibiting precipitous hearing loss; the increase was often transient. The impedance increases were significantly larger than the impedance changes observed for individuals with stable or symmetrical hearing loss. Moreover, the impedance changes were associated with changes in behavioral thresholds for individuals with a precipitous drop in behavioral thresholds. These findings suggest a change in the electrode environment coincident with the change in auditory status. Changes in ECAP thresholds, growth function slopes, and suprathreshold amplitudes were not correlated with changes in behavioral thresholds, suggesting that neural responsiveness in the region excited by the implant is relatively stable. Further exploration into etiology of delayed-onset hearing loss post implantation is needed, with particular interest in mechanisms associated with changes in the intracochlear environment.
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A non-toxic dose of cobalt chloride blocks hair cells of the zebrafish lateral line
Source:Hearing Research
Author(s): William J. Stewart, Jacob L. Johansen, James C. Liao
Experiments on the flow-sensitive lateral line system of fishes have provided important insights into the function and sensory transduction of vertebrate hair cells. A common experimental approach has been to pharmacologically block lateral line hair cells and measure how behavior changes. Cobalt chloride (CoCl2) blocks the lateral line by inhibiting calcium movement through the membrane channels of hair cells, but high concentrations can be toxic, making it unclear whether changes in behavior are due to a blocked lateral line or poor health. Here, we identify a non-toxic treatment of cobalt that completely blocks lateral line hair cells. We exposed 5-day post fertilization zebrafish larvae to CoCl2 concentrations ranging from 1-20 mM for 15 minutes and measured 1) the spiking rate of the afferent neurons contacting hair cells and 2) the larvae’s health and long-term survival. Our results show that a 15-minute exposure to 5 mM CoCl2 abolishes both spontaneous and evoked afferent firing. This treatment does not change swimming behavior, and results in >85% survival after 5 days. Weaker treatments of CoCl2 did not eliminate afferent activity, while stronger treatments caused close to 50% mortality. Our work provides a guideline for future zebrafish investigations where physiological confirmation of a blocked lateral line system is required.
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Delayed Changes in Auditory Status in Cochlear Implant Users with Preserved Acoustic Hearing
Source:Hearing Research
Author(s): Rachel A. Scheperle, Viral D. Tejani, Julia K. Omtvedt, Carolyn J. Brown, Paul J. Abbas, Marlan R. Hansen, Bruce J. Gantz, Jacob J. Oleson, Marie V. Ozanne
This retrospective review explores delayed-onset hearing loss in 85 individuals receiving cochlear implants designed to preserve acoustic hearing at the University of Iowa Hospitals and Clinics between 2001 and 2015. Repeated measures of unaided behavioral audiometric thresholds, electrode impedance, and electrically evoked compound action potential (ECAP) amplitude growth functions were used to characterize longitudinal changes in auditory status. Participants were grouped into two primary categories according to changes in unaided behavioral thresholds: (1) stable hearing or symmetrical hearing loss and (2) delayed loss of hearing in the implanted ear. Thirty-eight percent of this sample presented with delayed-onset hearing loss of various degrees and rates of change. Neither array type nor insertion approach (round window or cochleostomy) had a significant effect on prevalence. Electrode impedance increased abruptly for many individuals exhibiting precipitous hearing loss; the increase was often transient. The impedance increases were significantly larger than the impedance changes observed for individuals with stable or symmetrical hearing loss. Moreover, the impedance changes were associated with changes in behavioral thresholds for individuals with a precipitous drop in behavioral thresholds. These findings suggest a change in the electrode environment coincident with the change in auditory status. Changes in ECAP thresholds, growth function slopes, and suprathreshold amplitudes were not correlated with changes in behavioral thresholds, suggesting that neural responsiveness in the region excited by the implant is relatively stable. Further exploration into etiology of delayed-onset hearing loss post implantation is needed, with particular interest in mechanisms associated with changes in the intracochlear environment.
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