Symptoms Associated with Vestibular Impairment in Veterans with Posttraumatic Stress Disorder

by Yaa O. Haber, Helena K. Chandler, Jorge M. Serrador

Posttraumatic stress disorder (PTSD) is a chronic and disabling, anxiety disorder resulting from exposure to life threatening events such as a serious accident, abuse or combat (DSM IV definition). Among veterans with PTSD, a common complaint is dizziness, disorientation and/or postural imbalance in environments such as grocery stores and shopping malls. The etiology of these symptoms in PTSD is poorly understood and some attribute them to anxiety or traumatic brain injury. There is a possibility that an impaired vestibular system may contribute to these symptoms since, symptoms of an impaired vestibular system include dizziness, disorientation and postural imbalance. To our knowledge, this is the first report to describe the nature of vestibular related symptoms in veterans with and without PTSD. We measured PTSD symptoms using the Posttraumatic Stress Disorder Checklist (PCL-C) and compared it to responses on vestibular function scales including the Dizziness Handicap Inventory (DHI), the Vertigo Symptom Scale Short Form (VSS-SF), the Chambless Mobility Inventory (CMI), and the Neurobehavioral Scale Inventory (NSI) in order to identify vestibular-related symptoms. Our findings indicate that veterans with worse PTSD symptoms report increased vestibular related symptoms. Additionally veterans with PTSD reported 3 times more dizziness related handicap than veterans without PTSD. Veterans with increased avoidance reported more vertigo and dizziness related handicap than those with PTSD and reduced avoidance. We describe possible contributing factors to increased reports of vestibular symptoms in PTSD, namely, anxiety, a vestibular component as well as an interactive effect of anxiety and vestibular impairment. We also present some preliminary analyses regarding the contribution of TBI. This data suggests possible evidence for vestibular symptom reporting in veterans with PTSD, which may be explained by possible underlying vestibular impairment, worthy of further exploration.

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Muckle-Wells syndrome in Chinese patients: a single center case series.

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Muckle-Wells syndrome in Chinese patients: a single center case series.

Clin Rheumatol. 2016 Dec 27;:

Authors: Wu D, Shen M

Abstract
Muckle-Wells syndrome (MWS) is a rare autoinflammatory disease. This study aimed to report the clinical features and gene variations of the first case series of MWS patients in Chinese population. Four Han Chinese patients were diagnosed with MWS and followed up at our adult clinic for autoinflammatory diseases. All relevant phenotypes and genotypes were collected. All patients were adult male. The median age of disease onset was 4.5 years, and one patient had adult-onset disease. No positive family history was observed. All patients had a remittent disease course. The duration of fever attacks ranged from 0.5 to 7 days. Skin rashes were present in all patients. The other manifestations included polyarthralgia/arthritis (n = 3), oral ulcers (n = 2), conjunctivitis (n = 2), myalgia (n = 2), headache (n = 2), pharyngitis (n = 1), abdominal pain (n = 1), severe sensorineural hearing loss (n = 1), and chronic meningitis with communicating hydrocephalus (n = 1). None of the patients showed evidence of renal amyloidosis. Each patient carried a heterozygous mutation in an NLRP3 gene, including D29V, V70M, T348M, and Q703K, respectively. D29V and V70M variants were novel mutations in exon 1 of NLRP3. All patients had good response to corticosteroids. Our study suggests that MWS could be identified in Chinese population. Our finding of novel mutations in NLRP3 may expand the diversity of MWS.

PMID: 28028683 [PubMed - as supplied by publisher]

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Voice-Vibratory Assessment With Laryngeal Imaging (VALI) Form: Reliability of Rating Stroboscopy and High-speed Videoendoscopy

Publication date: Available online 28 December 2016
Source:Journal of Voice
Author(s): Bruce J. Poburka, Rita R. Patel, Diane M. Bless
ObjectiveThe purpose of the study was to evaluate the inter-judge and intra-judge reliability of raters using the Voice-Vibratory Assessment with Laryngeal Imaging (VALI) rating form that was developed for assessing videostroboscopy and high-speed videoendoscopic (HSV) recordings.Subjects and MethodsNine speech-language pathologists with an average of 12.8 years of experience with laryngeal imaging were trained to use the VALI form for rating 66 de-identified and randomized samples with voice disorders. Inter-judge reliability for parameters with scale data (amplitude, mucosal wave, nonvibratory portion, supraglottic activity, phase closure, symmetry, and regularity or periodicity) was assessed with intraclass correlations, and parameters with nominal data (glottal closure, vertical level, and free edge contour) were assessed with Fleiss' kappa. Intra-judge reliability was assessed using the Spearman rho statistic for scale data and percentage of concordant pairs for nominal data.ResultsInter-judge reliability for parameters with scale data ranged from 0.57 to 0.96 for stroboscopy and from 0.81 to 0.94 for HSV. For nominal parameters, correlations ranged from 0.18 to 0.35 for stroboscopy and from 0.13 to 0.33 for HSV. Intra-judge reliability correlations for parameters with scale data ranged from 0.19 to 0.87 for stroboscopy and from 0.28 to 0.85 for HSV. For parameters with nominal data, percentage of concordance ranged from 44% to 78% for stroboscopy and from 52% to 89% for HSV.ConclusionsThe VALI rating form and the training protocol is a first, a priori developed rating form that includes visual-perceptual ratings of both stroboscopy and HSV. The current form can be used to make reliable visual-perceptual judgments for selected features of vibratory motion from stroboscopy and HSV.



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The Influence of Vowels on Vocal Fold Dynamics in the Tenor's Passaggio

Publication date: Available online 28 December 2016
Source:Journal of Voice
Author(s): Matthias Echternach, Fabian Burk, Marie Köberlein, Michael Burdumy, Michael Döllinger, Bernhard Richter
IntroductionThe influence of vowels on the frequency region where registration events in male voices usually occur (passaggio) has not yet been clarified. Particularly, for tenors who frequently have to sing across the passaggio, it might be assumed that the vowel quality has an influence on the stability of phonation.MethodsIn this investigation, six professionally trained Western classical tenors performed a glide from A3 (220 Hz) to A4 (440 Hz) and were recorded using high-speed videoendoscopy at 20,000 fps via transnasal flexible endoscopy. The participants produced transitions (1) from modal register to falsetto and (2) from modal register to stage voice above the passaggio on the vowels [aː], [iː], and [uː]. Simultaneously, acoustic and electroglottographic (EGG) signals were recorded. The glottal area waveform (GAW) open quotient (OQ), the EGG OQ, and the sample entropy derived from the EGG were calculated and phonovibrograms were established.ResultsIn comparison to [iː] and [uː], vowel [aː] showed lower values regarding the sample entropy and greater periodicity in the phonovibrograms during the passaggio. For [iː] and [uː], the falsetto showed greater GAW OQ than the stage voice above the passaggio but no great difference for vowel [aː]. There was a good agreement between GAW OQ and EGG OQ for GAW OQ values below .65. However, for values greater than .65, the EGG OQ showed greater disagreement.ConclusionsThe data support the hypothesis that the vowel condition influences the phonatory stability concerning the passaggio, suggesting that vowel [aː] is associated with greater phonation stability.



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Patient Satisfaction by Design.

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Patient Satisfaction by Design.

Semin Hear. 2016 Nov;37(4):316-324

Authors: Jacobs K

Abstract
The concept of the patient experience as it relates to patient satisfaction is a complex dynamic. It is a dynamic that is becoming increasingly more important as patients are faced with multiple choices for their hearing and balance care. As reimbursement and performance policies have become more normative within health care, patient satisfaction has become a metric to measure quality. Patient satisfaction is no longer contained to just the interaction with the audiologist. It extends to the entire experience-the staff, the service, the product, and other factors. Many practices fail to capitalize on one of the primary components of the patient experience-office design. This article discusses the role of evidence-based design in facility planning as it relates to patient satisfaction. It will illustrate how design principles and ideal attributes may be used to send conscious and subconscious cues that will motivate staff, facilitate patient-centered care, and ultimately increase patient satisfaction.

PMID: 28028324 [PubMed]

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Patient Satisfaction by Design.

Related Articles

Patient Satisfaction by Design.

Semin Hear. 2016 Nov;37(4):316-324

Authors: Jacobs K

Abstract
The concept of the patient experience as it relates to patient satisfaction is a complex dynamic. It is a dynamic that is becoming increasingly more important as patients are faced with multiple choices for their hearing and balance care. As reimbursement and performance policies have become more normative within health care, patient satisfaction has become a metric to measure quality. Patient satisfaction is no longer contained to just the interaction with the audiologist. It extends to the entire experience-the staff, the service, the product, and other factors. Many practices fail to capitalize on one of the primary components of the patient experience-office design. This article discusses the role of evidence-based design in facility planning as it relates to patient satisfaction. It will illustrate how design principles and ideal attributes may be used to send conscious and subconscious cues that will motivate staff, facilitate patient-centered care, and ultimately increase patient satisfaction.

PMID: 28028324 [PubMed]

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