New Tool Enables Superior 3D Visualization of the Middle Ear

Imaging the middle-ear structure is problematic but researchers at the Canadian Light Source (CLS), Canada's national synchrotron light source facility, have made it possible to take complete, high-resolution 3D images.

In a recently published article, Western University biomedical engineering professor Hanif Ladak and his team detailed the methodology and findings of their comparison of commonly used imaging techniques, particularly micro-computed tomography (CT) and optical microscopy, with synchrotron radiation phase-contrast imaging (SR-PCI) in the visualization of structural details and soft-tissue contrast of the middle ear. The goal of their research was to study the biomechanical function of the middle ear, which is possible through finite-element (FE) modeling using high-resolution images.

Ladak explained that comprehensive unified three-dimensional images of both the bones and the soft tissue are necessary for designing prostheses or implants.

What makes generating three-dimensional images that capture of all the parts together problematic? The complexity and size of the organ. The middle ear has very small and complicated structure. It is made up of three microscopic bones, which measure only a few millimeters across, and even more microscopic soft tissues that connect these tiny bones. While there are facilities that can take 3D images of the middle ear's bones, they fail to capture the soft tissues. Ladak said that the biomedical imaging facility at CLS allowed his team to successfully image both.

Another advantage of SR-PCI is that unlike the widely used computed tomography (CT) and optical microscopy that require tedious sample preparation to achieve sufficient soft-tissue contrast, SR-PCI delivers superior images without the need for staining or decalcification.

The researchers concluded that SR-PCI provides superior visualization of microstructures over conventional micro-CT and that it is an exceptional device for simultaneously imagining both middle-ear bones and soft tissue. The article highlighted that SR-PCI's improved visualization, modeling accuracy, and simple sample preparation, make it a promising high-performance device for generating reliable FE models of the middle-ear structures.

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Published: 1/9/2018 2:28:00 PM

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New Tool Enables Superior 3D Visualization of the Middle Ear

Imaging the middle-ear structure is problematic but researchers at the Canadian Light Source (CLS), Canada's national synchrotron light source facility, have made it possible to take complete, high-resolution 3D images.

In a recently published article, Western University biomedical engineering professor Hanif Ladak and his team detailed the methodology and findings of their comparison of commonly used imaging techniques, particularly micro-computed tomography (CT) and optical microscopy, with synchrotron radiation phase-contrast imaging (SR-PCI) in the visualization of structural details and soft-tissue contrast of the middle ear. The goal of their research was to study the biomechanical function of the middle ear, which is possible through finite-element (FE) modeling using high-resolution images.

Ladak explained that comprehensive unified three-dimensional images of both the bones and the soft tissue are necessary for designing prostheses or implants.

What makes generating three-dimensional images that capture of all the parts together problematic? The complexity and size of the organ. The middle ear has very small and complicated structure. It is made up of three microscopic bones, which measure only a few millimeters across, and even more microscopic soft tissues that connect these tiny bones. While there are facilities that can take 3D images of the middle ear's bones, they fail to capture the soft tissues. Ladak said that the biomedical imaging facility at CLS allowed his team to successfully image both.

Another advantage of SR-PCI is that unlike the widely used computed tomography (CT) and optical microscopy that require tedious sample preparation to achieve sufficient soft-tissue contrast, SR-PCI delivers superior images without the need for staining or decalcification.

The researchers concluded that SR-PCI provides superior visualization of microstructures over conventional micro-CT and that it is an exceptional device for simultaneously imagining both middle-ear bones and soft tissue. The article highlighted that SR-PCI's improved visualization, modeling accuracy, and simple sample preparation, make it a promising high-performance device for generating reliable FE models of the middle-ear structures.

​ 

Published: 1/9/2018 2:28:00 PM

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New Tool Enables Superior 3D Visualization of the Middle Ear

Imaging the middle-ear structure is problematic but researchers at the Canadian Light Source (CLS), Canada's national synchrotron light source facility, have made it possible to take complete, high-resolution 3D images.

In a recently published article, Western University biomedical engineering professor Hanif Ladak and his team detailed the methodology and findings of their comparison of commonly used imaging techniques, particularly micro-computed tomography (CT) and optical microscopy, with synchrotron radiation phase-contrast imaging (SR-PCI) in the visualization of structural details and soft-tissue contrast of the middle ear. The goal of their research was to study the biomechanical function of the middle ear, which is possible through finite-element (FE) modeling using high-resolution images.

Ladak explained that comprehensive unified three-dimensional images of both the bones and the soft tissue are necessary for designing prostheses or implants.

What makes generating three-dimensional images that capture of all the parts together problematic? The complexity and size of the organ. The middle ear has very small and complicated structure. It is made up of three microscopic bones, which measure only a few millimeters across, and even more microscopic soft tissues that connect these tiny bones. While there are facilities that can take 3D images of the middle ear's bones, they fail to capture the soft tissues. Ladak said that the biomedical imaging facility at CLS allowed his team to successfully image both.

Another advantage of SR-PCI is that unlike the widely used computed tomography (CT) and optical microscopy that require tedious sample preparation to achieve sufficient soft-tissue contrast, SR-PCI delivers superior images without the need for staining or decalcification.

The researchers concluded that SR-PCI provides superior visualization of microstructures over conventional micro-CT and that it is an exceptional device for simultaneously imagining both middle-ear bones and soft tissue. The article highlighted that SR-PCI's improved visualization, modeling accuracy, and simple sample preparation, make it a promising high-performance device for generating reliable FE models of the middle-ear structures.

​ 

Published: 1/9/2018 2:28:00 PM

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Transcanal Transpromontorial Acoustic Neuroma Surgery: Results and Facial Nerve Outcomes

Background: Recently, the transcanal approach for the removal of acoustic neuromas has been introduced. Facial nerve (FN) preservation is one of the main challenges of this kind of surgery. Objective: To describe our experience in the surgical treatment of acoustic neuromas, focusing on the functional results of FN preservation after a transcanal approach. Methods: A retrospective chart review was carried out on clinical data and videos from operations on 49 patients who underwent surgery with a totally transcanal exclusive endoscopic approach for Koos stage I–II lesions, or an enlarged transcanal transpromontorial approach for Koos stage II–III tumors, between March 2012 and February 2017. Patients and tumor characteristics, clinical manifestations, radiologic features, audiological results, FN outcomes (according to the House–Brackmann [HB] grading system) and complications were evaluated. Tumors were classified according to the Koos grading system. Results: The age of the patients (34 females and 15 males) ranged from 27 to 77 years (mean age: 54.9 yr). Preoperative diagnosis was “vestibular schwannoma” in all patients. At the last follow-up (range 1–60 mo, mean 13.9 mo), 42 of 49 showed grade I HB FN function, 5 of 49 grade II HB, and 2 of 49 grade III HB. Overall, in 95.9%, FN function was preserved (grade I–II HB) with stable results at follow-up; in 4.1% of cases, FN function was reduced, but not worse than grade III. Conclusion: The transcanal approach represents a feasible, minimally invasive, and conservative technique for the management of acoustic neuromas of the internal auditory canal.

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Outcome Measures for Baro-Challenge-Induced Eustachian Tube Dysfunction: A Systematic Review

Objectives: Baro-challenge-induced Eustachian tube dysfunction (baro-induced ETD) is characterized by failure of the Eustachian tube (ET) to open adequately to permit middle-ear pressure regulation during ambient pressure changes. There are no well-characterized tests for identifying the condition, which makes both patient diagnosis and research into treatment efficacy challenging. This systematic review evaluates ET function tests as potential outcome measures for baro-induced ETD. Data Sources: MEDLINE and CENTRAL were searched (database inception to March 2017) and reference lists reviewed for all relevant English Language articles. Study Selection: Tests in included studies were required to measure ET function in patients reporting baro-induced ear symptoms or barotrauma. Data Extraction: Data were extracted in a standardized manner, and studies assessed according to Standards for Reporting of Diagnostic Accuracy Studies (STARD) criteria. The primary outcome of interest was the accuracy of ET function tests. Data Synthesis: Heterogeneity of subject demographics, ET function test methodology, and reference standards only permitted narrative systematic review. Conclusion: Sixteen studies involving seven different types of ET function tests were identified. The nine-step test was the most commonly used outcome measure, with overall test sensitivity and specificity ranges of 37 to 100% and 57 to 100%, respectively. Tympanometry test sensitivity was consistently poor (0–50%) while specificity was higher (52–97%). Published accuracy data for other ET function tests and test combinations were limited. Currently, no single test can be recommended for use in clinical practice. A combination of the nine-step test with other objective tests or patient-reported measures appears most promising as a core set of outcome measures for baro-induced ETD.

