摘要:

HypothesisPatients with unilateral conductive hearing impairment often experience a great advantage in improved hearing thresholds after reconstructive ear surgery because the binaural hearing leads to increased speech recognition in competing noise. The aim of this study was to develop a clinical audiometric test to quantify the ability of speech recognition in background noise preoperatively and postoperatively.MethodsA model consisting of phonetically balanced (PB) monosyllabic words and/or a just-follow-conversation test (JFC) was used in 16 normal-hearing listeners. In 8 of the participants, JFC at two levels of background noise (60 and 40 dB sound pressure level) was used as the only method. The tasks were performed in an anechoic chamber with varying spatial separations of speech and noise sources under free field conditions. The tests were made binaurally and monaurally; the latter condition was achieved by occluding one ear with a hearing protector. In PB word tests, the percent of correctly repeated words was scored. In the JFC task, the speech signal was adjusted by the listener to a level where he or she could just understand what was being said. This was expressed as a signal-to-noise (S/N) ratio.ResultsIn both types of tests, the subjects achieved significantly better speech recognition scores in the binaural situations. In summary, compared with monaural conditions, the subjects achieved 17% to 18% better speech recognition in PB tests, and in JFC tests a 2-to 3-dB lower S/N ratio in binaural conditions.ConclusionThese free field tests can be developed further as a clinical tool preoperatively and postoperatively to evaluate the effect of binaural hearing after ear surgery.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo evaluate the reliability of the Speech Intelligibility Rating scale to monitor the speech intelligibility of deaf children who have received cochlear implants.Study DesignA prospective study assessing the speech intelligibility of deaf children with cochlear implants by local and cochlear implant program speech and language therapists.SettingPediatric tertiary referral center for cochlear implantation.Patients and MethodsFifty-four children were each rated by two speech and language therapists, one working with the child locally and the other working with the child at the cochlear implant program. All children were between 1.2 and 10.9 years of age at the time of implantation (median, 4.0 years). The follow-up intervals ranged from before implantation to 9 years after implantation.Main Outcome MeasureCorrelation coefficient, intraclass correlation coefficient, and kappa statistics were used to assess the interobserver reliability of the Speech Intelligibility Rating scale.ResultsSpearman rank correlation coefficient and intraclass correlation coefficient were 0.82 with high statistical significance (p < 0.00001). Kappa statistical analysis revealed a moderate to substantial agreement between the ratings. This agreement also reached a high statistical significance (overall &kgr; = 0.53, p < 0.000001). The Speech Intelligibility Rating scale was found to be able to discriminate speech intelligibility among subjects, and the ratings covaried with high consistency.ConclusionThe study found a high rate of agreement between observers when they used the Speech Intelligibility Rating scale to assess the speech intelligibility of deaf children after cochlear implantation. Because the scale presents information in a format that is understood by parents, local professionals, and health care purchasers, it will be useful to provide them with accessible information on speech intelligibility outcomes of deaf children who have received cochlear implants.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo determine the relationship between stimulation rate and adaptation in cochlear implant users.Study DesignA prospective clinical study.SettingThis study was conducted at Hacettepe University Medical Faculty, which is a tertiary care and cochlear implant center in Ankara, Turkey.PatientsSeven patients (three women, four men) who were using Nucleus CI 24 M cochlear implants (Cochlear Corp., Lane Cove, NSW, Australia). Two of them had become deaf after developing language skills, and five had congenitally deafness.ResultsSix patients demonstrated no tone decay. Only one patient, who had congenital hearing loss, demonstrated tone decay at stimulation rates of 250, 500, 720, 900 pulses per second. There is no statistically significant relationship between the stimulation rate and the selected electrode.ConclusionThe majority of the cochlear implant patients sustained the perception of a continuous electrical signal for 1 minute at 5 to 10 current levels above threshold.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo study the results of petrosal bone imaging and audiometric long-term follow-up of two patients with branchio-oto-renal (BOR) syndrome and relate them to the clinical features, including caloric responses.Study DesignLongitudinal case study.SettingTertiary referral center.PatientsA father and son with the BOR syndrome.Main Outcome MeasuresBoth patients underwent imaging studies to detect and evaluate inner ear anomalies. Longitudinal audiometric analysis of the hearing threshold data over the previous 23 years was performed. Caloric tests were performed at various ages.ResultsThe son had a short, wide internal acoustic canal, a hypoplastic cochlea, a plump vestibule, and a wide vestibular aqueduct on both sides; the semicircular canals and endolymphatic sac were of normal size. He showed progressive fluctuant sensorineural hearing loss. Caloric tests disclosed hyporeflexia on the left side. The father had a plump internal acoustic canal and hypoplastic cochlea on both sides. The left vestibule was hypoplastic, and the left vestibular aqueduct was marginally enlarged. He showed severe hearing impairment, without substantial progression or fluctuation, and caloric areflexia on the left side.ConclusionThese findings suggest a correlation between progressive fluctuant sensorineural hearing loss with caloric hypofunction and the presence of an enlarged vestibular aqueduct in the BOR syndrome. Additional longitudinal case studies are needed to further evaluate such a correlation.