Cognitive Abilities and Quality of Life After Cochlear Implantation in the Elderly

Objective: To evaluate quality of life (QoL) and cognitive function in elderly patients with cochlear implants relative to auditory improvement, using geriatric validated scales. Study Design: Prospective observational study. Setting: A tertiary referral center for cochlear implantation (CI) and a geriatric center in Nancy, France. Patients: Sixteen consecutive patients were included, from 65 to 80 years old, with postlingual severe-to-profound deafness. Main Outcome Measures: Evaluations were conducted before and at 6 and 12 months after cochlear implant surgery. A monosyllabic word recognition test was used to measure speech perception. QoL was evaluated by the World Health Organization Quality of Life Assessment for elderly people; cognitive function was evaluated by the Mini-Mental State Examination; depression was evaluated by the Hamilton Scale; autonomy was evaluated by the Instrumental Activities of Daily Living. Results: Speech intelligibility evolved from 10% before surgery to 63% and 69% at 6 and 12 months after cochlear implant activation, respectively. QoL showed significant improvement in sensory abilities. The Mini-Mental State Examination evaluations remained stable and executive functions tended to improve. Autonomy improved significantly. Conclusion: Cochlear implantation improves autonomy and the QoL in the elderly. Cognitive functions are not influenced by surgery, but executive functions appear to benefit from implantation. Age should not be a limiting factor, and cochlear implantation can be proposed as an efficient treatment for severe-to-profound hearing loss in the elderly.

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Impact of Cochlear Implantation on Cognitive Functions of Older Adults: Pilot Test Results

Background: A significant relationship between hearing loss and cognitive impairment has been previously reported. Overall, improvement in speech perception in quiet and quality of life has been observed after cochlear implantation. However, the impact of hearing loss treatment using cochlear implantation on cognitive functions is yet to be fully elucidated. Objective: To investigate the impact of cochlear implantation on cognitive and psychological functions of older adults. Study Design: Prospective patient-control study. Participants: A total of 39 participants took part in the study: 23 cochlear implant (CI) candidates (M = 69.04 ± 12.35 yr) and 16 CI recipients (M = 61.75 ± 15.62 yr). All participants completed an assessment of hearing (pure-tone thresholds and speech perception in quiet), and a computerised, nonverbal test battery of cognitive function assessment, as well as a depression, anxiety, and stress scale. Results: Independent-sample t test scores for the changes between 0 and 12 months revealed that CI recipients performed significantly better on measures of simple reaction time, cognitive flexibility, paired-associate learning, working memory, and strategy use (p 

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The Impact of Comorbidities in the Aging Population on Cochlear Implant Outcomes

Objectives: Cochlear implants have been used for many years for bilateral profound hearing loss. General longevity has continued to increase and, therefore, the age at which cochlear implants are placed has concomitantly increased. Our purpose is to determine whether outcomes and complications are significantly different in the elderly. Study Design: Retrospective, clinical review. Setting: Tertiary referral center, primarily ambulatory setting. Patients: One hundred and one patients with moderate-to-profound hearing loss who ranged in age from 18 to 89 years. Subjects were divided into younger (70, n = 50) groups for analysis. Intervention: All patients received either a unilateral or bilateral multichannel cochlear implant. The change in hearing in noise testing and AZBio testing between pre and postimplantation was evaluated in each group. Main Outcome Measures: Primary outcome measures include preimplant and postimplant hearing in noise test (HINT) and/or AZBio speech perception testing. Preimplant HINT/AZBio was compared with postimplant HINT/AZBio for each patient and between the two groups. In addition, we reviewed the comorbidities between the two groups as well as complication rates between less than 70 and more than 70 group. Results: Both the younger and the older group demonstrated a significant improvement in postimplant HINT and/or AZBio scores. No statistically significant difference was noted in precochlear implant HINT/AZBio testing (p = 0.65/p = 0.48) between the two groups or the postimplant HINT/AZBio testing (p = 0.19/p = 0.22) between the two groups. Although, more than 70 yo group had significantly more comorbidities, the complication rates between the groups were insignificant. There was no shown association of specific comorbidities to complications between the two groups. Conclusions: Both older and younger patients can receive a significant improvement in speech perception with cochlear implantation. Older patients tend to have more comorbidities compared with the younger patients, however, the complication rates are not higher in this population.

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Introduction to the 14th International Symposium on Cochlear Implants and other Implantable Auditory Technologies, Toronto, Canada, May 11 to 14, 2016

No abstract available

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Cochlear Implantation in Postlingual Adult Patients With Long-Term Auditory Deprivation

Objective: The role of long-term hearing deprivation in cochlear implant performance is not well established, and the limits for implanting an auditory deprived ear are still unknown. The objective of this study was to evaluate the effect of long-term auditory deprivation time on cochlear implant results. Study Design: Retrospective case review study. Setting: Cochlear implantation tertiary referral center. Patients: Adult patients with postlingual deafness. Intervention: Unilateral cochlear implantation between 2001 and January 2015. Main Outcome Measures: Age at implantation, sex, etiology of hearing loss, and duration of auditory deprivation in the implanted ear were collected. Cochlear implants results were expressed in terms of vowel identification, disyllabic word recognition, and sentence recognition. Spearman's correlation test was applied to determine the relationship between auditory deprivation time and speech recognition scores. Additionally, patients were divided according to their auditory deprivation time before implantation in group A (less than 10 yr) and group B (more than 10 yr). Results: One hundred three patients met inclusion criteria for this study. There were 61 patients in group A, with a mean deprivation time of 2.52 years. There were 42 patients in group B, with a mean deprivation time of 19.67 years. There were no statistically significant differences between both groups regarding speech recognition scores. Deprivation time in the implanted ear was not statistically correlated with cochlear implantation performance. Conclusions: Long-term auditory deprivation in the ear to be implanted does not negatively influence cochlear implantation results and should not be considered criterion to reject cochlear implantation.

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Cochlear Implants Meet Regenerative Biology: State of the Science and Future Research Directions

The cochlear implant, the first device to restore a human sense, is an electronic substitute for lost mechanosensory hair cells. It has been successful at providing hearing to people with severe to profound hearing loss and as of 2012, an estimated 324,000 patients worldwide have received cochlear implants. Users of cochlear implants however, suffer from difficulties in processing complex sounds such as music and in discriminating sounds in noisy environments. Recent advances in regenerative biology and medicine are opening new avenues for enhancing the efficacy of cochlear implants by improving the neural interface in the future and offer the possibility of an entirely biological solution for hearing loss in the long term. This report comprises the latest developments presented in the first Symposium on cochlear implants and regenerative biology, held at the 14th International Conference on Cochlear Implants in 2016 in Toronto, Canada.

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NANOCI—Nanotechnology Based Cochlear Implant With Gapless Interface to Auditory Neurons

Cochlear implants (CI) restore functional hearing in the majority of deaf patients. Despite the tremendous success of these devices, some limitations remain. The bottleneck for optimal electrical stimulation with CI is caused by the anatomical gap between the electrode array and the auditory neurons in the inner ear. As a consequence, current devices are limited through 1) low frequency resolution, hence sub-optimal sound quality and 2), large stimulation currents, hence high energy consumption (responsible for significant battery costs and for impeding the development of fully implantable systems). A recently completed, multinational and interdisciplinary project called NANOCI aimed at overcoming current limitations by creating a gapless interface between auditory nerve fibers and the cochlear implant electrode array. This ambitious goal was achieved in vivo by neurotrophin-induced attraction of neurites through an intracochlear gel-nanomatrix onto a modified nanoCI electrode array located in the scala tympani of deafened guinea pigs. Functionally, the gapless interface led to lower stimulation thresholds and a larger dynamic range in vivo, and to reduced stimulation energy requirement (up to fivefold) in an in vitro model using auditory neurons cultured on multi-electrode arrays. In conclusion, the NANOCI project yielded proof of concept that a gapless interface between auditory neurons and cochlear implant electrode arrays is feasible. These findings may be of relevance for the development of future CI systems with better sound quality and performance and lower energy consumption. The present overview/review paper summarizes the NANOCI project history and highlights achievements of the individual work packages.

