Evaluation of Vestibular Functions in Patients with Vogt-Koyanagi-Harada Disease

Vogt-Koyanagi-Harada (VKH) disease is an idiopathic, multisystem autoimmune disorder characterized by bilateral, diffuse granulomatous uveitis associated with neurological, audiovestibular, and dermatological manifestations. The purpose of this study is to investigate vestibular functions in patients with VKH disease. A total of 43 patients with VKH disease in Hokkaido University Hospital were enrolled in this study. Subjective symptoms such as dizziness or vertigo and the results of various vestibular examinations including nystagmus testing, caloric testing, and vestibular-evoked myogenic potential (VEMP) testing were investigated. Eight of 42 patients (19.0%) complained of subjective vestibular symptoms. On the other hand, 12 of 28 patients (42.9%) showed nystagmus, and 7 of 15 patients (46.7%) showed unilateral or bilateral weakness in the caloric test. VEMP testing was performed for 16 patients. Seven (43.8%) and 8 (50.0%) patients were evaluated as abnormal in cervical VEMP and ocular VEMP testing, respectively. The rate of detection of nystagmus was significantly higher than that of subjective symptoms. As vestibular dysfunction in patients with VKH disease cannot be detected through history taking alone, nystagmus testing, caloric testing, and VEMP testing should be performed to evaluate vestibular functions associated with VKH disease. It is considered that abnormal VEMP findings are associated with otolith organ dysfunction.
Audiol Neurotol 2017;22:190-195

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How Was Your Otology Training? A Survey of Recent Otolaryngology Residents.

Objective: To survey graduating residents or recent graduates of otolaryngology residency programs to evaluate their Otology/Neurotology (ON) experience in residency and discern if they had received adequate training in time to decide whether to pursue a fellowship in Otology or Neurotology. Study Design: Internet-based survey. Methods: A survey was distributed to all US otolaryngology residency programs to distribute to 5th year residents and recent graduates in last 4 years. The survey assessed satisfaction in ON experience, presence of ON fellows, adequacy of experience to decide on ON fellowship, post-graduate year (PGY) year at which residents observed, performed, and proficiently performed five procedures (tympanoplasty, mastoidectomy, ossiculoplasty, stapedectomy, and cochlear implant), and plan for performing these surgeries in practice. Results: 89/106 (84%) of respondents felt they had adequate training in Otology in time to decide whether or not to pursue a fellowship and were found to observe and perform surgeries significantly earlier in training by PGY including: mastoidectomy (observed PGY 1.9 versus PGY 2.3, performed PGY 2.9 versus PGY 3.5), ossiculoplasty (observed 2.1 versus 3.0, performed 3.6 versus 4.3), stapedectomy (observed 2.3 versus 3.0, performed 3.9 versus 4.5), and cochlear implant (observed 2.1 versus 2.8, performed 3.4 versus 4.1) all p

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Bone-conducted Vestibular-evoked Myogenic Potentials Before and After Stapes Surgery.

Objective: To identify whether stapes surgery causes otolith dysfunction using bone-conducted vestibular-evoked myogenic potentials (VEMPs). Study Design: Prospective study. Setting: Hyogo College of Medicine Hospital. Patients: Twenty primary ears (19 otosclerosis, 1 congenital stapes fixation) in 17 patients (2 men, 15 women; mean age 51 yr, range 20-68 yr) who had normal cervical VEMP (cVEMP) and ocular VEMP (oVEMP) results with bone-conducted stimulation were included. Intervention: Stapes surgery. Main Outcome Measure: Both VEMP tests with bone-conducted stimulation were performed before and after stapes surgery. The normalized p13-n23 amplitude of cVEMPs and the nI-pI amplitude of oVEMPs were measured within 3 months after stapes surgery. Then, the asymmetry ratio (AR) was calculated to examine the effect of surgery on otolith function. Results: Seven patients complained of temporary dizziness postoperatively, but their symptoms disappeared within approximately a week. Deterioration of VEMPs of the operated ear was not seen in any ears. Significantly greater amplitude compared with the opposite ear was found for cVEMP in one ear and oVEMP in two ears after the surgery. Their VEMP results recovered to the normal range at 6 months postoperatively. Conclusions: These findings suggest that stapes surgery causes no or undetectably small otolith dysfunction from the perspective of VEMP evaluation. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Acoustics of Clear and Noise-Adapted Speech in Children, Young, and Older Adults

Purpose

This study investigated acoustic–phonetic modifications produced in noise-adapted speech (NAS) and clear speech (CS) by children, young adults, and older adults.

Method

Ten children (11–13 years of age), 10 young adults (18–29 years of age), and 10 older adults (60–84 years of age) read sentences in conversational and clear speaking style in quiet and in noise. A number of acoustic measurements were obtained.

Results

NAS and CS were characterized by a decrease in speaking rate and an increase in 1–3 kHz energy, sound pressure level (SPL), vowel space area (VSA), and harmonics-to-noise ratio. NAS increased fundamental frequency (F0) mean and decreased jitter and shimmer. CS increased frequency and duration of pauses. Older adults produced the slowest speaking rate, longest pauses, and smallest increase in F0 mean, 1–3 kHz energy, and SPL when speaking clearly. They produced the smallest increases in VSA in NAS and CS. Children slowed down less, increased the VSA least, increased harmonics-to-noise ratio, and decreased jitter and shimmer most in CS. Children increased mean F0 and F1 most in noise.

Conclusions

Findings have implications for a model of speech production in healthy speakers as well as the potential to aid in clinical decision making for individuals with speech disorders, particularly dysarthria.

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Generalized Adaptation to Dysarthric Speech

Purpose

Generalization of perceptual learning has received limited attention in listener adaptation studies with dysarthric speech. This study investigated whether adaptation to a talker with dysarthria could be predicted by the nature of the listener's prior familiarization experience, specifically similarity of perceptual features, and level of intelligibility.

Method

Following an intelligibility pretest involving a talker with ataxic dysarthria, 160 listeners were familiarized with 1 of 7 talkers with dysarthria—who differed from the test talker in terms of perceptual similarity (same, similar, dissimilar) and level of intelligibility (low, mid, high)—or a talker with no neurological impairment (control). Listeners then completed an intelligibility posttest on the test talker.

Results

All listeners benefited from familiarization with a talker with dysarthria; however, adaptation to the test talker was superior when the familiarization talker had similar perceptual features and reduced when the familiarization talker had low intelligibility.

Conclusion

Evidence for both generalization and specificity of learning highlights the differential value of listeners' prior experiences for adaptation to, and improved understanding of, a talker with dysarthria. These findings broaden our theoretical knowledge of adaptation to degraded speech, as well as the clinical application of training paradigms that exploit perceptual processes for therapeutic gain.

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Intelligibility of Noise-Adapted and Clear Speech in Child, Young Adult, and Older Adult Talkers

Purpose

This study examined intelligibility of conversational and clear speech sentences produced in quiet and in noise by children, young adults, and older adults. Relative talker intelligibility was assessed across speaking styles.

Method

Sixty-one young adult participants listened to sentences mixed with speech-shaped noise at −5 dB signal-to-noise ratio. The analyses examined percent correct scores across conversational, clear, and noise-adapted conditions and the three talker groups. Correlation analyses examined whether talker intelligibility is consistent across speaking style adaptations.

Results

Noise-adapted and clear speech significantly enhanced intelligibility for young adult listeners. The intelligibility improvement varied across the three talker groups. Notably, intelligibility benefit was smallest for children's speaking style modifications. Listeners also perceived speech produced in noise by older adults to be less intelligible compared to the younger talkers. Talker intelligibility was correlated strongly between conversational and clear speech in quiet, but not for conversational speech produced in quiet and in noise.

Conclusions

Results provide evidence that intelligibility variation related to age and communicative barrier has the potential to aid clinical decision making for individuals with speech disorders, particularly dysarthria.

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Influence of Altered Auditory Feedback on Oral–Nasal Balance in Speech

Purpose

This study explored the role of auditory feedback in the regulation of oral–nasal balance in speech.

Method

Twenty typical female speakers wore a Nasometer 6450 (KayPentax) headset and headphones while continuously repeating a sentence with oral and nasal sounds. Oral–nasal balance was quantified with nasalance scores. The signals from 2 additional oral and nasal microphones were played back to the participants through the headphones. The relative loudness of the nasal channel in the mix was gradually changed so that the speakers heard themselves as more or less nasal. An additional amplitude control group of 9 female speakers completed the same task while hearing themselves louder or softer in the headphones.

Results

A repeated-measures analysis of variance of the mean nasalance scores of the stimulus sentence at baseline, minimum, and maximum nasal feedback conditions demonstrated a significant effect of the nasal feedback condition. Post hoc analyses found that the mean nasalance scores were lowest for the maximum nasal feedback condition. The scores of the minimum nasal feedback condition were significantly higher than 2 of the 3 baseline feedback conditions. The amplitude control group did not show any effects of volume changes on nasalance scores.

Conclusions

Increased nasal feedback led to a compensatory adjustment in the opposite direction, confirming that oral–nasal balance is regulated by auditory feedback. However, a lack of nasal feedback did not lead to a consistent compensatory response of similar magnitude.

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