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo discuss the various symptoms and causes of objective tinnitus in children.Study DesignRetrospective case review.PatientsFive children who had audible signals emanating from their ears caused by audible spontaneous otoacoustic emissions, palatal myoclonus, arteriovenous malformation, and acoustic trauma.Main Outcome MeasureThe tinnitus reported by the patients was linked to acoustic signals that could be measured objectively or heard by the examiner.ResultsFour of the five children had essentially normal hearing. The one child who demonstrated a hearing loss audiometrically was thought to have normal hearing sensitivity, but his intense roaring objective tinnitus appeared to mask his low-frequency thresholds. All five patients had measurable acoustic signals in the ear canal that matched the patients' descriptions of their tinnitus.ConclusionThe cases illustrate how the objective tinnitus was diagnosed and measured, how a treatment algorithm was applied, and the expected results of treatment. In addition, the cases provide support for the use of psychologic counseling throughout the examination and treatment of objective tinnitus in children.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe authors describe symptoms and population characteristics in subjects who can modulate the loudness and/or pitch of their tinnitus by eye movements.Study DesignData were obtained by questionnaire.SettingThe study was conducted at a university center and a tertiary care center.PatientsRespondents had the self-reported ability to modulate their tinnitus with eye movements.ResultsNinety-one subjects reported having gaze-evoked tinnitus after posterior fossa surgery involving the eighth nerve. Eighty-seven of them underwent removal of a vestibular schwannoma (acoustic neuroma), two had bilateral eighth nerve tumors (one underwent bilateral tumor removal; the other unilateral tumor removal), one underwent removal of a cholesteatoma, and one underwent removal of a glomus jugulare tumor. Seventeen subjects who had never had posterior fossa surgery reported gaze-evoked tinnitus. Of those with vestibular schwannomas, tumor size ranged from small (<2 cm) to large (>4 cm). The gender distribution was 48.3% male and 51.7% female. In 77% of patients, the gaze-evoked tinnitus was localized to the surgical ear or side of head; 21.8% had bilateral tinnitus that was louder in the surgical ear or side of head. In 86 of 87 subjects, loudness of tinnitus changed with eye movement. Eye movement away from the central (eyes centered) position increased the loudness of tinnitus in all 86 subjects who responded to this question. Seventy-three of 85 (85.9%) patients indicated that pitch changed with eye movement, with pitch increasing in 64/72 (88.9%) of them. Eighty-three of 87 (95.4%) patients reported total loss of hearing in the surgical ear. Seventy of 83 (84.3%) patients reported facial nerve problems immediately after surgery, 52 of 87 (60%) reported persistent facial weakness, and 16 of 87 (18.4%) patients reported persistent double vision. In those 17 subjects with gaze-evoked tinnitus and no posterior fossa surgery, the majority of respondents (14/17, 82.4%) were male.ConclusionsGaze-evoked tinnitus after cerebellar pontine angle surgery is more common than was previously believed. In addition, posterior fossa surgery is not a prerequisite for the development of gaze-evoked tinnitus. It is likely that gaze-evoked tinnitus is a manifestation of functional reorganization. Gaze-evoked tinnitus could result from an unmasking of brain regions that respond to multiple stimulus/response modalities, and/or from anomalous cross-modality interactions, perhaps caused by collateral sprouting.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

HypothesisThe aim of this study was to create a more dynamic animal model of Ménière's disease combining multiple causes, such as the role of endocrine factors and endolymphatic sac dysfunction, that may mimic the fluctuant characteristics of Ménière's disease.BackgroundEndolymphatic hydrops remains to be considered a pathologic substrate in the etiology of Ménière's disease. The classic guinea pig model of inducing hydrops by total destruction of the endolymphatic sac is a nonphysiologic rigid model of Ménière's disease.MethodsThe authors developed the two-phase endolymphatic hydrops model by inducing hydrops by mild chronic endolymphatic sac dysfunction, in combination with increased endolymph production by aldosterone. Sensory cell damage was evaluated by low-voltage field emission scanning microscopy.ResultsThis study describes a wide spectrum of morphologic effects of the outer hair cells in radial gradients, in which most effects were observed in the third to second row of outer hair cells, and longitudinal gradients in which the most severe effects were observed in the apical turns. Most affected were the ears that underwent distal endolymphatic sac dissection followed by the administration of aldosterone. Damaging effects proceeded from degeneration and absence of short stereocilia of outer hair cells and even some inner hair cells in the apical turns, to stereociliary disarrangement and atrophy, followed by degeneration and absence of outer hair cells, which were replaced by supporting cells.ConclusionThe two-phase endolymphatic hydrops model seems to represent a functional model that may mimic the fluctuant characteristics of Ménière's disease and emphasizes the influence of multiple and coexisting hydrops-inducing influences.