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Physiological Mechanisms in Combined Electric–Acoustic Stimulation

Objective: Electrical stimulation is normally performed on ears that have no hearing function, i.e., lack functional hair cells. The properties of electrically-evoked responses in these cochleae were investigated in several previous studies. Recent clinical developments have introduced cochlear implantation (CI) in residually-hearing ears to improve speech understanding in noise. The present study documents the known physiological differences between electrical stimulation of hair cells and of spiral ganglion cells, respectively, and reviews the mechanisms of combined electric and acoustic stimulation in the hearing ears. Data Sources: Literature review from 1971 to 2016. Conclusions: Compared with pure electrical stimulation the combined electroacoustic stimulation provides additional low-frequency information and expands the dynamic range of the input. Physiological studies document a weaker synchronization of the evoked activity in electrically stimulated hearing ears compared with deaf ears that reduces the hypersynchronization of electrically-evoked activity. The findings suggest the possibility of balancing the information provided by acoustic and electric input using stimulus intensity. Absence of distorting acoustic–electric interactions allows exploiting these clinical benefits of electroacoustic stimulation.

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Cognitive Evaluation of Cochlear Implanted Adults Using CODEX and MoCA Screening Tests

Objective: The relationship between hearing loss and cognitive function has already been established. The objective of our study was to determine whether the two short cognitive tests, COgnitive Disorders EXamination (CODEX) and Montreal Cognitive Assessment (MoCA), could be used in daily clinical practice to detect cognitive impairment, and its changes after cochlear implantation. Patients: Eighteen patients with severe to profound postlingual progressive hearing loss (mean age ± SEM: 64 ± 3.5 yr; range, 23–83 yr) were tested before, and 12 months after cochlear implantation, with adapted visual presentation of CODEX and MoCA tests. Auditory performance was tested under best-aided conditions in quiet and noise. Results: Twelve months after cochlear implantation, hearing performance had clearly improved (paired t tests, p 

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Isolated Second Implant Adaptation Period in Sequential Cochlear Implantation in Adults

Objective: To determine if depriving the use of the first cochlear implant (CI1) impacts adaptation to a sequential implant (CI2). Study Design: Prospective cohort. Setting: Academic center. Patients: Sixteen unilateral cochlear implant recipients undergoing contralateral implantation (sequential bilateral) were matched according to age, etiology, duration of deafness, device age, and delay between implants. Intervention: During a 4-week adaptation period after CI2 activation, patients underwent deprivation of CI1 or were permitted continued use of it. Main Outcome Measures: Speech perception scores and subjective quality of life outcomes before CI2 and at 1, 3, 6, and 12-months following activation. Results: Maximal CI2 speech perception scores in quiet were achieved by 1-month postactivation for the “deprivation” group (71.3% for hearing in noise test [HINT], p = 0.767 for change beyond 1-mo) compared with 6-months for the “continued use” group (67.9% for HINT, p = 0.064 for change beyond 6-mo). The “deprivation” group experienced a temporary drop in CI1 scores (67.9% for HINT in quiet at 1-mo versus 78.4% pre-CI2, p = 0.009) recovering to 77.3% by 3-months; unchanged from baseline levels (p = 1.0). A binaural advantage over the better hearing ear was present for HINT sentences with noise (72.4% versus 58.8% for “deprivation”, p = 0.001; 71.5% versus 52.7% for “continued use,” p = 0.01). Missing data precluded a meaningful analysis of subjective quality of life outcome scales. Conclusion: Bilateral cochlear implantation improves speech perception compared with one implant. A period of deprivation from CI1 shortens time to maximum speech perception by CI2 without long-term consequences on the performance of CI1.

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The Sound Quality of Cochlear Implants: Studies With Single-sided Deaf Patients

Objective: The goal of the present study was to assess the sound quality of a cochlear implant for single-sided deaf (SSD) patients fit with a cochlear implant (CI). Background: One of the fundamental, unanswered questions in CI research is “what does an implant sound like?” Conventional CI patients must use the memory of a clean signal, often decades old, to judge the sound quality of their CIs. In contrast, SSD-CI patients can rate the similarity of a clean signal presented to the CI ear and candidate, CI-like signals presented to the ear with normal hearing. Methods: For Experiment 1 four types of stimuli were created for presentation to the normal hearing ear: noise vocoded signals, sine vocoded signals, frequency shifted, sine vocoded signals and band-pass filtered, natural speech signals. Listeners rated the similarity of these signals to unmodified signals sent to the CI on a scale of 0 to 10 with 10 being a complete match to the CI signal. For Experiment 2 multitrack signal mixing was used to create natural speech signals that varied along multiple dimensions. Results: In Experiment 1 for eight adult SSD-CI listeners, the best median similarity rating to the sound of the CI for noise vocoded signals was 1.9; for sine vocoded signals 2.9; for frequency upshifted signals, 1.9; and for band pass filtered signals, 5.5. In Experiment 2 for three young listeners, combinations of band pass filtering and spectral smearing lead to ratings of 10. Conclusion: The sound quality of noise and sine vocoders does not generally correspond to the sound quality of cochlear implants fit to SSD patients. Our preliminary conclusion is that natural speech signals that have been muffled to one degree or another by band pass filtering and/or spectral smearing provide a close, but incomplete, match to CI sound quality for some patients.

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Musical Rehabilitation in Adult Cochlear Implant Recipients With a Self-administered Software

Objective: The goal of this study was to determine if a self-administered computer-based rehabilitation program could improve music appreciation and speech understanding in adults who have a cochlear implant (CI). Study Design: Prospective study. Setting: Tertiary adult CI program. Patients: Twenty-one postlingually deafened cochlear implant users between the ages of 27 and 79 years were recruited. Interventions(s): A self-administered music rehabilitative software was designed to help improve the perception of musical patterns of increasing complexity, as well as pitch and timbre perception, premised on focused and divided attention. All participants completed a diagnostic music test before and after rehabilitative training, including tests of pitch and timbre perception and pattern identification with increasing levels of difficulty. Speech data in quiet and noise was also collected both pre- and post-training. Participants trained for a minimum of 3.5 hours a week, for 4 weeks. Main Outcome Measure(s): Mean changes in music perception and enjoyment as well as speech perception (IEEE sentence test in quiet and noise). Results: Post-training diagnostic test scores, as compared with pretraining scores, indicated significant improvements in musical pattern perception. Tests of speech perception in quiet and in noise were significantly improved in a subset of this cohort. All of the training participants thought that the training helped to improve their recognition skills, and found the program to be beneficial. Conclusion: Despite the limitations of current CI technology, the results of this study suggest that auditory training can improve music perception skills, and possibly speech intelligibility, lending further support to rehabilitation being an integral part of the postimplantation paradigm.

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A Smartphone Application for Customized Frequency Table Selection in Cochlear Implants

Hypothesis: A novel smartphone-based software application can facilitate self-selection of frequency allocation tables (FAT) in postlingually deaf cochlear implant (CI) users. Background: CIs use FATs to represent the tonotopic organization of a normal cochlea. Current CI fitting methods typically use a standard FAT for all patients regardless of individual differences in cochlear size and electrode location. In postlingually deaf patients, different amounts of mismatch can result between the frequency-place function they experienced when they had normal hearing and the frequency-place function that results from the standard FAT. For some CI users, an alternative FAT may enhance sound quality or speech perception. Currently, no widely available tools exist to aid real-time selection of different FATs. This study aims to develop a new smartphone tool for this purpose and to evaluate speech perception and sound quality measures in a pilot study of CI subjects using this application. Methods: A smartphone application for a widely available mobile platform (iOS) was developed to serve as a preprocessor of auditory input to a clinical CI speech processor and enable interactive real-time selection of FATs. The application's output was validated by measuring electrodograms for various inputs. A pilot study was conducted in six CI subjects. Speech perception was evaluated using word recognition tests. Results: All subjects successfully used the portable application with their clinical speech processors to experience different FATs while listening to running speech. The users were all able to select one table that they judged provided the best sound quality. All subjects chose a FAT different from the standard FAT in their everyday clinical processor. Using the smartphone application, the mean consonant–nucleus–consonant score with the default FAT selection was 28.5% (SD 16.8) and 29.5% (SD 16.4) when using a self-selected FAT. Conclusion: A portable smartphone application enables CI users to self-select frequency allocation tables in real time. Even though the self-selected FATs that were deemed to have better sound quality were only tested acutely (i.e., without long-term experience with them), speech perception scores were not inferior to those obtained with the clinical FATs. This software application may be a valuable tool for improving future methods of CI fitting.

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Linking Deafness and Dementia: Challenges and Opportunities

The rising incidence of dementia locally and worldwide has now reached a critical level. The associated costs associated with these individuals will ultimately be untenable to most societies. Furthermore there is a paucity of highly effective treatments. However, the recent discovery of the association of hearing loss and dementia may open many potential opportunities. Although we still are acquiring knowledge on the pathophysiology of this association, clinicians are hopeful that our current highly effective treatments of hearing loss may ultimately be shown to have a positive effect on those with dementia.

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What Does Music Sound Like for a Cochlear Implant User?

Objective: Cochlear implant research and product development over the past 40 years have been heavily focused on speech comprehension with little emphasis on music listening and enjoyment. The relatively little understanding of how music sounds in a cochlear implant user stands in stark contrast to the overall degree of importance the public places on music and quality of life. The purpose of this article is to describe what music sounds like to cochlear implant users, using a combination of existing research studies and listener descriptions. We examined the published literature on music perception in cochlear implant users, particularly postlingual cochlear implant users, with an emphasis on the primary elements of music and recorded music. Additionally, we administered an informal survey to cochlear implant users to gather first-hand descriptions of music listening experience and satisfaction from the cochlear implant population. Conclusion: Limitations in cochlear implant technology lead to a music listening experience that is significantly distorted compared with that of normal hearing listeners. On the basis of many studies and sources, we describe how music is frequently perceived as out-of-tune, dissonant, indistinct, emotionless, and weak in bass frequencies, especially for postlingual cochlear implant users—which may in part explain why music enjoyment and participation levels are lower after implantation. Additionally, cochlear implant users report difficulty in specific musical contexts based on factors including but not limited to genre, presence of lyrics, timbres (woodwinds, brass, instrument families), and complexity of the perceived music. Future research and cochlear implant development should target these areas as parameters for improvement in cochlear implant-mediated music perception.

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Procesos fonológicos en una prueba de repetición de no-palabras en niños con trastorno específico del lenguaje

Publication date: Available online 19 August 2017
Source:Revista de Logopedia, Foniatría y Audiología
Author(s): Ana Susana Mejía Villalobos, Donna Jackson-Maldonado
El análisis de los procesos fonológicos se ha centrado en muestras provenientes de habla espontánea y en edades muy tempranas. Actualmente, existen muy pocos estudios que describan estos procesos fonológicos en español en edades tardías y que se basen en tareas que involucren una alta carga de procesamiento de la memoria de trabajo como lo es en una prueba de repetición de no-palabras (RNP) en poblaciones con trastorno específico del lenguaje (TEL). Este trabajo contrasta el tipo y ocurrencia de los errores fonológicos entre niños mexicanos con TEL y niños con desarrollo típico (DT) de edad escolar en una prueba de RNP. Participaron en el estudio 16 niños de 5 a 6 años, 8 niños con DT y 8 con TEL. Los resultados mostraron patrones generales de los procesos fonológicos en ambos grupos. Se encontró una distribución similar de los procesos en los grupos TEL y DT. Estos resultados coinciden con otros estudios en otras lenguas y en otras poblaciones en tipo y ocurrencia de procesos: los grupos de niños con TEL presentaron un mayor número de procesos fonológicos. Los procesos más frecuentes en los grupos fueron los de asimilación, modificación de la estructura silábica y los de procesos múltiples. Los procesos que distinguieron las poblaciones de niños con DT y TEL fueron los procesos múltiples, seguidos por los procesos que modifican la estructura silábica. Se muestra que, efectivamente, hay persistencia de los procesos fonológicos en etapas escolares, cuando la tarea exige un mayor nivel de procesamiento.Phonological processes have been extensively studied in spontaneous speech samples and in early stages of development. However, there are very few studies that have addressed these processes in Spanish at later ages in tasks involving a high processing load of the working memory such as a test of non-word repetition (NWR) in children with specific language impairment (SLI). This paper contrasts the occurrence of phonological errors among Mexican children with SLI and typically developing children (TD) using a NWR task. The study included 16 children aged 5-6 years: 8 children with SLI and 8 with TD. The results showed general patterns in the behavior of phonological processes in both groups. Also, a similar distribution of processes was in the SLI and TD groups. These results support studies in other languages both in type and tokens of processes: the SLI group had a higher number of phonological processes. The most productive processes in both groups were assimilation, processes with modification of the syllabic structure and multiple processes. The TD and SLI groups could be distinguished by phonological processes. Among those processes that showed differences between groups were multiple processes, followed by processes that modify the syllabic structure. We show that phonological processes are persistent into the school years when children are presented with a task that involves a greater processing load.



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Procesos fonológicos en una prueba de repetición de no-palabras en niños con trastorno específico del lenguaje

Publication date: Available online 19 August 2017
Source:Revista de Logopedia, Foniatría y Audiología
Author(s): Ana Susana Mejía Villalobos, Donna Jackson-Maldonado
El análisis de los procesos fonológicos se ha centrado en muestras provenientes de habla espontánea y en edades muy tempranas. Actualmente, existen muy pocos estudios que describan estos procesos fonológicos en español en edades tardías y que se basen en tareas que involucren una alta carga de procesamiento de la memoria de trabajo como lo es en una prueba de repetición de no-palabras (RNP) en poblaciones con trastorno específico del lenguaje (TEL). Este trabajo contrasta el tipo y ocurrencia de los errores fonológicos entre niños mexicanos con TEL y niños con desarrollo típico (DT) de edad escolar en una prueba de RNP. Participaron en el estudio 16 niños de 5 a 6 años, 8 niños con DT y 8 con TEL. Los resultados mostraron patrones generales de los procesos fonológicos en ambos grupos. Se encontró una distribución similar de los procesos en los grupos TEL y DT. Estos resultados coinciden con otros estudios en otras lenguas y en otras poblaciones en tipo y ocurrencia de procesos: los grupos de niños con TEL presentaron un mayor número de procesos fonológicos. Los procesos más frecuentes en los grupos fueron los de asimilación, modificación de la estructura silábica y los de procesos múltiples. Los procesos que distinguieron las poblaciones de niños con DT y TEL fueron los procesos múltiples, seguidos por los procesos que modifican la estructura silábica. Se muestra que, efectivamente, hay persistencia de los procesos fonológicos en etapas escolares, cuando la tarea exige un mayor nivel de procesamiento.Phonological processes have been extensively studied in spontaneous speech samples and in early stages of development. However, there are very few studies that have addressed these processes in Spanish at later ages in tasks involving a high processing load of the working memory such as a test of non-word repetition (NWR) in children with specific language impairment (SLI). This paper contrasts the occurrence of phonological errors among Mexican children with SLI and typically developing children (TD) using a NWR task. The study included 16 children aged 5-6 years: 8 children with SLI and 8 with TD. The results showed general patterns in the behavior of phonological processes in both groups. Also, a similar distribution of processes was in the SLI and TD groups. These results support studies in other languages both in type and tokens of processes: the SLI group had a higher number of phonological processes. The most productive processes in both groups were assimilation, processes with modification of the syllabic structure and multiple processes. The TD and SLI groups could be distinguished by phonological processes. Among those processes that showed differences between groups were multiple processes, followed by processes that modify the syllabic structure. We show that phonological processes are persistent into the school years when children are presented with a task that involves a greater processing load.



