Assessment of Subjective Visual Vertical (SVV) Using the “Bucket Test” and the Virtual SVV System

Objective

The purpose of this study was to describe the variability and test–retest reliability of a commercially available subjective visual vertical (SVV) system known as Virtual SVV (Interacoustics). In addition, the study aimed to compare the reliability of the Virtual system with a previously established bucket test of SVV.

Study Design

Fifteen participants with normal hearing, normal middle ear function, and normal utricular function were included in the study. Each participant underwent static SVV testing using both the Virtual system and the bucket test. Subjects completed 2 testing sessions to determine test–retest reliability. For each test, data were collected with the head at 0°, tilted 45° to the right, and tilted 45° to the left.

Setting

This study was conducted in a balance function laboratory embedded in a large, tertiary care otology clinic.

Results

The mean SVV values obtained with the Virtual system were within 1°–2° from 0 with the head positioned at 0°, which is in agreement with many other studies of SVV with the head at 0° (Akin & Murnane, 2009; Halmagyi & Curthoys, 1999; Zwergal, Rettinger, Frenzel, Dieterich, & Strupp, 2009). Using the intraclass correlation coefficient, test–retest reliability of the Virtual system was excellent in the 45° left position and fair to good in the 45° right and 0° position. Test–retest reliability of the bucket test was poor in all head positions.

Conclusions

The Virtual system is a more reliable measure of static SVV than the bucket test. Therefore, the Virtual system could be utilized as a screening device for utricular dysfunction in busy clinical settings.

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Audiology Faculty Author Impact Metrics as a Function of Institution

Purpose

The purpose of this study was to develop a method for the assessment of audiology author impact as a function of institution and compare these results to a recent college ranking of audiology graduate programs.

Method

Scopus author impact metrics (i.e., number of documents, number of citations, and h index) from a previous study (Stuart, Faucette, & Thomas, 2017) were generated for 79 accredited graduate programs in audiology in the United States and Canada. Author impact metrics were summed to represent the total institution output, and median values were calculated to reflect a measure of central tendency of individual faculty performance.

Results

Three hundred and seventy-nine audiology faculty members were identified and of those 86.0% (n = 326) were found in Scopus. Database presence increased with increasing rank (p = .003). Scopus index values were positively skewed. The total summed number of documents, citations, and h indices were positively correlated with the total number of faculty in the institutions and with the summed number of coauthors (p < .001). The median number of documents, citations, and h indices were not significantly correlated with the total number of faculty in the institutions but were positively correlated with the median number of coauthors (p < .001). In general, indices were higher for research/doctoral versus nonresearch universities. Higher college program rankings were statistically related with better Scopus index values.

Conclusion

These institutional metrics may be used to serve as a benchmark for institutional production, attracting students, hiring faculty, and assessing allocation of institutional funding.

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Parenting Stress and Maternal Coherence: Mothers With Deaf or Hard-of-Hearing Children

Purpose

The aim of this study was to develop a substantive theory that explains parenting stress among mothers of deaf or hard-of-hearing (D/HH) children.

Method

Fifteen hearing mothers of children with severe-to-profound sensorineural hearing loss were interviewed. Interviews were transcribed verbatim, and a grounded theory approach was used to inductively analyze parental stress in mothers of D/HH children. Theory generation was achieved through triangulation of data sources and systematic organization of data into codes. The coding process identified salient themes that were constantly cross-checked and compared across data to further develop categories, properties, and tentative hypotheses.

Results

In general, two main themes emerged from the interviews: the contextual stressors and stress-reducing resources. The contextual stressors were labeled as distress over audiology-related needs, pressure to acquire new knowledge and skills, apprehension about the child's future, and demoralizing negative social attitudes. The stress-reducing resources that moderated parenting stress were identified to be the child's progress, mother's characteristics, professional support, and social support. The interaction between the identified stressors and adjustment process uncovered a central theme termed maternal coherence.

Conclusion

The substantive theory suggests that mothers of D/HH children can effectively manage parenting stress and increase well-being by capitalizing on relevant stress-reducing resources to achieve maternal coherence.

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Does Contralateral Inhibition of Transient Evoked Otoacoustic Emissions Suggest Sex or Ear Laterality Effects?

Purpose

The purpose of this study was to examine contralateral inhibition of transient evoked otoacoustic emissions (TEOAEs) in young adults with normal hearing as a function of ear and sex.

Method

Young female (n = 50) and male (n = 50) adults with normal hearing participated. TEOAEs were measured bilaterally with 80 dB peSPL nonlinear clicks and 60 dB peSPL linear clicks with and without a contralateral broadband noise elicitor at 65 dB SPL. Absolute TEOAE inhibition and normalized TEOAE inhibition (i.e., percentage of inhibition) were examined.

Results

With both 80 and 60 dB peSPL evoking stimuli, there were significant main effects of ear and sex (p < .05). TEOAE levels were larger in women and in the right ear. There were no statistically significant main effects of ear and sex on absolute TEOAE inhibition (p > .05). Significant main effects of ear and sex were, however, found with normalized TEOAE inhibition (p < .05; greater in men and in the left ear). Statistically significant negative correlations and significant linear predictive relations were found between TEOAE levels and normalized TEOAE inhibitions in both ears (p < .001). There is no evidence of the same with absolute inhibition of TEOAEs (p > .05).

Conclusions

If one considers that efferent inhibition of TEOAEs is an absolute quantity, the significant effect of ear and sex on normalized inhibition and the negative association and linear predictive relationship between TEOAE level and inhibition can be viewed as spurious effects. As such, contralateral inhibition of TEOAEs does not suggest sex or ear laterality effects.

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Author Response to Peck (2018), “Questionable Use of ‘Nonorganic’ in ‘Estimating Nonorganic Hearing Thresholds’”

Purpose

The purpose of this letter is to respond to Dr. Peck's (2018) letter to the editor regarding the use of the term “nonorganic” to describe hearing loss, demonstrated by the pure tone audiogram that cannot be explained or is greater than what can be explained by a physiological auditory disorder.

Conclusions

We prefer the term “nonorganic” rather than the term “false and exaggerated hearing loss.” “Nonorganic,” in our view, is a nonjudgmental term and, as stated by Austen and Lynch (2004), implies “as little as possible about its cause” (p. 450).

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The Role of Audiologists in Assuring Follow-Up to Outpatient Screening in Early Hearing Detection and Intervention Systems

Purpose

The purpose of this study was to investigate the role of audiology involvement and other factors associated with failure to follow through from the initial hearing screening to the second outpatient screen.

Method

Linear regression, logistical regression, and descriptive analyses were used across demographic and hospital variables associated with infants who did not receive a follow-up outpatient screen.

Results

The results included birthing hospital outpatient rescreen rates from January 1, 2005, through December 31, 2005. Variables were collected from the birth certificate and hospital surveys. Results showed higher loss to follow-up/documentation to outpatient screen for (a) infants born in hospitals with low rates for returning for follow-up, (b) infants born in hospitals that did not have an audiologist involved, (c) infants who were Hispanic, (d) infants who were born to mothers who were not married, (e) infants with mother's with < 12 years of education, and (f) infants with Apgar scores of 7 or below.

Conclusions

The findings were used to identify quality improvement strategies to decrease the loss to follow-up. Strategies included ensuring audiology support, providing information in the parent's native language, educating personnel in the newborn intensive care units, developing and disseminating information in Spanish in written form, and educating hospitals on the importance of scheduling the outpatient rescreening before hospital discharge.

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Negative Association of Hepatitis B Virus With Hearing Impairment

Purpose

Hearing impairment is one of the most common chronic diseases causing deterioration of the quality of life in elderly individuals. Several viral infections have been suggested to cause hearing impairment. We investigated association of hepatitis B virus (HBV) infection with hearing impairment using a representative sample of the Korean population.

Method

Participants included 6,583 men and 8,702 women, who were ≥ 20 years of age from the Korea National Health and Nutritional Examination Surveys of the Korean population (2010–2012). Air-conduction pure-tone thresholds were measured in a soundproof booth using an automatic audiometer for each ear at 6 frequencies (500, 1000, 2000, 3000, 4000, and 6000 Hz). An audiometric test and a laboratory examination, including an HBV surface antigen (HBsAg) test, were performed.

Results

Subjects who are HBsAg positive had lower average of pure-tone thresholds and lower prevalence of hearing impairment at both low/mid and high frequency compared with those without. Adjusted means of hearing thresholds were also lower among subjects who are HBsAg positive compared with subjects who are HBsAg negative. After the adjustment for age and gender, the odds of high-frequency mild hearing impairment were lower for subjects with HBV infection. In the multiple logistic regression analyses adjusting for confounding variables, the significant negative association between HBV infection and high-frequency mild hearing impairment still remained.

Conclusions

Contrary to previous reports, subjects who are HBsAg positive had a lower prevalence of hearing impairment compared with subjects who are HBsAg negative. Further studies are warranted to investigate the underlying mechanism regarding their negative relationship.

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Effects of Different Electrode Configurations on the Narrow Band Level-Specific CE-Chirp and Tone-Burst Auditory Brainstem Response at Multiple Intensity Levels and Frequencies in Subjects With Normal Hearing

Purpose

The purpose of this study was to investigate the influence of 2 different electrode montages (ipsilateral and vertical) on the auditory brainstem response (ABR) findings elicited from narrow band (NB) level-specific (LS) CE-Chirp and tone-burst in subjects with normal hearing at several intensity levels and frequency combinations.

Method

Quasi-experimental and repeated-measures study designs were used in this study. Twenty-six adults with normal hearing (17 females, 9 males) participated. ABRs were acquired from the study participants at 3 intensity levels (80, 60, and 40 dB nHL), 3 frequencies (500, 1000, and 2000 Hz), 2 electrode montages (ipsilateral and vertical), and 2 stimuli (NB LS CE-Chirp and tone-burst) using 2 stopping criteria (fixed averages at 4,000 sweeps and F test at multiple points = 3.1).

Results

Wave V amplitudes were only 19%–26% larger for the vertical recordings than the ipsilateral recordings in both the ABRs obtained from the NB LS CE-Chirp and tone-burst stimuli. The mean differences in the F test at multiple points values and the residual noise levels between the ABRs obtained from the vertical and ipsilateral montages were statistically not significant. In addition, the ABR elicited from the NB LS CE-Chirp was significantly larger (up to 69%) than those from the tone-burst, except at the lower intensity level.

Conclusion

Both the ipsilateral and vertical montages can be used to record ABR to the NB LS CE-Chirp because of the small enhancement in the wave V amplitude provided by the vertical montage.

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Could the Use of Acoustic Reflexes Prior to Administering Distortion Product Otoacoustic Emissions (DPOAEs) Affect the Results of DPOAEs?

Purpose

The purpose of this study is to investigate whether acoustic reflex threshold testing before administration of distortion product otoacoustic emissions can affect the results of the distortion product otoacoustic emissions testing using an automated protocol.

Method

Fifteen young adults with normal hearing ranging in age from 19 to 25 years participated in the study. All participants had clear external ear canals and normal Jerger Type A tympanograms and had passed a hearing screening. Testing was performed using the Interacoustics Titan acoustic reflex threshold and distortion product otoacoustic emissions protocol. Participants underwent baseline distortion product otoacoustic emissions.

Results

A paired-samples t test was conducted for both the right and left ears to assess within-group differences between baseline distortion product otoacoustic emissions and repeated distortion product otoacoustic emissions measures. No significant differences were found in distortion product otoacoustic emission measures following administration of acoustic reflexes.

Conclusions

The use of a protocol when using an automated system that includes both acoustic reflexes and distortion product otoacoustic emissions is important. Overall, presentation of acoustic reflexes prior to measuring distortion product otoacoustic emission did not affect distortion product otoacoustic emission results; therefore, test sequence can be modified as needed.

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Auditory Outcomes in Patients Who Received Proton Radiotherapy for Craniopharyngioma

Purpose

Compared to photon-based radiotherapy, protons deliver less radiation to healthy tissue resulting in the potential reduction of late complications such as sensorineural hearing loss (SNHL). We report early auditory outcomes in children treated with proton radiotherapy (PRT) for craniopharyngioma.

Method

Conventional frequency (CF = 0.25–8.0 kHz) audiometry, extended high-frequency (EHF = 9.0–16.0 kHz) audiometry, distortion product otoacoustic emission (DPOAE) testing, and speech-in-noise (SIN) assessments were prospectively and longitudinally conducted on 74 children with a median of 2 post-PRT evaluations (range, 1–5) per patient. The median age at PRT initiation was 10 years, and median follow-up time was 2 years. Ototoxicity was classified using the Chang Ototoxicity Grading Scale (Chang & Chinosornvatana, 2010) and the American Speech-Language-Hearing Association (ASHA) criteria (ASHA, 1994). Comparisons were made between baseline and most recent DPOAE levels, with evidence of ototoxicity based on criterion reductions of ≥ 6 dB. The critical difference values for comparing SIN scores between two conditions (i.e., pre- and post-PRT) were used to determine a significant change between test scores.

Results

At last evaluation, no patients had SNHL in the CF range, and 2 patients had SNHL (Chang Grade 1a) in the EHF range. Based on the ASHA criteria, a decrease in hearing was observed in 0 patients in the CF range alone, in 9 patients in the EHF range alone, and in 15 patients in both the CF and EHF ranges. DPOAE levels decreased at a faster rate at higher versus lower frequencies. For 41 evaluable patients, SIN perception did not decline over time (p = .6463).

Conclusion

At a median follow-up time of 2 years post-PRT, normal hearing was maintained within the CF range. However, subclinical decreases in hearing were observed, particularly in the EHF range and in the DPOAE level; thus, long-term follow-up is recommended to monitor for potential auditory late effects from PRT.

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Questionable Use of “Nonorganic” in Norrix et al. (2017), “Estimating Nonorganic Hearing Thresholds”

Purpose

The author of this letter to the editor expresses concern about the use of the word “nonorganic” as a source of confusion in terminology. Specifically, this is in response to the December 2017 American Journal of Audiology article, “Estimating Nonorganic Hearing Thresholds Using Binaural Auditory Stimuli” (Norrix, Rubiano, & Mueller, 2017). “Nonorganic” is a source of confusion in terminology, because it can be used in two different ways. One way can mean to say there is no hearing loss. When used in this sense, it is illogical because it is qualifying a hearing loss believed not to exist. The second usage means there is a real disorder of function, but the organs themselves are not damaged and the basis is unknown. In the place of “nonorganic,” I have proposed “false hearing loss.” “Nonorganic” might carry a negative connotation that “false” might not. Many instances of false hearing loss stem from physical–mental health disturbances. Audiologists must stay alert to signs of psychosocial difficulty and refer for further evaluation accordingly.

Conclusion

“False” hearing loss is a more appropriate term than “nonorganic” hearing loss.

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Tinnitus Suppression in Cochlear Implant Patients Using a Sound Therapy App

Purpose

The use of acoustic stimuli to reduce the prominence of tinnitus has been used for decades. Counseling and tinnitus sound therapy options are not currently widespread for cochlear implant (CI) users. The goal of this study was to determine whether tinnitus therapy sounds created for individuals with acoustic hearing may also benefit CI users.

Method

Sixteen sounds from the ReSound Relief app (Version 3.0) were selected for the study. Sixteen participants were asked to rate the overall acceptability of each sound and to write the description of the sound they perceived. Sounds were streamed from an Apple™ iPod (6th generation) to the CI using a Cochlear™ Wireless Mini Microphone 2+. Thirteen participants then completed a 5-min trial where they rated their pretrial and posttrial tinnitus and the acceptability of a subset of preferred sounds. Ten out of these 13 participants completed a 2-week home trial with a preferred sound after which they answered an online tinnitus questionnaire and rated the effectiveness of the sound therapy.

Results

Individual differences were large. Results from the 5-min trial showed that sounds perceived as rain, music, and waves were rated the most acceptable. For all of the participants, the posttrial tinnitus loudness rating was lower than the pretrial rating, with some participants experiencing greater difference in their tinnitus loudness than others. At the end of the 2-week home trial, 3 of 10 participants rated the effectiveness of sound therapy 70% or higher.

Conclusion

The results suggest that the use of tinnitus therapy sounds delivered through a CI can be acceptable and provides relief for some tinnitus sufferers.

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Masthead

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Assessment of Subjective Visual Vertical (SVV) Using the “Bucket Test” and the Virtual SVV System

Objective

The purpose of this study was to describe the variability and test–retest reliability of a commercially available subjective visual vertical (SVV) system known as Virtual SVV (Interacoustics). In addition, the study aimed to compare the reliability of the Virtual system with a previously established bucket test of SVV.

Study Design

Fifteen participants with normal hearing, normal middle ear function, and normal utricular function were included in the study. Each participant underwent static SVV testing using both the Virtual system and the bucket test. Subjects completed 2 testing sessions to determine test–retest reliability. For each test, data were collected with the head at 0°, tilted 45° to the right, and tilted 45° to the left.

Setting

This study was conducted in a balance function laboratory embedded in a large, tertiary care otology clinic.

Results

The mean SVV values obtained with the Virtual system were within 1°–2° from 0 with the head positioned at 0°, which is in agreement with many other studies of SVV with the head at 0° (Akin & Murnane, 2009; Halmagyi & Curthoys, 1999; Zwergal, Rettinger, Frenzel, Dieterich, & Strupp, 2009). Using the intraclass correlation coefficient, test–retest reliability of the Virtual system was excellent in the 45° left position and fair to good in the 45° right and 0° position. Test–retest reliability of the bucket test was poor in all head positions.

Conclusions

The Virtual system is a more reliable measure of static SVV than the bucket test. Therefore, the Virtual system could be utilized as a screening device for utricular dysfunction in busy clinical settings.

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Audiology Faculty Author Impact Metrics as a Function of Institution

Purpose

The purpose of this study was to develop a method for the assessment of audiology author impact as a function of institution and compare these results to a recent college ranking of audiology graduate programs.

Method

Scopus author impact metrics (i.e., number of documents, number of citations, and h index) from a previous study (Stuart, Faucette, & Thomas, 2017) were generated for 79 accredited graduate programs in audiology in the United States and Canada. Author impact metrics were summed to represent the total institution output, and median values were calculated to reflect a measure of central tendency of individual faculty performance.

Results

Three hundred and seventy-nine audiology faculty members were identified and of those 86.0% (n = 326) were found in Scopus. Database presence increased with increasing rank (p = .003). Scopus index values were positively skewed. The total summed number of documents, citations, and h indices were positively correlated with the total number of faculty in the institutions and with the summed number of coauthors (p < .001). The median number of documents, citations, and h indices were not significantly correlated with the total number of faculty in the institutions but were positively correlated with the median number of coauthors (p < .001). In general, indices were higher for research/doctoral versus nonresearch universities. Higher college program rankings were statistically related with better Scopus index values.

Conclusion

These institutional metrics may be used to serve as a benchmark for institutional production, attracting students, hiring faculty, and assessing allocation of institutional funding.

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Parenting Stress and Maternal Coherence: Mothers With Deaf or Hard-of-Hearing Children

Purpose

The aim of this study was to develop a substantive theory that explains parenting stress among mothers of deaf or hard-of-hearing (D/HH) children.

Method

Fifteen hearing mothers of children with severe-to-profound sensorineural hearing loss were interviewed. Interviews were transcribed verbatim, and a grounded theory approach was used to inductively analyze parental stress in mothers of D/HH children. Theory generation was achieved through triangulation of data sources and systematic organization of data into codes. The coding process identified salient themes that were constantly cross-checked and compared across data to further develop categories, properties, and tentative hypotheses.

Results

In general, two main themes emerged from the interviews: the contextual stressors and stress-reducing resources. The contextual stressors were labeled as distress over audiology-related needs, pressure to acquire new knowledge and skills, apprehension about the child's future, and demoralizing negative social attitudes. The stress-reducing resources that moderated parenting stress were identified to be the child's progress, mother's characteristics, professional support, and social support. The interaction between the identified stressors and adjustment process uncovered a central theme termed maternal coherence.

Conclusion

The substantive theory suggests that mothers of D/HH children can effectively manage parenting stress and increase well-being by capitalizing on relevant stress-reducing resources to achieve maternal coherence.

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Does Contralateral Inhibition of Transient Evoked Otoacoustic Emissions Suggest Sex or Ear Laterality Effects?

Purpose

The purpose of this study was to examine contralateral inhibition of transient evoked otoacoustic emissions (TEOAEs) in young adults with normal hearing as a function of ear and sex.

Method

Young female (n = 50) and male (n = 50) adults with normal hearing participated. TEOAEs were measured bilaterally with 80 dB peSPL nonlinear clicks and 60 dB peSPL linear clicks with and without a contralateral broadband noise elicitor at 65 dB SPL. Absolute TEOAE inhibition and normalized TEOAE inhibition (i.e., percentage of inhibition) were examined.

Results

With both 80 and 60 dB peSPL evoking stimuli, there were significant main effects of ear and sex (p < .05). TEOAE levels were larger in women and in the right ear. There were no statistically significant main effects of ear and sex on absolute TEOAE inhibition (p > .05). Significant main effects of ear and sex were, however, found with normalized TEOAE inhibition (p < .05; greater in men and in the left ear). Statistically significant negative correlations and significant linear predictive relations were found between TEOAE levels and normalized TEOAE inhibitions in both ears (p < .001). There is no evidence of the same with absolute inhibition of TEOAEs (p > .05).

Conclusions

If one considers that efferent inhibition of TEOAEs is an absolute quantity, the significant effect of ear and sex on normalized inhibition and the negative association and linear predictive relationship between TEOAE level and inhibition can be viewed as spurious effects. As such, contralateral inhibition of TEOAEs does not suggest sex or ear laterality effects.

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Author Response to Peck (2018), “Questionable Use of ‘Nonorganic’ in ‘Estimating Nonorganic Hearing Thresholds’”

Purpose

The purpose of this letter is to respond to Dr. Peck's (2018) letter to the editor regarding the use of the term “nonorganic” to describe hearing loss, demonstrated by the pure tone audiogram that cannot be explained or is greater than what can be explained by a physiological auditory disorder.

Conclusions

We prefer the term “nonorganic” rather than the term “false and exaggerated hearing loss.” “Nonorganic,” in our view, is a nonjudgmental term and, as stated by Austen and Lynch (2004), implies “as little as possible about its cause” (p. 450).

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The Role of Audiologists in Assuring Follow-Up to Outpatient Screening in Early Hearing Detection and Intervention Systems

Purpose

The purpose of this study was to investigate the role of audiology involvement and other factors associated with failure to follow through from the initial hearing screening to the second outpatient screen.

Method

Linear regression, logistical regression, and descriptive analyses were used across demographic and hospital variables associated with infants who did not receive a follow-up outpatient screen.

Results

The results included birthing hospital outpatient rescreen rates from January 1, 2005, through December 31, 2005. Variables were collected from the birth certificate and hospital surveys. Results showed higher loss to follow-up/documentation to outpatient screen for (a) infants born in hospitals with low rates for returning for follow-up, (b) infants born in hospitals that did not have an audiologist involved, (c) infants who were Hispanic, (d) infants who were born to mothers who were not married, (e) infants with mother's with < 12 years of education, and (f) infants with Apgar scores of 7 or below.

Conclusions

The findings were used to identify quality improvement strategies to decrease the loss to follow-up. Strategies included ensuring audiology support, providing information in the parent's native language, educating personnel in the newborn intensive care units, developing and disseminating information in Spanish in written form, and educating hospitals on the importance of scheduling the outpatient rescreening before hospital discharge.

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Negative Association of Hepatitis B Virus With Hearing Impairment

Purpose

Hearing impairment is one of the most common chronic diseases causing deterioration of the quality of life in elderly individuals. Several viral infections have been suggested to cause hearing impairment. We investigated association of hepatitis B virus (HBV) infection with hearing impairment using a representative sample of the Korean population.

Method

Participants included 6,583 men and 8,702 women, who were ≥ 20 years of age from the Korea National Health and Nutritional Examination Surveys of the Korean population (2010–2012). Air-conduction pure-tone thresholds were measured in a soundproof booth using an automatic audiometer for each ear at 6 frequencies (500, 1000, 2000, 3000, 4000, and 6000 Hz). An audiometric test and a laboratory examination, including an HBV surface antigen (HBsAg) test, were performed.

Results

Subjects who are HBsAg positive had lower average of pure-tone thresholds and lower prevalence of hearing impairment at both low/mid and high frequency compared with those without. Adjusted means of hearing thresholds were also lower among subjects who are HBsAg positive compared with subjects who are HBsAg negative. After the adjustment for age and gender, the odds of high-frequency mild hearing impairment were lower for subjects with HBV infection. In the multiple logistic regression analyses adjusting for confounding variables, the significant negative association between HBV infection and high-frequency mild hearing impairment still remained.

Conclusions

Contrary to previous reports, subjects who are HBsAg positive had a lower prevalence of hearing impairment compared with subjects who are HBsAg negative. Further studies are warranted to investigate the underlying mechanism regarding their negative relationship.

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Effects of Different Electrode Configurations on the Narrow Band Level-Specific CE-Chirp and Tone-Burst Auditory Brainstem Response at Multiple Intensity Levels and Frequencies in Subjects With Normal Hearing

Purpose

The purpose of this study was to investigate the influence of 2 different electrode montages (ipsilateral and vertical) on the auditory brainstem response (ABR) findings elicited from narrow band (NB) level-specific (LS) CE-Chirp and tone-burst in subjects with normal hearing at several intensity levels and frequency combinations.

Method

Quasi-experimental and repeated-measures study designs were used in this study. Twenty-six adults with normal hearing (17 females, 9 males) participated. ABRs were acquired from the study participants at 3 intensity levels (80, 60, and 40 dB nHL), 3 frequencies (500, 1000, and 2000 Hz), 2 electrode montages (ipsilateral and vertical), and 2 stimuli (NB LS CE-Chirp and tone-burst) using 2 stopping criteria (fixed averages at 4,000 sweeps and F test at multiple points = 3.1).

Results

Wave V amplitudes were only 19%–26% larger for the vertical recordings than the ipsilateral recordings in both the ABRs obtained from the NB LS CE-Chirp and tone-burst stimuli. The mean differences in the F test at multiple points values and the residual noise levels between the ABRs obtained from the vertical and ipsilateral montages were statistically not significant. In addition, the ABR elicited from the NB LS CE-Chirp was significantly larger (up to 69%) than those from the tone-burst, except at the lower intensity level.

Conclusion

Both the ipsilateral and vertical montages can be used to record ABR to the NB LS CE-Chirp because of the small enhancement in the wave V amplitude provided by the vertical montage.

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Could the Use of Acoustic Reflexes Prior to Administering Distortion Product Otoacoustic Emissions (DPOAEs) Affect the Results of DPOAEs?

Purpose

The purpose of this study is to investigate whether acoustic reflex threshold testing before administration of distortion product otoacoustic emissions can affect the results of the distortion product otoacoustic emissions testing using an automated protocol.

Method

Fifteen young adults with normal hearing ranging in age from 19 to 25 years participated in the study. All participants had clear external ear canals and normal Jerger Type A tympanograms and had passed a hearing screening. Testing was performed using the Interacoustics Titan acoustic reflex threshold and distortion product otoacoustic emissions protocol. Participants underwent baseline distortion product otoacoustic emissions.

Results

A paired-samples t test was conducted for both the right and left ears to assess within-group differences between baseline distortion product otoacoustic emissions and repeated distortion product otoacoustic emissions measures. No significant differences were found in distortion product otoacoustic emission measures following administration of acoustic reflexes.

Conclusions

The use of a protocol when using an automated system that includes both acoustic reflexes and distortion product otoacoustic emissions is important. Overall, presentation of acoustic reflexes prior to measuring distortion product otoacoustic emission did not affect distortion product otoacoustic emission results; therefore, test sequence can be modified as needed.

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Auditory Outcomes in Patients Who Received Proton Radiotherapy for Craniopharyngioma

Purpose

Compared to photon-based radiotherapy, protons deliver less radiation to healthy tissue resulting in the potential reduction of late complications such as sensorineural hearing loss (SNHL). We report early auditory outcomes in children treated with proton radiotherapy (PRT) for craniopharyngioma.

Method

Conventional frequency (CF = 0.25–8.0 kHz) audiometry, extended high-frequency (EHF = 9.0–16.0 kHz) audiometry, distortion product otoacoustic emission (DPOAE) testing, and speech-in-noise (SIN) assessments were prospectively and longitudinally conducted on 74 children with a median of 2 post-PRT evaluations (range, 1–5) per patient. The median age at PRT initiation was 10 years, and median follow-up time was 2 years. Ototoxicity was classified using the Chang Ototoxicity Grading Scale (Chang & Chinosornvatana, 2010) and the American Speech-Language-Hearing Association (ASHA) criteria (ASHA, 1994). Comparisons were made between baseline and most recent DPOAE levels, with evidence of ototoxicity based on criterion reductions of ≥ 6 dB. The critical difference values for comparing SIN scores between two conditions (i.e., pre- and post-PRT) were used to determine a significant change between test scores.

Results

At last evaluation, no patients had SNHL in the CF range, and 2 patients had SNHL (Chang Grade 1a) in the EHF range. Based on the ASHA criteria, a decrease in hearing was observed in 0 patients in the CF range alone, in 9 patients in the EHF range alone, and in 15 patients in both the CF and EHF ranges. DPOAE levels decreased at a faster rate at higher versus lower frequencies. For 41 evaluable patients, SIN perception did not decline over time (p = .6463).

Conclusion

At a median follow-up time of 2 years post-PRT, normal hearing was maintained within the CF range. However, subclinical decreases in hearing were observed, particularly in the EHF range and in the DPOAE level; thus, long-term follow-up is recommended to monitor for potential auditory late effects from PRT.

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Questionable Use of “Nonorganic” in Norrix et al. (2017), “Estimating Nonorganic Hearing Thresholds”

Purpose

The author of this letter to the editor expresses concern about the use of the word “nonorganic” as a source of confusion in terminology. Specifically, this is in response to the December 2017 American Journal of Audiology article, “Estimating Nonorganic Hearing Thresholds Using Binaural Auditory Stimuli” (Norrix, Rubiano, & Mueller, 2017). “Nonorganic” is a source of confusion in terminology, because it can be used in two different ways. One way can mean to say there is no hearing loss. When used in this sense, it is illogical because it is qualifying a hearing loss believed not to exist. The second usage means there is a real disorder of function, but the organs themselves are not damaged and the basis is unknown. In the place of “nonorganic,” I have proposed “false hearing loss.” “Nonorganic” might carry a negative connotation that “false” might not. Many instances of false hearing loss stem from physical–mental health disturbances. Audiologists must stay alert to signs of psychosocial difficulty and refer for further evaluation accordingly.

Conclusion

“False” hearing loss is a more appropriate term than “nonorganic” hearing loss.

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Tinnitus Suppression in Cochlear Implant Patients Using a Sound Therapy App

Purpose

The use of acoustic stimuli to reduce the prominence of tinnitus has been used for decades. Counseling and tinnitus sound therapy options are not currently widespread for cochlear implant (CI) users. The goal of this study was to determine whether tinnitus therapy sounds created for individuals with acoustic hearing may also benefit CI users.

Method

Sixteen sounds from the ReSound Relief app (Version 3.0) were selected for the study. Sixteen participants were asked to rate the overall acceptability of each sound and to write the description of the sound they perceived. Sounds were streamed from an Apple™ iPod (6th generation) to the CI using a Cochlear™ Wireless Mini Microphone 2+. Thirteen participants then completed a 5-min trial where they rated their pretrial and posttrial tinnitus and the acceptability of a subset of preferred sounds. Ten out of these 13 participants completed a 2-week home trial with a preferred sound after which they answered an online tinnitus questionnaire and rated the effectiveness of the sound therapy.

Results

Individual differences were large. Results from the 5-min trial showed that sounds perceived as rain, music, and waves were rated the most acceptable. For all of the participants, the posttrial tinnitus loudness rating was lower than the pretrial rating, with some participants experiencing greater difference in their tinnitus loudness than others. At the end of the 2-week home trial, 3 of 10 participants rated the effectiveness of sound therapy 70% or higher.

Conclusion

The results suggest that the use of tinnitus therapy sounds delivered through a CI can be acceptable and provides relief for some tinnitus sufferers.

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Masthead

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Development of Phonological, Lexical, and Syntactic Abilities in Children With Cochlear Implants Across the Elementary Grades

Purpose

This study assessed phonological, lexical, and morphosyntactic abilities at 6th grade for a group of children previously tested at 2nd grade to address 4 questions: (a) Do children with cochlear implants (CIs) demonstrate deficits at 6th grade? (b) Are those deficits greater, the same, or lesser in magnitude than those observed at 2nd grade? (c) How do the measured skills relate to each other? and (d) How do treatment variables affect outcome measures?

Participants

Sixty-two 6th graders (29 with normal hearing, 33 with CIs) participated, all of whom had their language assessed at 2nd grade.

Method

Data are reported for 12 measures obtained at 6th grade, assessing phonological, lexical, and morphosyntactic abilities. Between-groups analyses were conducted on 6th-grade measures and the magnitude of observed effects compared with those observed at 2nd grade. Correlational analyses were performed among the measures at 6th grade. Cross-lagged analyses were performed on specific 2nd- and 6th-grade measures of phonological awareness, vocabulary, and literacy to assess factors promoting phonological and lexical development. Treatment effects of age of 1st CI, preimplant thresholds, and bimodal experience were evaluated.

Results

Deficits remained fairly consistent in type and magnitude across elementary school. The largest deficits were found for phonological skills and the least for morphosyntactic skills, with lexical skills intermediate. Phonological and morphosyntactic skills were largely independent of each other; lexical skills were moderately related to phonological skills but not morphosyntactic skills. Literacy acquisition strongly promoted both phonological and lexical development. Of the treatment variables, only bimodal experience affected outcomes and did so positively.

Conclusions

Congenital hearing loss puts children at continued risk of language deficits, especially for phonologically based skills. Two interventions that appear to ameliorate that risk are providing a period of bimodal stimulation and strong literacy instruction.

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Accuracy of Smartphone Self-Hearing Test Applications Across Frequencies and Earphone Styles in Adults

Purpose

The purpose of this study is to evaluate smartphone-based self-hearing test applications (apps) for accuracy in threshold assessment and validity in screening for hearing loss across frequencies and earphone transducer styles.

Method

Twenty-two adult participants (10 = normal hearing; 12 = sensorineural hearing loss; n = 44 ears) underwent conventional audiometry and performed 6 self-administered hearing tests using two iPhone-based apps (App 1 = uHear [Version 2.0.2, Unitron]; App 2 = uHearingTest [Version 1.0.3, WooFu Tech, LLC.]) each with 3 different transducers (earbud earphones, supra-aural headphones, circumaural headphones). Hearing sensitivity results using the smartphone apps across frequencies and transducers were compared with conventional audiometry.

Results

Differences in accuracy were revealed between the hearing test apps across frequencies and earphone styles. The uHear app using the iPhone standard EarPod earbud earphones was accurate to conventional thresholds (p > .002 with Bonferroni correction) at 1000, 2000, 4000, and 6000 Hz and found valid (81%–100% sensitivity, specificity, positive and negative predictive values) for screening mild or greater hearing loss (> 25 dB HL) at 500, 1000, 2000, 4000, and 6000 Hz. The uHearingTest app was accurate in threshold assessment and determined valid for screening mild or greater hearing loss (> 25 dB HL) using supra-aural headphones at 2000, 4000, and 8000 Hz.

Conclusions

Self-hearing test apps can be accurate in hearing threshold assessment and screening for mild or greater hearing loss (> 25 dB HL) when using appropriate transducers. To ensure accuracy, manufacturers should specify earphone model instructions to users of smartphone-based self-hearing test apps.

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Development of Phonological, Lexical, and Syntactic Abilities in Children With Cochlear Implants Across the Elementary Grades

Purpose

This study assessed phonological, lexical, and morphosyntactic abilities at 6th grade for a group of children previously tested at 2nd grade to address 4 questions: (a) Do children with cochlear implants (CIs) demonstrate deficits at 6th grade? (b) Are those deficits greater, the same, or lesser in magnitude than those observed at 2nd grade? (c) How do the measured skills relate to each other? and (d) How do treatment variables affect outcome measures?

Participants

Sixty-two 6th graders (29 with normal hearing, 33 with CIs) participated, all of whom had their language assessed at 2nd grade.

Method

Data are reported for 12 measures obtained at 6th grade, assessing phonological, lexical, and morphosyntactic abilities. Between-groups analyses were conducted on 6th-grade measures and the magnitude of observed effects compared with those observed at 2nd grade. Correlational analyses were performed among the measures at 6th grade. Cross-lagged analyses were performed on specific 2nd- and 6th-grade measures of phonological awareness, vocabulary, and literacy to assess factors promoting phonological and lexical development. Treatment effects of age of 1st CI, preimplant thresholds, and bimodal experience were evaluated.

Results

Deficits remained fairly consistent in type and magnitude across elementary school. The largest deficits were found for phonological skills and the least for morphosyntactic skills, with lexical skills intermediate. Phonological and morphosyntactic skills were largely independent of each other; lexical skills were moderately related to phonological skills but not morphosyntactic skills. Literacy acquisition strongly promoted both phonological and lexical development. Of the treatment variables, only bimodal experience affected outcomes and did so positively.

Conclusions

Congenital hearing loss puts children at continued risk of language deficits, especially for phonologically based skills. Two interventions that appear to ameliorate that risk are providing a period of bimodal stimulation and strong literacy instruction.

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Accuracy of Smartphone Self-Hearing Test Applications Across Frequencies and Earphone Styles in Adults

Purpose

The purpose of this study is to evaluate smartphone-based self-hearing test applications (apps) for accuracy in threshold assessment and validity in screening for hearing loss across frequencies and earphone transducer styles.

Method

Twenty-two adult participants (10 = normal hearing; 12 = sensorineural hearing loss; n = 44 ears) underwent conventional audiometry and performed 6 self-administered hearing tests using two iPhone-based apps (App 1 = uHear [Version 2.0.2, Unitron]; App 2 = uHearingTest [Version 1.0.3, WooFu Tech, LLC.]) each with 3 different transducers (earbud earphones, supra-aural headphones, circumaural headphones). Hearing sensitivity results using the smartphone apps across frequencies and transducers were compared with conventional audiometry.

Results

Differences in accuracy were revealed between the hearing test apps across frequencies and earphone styles. The uHear app using the iPhone standard EarPod earbud earphones was accurate to conventional thresholds (p > .002 with Bonferroni correction) at 1000, 2000, 4000, and 6000 Hz and found valid (81%–100% sensitivity, specificity, positive and negative predictive values) for screening mild or greater hearing loss (> 25 dB HL) at 500, 1000, 2000, 4000, and 6000 Hz. The uHearingTest app was accurate in threshold assessment and determined valid for screening mild or greater hearing loss (> 25 dB HL) using supra-aural headphones at 2000, 4000, and 8000 Hz.

Conclusions

Self-hearing test apps can be accurate in hearing threshold assessment and screening for mild or greater hearing loss (> 25 dB HL) when using appropriate transducers. To ensure accuracy, manufacturers should specify earphone model instructions to users of smartphone-based self-hearing test apps.

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The Effects of Habitual Foot Strike Patterns on Achilles Tendon Loading in Female Runners

Publication date: Available online 12 September 2018

Source: Gait & Posture

Author(s): Thomas W. Kernozek, Allie Knaus, Tess Rademaker, Thomas G. Almonroeder

Abstract

Background

Female runners that habitually use a forefoot/midfoot strike pattern (non-rearfoot runners) may be at greater risk for Achilles tendinopathy compared to runners that habitually use a rearfoot strike pattern. Differences in Achilles tendon loading between non-rearfoot and rearfoot strike runners may be a contributing factor.

Research Question

Our purpose was to determine if there were differences in Achilles tendon loading and cross-sectional area between female habitual rearfoot and non-rearfoot strike runners.

Methods

Thirty-five female runners participated in this cross-sectional study (17 rearfoot strike runners, 18 non-rearfoot strike runners). Ultrasound images of the Achilles tendon were used to measure cross-sectional area. Kinematic and kinetic data were collected at a set running speed and used in a muscloskeletal model to calculate Achilles tendon force. Achilles tendon stress was determined from specific Achilles tendon cross-sectional area. Principal components (PC) analysis was performed to identify/characterize the primary sources of variability in the Achilles tendon stress time series. The PC scores and cross-sectional area where compared using independent t-tests.

Results

PC 1 reflected variability in the Achilles tendon stress magnitude from 25-100% of stance, PC 2 reflected timing variability, and PC 3 reflected variability in the magnitude during early stance (0-25%). The non-rearfoot strike runners demonstrated higher PC scores for PC 1 and PC 3 compared to the rearfoot strike runners. This reflected greater Achilles tendon stress during mid/late stance (PC 1) and early stance (PC 3) for the non-rearfoot strike runners. For PC 2, there was a trend toward higher PC scores in the non-rearfoot strike runners. Achilles tendon cross-sectional area for the rearfoot and non-rearfoot strike runners were not different.

Significance

Habitual non-rearfoot strike runners did not have greater cross-sectional area despite higher Achilles tendon loading, which may pose a higher risk for Achilles tendinopathy.

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Transitioning from the level surface to stairs in children with and without Down syndrome: Motor strategy and anticipatory locomotor adjustments

Publication date: Available online 12 September 2018

Source: Gait & Posture

Author(s): Huaqing Liang, Xiang Ke, Jianhua Wu

Abstract

Background

Children with Down syndrome (DS) show underdeveloped motor strategy and anticipatory locomotor adjustments (ALA) before crossing an obstacle. Stairs presents another important setting to study environment navigation and motor adaptation. Inclusion of external ankle load is often used to perturb the stability of a system and observe the emergence of new patterns.

Research question

How do stair height and external ankle load affect motor strategy and ALA in 5-to-11-year-old children with typical development (TD) and with DS when approaching the stairs?

Methods

Fourteen children with DS and 14 age- and sex-matched children with TD participated in the study. They walked along a 5-meter walkway and ascended 3-step staircases. There were three staircases (low, moderate, and high heights) and 2 loading conditions (no load and ankle load). A 3D motion capture system was used to collect data. Motor strategy was coded for each trial. Step length, width, time, and velocity, minimum toe clearance, and horizontal toe velocity were calculated for the last four steps before stair ascent. Mixed ANOVAs with repeated measures were conducted for statistical analysis.

Results

The TD group walked up all the stairs, while the DS group displayed a strategy shift from walking to crawling when the stairs became higher. While the TD group maintained the values of most spatiotemporal variables, the DS group continuously decreased step length and velocity but not step width over the last four approaching steps. Ankle load decreased step length, step velocity, minimum toe clearance, and horizontal toe velocity in the DS group, to a greater extent, than in the TD group.

Significance

Children with DS show underdeveloped motor strategy and ALA when approaching the stairs, and external ankle load further disrupts these patterns. Stair negotiation appears to be an effective assessment tool for evaluating motor adaptation in children with DS.

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Cognitive function impacts gait, functional mobility and falls in Fragile X-Associated Tremor/Ataxia Syndrome

Publication date: Available online 12 September 2018

Source: Gait & Posture

Author(s): Joan A. O’Keefe, Erin E. Robertson, Bichun Ouyang, Danielle Carnes, Andrew McAsey, Yuanqing Liu, Maija Swanson, Bryan Bernard, Elizabeth Berry-Kravis, Deborah A. Hall

Abstract

Background

Executive function and information processing speed deficits occur in fragile X premutation carriers (PMC) with and without fragile X-associated tremor/ataxia syndrome (FXTAS). Gait is negatively impacted by cognitive deficits in many patient populations resulting in increased morbidity and falls but these relationships have not been studied in FXTAS.

Research question

We sought to investigate the associations between executive function and information processing speed and gait, turning and falls in PMC with and without FXTAS compared to healthy controls.

Methods

Global cognition and the cognitive domains of information processing speed, attention, response inhibition, working memory and verbal fluency were tested with a neuropsychological test battery in 18 PMC with FXTAS, 15 PMC without FXTAS, and 27 controls. An inertial sensor based instrumented Timed Up and Go was employed to test gait, turns and functional mobility.

Results

Lower information processing speed was significantly associated with shorter stride length, reflecting slower gait speed, in PMC with FXTAS (p = 0.0006) but not PMC without FXTAS or controls. Lower response inhibition was also significantly associated with slower turn-to-sit times in PMC with FXTAS (p = 0.034) but not in those without FXTAS or controls. Lower information processing speed (p = 0.012) and working memory (p = 0.004), were significantly correlated with a greater number of self-reported falls in the past year in FXTAS participants.

Significance

This is the first study demonstrating that worse executive function and slower information processing speed is associated with reduced gait speed and functional mobility, as well as with a higher retrospective fall history in participants with FXTAS. This information may be important in the design of cognitive and motor interventions for this neurodegenerative disorder.