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Assessment of Masses of the External Ear With Diffusion-Weighted MR Imaging

Purpose: To assess masses of the external ear with diffusion-weighted MR imaging. Material and Methods: Retrospective analysis of 43 consecutive patients with soft tissue mass of the external ear. They underwent single shot diffusion-weighted MR imaging of the ear. The apparent diffusion coefficient (ADC) value of the mass of the external ear was calculated. The final diagnosis was performed by biopsy. The ADC value correlated with the biopsy results. Results: The mean ADC value of malignancy (=27) of external ear (0.95 ± 0.19 × 10−3 mm2/s) was significantly lower (p = 0.001) than that of benign (n = 16) lesions (1.49 ± 0.08 × 10−3 mm2/s). The cutoff ADC used for differentiation of malignancy from benign lesions was 1.18 × 10−3 mm2/s with an area under the curve of 0.959, an accuracy of 93%, a sensitivity of 92%, and specificity of 93%. There was a significant difference in the ADC of well and moderately differentiated malignancy versus poorly and undifferentiated squamous cell carcinoma (p = 0.001), and stages I and II versus stages III and IV (p = 0.04) of squamous cell carcinoma. Conclusion: ADC value is a non-invasive promising imaging parameter that can be used for differentiation of malignancy of the external ear from benign lesions, and grading and staging of squamous cell carcinoma of the external ear.

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Forward Masking of the Speech-Evoked Auditory Brainstem Response

Hypothesis: The hypothesis tested was that forward masking of the speech-evoked auditory brainstem response (sABR) increases peak latency as an inverse function of masker-signal interval (Δt), and that the overall persistence of forward masking is age dependent. Background: Older listeners exhibit deficits in forward masking. If forward-masked sABRs provide an objective measure of the susceptibility of speech sounds to prior stimulation, then this provides a novel approach to examining the age dependence of temporal processing. Methods: A /da/ stimulus forward masked by speech-shaped noise (Δt = 4–64 ms) was used to measure sABRs in 10 younger and nine older participants. Forward masking of subsegments of the /da/ stimulus (Δt = 16 ms) and click trains (Δt = 0–64 ms) was also measured. Results: Forward-masked sABRs from young participants showed an increase in latency with decreasing Δt for the initial peak. Latency shifts for later peaks were smaller and more uniform. None of the peak latencies returned to baseline by Δt = 64 ms. Forward-masked /da/ subsegments showed peak latency shifts that did not depend simply on peak position, while forward-masked click trains showed latency shifts that were dependent on click position. The sABRs from older adults were less robust but confirmed the viability of the approach. Conclusion: Forward masking of the sABR provides an objective measure of the susceptibility of the auditory system to prior stimulation. Failure of recovery functions to return to baseline suggests an interaction between forward masking by the prior masker and temporal effects within the stimulus itself.

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The Progressive Nature of Menière's Disease: Stress Projections and Lesion Analysis

Hypothesis: An engineering model of the labyrinth can provide a mechanism that accounts for the pattern of lesion development observed in Menière's disease. Background: Membrane lesions in Menière's disease can occur in virtually every part of the membranous labyrinth. How these lesions are induced is unclear and their mode of distribution uncertain. Pressure induced stress in the membranous labyrinth may play a mechanistic role in lesion formation and distribution. Methods: An engineering model of the labyrinth was used to provide membrane stress formulations and projections for lesion induction in the several chambers using membrane theory. These were compared with an analysis of actual lesions observed in Menière's disease to evaluate the model's accuracy. Results: The model projects that lesions in the membranous labyrinth will be induced progressively because of stress differentials among the chambers, with a chain of lesion pattern that follows the serial anatomic order and occurs with a frequency commensurate with chamber stress level. An analysis of lesions observed in actual cases of Menière's disease reveals a pattern of lesion development that is progressive, sequential, commensurate, and concordant with the model's stress projections. Conclusions: The concordance between the stress projections and the lesion analysis strengthens the hypothesis that Menière's is a progressive disease that follows a chain of lesions paradigm based on pressure-induced stress differentials in the variously configured chambers of the membranous labyrinth.

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Utilization of Nerve Integrity Monitor for Promontory Stimulation Testing Prior to Cochlear Implant

Objective: To demonstrate the feasibility of a nerve integrity monitor as a tool for promontory stimulation testing in patients with profound sensorineural hearing loss considering cochlear implantation. Patients: Adult patients considered for cochlear implantation with no auditory response on audiometric testing Intervention: Promontory stimulation testing using the nerve integrity monitor. Main Outcome Measure: By using a facial nerve stimulator and the nerve integrity monitor, transtympanic promontory stimulation testing was performed to assess auditory nerve function and determine candidacy for cochlear implantation. Patients indicated if they heard the stimulus. Results: Of the four patients completing the promontory stimulation tests, three patients heard the stimulus and one patient did not hear the stimulus. Of the three patients with a positive stimulation test, two patients have a history of progressive profound sensorineural hearing loss and one patient had a history of severe blunt temporal bone trauma. Two of these patients proceeded with cochlear implantation. The patient who had a negative promontory stimulation test has a history of neurofibromatosis type 2. Conclusion: The nerve integrity monitor is a convenient tool that can be used in the clinic setting to perform promontory stimulation tests and aid in determining cochlear implant candidates, specifically in those patients who require verification of auditory nerve function. This tool is a feasible and reasonable method for promontory stimulation testing.

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Audiological Outcomes in Growing Vestibular Schwannomas Managed Either Conservatively, or With Stereotactic Radiosurgery

Objective: Recent studies have suggested good hearing preservation following stereotactic radiosurgery (STRS) in patients with vestibular schwannomas (VS). This study aims to assess audiological outcomes in patients with growing VS treated either with STRS, or managed conservatively. Study Design: Retrospective cohort study. Setting: Tertiary referral center. Patients: Out of 540 patients with VS, 69 patients with growing VS fulfilled the inclusion criteria; 24 treated conservatively and 45 with STRS. VS were considered growing if demonstrating more than 15% tumor volume increase during 1 year of watchful waiting. Intervention: American Association of Otolaryngology–Head and Neck Surgery (AAOHNS) hearing threshold (dB averaged over 500–3000 Hz) deterioration and Gardner–Robertson class deterioration over time were used as the primary outcome measures. Rate of progression to loss of functional hearing (Gardner–Robertson class I–II) was also determined between cohorts. Results: Mean follow-up was similar between treatment cohorts (STRS = 69.6 mo, conservative management = 71.7 mo). There was no significant difference in AAOHNS deterioration (t = 1.05, df = 53, p = 0.301) or Gardner–Robertson deterioration (χ2 = 0.47, df = 1, p = 0.492) between cohorts. Furthermore, rate of progression to loss of functional hearing was similar between cohorts (Hazard ratio = 0.704, 95% CI 0.287–1.728, p = 0.44). In STRS patients, AAOHNS deterioration was greater in those with lower AAOHNS thresholds at diagnosis (t = –2.683, df = 28, p = 0.0121). Similarly, Gardner–Robertson deterioration was significantly more likely in STRS patients with functional hearing (Gardner–Robertson class I–II) (Adjusted odds ratio = 32.14, 95% CI 3.15–328, p = 0.0034). Conclusions: STRS results in similar audiological outcomes compared with patients managed conservatively; Consequently, STRS given to patients with VS to preserve hearing is not justified. In contrast to recent studies, patients with preserved hearing at diagnosis have significantly greater audiological deterioration when undergoing STRS.