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Procesos fonológicos en una prueba de repetición de no-palabras en niños con trastorno específico del lenguaje

Publication date: Available online 19 August 2017
Source:Revista de Logopedia, Foniatría y Audiología
Author(s): Ana Susana Mejía Villalobos, Donna Jackson-Maldonado
El análisis de los procesos fonológicos se ha centrado en muestras provenientes de habla espontánea y en edades muy tempranas. Actualmente, existen muy pocos estudios que describan estos procesos fonológicos en español en edades tardías y que se basen en tareas que involucren una alta carga de procesamiento de la memoria de trabajo como lo es en una prueba de repetición de no-palabras (RNP) en poblaciones con trastorno específico del lenguaje (TEL). Este trabajo contrasta el tipo y ocurrencia de los errores fonológicos entre niños mexicanos con TEL y niños con desarrollo típico (DT) de edad escolar en una prueba de RNP. Participaron en el estudio 16 niños de 5 a 6 años, 8 niños con DT y 8 con TEL. Los resultados mostraron patrones generales de los procesos fonológicos en ambos grupos. Se encontró una distribución similar de los procesos en los grupos TEL y DT. Estos resultados coinciden con otros estudios en otras lenguas y en otras poblaciones en tipo y ocurrencia de procesos: los grupos de niños con TEL presentaron un mayor número de procesos fonológicos. Los procesos más frecuentes en los grupos fueron los de asimilación, modificación de la estructura silábica y los de procesos múltiples. Los procesos que distinguieron las poblaciones de niños con DT y TEL fueron los procesos múltiples, seguidos por los procesos que modifican la estructura silábica. Se muestra que, efectivamente, hay persistencia de los procesos fonológicos en etapas escolares, cuando la tarea exige un mayor nivel de procesamiento.Phonological processes have been extensively studied in spontaneous speech samples and in early stages of development. However, there are very few studies that have addressed these processes in Spanish at later ages in tasks involving a high processing load of the working memory such as a test of non-word repetition (NWR) in children with specific language impairment (SLI). This paper contrasts the occurrence of phonological errors among Mexican children with SLI and typically developing children (TD) using a NWR task. The study included 16 children aged 5-6 years: 8 children with SLI and 8 with TD. The results showed general patterns in the behavior of phonological processes in both groups. Also, a similar distribution of processes was in the SLI and TD groups. These results support studies in other languages both in type and tokens of processes: the SLI group had a higher number of phonological processes. The most productive processes in both groups were assimilation, processes with modification of the syllabic structure and multiple processes. The TD and SLI groups could be distinguished by phonological processes. Among those processes that showed differences between groups were multiple processes, followed by processes that modify the syllabic structure. We show that phonological processes are persistent into the school years when children are presented with a task that involves a greater processing load.



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Development and Validation of a Modular Endoscopic Ear Surgery Skills Trainer

Objective: Endoscopic ear surgery (EES) is an emerging technique requiring single-handed dissection with limited depth perception. Current options for EES simulation and training are limited. Herein, we introduce a versatile, low-cost surgical skills trainer that aims to improve the fine motor control necessary for EES. Study Design: Prospective validation study. Setting: Surgical simulation laboratory. Participants: Seven subjects ranging in experience from medical students (“Novices”) to experienced ear surgeons (“Experts”) participated in the validation study. Experts (n = 3) were defined as performing >10 EES cases per year. Methods: The skills trainer was constructed from a 3” diameter polyvinyl chloride pipe cap modified with two ports for instrument passage. A wooden platform was placed inside at an appropriate working distance for ear surgery. Eight interchangeable skills modules were fabricated on wooden squares (3 cm × 3 cm) using materials such as #19 wire brads, 1.6 mm glass beads, and 26-gauge jewelry wire. The material cost of this reusable model was $15. Subjects completed each skills module in triplicate, followed by a Likert-based survey. Results: Expert performance was superior to novices in 100% (8/8) of skills modules, i.e., threading beads on a wire (43 versus 127 s, p 

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Diagnosis of Superior Semicircular Canal Dehiscence in the Presence of Concomitant Otosclerosis

Objective: To review three patients with concurrent otosclerosis and superior canal dehiscence identified before operative intervention and provide a practical diagnostic approach to this clinical scenario. Study Design: Retrospective patient series. Setting: Tertiary/quaternary referral center. Patients: Individuals with confirmed diagnoses of concurrent otosclerosis and superior semicircular canal dehiscence syndrome. Interventions: Detailed history and physical examinations were performed on these patients, as well as detailed audiovestibular testing and computed tomography imaging. Main Outcome Measures: Establishing a clear diagnosis of concurrent otosclerosis and superior semicircular canal dehiscence syndrome using a thorough diagnostic approach. Results: Three patients presented with conductive hearing loss and normal tympanic membranes. When history and physical examination yielded suspicious third window symptoms/signs, more detailed audiovestibular testing and computed tomography scan imaging were performed. All three patients were ultimately identified to have concurrent otosclerosis and superior canal dehiscence. Conservative management was the option of choice for two of these patients (trial of a hearing aid) and surgical intervention was performed to treat the otosclerosis in the remaining patient.

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Significance of Endolymphatic Hydrops in Ears With Unilateral Sensorineural Hearing Loss

Objective: The purpose of this study was to investigate the existence of endolymphatic hydrops (EH) in affected and unaffected ears in patients with unilateral sensorineural hearing loss (SNHL) using contrast-enhanced magnetic resonance imaging (MRI), and to evaluate the significance of EH in various otological diseases. Study Design: Retrospective study. Setting: University hospital. Methods: One hundred eighty-two ears from 91 patients with unilateral SNHL were studied. The endolymphatic space was evaluated using 3-Tesla MRI with gadodiamide hydrate. Imaging data about the degree of EH in the cochlea and vestibule were analyzed and compared between ears with various otological diseases. Results: All affected ears with delayed endolymphatic hydrops had EH. In affected ears with definite Menière's disease, cochlear EH was observed in all ears and vestibular EH in 93% of ears, and these rates were significantly higher in the affected than in the unaffected ears. EH was also observed in the cochlea and vestibule in 66% and 41%, respectively, of the affected ears with idiopathic sudden SNHL; however, these percentages did not differ significantly from those in the unaffected ears (52% and 38%, respectively). Conclusion: MRI showed that a high percentage of ears affected by Menière's disease or delayed endolymphatic hydrops had EH. Further studies should evaluate the implications of EH in ears, especially in those with sudden SNHL, in terms of secondary or pre-existing EH.

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Vestibular Function in Adults With Epilepsy of Unknown Etiology

Objective: This study aimed to evaluate vestibular function in adults with chronic epilepsy of unknown etiology in the inter-ictal period. Background: Epilepsy is a chronic medical disorder. Life-long therapy may be required in one-third of patients. Epilepsy is associated with comorbid somatic conditions which impairs patients’ quality of life. Methods: This cross-sectional study included 28 with generalized tonic clonic (GTC) convulsions and 14 and 3 with temporal (TLE) and frontal lobe (FLE) epilepsies with secondary generalization (all were on regular carbamazepine therapy) and 40 healthy control subjects. The patients’ mean age was 34.97 ± 7.35 years and the duration of illness was 18.75 ± 7.99 years. All underwent videonystagmography (VNG). Results: Compared with controls, patients had frequent vestibular symptoms including dizziness (62.22%) (p = 0.0001) and sense of imbalance (44.44%) (p = 0.0001). Eleven patients (24.44%) had central vestibular dysfunction (p = 0.0001); 9 (20%) had mixed vestibular dysfunction and one (2.22%) had peripheral vestibular dysfunction (p = 0.0001). Abnormalities were observed in saccadic (44.4%) and pursuit (42.2%) eye movements, optokinetic nystagmus (42.2%) and positioning/positional (11.11%) and caloric (13.33%) testing. TLE and FLE were associated with more VNG abnormalities than GTC. No significant differences were observed in the demographic and clinical characteristics between patients with and without VNG abnormalities. Conclusion: Vestibular manifestations are frequent in patients with epilepsy. This may be a result of the permanent damaging effect of chronic epilepsy on the vestibular cortical areas and/or a toxic effect from prolonged carbamazepine therapy on the peripheral and central vestibular systems.

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Noonan Syndrome: An Underestimated Cause of Severe to Profound Sensorineural Hearing Impairment. Which Clues to Suspect the Diagnosis?

Objective: To highlight Noonan syndrome as a clinically recognizable cause of severe to profound sensorineural hearing impairment. Study Design: New clinical cases and review. Setting: Patients evaluated for etiological diagnosis by a medical geneticist in a reference center for hearing impairment. Patients: Five patients presenting with confirmed Noonan syndrome and profound sensorineural hearing impairment. Interventions: Diagnostic and review of the literature. Results: Five patients presented with profound sensorineural hearing impairment and molecularly confirmed Noonan syndrome. Sensorineural hearing impairment has been progressive for three patients. Cardiac echography identified pulmonary stenosis in two patients and was normal for the three other patients. Short stature was found in two patients. Mild intellectual disability was found in one patient. Inconspicuous clinical features as facial dysmorphism, cryptorchidism, or easy bruising were of peculiar interest to reach the diagnosis of Noonan syndrome. Conclusion: Profound sensorineural hearing impairment can be the main feature of Noonan syndrome. Associated features are highly variable; thus, detailed medical history and careful physical examination are mandatory to consider the diagnosis in case of a sensorineural hearing impairment.

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Outcomes and Time to Emergence of Auditory Skills After Cochlear Implantation of Children With Charge Syndrome

Objective: Review perioperative complications, benefits, and the timeframe over which auditory skills develop in children with CHARGE syndrome who receive a cochlear implant (CI). Study Design: IRB-approved retrospective chart review of children with CHARGE syndrome who had at least 12 months of cochlear implant use. Setting: Tertiary care children's hospital. Patients: Twelve children, seven males and five females. Mean age implant = 3.5 years (1.7–8.2 yr); mean duration follow-up = 4.7 years (1.5–10.1 yr). Intervention: Cochlear implantation. Main Outcome Measures: Auditory skills categorized into four levels, temporal bone imaging findings, perioperative complications, time to emergence of speech perception, expressive communication mode. Results: All children imaged with magnetic resonance imaging had cochlear nerve deficiency in at least one ear. Speech awareness threshold improved with the CI compared with aided preoperative in 83% of children, with means of 51.7 dB SAT preoperative and 27.1 dB with the CI (p ≤ 0.002). Overall, four children improved to auditory Level 2 (improved detection), three obtained Level 3 (closed-set speech perception), and three had open-set speech perception with their CIs (Level 4) that was first evident at 3.5, 3.3, and 0.8 years postimplant testing. Two children had minimal or limited improvement. One child with hypoplasia of the cochlear nerve obtained open-set levels. Conclusion: Auditory skills may develop slowly in children with CHARGE syndrome who receive a CI but most can achieve at least improved detection. In our series, half acquired some speech perception ability. Cochlear nerve deficiency is frequent, but should not be a contraindication to implantation.

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Audiologic Gain of Incus Short Process Vibroplasty With Conventional Incus Long Process Vibroplasty: A Retrospective Analysis of 36 Patients

Objective: To compare the audiological and non-audiological benefits of incus short process (SP) vibroplasty with those of conventional incus long process (LP) vibroplasty. Study Design: Retrospective analysis. Setting: Tertiary referral center. Patients: Thirty-six patients with sensorineural hearing loss were treated with the semi-implantable middle ear hearing device. Of these, 22 were treated with conventional LP vibroplasty, and 14 were treated with SP vibroplasty using SP couplers. Interventions: Implantation with the semi-implantable middle ear hearing device by different methods. Main Outcome Measures: Pre- and postoperative hearing level, word recognition score, operation time, and duration of hospital stay were compared. We also surveyed a questionnaire to assess postoperative complications. Results: The improvement in hearing gain was comparable between SP vibroplasty and conventional LP vibroplasty, except at 8 kHz, at which LP vibroplasty showed better hearing gain (p 

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The Influence of Intraoperative Testing on Surgical Decision-making During Cochlear Implantation

Objective: To review our use of intraoperative testing during cochlear implantation (CI) and determine its impact on surgical decision-making. Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: A total of 197 children and adults who underwent a total of 266 primary and/or revision CI by a single surgeon from 2010 to 2015. Intervention: Intraoperative electrophysiologic monitoring including evoked compound action potentials and electrical impedances. Main Outcome Measures: Whether surgical management was changed based on intraoperative testing. Results: In only 2 of 266 patients (0.8%), the back-up device was used due to findings on intraoperative testing. In three patients (1.1%), X-ray was performed intraoperatively to confirm intracochlear electrode placement, which was found to be normal in all patients. Conclusion: Our data suggest that with respect to CI in children and adults in straightforward cases (e.g., normal anatomy, nondifficult insertion, etc.), routine intraoperative evoked compound action potentials, impedances, and imaging rarely influence surgical decision-making in our clinic and may have limited usefulness in these patients. The implications of this are discussed and a review of the literature is presented.

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Reduction in Temporary and Permanent Audiological Injury Through Internal Jugular Vein Compression in a Rodent Blast Injury Model

Hypothesis: Internal jugular vein (IJV) compression influences not only intracranial but also intracochlear physiology and has demonstrated preclinical effectiveness in reducing acute audiological injury in a rodent blast model. However, the long-term effects in this model are unknown. Background: Blast wave-induced audiological injury from an improvised explosive device is a leading cause of morbidity among service members in theater but there are limitations to the current protective measures. Methods: For this study, we exposed 20 Sprague Dawley rats to a 16.8 ± 0.3 PSI (195.3 dB SPL) right-sided shock wave in which 10 had application of a custom IJV compression collar in place at the time of injury. Results: IJV compression at the time of injury was shown acutely to significantly reduce the incidence of tympanic membrane rupture and the initial temporary threshold shift on otoacoustic emissions in both the right and left ears of animals who had collar application immediately after and 7 days post injury. At 28 days from injury, collared animals demonstrated a return to baseline of otoacoustic emission values while the noncollared animals had persistent threshold shifts, signifying the presence of a permanent threshold shift only in those animals without collar application. IJV compression was also found to significantly reduce hair cell loss at the base of the cochlea secondary to mechanical trauma from the blast wind. Conclusion: Previously observed acute protective effects of IJV compression are sustained at chronic time points. IJV compression can potentially be used to reduce long-term permanent morbidity from blast-induced audiological trauma.

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Role of Multislice CT Imaging in Predicting the Visibility of the Round Window in Pediatric Cochlear Implantation

Background: High-resolution computed tomography (HRCT) magnifies the role of preoperative imaging for detailed inner and middle ear anatomical information and enhances more efforts for better dependent correlation and measurements of round window (RW). Objective: To find an applicable way by HRCT imaging for the prediction of the visibility of the RW during cochlear implantation (CI) surgery. Methods: Five radiologic measurements were performed on the axial HRCT and these measurements were correlated with the degree of RW visibility after performing posterior tympanotomy during CI surgery. Results: Sixty ears of 60 children were included in the current study. A significant correlation was found between the degree of RW visibility and the following: 1) the angle between RW, facial nerve (FN), and the coronal axis (p 

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Visual Processing Recruits the Auditory Cortices in Prelingually Deaf Children and Influences Cochlear Implant Outcomes

Objective: Although visual processing recruitment of the auditory cortices has been reported previously in prelingually deaf children who have a rapidly developing brain and no auditory processing, the visual processing recruitment of auditory cortices might be different in processing different visual stimuli and may affect cochlear implant (CI) outcomes. Methods: Ten prelingually deaf children, 4 to 6 years old, were recruited for the study. Twenty prelingually deaf subjects, 4 to 6 years old with CIs for 1 year, were also recruited; 10 with well-performing CIs, 10 with poorly performing CIs. Ten age and sex-matched normal-hearing children were recruited as controls. Visual (“sound” photo [photograph with imaginative sound] and “nonsound” photo [photograph without imaginative sound]) evoked potentials were measured in all subjects. P1 at Oz and N1 at the bilateral temporal-frontal areas (FC3 and FC4) were compared. Results: N1 amplitudes were strongest in the deaf children, followed by those with poorly performing CIs, controls and those with well-performing CIs. There was no significant difference between controls and those with well-performing CIs. “Sound” photo stimuli evoked a stronger N1 than “nonsound” photo stimuli. Further analysis showed that only at FC4 in deaf subjects and those with poorly performing CIs were the N1 responses to “sound” photo stimuli stronger than those to “nonsound” photo stimuli. No significant difference was found for the FC3 and FC4 areas. No significant difference was found in N1 latencies and P1 amplitudes or latencies. Conclusion: The results indicate enhanced visual recruitment of the auditory cortices in prelingually deaf children. Additionally, the decrement in visual recruitment of auditory cortices was related to good CI outcomes.

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Can Preoperative CT Scans Be Used to Predict Facial Nerve Stimulation Following CI?

Objectives: 1) To determine the ability of preoperative computed tomography (CT) to predict facial nerve stimulation (FNS) after cochlear implantation (CI). 2) To recognize the limitations of CT in predicting FNS. Study Design: Patient control study. Setting: Tertiary care academic medical center. Subjects: Adult patients with CI from 2003 to 2015. Methods: Patients with severe FNS (n = 4) were compared with randomly selected CI patients (n = 28). Three blinded reviewers evaluated preoperative temporal bone CT scans to measure the distance from the labyrinthine segment of the facial nerve to the basal turn of the cochlea and attempted to predict whether or not the subject had FNS after CI. Results: In total, 32 CT scans were evaluated representing 49 ears that underwent CI. The distances (mm) measured from the labyrinthine segment of the facial nerve to the basal turn of the cochlea in both the axial (0.3 ± 0.3 versus 0.6 ± 0.3) and coronal (0.4 ± 0.2 versus 0.6 ± 0.2) orientation were significantly different between the two groups (p = 0.0001 and p = 0.0034) respectively. The intraclass correlation coefficient demonstrated good (K > 0.7) reviewer correlation in both the reviewers’ measurements and predictions. The sensitivity, specificity, positive predictive value, and negative predictive value for preoperative CT scans to predict FNS were 38.5, 85.1, 19.2, and 93.8% respectively. The reviewers were 23% accurate in predicting FNS. Conclusion: Based on a blinded retrospective patient-control study, CT scan measurements show a significantly reduced distance between the labyrinthine facial nerve and the basal turn of the cochlea in patients with FNS. However, it is difficult to predict who will have FNS based on these measurements.

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The Role of Preoperative Steroids in Atraumatic Cochlear Implantation Surgery

Hypothesis: Depth of insertion is related to the extent of tissue response and low frequency hearing loss. Intravenous steroids have greatest effect in reducing postimplantation fibrosis and hearing loss in the presence of significant electrode insertion trauma, when compared with saline treatment. Background: Experiments exploring the enhancement of cochlear implantation (CI) outcomes with glucocorticosteroids have produced mixed results, possibly due to lack of standardization of the CI model. Methods: Forty-eight normal-hearing guinea pigs were randomly implanted with a highly flexible electrode to a depth of 1.5, 3.0, or 5.0 mm. For each insertion depth, sub-cohorts received either intravenous saline (“saline”) or dexamethasone (“steroid”) 60 minutes before implantation. Shifts in electrocochleography thresholds at 2 to 32 kHz were determined before and 4 weeks after implantation. Cochleae were harvested and imaged. Results: Low-frequency hearing loss was greatest with 5.0 mm insertions. Fracture of the osseous spiral lamina and/or fibrotic involvement of the round window membrane exacerbated hearing loss. The extent of intracochlear fibrosis was directly related to the depth of insertion. Steroids reduced the intracochlear tissue response for deepest insertions and in apical regions of the cochlea where basilar membrane contact was prevalent. Steroids preserved no more hearing than saline at all insertion depths. Conclusion: Cochlear trauma influenced postimplantation hearing loss and steroid effect on fibrosis. Fibrosis, and to a lesser extent, postimplantation hearing loss increased proportionally to the depth of insertion. Steroids did not influence fibrosis relating to the cochleostomy, but could reduce scarring as the electrode negotiated the hook region or near the electrode tip.

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SIAMOC position paper on gait analysis in clinical practice: General requirements, methods and appropriateness. Results of an Italian consensus conference

Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Maria Grazia Benedetti, Ettore Beghi, Antonio De Tanti, Aurelio Cappozzo, Nino Basaglia, Andrea Giovanni Cutti, Andrea Cereatti, Rita Stagni, Federica Verdini, Mario Manca, Silvia Fantozzi, Claudia Mazzà, Valentina Camomilla, Isabella Campanini, Anna Castagna, Lorenzo Cavazzuti, Martina Del Maestro, Ugo Della Croce, Marco Gasperi, Tommaso Leo, Pia Marchi, Maurizio Petrarca, Luigi Piccinini, Marco Rabuffetti, Andrea Ravaschio, Zimi Sawacha, Fabiola Spolaor, Luigi Tesio, Giuseppe Vannozzi, Isabella Visintin, Maurizio Ferrarin
Gait analysis is recognized as a useful assessment tool in the field of human movement research. However, doubts remain on its real effectiveness as a clinical tool, i.e. on its capability to change the diagnostic-therapeutic practice. In particular, the conditions in which evidence of a favorable cost-benefit ratio is found and the methodology for properly conducting and interpreting the exam are not identified clearly.To provide guidelines for the use of Gait Analysis in the context of rehabilitation medicine, SIAMOC (the Italian Society of Clinical Movement Analysis) promoted a National Consensus Conference which was held in Bologna on September 14th, 2013. The resulting recommendations were the result of a three-stage process entailing i) the preparation of working documents on specific open issues, ii) the holding of the consensus meeting, and iii) the drafting of consensus statements by an external Jury. The statements were formulated based on scientific evidence or experts’ opinion, when the quality/quantity of the relevant literature was deemed insufficient.The aim of this work is to disseminate the consensus statements. These are divided into 13 questions grouped in three areas of interest: 1) General requirements and management, 2) Methodological and instrumental issues, and 3) Scientific evidence and clinical appropriateness.SIAMOC hopes that this document will contribute to improve clinical practice and help promoting further research in the field.



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An expert system feedback tool improves the reliability of clinical gait kinematics for older adults with lower limb osteoarthritis

Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Sean T. Osis, Dylan Kobsar, Ryan J. Leigh, Charles A.J. Macaulay, Reed Ferber
Recently, an expert system was developed to provide feedback to examiners with the aim of improving reliability of marker-based gait analysis. The purpose of the current study was to evaluate the effectiveness of this novel feedback tool in improving the reliability of gait analysis for individuals with lower limb osteoarthritis. Three-dimensional gait analysis was conducted for n=27 individuals, at two different time points, and during each session the feedback tool was used to refine marker placement. Results for both discrete variables and support vector machine classifications demonstrated improved reliability of the data with the feedback tool.



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SIAMOC position paper on gait analysis in clinical practice: General requirements, methods and appropriateness. Results of an Italian consensus conference

Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Maria Grazia Benedetti, Ettore Beghi, Antonio De Tanti, Aurelio Cappozzo, Nino Basaglia, Andrea Giovanni Cutti, Andrea Cereatti, Rita Stagni, Federica Verdini, Mario Manca, Silvia Fantozzi, Claudia Mazzà, Valentina Camomilla, Isabella Campanini, Anna Castagna, Lorenzo Cavazzuti, Martina Del Maestro, Ugo Della Croce, Marco Gasperi, Tommaso Leo, Pia Marchi, Maurizio Petrarca, Luigi Piccinini, Marco Rabuffetti, Andrea Ravaschio, Zimi Sawacha, Fabiola Spolaor, Luigi Tesio, Giuseppe Vannozzi, Isabella Visintin, Maurizio Ferrarin
Gait analysis is recognized as a useful assessment tool in the field of human movement research. However, doubts remain on its real effectiveness as a clinical tool, i.e. on its capability to change the diagnostic-therapeutic practice. In particular, the conditions in which evidence of a favorable cost-benefit ratio is found and the methodology for properly conducting and interpreting the exam are not identified clearly.To provide guidelines for the use of Gait Analysis in the context of rehabilitation medicine, SIAMOC (the Italian Society of Clinical Movement Analysis) promoted a National Consensus Conference which was held in Bologna on September 14th, 2013. The resulting recommendations were the result of a three-stage process entailing i) the preparation of working documents on specific open issues, ii) the holding of the consensus meeting, and iii) the drafting of consensus statements by an external Jury. The statements were formulated based on scientific evidence or experts’ opinion, when the quality/quantity of the relevant literature was deemed insufficient.The aim of this work is to disseminate the consensus statements. These are divided into 13 questions grouped in three areas of interest: 1) General requirements and management, 2) Methodological and instrumental issues, and 3) Scientific evidence and clinical appropriateness.SIAMOC hopes that this document will contribute to improve clinical practice and help promoting further research in the field.



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An expert system feedback tool improves the reliability of clinical gait kinematics for older adults with lower limb osteoarthritis

Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Sean T. Osis, Dylan Kobsar, Ryan J. Leigh, Charles A.J. Macaulay, Reed Ferber
Recently, an expert system was developed to provide feedback to examiners with the aim of improving reliability of marker-based gait analysis. The purpose of the current study was to evaluate the effectiveness of this novel feedback tool in improving the reliability of gait analysis for individuals with lower limb osteoarthritis. Three-dimensional gait analysis was conducted for n=27 individuals, at two different time points, and during each session the feedback tool was used to refine marker placement. Results for both discrete variables and support vector machine classifications demonstrated improved reliability of the data with the feedback tool.



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SIAMOC position paper on gait analysis in clinical practice: General requirements, methods and appropriateness. Results of an Italian consensus conference

Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Maria Grazia Benedetti, Ettore Beghi, Antonio De Tanti, Aurelio Cappozzo, Nino Basaglia, Andrea Giovanni Cutti, Andrea Cereatti, Rita Stagni, Federica Verdini, Mario Manca, Silvia Fantozzi, Claudia Mazzà, Valentina Camomilla, Isabella Campanini, Anna Castagna, Lorenzo Cavazzuti, Martina Del Maestro, Ugo Della Croce, Marco Gasperi, Tommaso Leo, Pia Marchi, Maurizio Petrarca, Luigi Piccinini, Marco Rabuffetti, Andrea Ravaschio, Zimi Sawacha, Fabiola Spolaor, Luigi Tesio, Giuseppe Vannozzi, Isabella Visintin, Maurizio Ferrarin
Gait analysis is recognized as a useful assessment tool in the field of human movement research. However, doubts remain on its real effectiveness as a clinical tool, i.e. on its capability to change the diagnostic-therapeutic practice. In particular, the conditions in which evidence of a favorable cost-benefit ratio is found and the methodology for properly conducting and interpreting the exam are not identified clearly.To provide guidelines for the use of Gait Analysis in the context of rehabilitation medicine, SIAMOC (the Italian Society of Clinical Movement Analysis) promoted a National Consensus Conference which was held in Bologna on September 14th, 2013. The resulting recommendations were the result of a three-stage process entailing i) the preparation of working documents on specific open issues, ii) the holding of the consensus meeting, and iii) the drafting of consensus statements by an external Jury. The statements were formulated based on scientific evidence or experts’ opinion, when the quality/quantity of the relevant literature was deemed insufficient.The aim of this work is to disseminate the consensus statements. These are divided into 13 questions grouped in three areas of interest: 1) General requirements and management, 2) Methodological and instrumental issues, and 3) Scientific evidence and clinical appropriateness.SIAMOC hopes that this document will contribute to improve clinical practice and help promoting further research in the field.



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An expert system feedback tool improves the reliability of clinical gait kinematics for older adults with lower limb osteoarthritis

Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Sean T. Osis, Dylan Kobsar, Ryan J. Leigh, Charles A.J. Macaulay, Reed Ferber
Recently, an expert system was developed to provide feedback to examiners with the aim of improving reliability of marker-based gait analysis. The purpose of the current study was to evaluate the effectiveness of this novel feedback tool in improving the reliability of gait analysis for individuals with lower limb osteoarthritis. Three-dimensional gait analysis was conducted for n=27 individuals, at two different time points, and during each session the feedback tool was used to refine marker placement. Results for both discrete variables and support vector machine classifications demonstrated improved reliability of the data with the feedback tool.



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The 3D Printing of the Paralyzed Vocal Fold: Added Value in Injection Laryngoplasty

Publication date: Available online 18 August 2017
Source:Journal of Voice
Author(s): Abdul-Latif Hamdan, Ghassan Haddad, Ali Haydar, Ramsey Hamade
IntroductionThree-dimensional (3D) printing has had numerous applications in various disciplines, especially otolaryngology. We report the first case of a high-fidelity 3D-printed model of the vocal cords of a patient with unilateral vocal cord paralysis in need of injection laryngoplasty.MethodologyA case report was carried out.ResultsA tailored 3D-printed anatomically precise models for injection laryngoplasty has the potential to enhance preoperative planning, resident teaching, and patient education.ConclusionA 3D printing model of the paralyzed vocal cord has an added value in the preoperative assessment of patients undergoing injection laryngoplasty.



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The Effect of Vocal Fold Inferior Surface Hypertrophy on Voice Function in Excised Canine Larynges

Publication date: Available online 18 August 2017
Source:Journal of Voice
Author(s): Ruiqing Wang, Huijing Bao, Xinlin Xu, David Piotrowski, Yu Zhang, Peiyun Zhuang
ObjectiveThis study aimed to explore the changes in vocal fold inferior surface hypertrophy (VFISH) on vocal fold vibration by aerodynamic and acoustic analysis. The present study allows us to gain new insights into the subglottal convergence angle (SCA), which will change with VFISH.Study DesignThe study is prospective, and designed for repeated measures with each excised canine larynx serving as own control.Subjects and MethodsThree degrees of VFISH, initial, mild, and severe, were simulated by injecting different doses of fructose injections into the inferior surface of the vocal folds of 10 excised canine larynges. Computed tomographic images of the larynx were gathered, and three-dimensional models of the airway and vocal folds were reconstructed using the Mimics software. The SCA was measured from the reconstructed models. Phonation threshold flow (PTF), phonation threshold pressure (PTP), and mean flow rate (MFR) were recorded directly in the excised canine larynx phonation setup. Glottal resistance (GR), sound pressure level (SPL), fundamental frequency (F0), and formants 1–4 (F1–4) were measured when subglottal pressure (Psub) was at 1.5 kPa or 2.5 kPa, separately. Using ordinary one-way analysis of variance, we compared the aerodynamic outcomes and voice quality among the three groups of hypertrophy.ResultsThe SCA, PTP, and PTF increased with the degree of VFISH. When the Psub was controlled at 1.5 kPa or 2.5 kPa, F0 also increased significantly with the degree of VFISH of the excised canine larynges. The MFR, GR, SPL, and F1–4 had little change between the three groups and were not significantly different.ConclusionThe VFISH makes onset phonation more difficult, increases the SCA, and increases the F0 in sustained phonation.



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Risk Factors for Voice Disorders in University Professors in Cyprus

Publication date: Available online 18 August 2017
Source:Journal of Voice
Author(s): Kyriaki Kyriakou, Kakia Petinou, Ioannis Phinikettos
AimsThe purpose of this study was to investigate risk factors for voice pathologies in university professors to determine the need for a preventative vocal hygiene education program that could improve the quality of life of university faculty.MethodsAn online questionnaire was completed by 196 professors from 12 universities in Cyprus. The questionnaire elicited data regarding risk factors that may lead to voice disorders on parameters including general health, voice use, lifestyle, and environment and the self-perceived severity of a subject's voice problem. Subjects were divided into two groups based on their Voice Disorder Index (VDI) score: professors with VDI ≤5 and professors with VDI >5. The chi-square test was used to examine the differences in responses for each voice risk factor between the VDI ≤5 and the VDI >5 groups.ResultsThe VDI >5 group was more likely to frequently or sometimes experience respiratory infections, coughing, throat clearing, and stress, teach above students talking, and speak over their natural breath cycle than the VDI ≤5 group. Professors in the VDI >5 category were also more likely to have taught in very or moderately noisy environments than the VDI ≤5 group.ConclusionsHealth, voice use, lifestyle, and environmental factors may contribute to the development of voice disorders in university professors in Cyprus. Therefore, a preventative vocal hygiene education program is recommended.



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A Review of the Physiological Effects and Mechanisms of Singing

Publication date: Available online 18 August 2017
Source:Journal of Voice
Author(s): Jing Kang, Austin Scholp, Jack J. Jiang
Daily experience suggests that singing can energize us and even provide a physical workout. A growing amount of evidence has been presented to support anecdotal claims of the benefits of singing on health and well-being. Singing has been shown to be related to numerous physiological changes. The cardiorespiratory system is utilized during persistent singing training, resulting in enhanced respiratory muscles and an optimized breathing mode. In addition, singing can also cause changes in neurotransmitters and hormones, including the upregulation of oxytocin, immunoglobulin A, and endorphins, which improves immune function and increases feelings of happiness. This review is organized by respiratory, circulatory, and hormonal changes that are collectively a part of singing in a healthy population. The various studies are discussed with the intention of helping researchers and clinicians realize the potential benefit of singing and provide a clinical option as an adjunct therapy for a given situation. Better understanding of physiological mechanisms will lay a solid theoretical foundation for singing activities and will present important implications for further study. Evaluations of existing research and recommendations for future research are given to promote the scale and duration to better demonstrate the effectiveness of singing before it can be recommended in clinical guidelines and satisfy criteria for funding by commissioners of health and social care.



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Effects of Vestibular Rehabilitation Interventions in the Elderly with Chronic Unilateral Vestibular Hypofunction.

Effects of Vestibular Rehabilitation Interventions in the Elderly with Chronic Unilateral Vestibular Hypofunction.

Iran J Otorhinolaryngol. 2017 Jul;29(93):183-188

Authors: Bayat A, Saki N

Abstract
INTRODUCTION: Although vestibular rehabilitation therapy (VRT) methods are relatively popular in treating patients with body balance deficits of vestibular origin, only limited studies have been conducted into customized exercises for unilateral vestibular hypofunction (UVH). Furthermore, very little evidence is available on the outcomes of VRT in the elderly population with chronic UVH.
MATERIALS AND METHODS: A total of 21 patients, aged 61 to 74 years, with UVH participated in this study. The dizziness handicap inventory (DHI) was performed immediately before, and 2 and 8 weeks after treatment.
RESULTS: All patients showed a reduction in DHI scores during the study. The average decrease in DHI score was 25.98 points after 2 weeks' intervention (P<0.001) and 32.54 points at the end of the study. This improvement was observed in all DHI subscores, and was most profound in the functional aspect. The correlation between the degree of final recovery and canal paresis was not significant (P>0.05). There were no relationships between the scores and gender.
CONCLUSION: Our study demonstrates that VRT is an effective method for the management of elderly patients with UVH, and shows maximal effect on functional aspects.

PMID: 28819615 [PubMed]

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Genome-wide identification and expression profiling of long non-coding RNAs in auditory and vestibular systems.

Genome-wide identification and expression profiling of long non-coding RNAs in auditory and vestibular systems.

Sci Rep. 2017 Aug 17;7(1):8637

Authors: Ushakov K, Koffler-Brill T, Rom A, Perl K, Ulitsky I, Avraham KB

Abstract
Mammalian genomes encode multiple layers of regulation, including a class of RNA molecules known as long non-coding RNAs (lncRNAs). These are >200 nucleotides in length and similar to mRNAs, they are capped, polyadenylated, and spliced. In contrast to mRNAs, lncRNAs are less abundant and have higher tissue specificity, and have been linked to development, epigenetic processes, and disease. However, little is known about lncRNA function in the auditory and vestibular systems, or how they play a role in deafness and vestibular dysfunction. To help address this need, we performed a whole-genome identification of lncRNAs using RNA-seq at two developmental stages of the mouse inner ear sensory epithelium of the cochlea and vestibule. We identified 3,239 lncRNA genes, most of which were intergenic (lincRNAs) and 721 are novel. We examined temporal and tissue specificity by analyzing the developmental profiles on embryonic day 16.5 and at birth. The spatial and temporal patterns of three lncRNAs, two of which are in proximity to genes associated with hearing and deafness, were explored further. Our findings indicate that lncRNAs are prevalent in the sensory epithelium of the mouse inner ear and are likely to play key roles in regulating critical pathways for hearing and balance.

PMID: 28819115 [PubMed - in process]

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Effects of Vestibular Rehabilitation Interventions in the Elderly with Chronic Unilateral Vestibular Hypofunction.

Effects of Vestibular Rehabilitation Interventions in the Elderly with Chronic Unilateral Vestibular Hypofunction.

Iran J Otorhinolaryngol. 2017 Jul;29(93):183-188

Authors: Bayat A, Saki N

Abstract
INTRODUCTION: Although vestibular rehabilitation therapy (VRT) methods are relatively popular in treating patients with body balance deficits of vestibular origin, only limited studies have been conducted into customized exercises for unilateral vestibular hypofunction (UVH). Furthermore, very little evidence is available on the outcomes of VRT in the elderly population with chronic UVH.
MATERIALS AND METHODS: A total of 21 patients, aged 61 to 74 years, with UVH participated in this study. The dizziness handicap inventory (DHI) was performed immediately before, and 2 and 8 weeks after treatment.
RESULTS: All patients showed a reduction in DHI scores during the study. The average decrease in DHI score was 25.98 points after 2 weeks' intervention (P<0.001) and 32.54 points at the end of the study. This improvement was observed in all DHI subscores, and was most profound in the functional aspect. The correlation between the degree of final recovery and canal paresis was not significant (P>0.05). There were no relationships between the scores and gender.
CONCLUSION: Our study demonstrates that VRT is an effective method for the management of elderly patients with UVH, and shows maximal effect on functional aspects.

PMID: 28819615 [PubMed]

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via IFTTT

Genome-wide identification and expression profiling of long non-coding RNAs in auditory and vestibular systems.

Genome-wide identification and expression profiling of long non-coding RNAs in auditory and vestibular systems.

Sci Rep. 2017 Aug 17;7(1):8637

Authors: Ushakov K, Koffler-Brill T, Rom A, Perl K, Ulitsky I, Avraham KB

Abstract
Mammalian genomes encode multiple layers of regulation, including a class of RNA molecules known as long non-coding RNAs (lncRNAs). These are >200 nucleotides in length and similar to mRNAs, they are capped, polyadenylated, and spliced. In contrast to mRNAs, lncRNAs are less abundant and have higher tissue specificity, and have been linked to development, epigenetic processes, and disease. However, little is known about lncRNA function in the auditory and vestibular systems, or how they play a role in deafness and vestibular dysfunction. To help address this need, we performed a whole-genome identification of lncRNAs using RNA-seq at two developmental stages of the mouse inner ear sensory epithelium of the cochlea and vestibule. We identified 3,239 lncRNA genes, most of which were intergenic (lincRNAs) and 721 are novel. We examined temporal and tissue specificity by analyzing the developmental profiles on embryonic day 16.5 and at birth. The spatial and temporal patterns of three lncRNAs, two of which are in proximity to genes associated with hearing and deafness, were explored further. Our findings indicate that lncRNAs are prevalent in the sensory epithelium of the mouse inner ear and are likely to play key roles in regulating critical pathways for hearing and balance.

PMID: 28819115 [PubMed - in process]

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Osteogenesis imperfecta.

Osteogenesis imperfecta.

Nat Rev Dis Primers. 2017 Aug 18;3:17052

Authors: Marini JC, Forlino A, Bächinger HP, Bishop NJ, Byers PH, Paepe A, Fassier F, Fratzl-Zelman N, Kozloff KM, Krakow D, Montpetit K, Semler O

Abstract
Skeletal deformity and bone fragility are the hallmarks of the brittle bone dysplasia osteogenesis imperfecta. The diagnosis of osteogenesis imperfecta usually depends on family history and clinical presentation characterized by a fracture (or fractures) during the prenatal period, at birth or in early childhood; genetic tests can confirm diagnosis. Osteogenesis imperfecta is caused by dominant autosomal mutations in the type I collagen coding genes (COL1A1 and COL1A2) in about 85% of individuals, affecting collagen quantity or structure. In the past decade, (mostly) recessive, dominant and X-linked defects in a wide variety of genes encoding proteins involved in type I collagen synthesis, processing, secretion and post-translational modification, as well as in proteins that regulate the differentiation and activity of bone-forming cells have been shown to cause osteogenesis imperfecta. The large number of causative genes has complicated the classic classification of the disease, and although a new genetic classification system is widely used, it is still debated. Phenotypic manifestations in many organs, in addition to bone, are reported, such as abnormalities in the cardiovascular and pulmonary systems, skin fragility, muscle weakness, hearing loss and dentinogenesis imperfecta. Management involves surgical and medical treatment of skeletal abnormalities, and treatment of other complications. More innovative approaches based on gene and cell therapy, and signalling pathway alterations, are under investigation.

PMID: 28820180 [PubMed - in process]

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