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The Effects of Habitual Foot Strike Patterns on Achilles Tendon Loading in Female Runners

Publication date: Available online 12 September 2018

Source: Gait & Posture

Author(s): Thomas W. Kernozek, Allie Knaus, Tess Rademaker, Thomas G. Almonroeder

Abstract

Background

Female runners that habitually use a forefoot/midfoot strike pattern (non-rearfoot runners) may be at greater risk for Achilles tendinopathy compared to runners that habitually use a rearfoot strike pattern. Differences in Achilles tendon loading between non-rearfoot and rearfoot strike runners may be a contributing factor.

Research Question

Our purpose was to determine if there were differences in Achilles tendon loading and cross-sectional area between female habitual rearfoot and non-rearfoot strike runners.

Methods

Thirty-five female runners participated in this cross-sectional study (17 rearfoot strike runners, 18 non-rearfoot strike runners). Ultrasound images of the Achilles tendon were used to measure cross-sectional area. Kinematic and kinetic data were collected at a set running speed and used in a muscloskeletal model to calculate Achilles tendon force. Achilles tendon stress was determined from specific Achilles tendon cross-sectional area. Principal components (PC) analysis was performed to identify/characterize the primary sources of variability in the Achilles tendon stress time series. The PC scores and cross-sectional area where compared using independent t-tests.

Results

PC 1 reflected variability in the Achilles tendon stress magnitude from 25-100% of stance, PC 2 reflected timing variability, and PC 3 reflected variability in the magnitude during early stance (0-25%). The non-rearfoot strike runners demonstrated higher PC scores for PC 1 and PC 3 compared to the rearfoot strike runners. This reflected greater Achilles tendon stress during mid/late stance (PC 1) and early stance (PC 3) for the non-rearfoot strike runners. For PC 2, there was a trend toward higher PC scores in the non-rearfoot strike runners. Achilles tendon cross-sectional area for the rearfoot and non-rearfoot strike runners were not different.

Significance

Habitual non-rearfoot strike runners did not have greater cross-sectional area despite higher Achilles tendon loading, which may pose a higher risk for Achilles tendinopathy.

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Transitioning from the level surface to stairs in children with and without Down syndrome: Motor strategy and anticipatory locomotor adjustments

Publication date: Available online 12 September 2018

Source: Gait & Posture

Author(s): Huaqing Liang, Xiang Ke, Jianhua Wu

Abstract

Background

Children with Down syndrome (DS) show underdeveloped motor strategy and anticipatory locomotor adjustments (ALA) before crossing an obstacle. Stairs presents another important setting to study environment navigation and motor adaptation. Inclusion of external ankle load is often used to perturb the stability of a system and observe the emergence of new patterns.

Research question

How do stair height and external ankle load affect motor strategy and ALA in 5-to-11-year-old children with typical development (TD) and with DS when approaching the stairs?

Methods

Fourteen children with DS and 14 age- and sex-matched children with TD participated in the study. They walked along a 5-meter walkway and ascended 3-step staircases. There were three staircases (low, moderate, and high heights) and 2 loading conditions (no load and ankle load). A 3D motion capture system was used to collect data. Motor strategy was coded for each trial. Step length, width, time, and velocity, minimum toe clearance, and horizontal toe velocity were calculated for the last four steps before stair ascent. Mixed ANOVAs with repeated measures were conducted for statistical analysis.

Results

The TD group walked up all the stairs, while the DS group displayed a strategy shift from walking to crawling when the stairs became higher. While the TD group maintained the values of most spatiotemporal variables, the DS group continuously decreased step length and velocity but not step width over the last four approaching steps. Ankle load decreased step length, step velocity, minimum toe clearance, and horizontal toe velocity in the DS group, to a greater extent, than in the TD group.

Significance

Children with DS show underdeveloped motor strategy and ALA when approaching the stairs, and external ankle load further disrupts these patterns. Stair negotiation appears to be an effective assessment tool for evaluating motor adaptation in children with DS.

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Cognitive function impacts gait, functional mobility and falls in Fragile X-Associated Tremor/Ataxia Syndrome

Publication date: Available online 12 September 2018

Source: Gait & Posture

Author(s): Joan A. O’Keefe, Erin E. Robertson, Bichun Ouyang, Danielle Carnes, Andrew McAsey, Yuanqing Liu, Maija Swanson, Bryan Bernard, Elizabeth Berry-Kravis, Deborah A. Hall

Abstract

Background

Executive function and information processing speed deficits occur in fragile X premutation carriers (PMC) with and without fragile X-associated tremor/ataxia syndrome (FXTAS). Gait is negatively impacted by cognitive deficits in many patient populations resulting in increased morbidity and falls but these relationships have not been studied in FXTAS.

Research question

We sought to investigate the associations between executive function and information processing speed and gait, turning and falls in PMC with and without FXTAS compared to healthy controls.

Methods

Global cognition and the cognitive domains of information processing speed, attention, response inhibition, working memory and verbal fluency were tested with a neuropsychological test battery in 18 PMC with FXTAS, 15 PMC without FXTAS, and 27 controls. An inertial sensor based instrumented Timed Up and Go was employed to test gait, turns and functional mobility.

Results

Lower information processing speed was significantly associated with shorter stride length, reflecting slower gait speed, in PMC with FXTAS (p = 0.0006) but not PMC without FXTAS or controls. Lower response inhibition was also significantly associated with slower turn-to-sit times in PMC with FXTAS (p = 0.034) but not in those without FXTAS or controls. Lower information processing speed (p = 0.012) and working memory (p = 0.004), were significantly correlated with a greater number of self-reported falls in the past year in FXTAS participants.

Significance

This is the first study demonstrating that worse executive function and slower information processing speed is associated with reduced gait speed and functional mobility, as well as with a higher retrospective fall history in participants with FXTAS. This information may be important in the design of cognitive and motor interventions for this neurodegenerative disorder.

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Endoscopic resection of a chorda tympani schwannoma: A novel approach for an exceedingly rare entity.

Endoscopic resection of a chorda tympani schwannoma: A novel approach for an exceedingly rare entity.

Laryngoscope. 2018 Sep 12;:

Authors: Schwam ZG, Kaul VZ, Wanna GB

Abstract
We present a novel approach for a rare chorda tympani schwannoma. A case report as well as special considerations in all phases of care are reviewed. Laryngoscope, 2018.

PMID: 30208237 [PubMed - as supplied by publisher]

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Vestibular-related eye movements in the rat following selective electrical stimulation of the vestibular sensors.

Related Articles

Vestibular-related eye movements in the rat following selective electrical stimulation of the vestibular sensors.

J Comp Physiol A Neuroethol Sens Neural Behav Physiol. 2018 Sep 11;:

Authors: Hitier M, Sato G, Zhang YF, Zheng Y, Besnard S, Smith PF

Abstract
Rats are the most commonly used species in the neurosciences; however, little is known about the effects of selective electrical stimulation of individual vestibular sensors, on their eye movements. This limits their use to study the effects of vestibular stimulation on the brain, and their use in further exploring novel technologies such as artificial vestibular implants. We describe the effects of electrical stimulation of each vestibular sensor on vestibular-related eye movement in rats and compared the results to other species. We demonstrated that each sensor is responsible for specific bilateral eye movements. We found that the eye movements in rats differed from other species. Although the results were similar when stimulating the horizontal canal ampulla, differences appeared when stimulating the vertical canal sensors. During utricular stimulation, the ipsilateral eye moved dorsally in most cases, while the contralateral eye usually moved either caudally, or in extorsion. Saccular stimulation usually moved the ipsilateral eye dorsally or ventrally, while the contralateral eye usually moved ventrally or caudally. This study provides the first data on the application of selective electrical vestibular stimulation in the rat to the study of vestibular-related eye movements.

PMID: 30206680 [PubMed - as supplied by publisher]

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Endoscopic resection of a chorda tympani schwannoma: A novel approach for an exceedingly rare entity.

Endoscopic resection of a chorda tympani schwannoma: A novel approach for an exceedingly rare entity.

Laryngoscope. 2018 Sep 12;:

Authors: Schwam ZG, Kaul VZ, Wanna GB

Abstract
We present a novel approach for a rare chorda tympani schwannoma. A case report as well as special considerations in all phases of care are reviewed. Laryngoscope, 2018.

PMID: 30208237 [PubMed - as supplied by publisher]

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Vestibular-related eye movements in the rat following selective electrical stimulation of the vestibular sensors.

Related Articles

Vestibular-related eye movements in the rat following selective electrical stimulation of the vestibular sensors.

J Comp Physiol A Neuroethol Sens Neural Behav Physiol. 2018 Sep 11;:

Authors: Hitier M, Sato G, Zhang YF, Zheng Y, Besnard S, Smith PF

Abstract
Rats are the most commonly used species in the neurosciences; however, little is known about the effects of selective electrical stimulation of individual vestibular sensors, on their eye movements. This limits their use to study the effects of vestibular stimulation on the brain, and their use in further exploring novel technologies such as artificial vestibular implants. We describe the effects of electrical stimulation of each vestibular sensor on vestibular-related eye movement in rats and compared the results to other species. We demonstrated that each sensor is responsible for specific bilateral eye movements. We found that the eye movements in rats differed from other species. Although the results were similar when stimulating the horizontal canal ampulla, differences appeared when stimulating the vertical canal sensors. During utricular stimulation, the ipsilateral eye moved dorsally in most cases, while the contralateral eye usually moved either caudally, or in extorsion. Saccular stimulation usually moved the ipsilateral eye dorsally or ventrally, while the contralateral eye usually moved ventrally or caudally. This study provides the first data on the application of selective electrical vestibular stimulation in the rat to the study of vestibular-related eye movements.

PMID: 30206680 [PubMed - as supplied by publisher]

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New Test Promises Safer Diagnosis of Dizziness

​Researchers have developed a new test for dizziness that poses less risk for hearing damage, as compared with the commonly used clinical test. Using bone conduction technology, Professor Bo Håkansson and colleagues at the Chalmers University of Technology in Sweden, created a behind-the-ear testing device that is safer and more efficient, especially for patients who already have hearing problems. 

Today, balance-related problems are typically diagnosed using vestibular-evoked myogenic potentials (VEMPs) test. However, this test uses high sound levels that may damage hearing. In fact, VEMPs have been associated with a high risk for noise-induced hearing loss, a concern that captured the attention of study lead, Professor Håkansson.

"I knew about the challenges with VEMP using air-conducted (AC) sound and when I understood from early publications that bone conduction (BC) may have some advantages, I became interested," said Håkansson.       

When asked about what inspired this idea, he shared: "I have been working with bone conduction applications since the 1980 ties. I have developed the BAHA (my Ph.D. project) and bone conduction implant concepts as well as the B81 for audiometric testing, so I am always open to new ideas for our technology. When I understood that B71 and that the Minishaker B&K 4810 had some other challenges, I came to the idea to modify the B81 to better adapt to BC-VEMP testing at 250 Hz, which had not been used before (my idea to use 250 Hz is based on both technical and physiological aspects."

This novel device is placed behind a patient's ear, where it transforms sound waves into vibrations through the skull, thereby inciting the cochlea inside the ear.

"The first prototype tested on our selves was surprisingly positive, so I applied for a bigger research grant that was approved. This first study is now published in Dove with very positive results," Håkansson noted.

Details of the prototype are discussed in the group's recently published study, "VEMP Using a New Low-Frequency Bone Conduction Transducer."

Compared with the standard VEMP tests, this device promises significant advantages for clinical assessment as well as patient safety.

"If we compare with AC stimuli, this method using BC at 250 Hz seems to be more efficient and require significantly less sound load, making it possible to measure VEMP in patients who have a conduction hearing loss," Håkansson said.

He explained that a missing VEMP response using air conduction can be due to either vestibular nerve issues or hearing loss, which in the latter case would make it practically impossible to measure VEMP.

"If you compare with previously used BC stimuli using the B71/81, they are not strong enough to produce reliable VEMP responses below 500 Hz. The option to the Minishaker, which is very clumsy and must be applied handheld (a vibration device developed form general structural dynamic testing), is not as strong as our new B250 at 250 Hz simply because of its wideband design. The B250 can be much smaller (actually 30 times smaller than the Minishaker) as it is based on a resonance design optimized for 250 Hz," he explained further.

So, what's the next step before this technology becomes available to clinicians?

"We are soon to start clinical studies using the B250 on a wider group of subjects, both on normal subjects, to gain normative data and patients with different vestibular disorders in order to determine the sensitivity and specificity of this method using the B250," said Håkansson.​

Published: 9/12/2018 2:12:00 PM

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New Test Promises Safer Diagnosis of Dizziness

​Researchers have developed a new test for dizziness that poses less risk for hearing damage, as compared with the commonly used clinical test. Using bone conduction technology, Professor Bo Håkansson and colleagues at the Chalmers University of Technology in Sweden, created a behind-the-ear testing device that is safer and more efficient, especially for patients who already have hearing problems. 

Today, balance-related problems are typically diagnosed using vestibular-evoked myogenic potentials (VEMPs) test. However, this test uses high sound levels that may damage hearing. In fact, VEMPs have been associated with a high risk for noise-induced hearing loss, a concern that captured the attention of study lead, Professor Håkansson.

"I knew about the challenges with VEMP using air-conducted (AC) sound and when I understood from early publications that bone conduction (BC) may have some advantages, I became interested," said Håkansson.       

When asked about what inspired this idea, he shared: "I have been working with bone conduction applications since the 1980 ties. I have developed the BAHA (my Ph.D. project) and bone conduction implant concepts as well as the B81 for audiometric testing, so I am always open to new ideas for our technology. When I understood that B71 and that the Minishaker B&K 4810 had some other challenges, I came to the idea to modify the B81 to better adapt to BC-VEMP testing at 250 Hz, which had not been used before (my idea to use 250 Hz is based on both technical and physiological aspects."

This novel device is placed behind a patient's ear, where it transforms sound waves into vibrations through the skull, thereby inciting the cochlea inside the ear.

"The first prototype tested on our selves was surprisingly positive, so I applied for a bigger research grant that was approved. This first study is now published in Dove with very positive results," Håkansson noted.

Details of the prototype are discussed in the group's recently published study, "VEMP Using a New Low-Frequency Bone Conduction Transducer."

Compared with the standard VEMP tests, this device promises significant advantages for clinical assessment as well as patient safety.

"If we compare with AC stimuli, this method using BC at 250 Hz seems to be more efficient and require significantly less sound load, making it possible to measure VEMP in patients who have a conduction hearing loss," Håkansson said.

He explained that a missing VEMP response using air conduction can be due to either vestibular nerve issues or hearing loss, which in the latter case would make it practically impossible to measure VEMP.

"If you compare with previously used BC stimuli using the B71/81, they are not strong enough to produce reliable VEMP responses below 500 Hz. The option to the Minishaker, which is very clumsy and must be applied handheld (a vibration device developed form general structural dynamic testing), is not as strong as our new B250 at 250 Hz simply because of its wideband design. The B250 can be much smaller (actually 30 times smaller than the Minishaker) as it is based on a resonance design optimized for 250 Hz," he explained further.

So, what's the next step before this technology becomes available to clinicians?

"We are soon to start clinical studies using the B250 on a wider group of subjects, both on normal subjects, to gain normative data and patients with different vestibular disorders in order to determine the sensitivity and specificity of this method using the B250," said Håkansson.​

Published: 9/12/2018 2:12:00 PM

from #Audiology via ola Kala on Inoreader https://ift.tt/2QnaSrj
via IFTTT