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Prevalence of Hearing Loss and Hearing Care Use Among Asian Americans: A Nationally Representative Sample

Objective: To assess the prevalence of hearing loss and factors affecting hearing care use among Asian Americans, using the first nationally representative sample of Asian Americans. Study Design: National cross-sectional survey. Setting: Ambulatory examination centers. Patients: Three thousand six hundred twelve adults (522 Asian American) aged 20 to 69 in the 2011 to 2012 National Health and Examination Survey with pure-tone audiometry. Main Outcome Measure(s): Percentage with hearing loss, undertaking a hearing test before the study, and hearing aid use. Hearing loss was defined as better hearing ear speech frequency pure-tone average ≥25 dBHL. Analyses incorporated sampling weights to account for complex sampling design. Results: The prevalence of hearing loss was 6.0% [95% CI 3.1–8.9%] among Asian Americans, comparable to White, Black, and Hispanic groups, and increased substantially with age (OR: 2.25 [95% CI: 1.6–3.2]). After adjusting for age and pure-tone average, Asian Americans with hearing loss were less likely to have received a hearing test compared with White (OR: 0.27 [95% CI: 0.20–0.36, p = 

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American Otological Society Preliminary Program

No abstract available

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Cochlear Implant Insertion Axis Into the Basal Turn: A Critical Factor in Electrode Array Translocation

Hypothesis: An inappropriate insertion axis leads to intracochlear trauma during cochlear implantation (CI). Background: Few studies assessed the relationship between the insertion axis and the electrode scalar location. Methods: Preimplantation cone-beam CT (CBCT) was performed on 12 human temporal bones. In five temporal bones, an optimal insertion axis was planned, due to the impossibility to attain the ST centerline from the posterior tympanotomy, because of facial canal position. In the seven other temporal bones, an inaccurate insertion axis was intentionally planned (optimal axis+15 degrees). Automated CI array insertion according to the planned axis was performed with a motorized insertion tool driven by a navigated robot-based arm. The cochlea and basilar membrane were segmented from the preimplantation CBCT and the array segmented from the postimplantation CBCT to construct a merged final three-dimensional (3D) model. Microscopical and 3D analysis were performed to determine the intracochlear trauma at the level of each electrode. Results: A good agreement was observed in determining electrode position between microscopic analysis and the 3D model (Cohen's kappa k = 0.67). The angle of approach to the ST centerline was associated with the number of electrodes inserted into the ST (r = −0.65, p = 0.02, [95% CI −0.90 to −0.11] Spearman's rank correlation). Conclusion: A 3D reconstruction model was effective in determining the array position in the cochlea scalae. Our data indicate that the angle of approach to the ST centerline is a critical factor in intracochlear trauma. Additional studies should be conducted to assess the importance of the insertion axis with other array designs.

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Intra- and Interexaminer Variability of Two Separate Video Head Impulse Test Systems Assessing All Six Semicircular Canals

Objective: To evaluate intra- and interexaminer variability of the video Head Impulse Test (v-HIT) when assessing all six semicircular canals (SCCs) of two separate v-HIT systems. Study Design: Prospective study. Setting: Department of Otolaryngology, Head and Neck Surgery, Aalborg University Hospital, Denmark. Patients: One hundred twenty healthy subjects. Intervention: Four separate tests of all six SCCs with either system A or system B. Two examiners tested all subjects twice. Pretest randomization included type of v-HIT system, order of paired SCC testing, as well as initial examiner. Main Outcome Measure: Gain values and the presence of pathological saccades were registered. Ninety-five percent limits of agreement (LOAs) were calculated for both intra- and interexaminer variability. Adding or subtracting the value from the mean difference achieves the upper and lower bound LOA. Ninety-five percent of the differences lie within these limits. Results: Interexaminer reliability: System A: LOAs between 0.13 and 0.24 for the horizontal SCCs and between 0.42 and 0.74 for the vertical SCCs. System B: LOAs between 0.09 and 0.13 for the horizontal SCCs and between 0.13 and 0.20 for the vertical SCCs. Intraexaminer reliability: System A: LOAs were 0.19 and 0.14 for the horizontal SCCs and varied from 0.43 to 0.53 for the vertical SCCs. System B: LOAs were 0.14 for the horizontal SCCs and varied from 0.13 to 0.22 for the vertical SCCs. Conclusion: Horizontal SCC testing: both v-HIT systems displayed good intra- and interexaminer variability. Vertical SCC testing: System B displayed good intra- and interexaminer variability whereas the opposite was true with system A.

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What Is the Sensitive Period to Initiate Auditory Stimulation for the Second Ear in Sequential Cochlear Implantation?

Objectives: Bilateral cochlear implants (CI) are the standard treatment for bilaterally deaf children, but it is unclear how much the second CI can be delayed in sequential bilateral CI. We investigated the performances of sequential CI to answer this question. Study Design: Retrospective case series review. Setting: Tertiary referral center. Methods: We studied a cohort of congenitally deaf children (n = 73) who underwent sequential CI without any inner ear anomaly or combined disabilities. Hearing threshold levels and speech perception were evaluated by aided pure tone audiometry and Asan-Samsung Korean word recognition test. The scores were analyzed by the ages at surgery and compared among the different age groups. Results: When the second CI was performed before 3.5 years (the optimal period for the first CI), the second CI scores (96.9%) were comparable to the first CI scores. Although the first CI scores were more than or equal to 80% when the first CI was implanted before the age of 7 years, the second CI scores were more than or equal to 80% when the second CI was implanted before the age of 12 to 13 years. The hearing threshold levels were not different regardless of the ages and between the first and second CIs. Conclusion: Our cohort demonstrated that the second CI showed comparable results to the first CI when implanted before 3.5 years, suggesting that optimal periods for the first CI and the second CI are same. However, the sensitive period (12–13 yr) for the second CI with good scores (≥80%) was much longer than that (7 yr) of the first CI, suggesting that the first CI prolongs the sensitive period for the second CI. The second CI should be implanted early, but considered even at a later age.

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What Is the Safety and Efficacy of Chemical Venous Thromboembolism Prophylaxis Following Vestibular Schwannoma Surgery?

Objective: The benefit of routine chemical prophylaxis use for venous thromboembolism (VTE) prevention in skull base surgery is controversial. Chemical prophylaxis can prevent undue morbidity and mortality, however there are risks for hemorrhagic complications. Study Design: Retrospective case-control. Methods: A retrospective chart review of patients who underwent surgery for vestibular schwannoma from 2011 to 2016 was performed. Patients were divided by receipt of chemical VTE prophylaxis. Number of VTEs and hemorrhagic complications (intracranial hemorrhage, abdominal hematoma, and postauricular hematoma) were recorded. Results: One hundred twenty-six patients were identified, 55 received chemical prophylaxis, and 71 did not. All the patients received mechanical prophylaxis. Two patients developed a deep vein thrombosis (DVT) and one patient developed a pulmonary embolism (PE). All patients who developed a DVT or PE received chemical prophylaxis. There was no difference in DVT (p = 0.1886) or PE (p = 0.4365) between those who received chemical prophylaxis and those who did not. Five patients developed a hemorrhagic complication, two intracranial hemorrhage, three abdominal hematoma, and zero postauricular hematoma. All five patients with a complication received chemical prophylaxis (p = 0.00142). The relative risk of a hemorrhagic complication was 14.14 (95% CI = 0.7987–250.4307; p = 0.0778). Conclusion: There was a significant difference between the number of hemorrhagic complications but not between numbers of DVT or PE. Mechanical and chemical prophylaxis may lower the risk of VTE but in our series, hemorrhagic complications were observed. These measures should be used selectively in conjunction with early ambulation.

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An In-Vitro Insertion-Force Study of Magnetically Guided Lateral-Wall Cochlear-Implant Electrode Arrays

Hypothesis: Insertion forces can be reduced by magnetically guiding the tip of lateral-wall cochlear-implant electrode arrays during insertion via both cochleostomy and the round window. Background: Steerable electrode arrays have the potential to minimize intracochlear trauma by reducing the severity of contact between the electrode-array tip and the cochlear wall. However, steerable electrode arrays typically have increased stiffness associated with the steering mechanism. In addition, steerable electrode arrays are typically designed to curve in the direction of the basal turn, which is not ideal for round-window insertions, as the cochlear hook's curvature is in the opposite direction. Lateral-wall electrode arrays can be modified to include magnets at their tips, augmenting their superior flexibility with a steering mechanism. By applying magnetic torque to the tip, an electrode array can be navigated through the cochlear hook and the basal turn. Methods: Automated insertions of candidate electrode arrays are conducted into a scala-tympani phantom with either a cochleostomy or round-window opening. The phantom is mounted on a multi-degree-of-freedom force sensor. An external magnet applies the necessary magnetic bending torque to the magnetic tip of a modified clinical electrode array, coordinated with the insertion, with the goal of directing the tip down the lumen. Steering of the electrode array is verified through a camera. Results: Statistical t-test results indicate that magnetic guidance does reduce insertion forces by as much as 50% with certain electrode-array models. Direct tip contact with the medial wall through the cochlear hook and the lateral wall of the basal turn is completely eliminated. The magnetic field required to accomplish these insertions varied from 77 to 225 mT based on the volume of the magnet at the tip of the electrode array. Alteration of the tip to accommodate a tiny magnet is minimal and does not change the insertion characteristic of the electrode array unless the tip shape is altered. Conclusion: Magnetic guidance can eliminate direct tip contact with the medial walls through the cochlear hook and the lateral walls of the basal turn. Insertion-force reduction will vary based on the electrode-array model, but is statistically significant for all models tested. Successful steering of lateral-wall electrode arrays is accomplished while maintaining its superior flexibility.

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Long-Term Hearing Preservation Outcomes for Small Vestibular Schwannomas: Retrosigmoid Removal Versus Observation

Objective: Management of small vestibular schwannomas (VSs) consists of three options: serial observation, radiosurgery, and microsurgery. The authors reported the long-term hearing outcomes after retrosigmoid tumor removal in 110 patients and hearing follow-up outcomes in 160 serial observation patients with small VSs to explore the appropriate management strategy and predictive factors of hearing preservation for small VSs. Study Design: Retrospective study. Setting: Tertiary referral center. Patients: In this study, 110 patients with small VS (purely intracanalicular/cerebellopontine angle tumor ≤15 mm) during a 15-year period, from January 2001 to December 2015, were candidates for hearing preservation surgery through retrosigmoid approach, while 160 patients were candidates for serial observation. The main outcome measure was preservation of hearing under different hearing levels, assessed with the classification of American Academy of Otolaryngology–Head and Neck Surgery. Results: Preoperative hearing levels of the 110 study patients were Class A in 49 patients, Class B in 43 patients, and Class C in 18 patients. In all surgery patients (n = 110), 97.3% (107/110) patients maintained the same level during postoperative follow-up (mean follow-up time was 49.1 ± 28.2 mo) and 86 (78.2%) had complete radiologic and audiometric data at least 4 years follow-up for review. In the 4 years follow-up surgery group (n = 86), postoperative hearing levels were Class A, B, C, and D for 22, 11, 18, and 35 patients, and postoperative rates of preservation of serviceable and useful hearing were 59.3% (51/86) and 47.1% (33/70), respectively. In serial observation group, mean follow-up time was 35.2 ± 33.1 months; mean tumor size at presentation was 8.6 ± 4.3 mm; overall mean tumor growth rate was 1.08 ± 2.3 mm/yr; serviceable hearing preservation rate of 98 patients was 54.1% (53/98) at the 5-year end point and 48.7% (37/76) at the 7-year end point. Conclusion: Tumor removal should be the first treatment option for patients with small VSs and preserved hearing, especially for young patients with good hearing; retrosigmoid approach is an effective and safe approach for small VSs removal with excellent functional outcomes; better preoperative hearing predicted a higher rate of postoperative hearing preservation; patients without fundal extension were more likely to achieve hearing preservation than those with fundal extension, but no difference had been detected when retrosigmoid removal assisted with endoscope was performed; patients with small tumors originating from SVN were more likely to achieve hearing preservation compared with those with IVN-originating tumors.

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Cochlear Implant Surgery and the Risk of Falls in an Adult Population

Objective: To determine the effect of cochlear implant surgery on the balance and risk of falls in an adult patient population using a mobile posturograph. Design: Prospective clinical pilot study. Setting: Cochlear implant center at a tertiary referral hospital. Subjects and Methods: Twenty adult patients undergoing cochlear implant surgery were tested using a mobile posturograph (VertiGuard). The standard balancing deficit test, or the geriatric standard balancing deficit test protocol (for patients older than 60 yr), was performed both 1 day before and 3 to 5 days after surgery. Outcome Measures: The risk of falls (%) was calculated from the body sway both forward-to-backward and side-to-side in degrees per second. Results: The mean preoperative risk of falls in the whole study population was 51% (24–max. 86%) and was thus already higher than that in a normal healthy population (norm 0–40%). Comparison of the postoperative risk of falls to the preoperative risk for all 20 patients revealed a mean increased risk of falls of 1.25% after CI surgery. This is not a statistically significant increase. There was also no statistically significant increase when comparing the fall risk calculated using either the standard balancing deficit test protocol or the geriatric standard balancing deficit test protocol alone. Conclusion: Postural control in cochlear implant candidates is already decreased before surgery compared with a healthy population. However Comparison of pre- and postoperative body sway measurements did not reveal a significant increase in fall risk as a result of cochlea implant surgery. Therefore in this study population, cochlear implant surgery did not influence balance and risk of falls. Further testing with a larger study population would be necessary to determine the development of falls risk over time after cochlear implant surgery.

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Reconstruction of the Canal wall in CWU Tympanoplasty for Cholesteatoma with Titanium Sheeting

No abstract available

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A Prospective Study of Pain From Magnetic Resonance Imaging With Cochlear Implant Magnets In Situ

Objective: To describe changes in pain associated with magnetic resonance imaging (MRI) with cochlear implant magnets in place. Study Design: Prospective, single-arm study. Setting: Tertiary referral center. Subjects: Adults with cochlear implants requiring MRI. Intervention: Tight head wrapping over internal device during MRI. Main Outcome Measures: Change in pain score using an 11-point visual analogue scale, duration/completion of MRI, body mass index (BMI), quality of pain, status of the skin, functioning of implant, displacement/polarity change of magnet, willingness to repeat MRI without magnet removal. Results: A total of 27 subjects obtained 42 MRI scans. Subjects were 59% male with age range of 21 to 80 years. All three manufacturers were represented. Forty-eight percent of scans imaged the brain/head while 52% imaged other sites. The mean individual change in pain was 3.9 (SD 3.5, range 0–10). The pain was most commonly described as “pressure”, “heat”, or “sharp”. There was no significant correlation between change in pain and scan duration, BMI, or body part imaged. Eighty-eight percent of the scans were completed. There were no skin complications except temporary erythema (29%) and there were no magnet/device complications. Eighty-eight percent said they would undergo MRI without magnet removal again. Conclusion: The pain associated with obtaining an MRI without cochlear implant magnet removal is highly variable. Increase in pain is not related to duration of MRI scan, body part imaged, or BMI. Despite the pain, almost all patients prefer MRI scanning with the magnet in place, to avoid two surgical procedures.

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Biological Therapies of the Inner Ear: What Otologists Need to Consider

No abstract available

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Cochlear Implantation in a Patient With Sickle Cell Disease With Early Cochlear Sclerosis

Objective: We report a case of bilateral sudden sensorineural hearing loss (SNHL) and early cochlear sclerosis in a patient with sickle cell disease. Methods: A 19-year-old female presented with sequential bilateral sudden SNHL and early cochlear sclerosis. Cochlear implantation was performed. Results: Early cochlear fibrosis in the hook region and basal turn was encountered within a few months of deafness. Implantation required serial dilation using various insertion guides. Postsurgical telemetry readings revealed 19 electrodes (7 paired basal electrodes, 5 single apical electrodes) in a good working order with low impedances in bilateral ears. Activation of the processors successfully provided access to the speech frequency range in both the ears. Conclusion: This is the first case of intraoperative documentation of rapid cochlear sclerosis in a patient with SNHL caused by sickle cell disease. Early cochlear implantation should be considered in these patients, and otolaryngologists should be aware of the possibility of rapid cochlear sclerosis without ossification in these patients.

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Erratum

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Erratum

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Erratum

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Inertial sensing of the motion speed effect on the sit-to-walk activity

Publication date: March 2018
Source:Gait & Posture, Volume 61
Author(s): Nikolaos Kondilopoulos, Elissavet N. Rousanoglou, Konstantinos D. Boudolos
The STW execution at motion speed faster than normal most possibly enhances the risk for balance loss due to the increase in body segment accelerations. The purpose of the study was to use inertial sensing to examine the effect of motion speed on the STW segmental kinematics and its temporal events. Eighteen young men (20.7 ± 2.0 years) performed STW trials at preferred (PS) and fast (FS) motion speed. Data were collected with Xsens inertial sensors positioned at the trunk, thigh, shank, and foot segments. The maximum segmental values of angular displacement, angular velocity and linear acceleration, the duration of total STW (ttotal), the absolute and relative (% ttotal) phase duration (Flexion, Transition, Extension, Walking) and, the absolute and relative time taken to reach each maximum value were determined. In FS, ttotal and the absolute phase duration (except for Transition), were all significantly shorter (p = 0.000). The relative phase duration was not altered (p > 0.05), except for the Extension shortening (p = 0.001). The maximum angular displacement was altered only for the thigh (decreased, p = 0.038) and shank (increased, p = 0.004). Maximum angular velocities and linear accelerations were all significantly increased (p = 0.000 for all). The absolute time to reach the maximum values shortened in FS (p ≤ 0.05), while, the relative times were not altered (p > 0.05), except for the delayed trunk maximum angular displacement (p = 0.039). Inertial sensing appears to identify the motion speed effect on STW segmental kinematics and their temporal events in healthy young men. The results of the study may contribute improving the preventive or rehabilitation interventions in persons with impaired postural control.



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Longitudinal joint loading in patients before and up to one year after unilateral total hip arthroplasty

Publication date: March 2018
Source:Gait & Posture, Volume 61
Author(s): Mariska Wesseling, Christophe Meyer, Kristoff Corten, Kaat Desloovere, Ilse Jonkers
Abnormal kinematics and kinetics have been reported in hip osteoarthritis (OA) patients before and after total hip arthroplasty (THA). These changes can affect the loading of the ipsilateral hip, as well as the contralateral hip and knee joint. As it is not clear how hip and knee loading evolves in THA patients during the first year after surgery, the goal of this study is to define how joint loading changes in patients before and at three evaluation times after THA surgery. Musculoskeletal modelling in combination with gait analysis data was used to calculate hip and knee contact forces in 14 patients before and 3-, 6- and 12-months after unilateral THA, as well as in 18 healthy controls. Results showed that bilateral hip and knee loading were decreased compared to controls, both before and after THA surgery. Loading symmetry was altered compared to controls at 3-months post-surgery for the hip and at all evaluation times, except for 6-months post-surgery, for the knee, with ipsilateral joint loading decreased compared to the contralateral side. To conclude, 12-months after THA joint loading was not normalized, with both hip and knee loading in patients decreased compared to controls. Therefore, no overloading of the ipsi- or contralateral hip and knee joint was found before and up to one year after unilateral THA.



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Inertial sensing of the motion speed effect on the sit-to-walk activity

Publication date: March 2018
Source:Gait & Posture, Volume 61
Author(s): Nikolaos Kondilopoulos, Elissavet N. Rousanoglou, Konstantinos D. Boudolos
The STW execution at motion speed faster than normal most possibly enhances the risk for balance loss due to the increase in body segment accelerations. The purpose of the study was to use inertial sensing to examine the effect of motion speed on the STW segmental kinematics and its temporal events. Eighteen young men (20.7 ± 2.0 years) performed STW trials at preferred (PS) and fast (FS) motion speed. Data were collected with Xsens inertial sensors positioned at the trunk, thigh, shank, and foot segments. The maximum segmental values of angular displacement, angular velocity and linear acceleration, the duration of total STW (ttotal), the absolute and relative (% ttotal) phase duration (Flexion, Transition, Extension, Walking) and, the absolute and relative time taken to reach each maximum value were determined. In FS, ttotal and the absolute phase duration (except for Transition), were all significantly shorter (p = 0.000). The relative phase duration was not altered (p > 0.05), except for the Extension shortening (p = 0.001). The maximum angular displacement was altered only for the thigh (decreased, p = 0.038) and shank (increased, p = 0.004). Maximum angular velocities and linear accelerations were all significantly increased (p = 0.000 for all). The absolute time to reach the maximum values shortened in FS (p ≤ 0.05), while, the relative times were not altered (p > 0.05), except for the delayed trunk maximum angular displacement (p = 0.039). Inertial sensing appears to identify the motion speed effect on STW segmental kinematics and their temporal events in healthy young men. The results of the study may contribute improving the preventive or rehabilitation interventions in persons with impaired postural control.



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Longitudinal joint loading in patients before and up to one year after unilateral total hip arthroplasty

Publication date: March 2018
Source:Gait & Posture, Volume 61
Author(s): Mariska Wesseling, Christophe Meyer, Kristoff Corten, Kaat Desloovere, Ilse Jonkers
Abnormal kinematics and kinetics have been reported in hip osteoarthritis (OA) patients before and after total hip arthroplasty (THA). These changes can affect the loading of the ipsilateral hip, as well as the contralateral hip and knee joint. As it is not clear how hip and knee loading evolves in THA patients during the first year after surgery, the goal of this study is to define how joint loading changes in patients before and at three evaluation times after THA surgery. Musculoskeletal modelling in combination with gait analysis data was used to calculate hip and knee contact forces in 14 patients before and 3-, 6- and 12-months after unilateral THA, as well as in 18 healthy controls. Results showed that bilateral hip and knee loading were decreased compared to controls, both before and after THA surgery. Loading symmetry was altered compared to controls at 3-months post-surgery for the hip and at all evaluation times, except for 6-months post-surgery, for the knee, with ipsilateral joint loading decreased compared to the contralateral side. To conclude, 12-months after THA joint loading was not normalized, with both hip and knee loading in patients decreased compared to controls. Therefore, no overloading of the ipsi- or contralateral hip and knee joint was found before and up to one year after unilateral THA.



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Inertial sensing of the motion speed effect on the sit-to-walk activity

Publication date: March 2018
Source:Gait & Posture, Volume 61
Author(s): Nikolaos Kondilopoulos, Elissavet N. Rousanoglou, Konstantinos D. Boudolos
The STW execution at motion speed faster than normal most possibly enhances the risk for balance loss due to the increase in body segment accelerations. The purpose of the study was to use inertial sensing to examine the effect of motion speed on the STW segmental kinematics and its temporal events. Eighteen young men (20.7 ± 2.0 years) performed STW trials at preferred (PS) and fast (FS) motion speed. Data were collected with Xsens inertial sensors positioned at the trunk, thigh, shank, and foot segments. The maximum segmental values of angular displacement, angular velocity and linear acceleration, the duration of total STW (ttotal), the absolute and relative (% ttotal) phase duration (Flexion, Transition, Extension, Walking) and, the absolute and relative time taken to reach each maximum value were determined. In FS, ttotal and the absolute phase duration (except for Transition), were all significantly shorter (p = 0.000). The relative phase duration was not altered (p > 0.05), except for the Extension shortening (p = 0.001). The maximum angular displacement was altered only for the thigh (decreased, p = 0.038) and shank (increased, p = 0.004). Maximum angular velocities and linear accelerations were all significantly increased (p = 0.000 for all). The absolute time to reach the maximum values shortened in FS (p ≤ 0.05), while, the relative times were not altered (p > 0.05), except for the delayed trunk maximum angular displacement (p = 0.039). Inertial sensing appears to identify the motion speed effect on STW segmental kinematics and their temporal events in healthy young men. The results of the study may contribute improving the preventive or rehabilitation interventions in persons with impaired postural control.



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Longitudinal joint loading in patients before and up to one year after unilateral total hip arthroplasty

Publication date: March 2018
Source:Gait & Posture, Volume 61
Author(s): Mariska Wesseling, Christophe Meyer, Kristoff Corten, Kaat Desloovere, Ilse Jonkers
Abnormal kinematics and kinetics have been reported in hip osteoarthritis (OA) patients before and after total hip arthroplasty (THA). These changes can affect the loading of the ipsilateral hip, as well as the contralateral hip and knee joint. As it is not clear how hip and knee loading evolves in THA patients during the first year after surgery, the goal of this study is to define how joint loading changes in patients before and at three evaluation times after THA surgery. Musculoskeletal modelling in combination with gait analysis data was used to calculate hip and knee contact forces in 14 patients before and 3-, 6- and 12-months after unilateral THA, as well as in 18 healthy controls. Results showed that bilateral hip and knee loading were decreased compared to controls, both before and after THA surgery. Loading symmetry was altered compared to controls at 3-months post-surgery for the hip and at all evaluation times, except for 6-months post-surgery, for the knee, with ipsilateral joint loading decreased compared to the contralateral side. To conclude, 12-months after THA joint loading was not normalized, with both hip and knee loading in patients decreased compared to controls. Therefore, no overloading of the ipsi- or contralateral hip and knee joint was found before and up to one year after unilateral THA.



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Oncomodulin Expression Reveals New Insights into the Cellular Organization of the Murine Utricle Striola

Abstract

Oncomodulin (OCM, aka β-parvalbumin) is an EF-hand calcium binding protein that is expressed in a restricted set of hair cells in the peristriolar region of the mammalian utricle. In the present study, we determined the topologic distribution of OCM among hair cell phenotypes to advance our understanding of the cellular organization of the striola and the relationship of these phenotypes with characteristics of tissue polarity. The distributions of OCM-positive (OCM+) hair cells were quantified in utricles of mature C57Bl/6 mice. Immunohistochemistry was conducted using antibodies to OCM, calretinin, and β3-tubulin. Fluorophore-conjugated phalloidin was used to label hair cell stereocilia, which provided the basis for determining hair cell counts and morphologic polarizations. We found OCM expression in striolar types I and II hair cells, though the distributions were dissimilar to the native striolar type I and II distributions, favoring type I hair cells. The distribution of OCM immunoreactivity among striolar type I hair cells also reflected nonrandom distribution among type I_c and I_d phenotypes (i.e., those receiving calretinin-positive and calretinin-negative calyces, respectively). However, many OCM+ hair cells were found lateral to the striola, and within the epithelial region encompassing OCM+ hair cells, the distributions of OCM+ types I_c and I_d hair cells were similar to the native distributions of I_c and I_d in this region. Summarily, these data provide a quantitative perspective supporting the existence of different underlying factors driving the topologic expression of OCM in hair cells than those responsible for tissue polarity characteristics associated within the utricular striola, including calretinin expression in afferent calyces.

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Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Surgical Resection for the Treatment of Patients With Vestibular Schwannomas.

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Surgical Resection for the Treatment of Patients With Vestibular Schwannomas.

Neurosurgery. 2017 Dec 20;:

Authors: Hadjipanayis CG, Carlson ML, Link MJ, Rayan TA, Parish J, Atkins T, Asher AL, Dunn IF, Corrales CE, Van Gompel JJ, Sughrue M, Olson JJ

Abstract
QUESTION 1: What surgical approaches for vestibular schwannomas (VS) are best for complete resection and facial nerve (FN) preservation when serviceable hearing is present?
RECOMMENDATION: There is insufficient evidence to support the superiority of either the middle fossa (MF) or the retrosigmoid (RS) approach for complete VS resection and FN preservation when serviceable hearing is present.
QUESTION 2: Which surgical approach (RS or translabyrinthine [TL]) for VS is best for complete resection and FN preservation when serviceable hearing is not present?
RECOMMENDATION: There is insufficient evidence to support the superiority of either the RS or the TL approach for complete VS resection and FN preservation when serviceable hearing is not present.
QUESTION 3: Does VS size matter for facial and vestibulocochlear nerve preservation with surgical resection?
RECOMMENDATION: Level 3: Patients with larger VS tumor size should be counseled about the greater than average risk of loss of serviceable hearing.
QUESTION 4: Should small intracanalicular tumors (<1.5 cm) be surgically resected?
RECOMMENDATION: There are insufficient data to support a firm recommendation that surgery be the primary treatment for this subclass of VSs.
QUESTION 5: Is hearing preservation routinely possible with VS surgical resection when serviceable hearing is present?
RECOMMENDATION: Level 3: Hearing preservation surgery via the MF or the RS approach may be attempted in patients with small tumor size (<1.5 cm) and good preoperative hearing.
QUESTION 6: When should surgical resection be the initial treatment in patients with neurofibromatosis type 2 (NF2)?
RECOMMENDATION: There is insufficient evidence that surgical resection should be the initial treatment in patients with NF2.
QUESTION 7: Does a multidisciplinary team, consisting of neurosurgery and neurotology, provides the best outcomes of complete resection and facial/vestibulocochlear nerve preservation for patients undergoing resection of VSs?
RECOMMENDATION: There is insufficient evidence to support stating that a multidisciplinary team, usually consisting of a neurosurgeon and a neurotologist, provides superior outcomes compared to either subspecialist working alone.
QUESTION 8: Does a subtotal surgical resection of a VS followed by stereotactic radiosurgery (SRS) to the residual tumor provide comparable hearing and FN preservation to patients who undergo a complete surgical resection?
RECOMMENDATION: There is insufficient evidence to support subtotal resection (STR) followed by SRS provides comparable hearing and FN preservation to patients who undergo a complete surgical resection.
QUESTION 9: Does surgical resection of VS treat preoperative balance problems more effectively than SRS?
RECOMMENDATION: There is insufficient evidence to support either surgical resection or SRS for treatment of preoperative balance problems.
QUESTION 10: Does surgical resection of VS treat preoperative trigeminal neuralgia more effectively than SRS?
RECOMMENDATION: Level 3: Surgical resection of VSs may be used to better relieve symptoms of trigeminal neuralgia than SRS.
QUESTION 11: Is surgical resection of VSs more difficult (associated with higher facial neuropathies and STR rates) after initial treatment with SRS?
RECOMMENDATION: Level 3: If microsurgical resection is necessary after SRS, it is recommended that patients be counseled that there is an increased likelihood of a STR and decreased FN function.  The full guideline can be found at: http://ift.tt/2CVD7JB.

PMID: 29309632 [PubMed - as supplied by publisher]

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The Effect of Vestibular Rehabilitation Therapy Program on Sensory Organization of Deaf Children With Bilateral Vestibular Dysfunction.

Related Articles

The Effect of Vestibular Rehabilitation Therapy Program on Sensory Organization of Deaf Children With Bilateral Vestibular Dysfunction.

Acta Med Iran. 2017 Nov;55(11):683-689

Authors: Ebrahimi AA, Jamshidi AA, Movallali G, Rahgozar M, Haghgoo HA

Abstract
The purpose of this study was to determine the effect of vestibular rehabilitation therapy program on the sensory organization of deaf children with bilateral vestibular dysfunction. This cross-sectional and analytic study was conducted on 24 students between the age of 7 and 12 years (6 girls and 18 boys) with the profound sensorineural hearing loss (PTA>90 dB). They were assessed through the balance subtest in Bruininks-Oseretsky test of motor proficiency (BOTMP). For children which the total score of the balance subtest was 3 standard deviation lower than their peers with typical development, vestibular function testing was completed pre-intervention. Posturography Sensory organization testing (SOT) was completed pre- and post-intervention with SPS (Synapsys, Marseille, France). Children with bilateral vestibular impairment were randomly assigned to either the exercise or control group. Exercise intervention consisted of compensatory training, emphasizing enhancement of visual and somatosensory function, and balance training. The exercise group entered in vestibular rehabilitation therapy program for 8 weeks. The children initially participating in the control group were provided the exercise intervention following the post-test. Based on the results there was significant difference in condition 5 and 6, areas of limits of stability (LOS), vestibular ratio and global score in posturography at the end of the intervention, but there was no significant difference in the control group in posturography (P<0.05). The results indicated that testing of vestibular, and postural control function, as well as intervention for deficiencies identified, should be included in deaf children rehabilitation program.

PMID: 29307157 [PubMed - in process]

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Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Surgical Resection for the Treatment of Patients With Vestibular Schwannomas.

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Surgical Resection for the Treatment of Patients With Vestibular Schwannomas.

Neurosurgery. 2017 Dec 20;:

Authors: Hadjipanayis CG, Carlson ML, Link MJ, Rayan TA, Parish J, Atkins T, Asher AL, Dunn IF, Corrales CE, Van Gompel JJ, Sughrue M, Olson JJ

Abstract
QUESTION 1: What surgical approaches for vestibular schwannomas (VS) are best for complete resection and facial nerve (FN) preservation when serviceable hearing is present?
RECOMMENDATION: There is insufficient evidence to support the superiority of either the middle fossa (MF) or the retrosigmoid (RS) approach for complete VS resection and FN preservation when serviceable hearing is present.
QUESTION 2: Which surgical approach (RS or translabyrinthine [TL]) for VS is best for complete resection and FN preservation when serviceable hearing is not present?
RECOMMENDATION: There is insufficient evidence to support the superiority of either the RS or the TL approach for complete VS resection and FN preservation when serviceable hearing is not present.
QUESTION 3: Does VS size matter for facial and vestibulocochlear nerve preservation with surgical resection?
RECOMMENDATION: Level 3: Patients with larger VS tumor size should be counseled about the greater than average risk of loss of serviceable hearing.
QUESTION 4: Should small intracanalicular tumors (<1.5 cm) be surgically resected?
RECOMMENDATION: There are insufficient data to support a firm recommendation that surgery be the primary treatment for this subclass of VSs.
QUESTION 5: Is hearing preservation routinely possible with VS surgical resection when serviceable hearing is present?
RECOMMENDATION: Level 3: Hearing preservation surgery via the MF or the RS approach may be attempted in patients with small tumor size (<1.5 cm) and good preoperative hearing.
QUESTION 6: When should surgical resection be the initial treatment in patients with neurofibromatosis type 2 (NF2)?
RECOMMENDATION: There is insufficient evidence that surgical resection should be the initial treatment in patients with NF2.
QUESTION 7: Does a multidisciplinary team, consisting of neurosurgery and neurotology, provides the best outcomes of complete resection and facial/vestibulocochlear nerve preservation for patients undergoing resection of VSs?
RECOMMENDATION: There is insufficient evidence to support stating that a multidisciplinary team, usually consisting of a neurosurgeon and a neurotologist, provides superior outcomes compared to either subspecialist working alone.
QUESTION 8: Does a subtotal surgical resection of a VS followed by stereotactic radiosurgery (SRS) to the residual tumor provide comparable hearing and FN preservation to patients who undergo a complete surgical resection?
RECOMMENDATION: There is insufficient evidence to support subtotal resection (STR) followed by SRS provides comparable hearing and FN preservation to patients who undergo a complete surgical resection.
QUESTION 9: Does surgical resection of VS treat preoperative balance problems more effectively than SRS?
RECOMMENDATION: There is insufficient evidence to support either surgical resection or SRS for treatment of preoperative balance problems.
QUESTION 10: Does surgical resection of VS treat preoperative trigeminal neuralgia more effectively than SRS?
RECOMMENDATION: Level 3: Surgical resection of VSs may be used to better relieve symptoms of trigeminal neuralgia than SRS.
QUESTION 11: Is surgical resection of VSs more difficult (associated with higher facial neuropathies and STR rates) after initial treatment with SRS?
RECOMMENDATION: Level 3: If microsurgical resection is necessary after SRS, it is recommended that patients be counseled that there is an increased likelihood of a STR and decreased FN function.  The full guideline can be found at: http://ift.tt/2CVD7JB.

PMID: 29309632 [PubMed - as supplied by publisher]

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The Effect of Vestibular Rehabilitation Therapy Program on Sensory Organization of Deaf Children With Bilateral Vestibular Dysfunction.

Related Articles

The Effect of Vestibular Rehabilitation Therapy Program on Sensory Organization of Deaf Children With Bilateral Vestibular Dysfunction.

Acta Med Iran. 2017 Nov;55(11):683-689

Authors: Ebrahimi AA, Jamshidi AA, Movallali G, Rahgozar M, Haghgoo HA

Abstract
The purpose of this study was to determine the effect of vestibular rehabilitation therapy program on the sensory organization of deaf children with bilateral vestibular dysfunction. This cross-sectional and analytic study was conducted on 24 students between the age of 7 and 12 years (6 girls and 18 boys) with the profound sensorineural hearing loss (PTA>90 dB). They were assessed through the balance subtest in Bruininks-Oseretsky test of motor proficiency (BOTMP). For children which the total score of the balance subtest was 3 standard deviation lower than their peers with typical development, vestibular function testing was completed pre-intervention. Posturography Sensory organization testing (SOT) was completed pre- and post-intervention with SPS (Synapsys, Marseille, France). Children with bilateral vestibular impairment were randomly assigned to either the exercise or control group. Exercise intervention consisted of compensatory training, emphasizing enhancement of visual and somatosensory function, and balance training. The exercise group entered in vestibular rehabilitation therapy program for 8 weeks. The children initially participating in the control group were provided the exercise intervention following the post-test. Based on the results there was significant difference in condition 5 and 6, areas of limits of stability (LOS), vestibular ratio and global score in posturography at the end of the intervention, but there was no significant difference in the control group in posturography (P<0.05). The results indicated that testing of vestibular, and postural control function, as well as intervention for deficiencies identified, should be included in deaf children rehabilitation program.

PMID: 29307157 [PubMed - in process]

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A C-terminal nonsense mutation links PTPRQ with autosomal-dominant hearing loss, DFNA73.

A C-terminal nonsense mutation links PTPRQ with autosomal-dominant hearing loss, DFNA73.

Genet Med. 2017 Oct 12;:

Authors: Eisenberger T, Di Donato N, Decker C, Delle Vedove A, Neuhaus C, Nürnberg G, Toliat M, Nürnberg P, Mürbe D, Bolz HJ

Abstract
PurposeHearing loss is genetically extremely heterogeneous, making it suitable for next-generation sequencing (NGS). We identified a four-generation family with nonsyndromic mild to severe hearing loss of the mid- to high frequencies and onset from early childhood to second decade in seven members.MethodsNGS of 66 deafness genes, Sanger sequencing, genome-wide linkage analysis, whole-exome sequencing (WES), semiquantitative reverse-transcriptase polymerase chain reaction.ResultsWe identified a heterozygous nonsense mutation, c.6881G>A (p.Trp2294*), in the last coding exon of PTPRQ. PTPRQ has been linked with recessive (DFNB84A), but not dominant deafness. NGS and Sanger sequencing of all exons (including alternatively spliced 5' and N-scan-predicted exons of a putative "extended" transcript) did not identify a second mutation. The highest logarithm of the odds score was in the PTPRQ-containing region on chromosome 12, and p.Trp2294* cosegregated with hearing loss. WES did not identify other cosegregating candidate variants from the mapped region. PTPRQ expression in patient fibroblasts indicated that the mutant allele escapes nonsense-mediated decay (NMD).ConclusionKnown PTPRQ mutations are recessive and do not affect the C-terminal exon. In contrast to recessive loss-of-function mutations, c.6881G>A transcripts may escape NMD. PTPRQTrp2294* protein would lack only six terminal residues and could exert a dominant-negative effect, a possible explanation for allelic deafness, DFNA73, clinically and genetically distinct from DFNB84A.GENETICS in MEDICINE advance online publication, 12 October 2017; doi:10.1038/gim.2017.155.

PMID: 29309402 [PubMed - as supplied by publisher]

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Identification of Novel PTPRQ and MYO1A Mutations in An Iranian Pedigree with Autosomal Recessive Hearing Loss.

Related Articles

Identification of Novel PTPRQ and MYO1A Mutations in An Iranian Pedigree with Autosomal Recessive Hearing Loss.

Cell J. 2018 Apr;20(1):127-131

Authors: Talebi F, Ghanbari Mardasi F, Mohammadi Asl J, Tizno S, Najafvand Zadeh M

Abstract
Autosomal recessive non-syndromic hearing loss (ARNSHL) is defined as a genetically heterogeneous disorder. The aim of the present study was to screen for pathogenic variants in an Iranian pedigree with ARNSHL. Next-generation targeted sequencing of 127 deafness genes in the proband detected two novel variants, a homozygous missense variant in PTPRQ (c.2599 T>C, p.Ser867Pro and a heterozygous missense variant in MYO1A (c.2804 T>C, p.Ile935Thr), both of which were absent in unaffected sibs and two hundred unaffected controls. Our results suggest that the homozygous PTPRQ variant maybe the pathogenic variant for ARNSHL due to the recessive nature of the disorder. Nevertheless, the heterozygous MYO1A may also be involved in this disorder due to the multigenic pattern of ARNSHL. Our data extend the mutation spectrum of PTPRQ and MYO1A, and have important implications for genetic counseling in unaffected sibs of this family. In addition, PTPRQ and MYO1A pathogenic variants have not to date been reported in the Iranian population.

PMID: 29308629 [PubMed]

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Neural representation of octave illusion in the human cortex revealed with functional magnetic resonance imaging

Publication date: Available online 8 January 2018
Source:Hearing Research
Author(s): Keita Tanaka, Hiroki Kurasaki, Shinya Kuriki
The auditory “octave illusion” arises when dichotic tones, presented one octave apart, alternate rapidly between the ears. This study aimed to explore the link between the perception of illusory pitches and brain activity during presentation of dichotic tones. We conducted a behavioral study of how participants perceived binaural dichotic tones of octave illusions and classified them, based on the reported percepts, in an illusion (ILL) group, without an illusion (non-ILL) group, and others. We recorded brain activity using functional magnetic resonance imaging and analyzed the activation due to dichotic illusion tones. The activation in the bilateral planum polare in the auditory cortex was significantly larger in the ILL group than in the non-ILL group. In the right premotor cortex, the non-ILL group showed a significantly larger activation than did the ILL group, suggesting that the sensation of the meter to the stimulus sound was significant in the non-ILL but not in the ILL group. The results indicated that the activity in these areas was related to the occurrence of octave illusions. The nonsignificant sensation of the meter to the stimulus sound in the ILL group may be consistent with the perception of octave illusion.



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Neural representation of octave illusion in the human cortex revealed with functional magnetic resonance imaging

Publication date: Available online 8 January 2018
Source:Hearing Research
Author(s): Keita Tanaka, Hiroki Kurasaki, Shinya Kuriki
The auditory “octave illusion” arises when dichotic tones, presented one octave apart, alternate rapidly between the ears. This study aimed to explore the link between the perception of illusory pitches and brain activity during presentation of dichotic tones. We conducted a behavioral study of how participants perceived binaural dichotic tones of octave illusions and classified them, based on the reported percepts, in an illusion (ILL) group, without an illusion (non-ILL) group, and others. We recorded brain activity using functional magnetic resonance imaging and analyzed the activation due to dichotic illusion tones. The activation in the bilateral planum polare in the auditory cortex was significantly larger in the ILL group than in the non-ILL group. In the right premotor cortex, the non-ILL group showed a significantly larger activation than did the ILL group, suggesting that the sensation of the meter to the stimulus sound was significant in the non-ILL but not in the ILL group. The results indicated that the activity in these areas was related to the occurrence of octave illusions. The nonsignificant sensation of the meter to the stimulus sound in the ILL group may be consistent with the perception of octave illusion.



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Neural representation of octave illusion in the human cortex revealed with functional magnetic resonance imaging

Publication date: Available online 8 January 2018
Source:Hearing Research
Author(s): Keita Tanaka, Hiroki Kurasaki, Shinya Kuriki
The auditory “octave illusion” arises when dichotic tones, presented one octave apart, alternate rapidly between the ears. This study aimed to explore the link between the perception of illusory pitches and brain activity during presentation of dichotic tones. We conducted a behavioral study of how participants perceived binaural dichotic tones of octave illusions and classified them, based on the reported percepts, in an illusion (ILL) group, without an illusion (non-ILL) group, and others. We recorded brain activity using functional magnetic resonance imaging and analyzed the activation due to dichotic illusion tones. The activation in the bilateral planum polare in the auditory cortex was significantly larger in the ILL group than in the non-ILL group. In the right premotor cortex, the non-ILL group showed a significantly larger activation than did the ILL group, suggesting that the sensation of the meter to the stimulus sound was significant in the non-ILL but not in the ILL group. The results indicated that the activity in these areas was related to the occurrence of octave illusions. The nonsignificant sensation of the meter to the stimulus sound in the ILL group may be consistent with the perception of octave illusion.



from #Audiology via ola Kala on Inoreader http://ift.tt/2mdP1Fi
via IFTTT

Neural representation of octave illusion in the human cortex revealed with functional magnetic resonance imaging

Publication date: Available online 8 January 2018
Source:Hearing Research
Author(s): Keita Tanaka, Hiroki Kurasaki, Shinya Kuriki
The auditory “octave illusion” arises when dichotic tones, presented one octave apart, alternate rapidly between the ears. This study aimed to explore the link between the perception of illusory pitches and brain activity during presentation of dichotic tones. We conducted a behavioral study of how participants perceived binaural dichotic tones of octave illusions and classified them, based on the reported percepts, in an illusion (ILL) group, without an illusion (non-ILL) group, and others. We recorded brain activity using functional magnetic resonance imaging and analyzed the activation due to dichotic illusion tones. The activation in the bilateral planum polare in the auditory cortex was significantly larger in the ILL group than in the non-ILL group. In the right premotor cortex, the non-ILL group showed a significantly larger activation than did the ILL group, suggesting that the sensation of the meter to the stimulus sound was significant in the non-ILL but not in the ILL group. The results indicated that the activity in these areas was related to the occurrence of octave illusions. The nonsignificant sensation of the meter to the stimulus sound in the ILL group may be consistent with the perception of octave illusion.



from #Audiology via ola Kala on Inoreader http://ift.tt/2mdP1Fi
via IFTTT

Neural representation of octave illusion in the human cortex revealed with functional magnetic resonance imaging

Publication date: Available online 8 January 2018
Source:Hearing Research
Author(s): Keita Tanaka, Hiroki Kurasaki, Shinya Kuriki
The auditory “octave illusion” arises when dichotic tones, presented one octave apart, alternate rapidly between the ears. This study aimed to explore the link between the perception of illusory pitches and brain activity during presentation of dichotic tones. We conducted a behavioral study of how participants perceived binaural dichotic tones of octave illusions and classified them, based on the reported percepts, in an illusion (ILL) group, without an illusion (non-ILL) group, and others. We recorded brain activity using functional magnetic resonance imaging and analyzed the activation due to dichotic illusion tones. The activation in the bilateral planum polare in the auditory cortex was significantly larger in the ILL group than in the non-ILL group. In the right premotor cortex, the non-ILL group showed a significantly larger activation than did the ILL group, suggesting that the sensation of the meter to the stimulus sound was significant in the non-ILL but not in the ILL group. The results indicated that the activity in these areas was related to the occurrence of octave illusions. The nonsignificant sensation of the meter to the stimulus sound in the ILL group may be consistent with the perception of octave illusion.



from #Audiology via ola Kala on Inoreader http://ift.tt/2mdP1Fi
via IFTTT