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveDetermine whether subjects with documented vestibular ototoxicity recover vestibular function and, if so, investigate the recovery dynamics.Study designProspective and retrospective reviews and repeated measures.SettingClinical research and technology center.SubjectsTwenty-eight subjects who received vestibulotoxic medications were followed for at least 12 months after initial treatment.ControlsOur subject sample was compared with a published database of normal individuals.InterventionsAll 28 subjects received systemically administered medications known to be ototoxic. The subjects' treating physicians controlled medication, dosage, and administration schedules.Main Outcome MeasuresTests of horizontal canal vestibulo-ocular function were performed. Subjects' auditory and vestibular symptoms were recorded.ResultsEleven subjects (39%) showed changes in horizontal canal vestibulo-ocular gain constant (GC) and/or time constant (TC) consistent with vestibular ototoxicity. When tested 1 year after ototoxic drug administration, eight of the nine subjects who experienced ototoxic decrease in GC showed a recovery of GC to normal limits. Only one of the eight subjects who experienced ototoxic decrease in TC showed recovery of TC to within normal limits. Ototoxicity onset and recovery were independent of baseline vestibular function, and ototoxicity onset did not correlate with cumulative dose of ototoxic medication. There was no relationship between subjective symptoms and ototoxicity onset.ConclusionsRecovery of GC after vestibular ototoxicity is more commonly observed than recovery of TC. Because ototoxic changes developed and continued in an unpredictable time and manner in relation to ototoxic drug administration, we propose that once ototoxic changes in vestibulo-ocular reflex are detected, ototoxic medications should be discontinued as soon as possible.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundThe microscopically small middle ear structures require the otosurgeon to have a steady hand because instrument stability is a critical factor for a successful microsurgical procedure. Hand steadiness is mainly influenced by the tremor movements of the hand. The aim of this study was to measure hand tremor under simulated microsurgical conditions and to estimate the influence of different kinds of physical strain (e.g., physical exertion and hand exercise), as well as food abstinence and coffee consumption. Further, the effect of one-or two-handed manipulation and microsurgical experience was investigated.MethodsThe hand movements of 16 adult subjects were assessed during a defined manual manipulation using a stapes model to simulate microsurgical procedures. A laserinterferometric-based displacement technique was developed to measure tremor amplitude and frequency, as well as maximum displacement, to evaluate the subjects' fine motor skills.ResultsThe mean tremor frequency across all measurements was 8.1 Hz and did not show any dependence on different kinds of physical strain. Two-handed manipulations showed significantly lower tremor amplitudes than one-handed performances. Tremor amplitude and maximum displacement did not change after hand exercise, food abstinence, and coffee consumption. However, after physical exertion, a significant increase in the tremor amplitude was found. Subjects with advanced microsurgical experience showed smaller tremor amplitudes for one-handed runs.ConclusionThe tremor data are interpreted as a recommendation to avoid physical exertion before microsurgery. In cases of absolute necessity for hand steadiness, two-handed manipulations are preferable. Further, hand steadiness might be improved by microsurgical training and experience.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo assess the prevalence of otologic symptoms in patients undergoing surgical decompression for symptomatic Chiari I malformation.Study DesignCross-sectional, prospective, nonrandomized.SettingUrban tertiary referral center.PatientsPatients with Chiari I malformation before surgical intervention.InterventionsNone.Main Outcome MeasureResults of completed questionnaire.ResultsSixteen consecutive patients with Chiari I malformation completed the self-administered questionnaire. Eighty-one percent of patients reported episodic aural fullness, 81% reported tinnitus, 69% reported vertigo, and 56% reported fluctuating hearing loss. Headaches were reported as frequently as aural fullness and tinnitus.ConclusionsMost patients with Chiari I malformation have symptoms that mimic primary otologic pathologic changes. The existence of common pathophysiologic mechanisms is proposed.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID