Audiologists’ communication behaviour during hearing device management appointments

Objective: The aim of this exploratory study was to describe audiologist communication behaviours during appointments for hearing device monitoring and management before and after participation in counselling skills training. Design: The study used a longitudinal design with three assessment points over 6 months. Study sample: The sample included 10 audiologists and audiology graduate students interacting in a professional setting with their clients. Results: Audiologists reported improvement in their counselling skills from pre-training to follow-up, which was consistent with objective findings that audiologist relative speaking time decreased from pre-training to post-training as well as from pre-training to follow-up. Observer-rated scores of participants’ counselling skills; however, yielded no significant differences across time. Conclusions: Some improvement was noted in audiologists’ counselling behaviour following a 1-day communication skills workshop and continued learning support. It is evident; however, that further training, such as increased training and performance feedback, is needed to maintain and enhance audiologist progress in the various aspects of counselling.     

Surgical and medical complications in different cochlear implant devices

Conclusion: There were no surgery-related complications among the patients in the current study. Positioner and removable magnets have been associated with postoperative problems, and the silicone devices were the only ones found by us to cause foreign body and allergic reactions. Objectives: To evaluate the complication rate in patients who were implanted with cochlear devices manufactured by different companies. Patients and methods: This retrospective study included all the patients who underwent cochlear implantation (138 Nucleus, 105 Med-El and 14 Clarion devices) via the suprameatal approach in our department during 2001–2007 and followed up for at least 18 months. Complications such as magnet displacement, foreign body reaction and protrusion of the positioner were considered as being implant-related. Allergy to implant, cholesteatoma, perforated tympanic membrane, intraoperative cerebrospinal fluid (CSF) leakage, wound breakdown, haematoma or seroma, and vestibular disturbances were considered to be patient-related. Results: Vestibular and wound problems emerged as the most common complications, but there were no significant differences in their rate of occurrence among the various devices. Explantation of the device was required in one case of foreign body reaction, one case of allergy to implant and one case of extrusion of the positioner followed by device failure.     

Development of a new method and device for securing haemostasis during transoral surgery: in vitro and cadaver experiments

The objective of this study is to present cadaver and model experiments of an instrument and technique that may overcome the problems of achieving hemostasis after tonsillectomy and surgery of the tongue base. The safety and the reduced need for microclips in surgeries in these areas can be accomplished by introducing the ligature device, which makes it possible to pass a suture under a blood vessel or other diffuse areas of bleeding with a single movement. This technique may also be applied to operations on the supraglottic larynx, oropharynx and hypopharynx. Utilization in the larynx may be more limited. This new instrument and technique for the ligature device has the potential to be applied successfully in other fields of surgery. The main advantages of this technique are its simplicity and safety.This paper was presented at the 4th ELS Congress in Brussels, 5–7 September 2002     

Hearing devices for children with unilateral hearing loss: Patient- and parent-reported perspectives

ObjectiveManagement of children with unilateral hearing loss is not standardized. The primary goal of this study was to elicit patient- and parent-reported perspectives regarding usage of hearing devices in pediatric UHL and to suggest a basic algorithmic approach to management.MethodsOur tertiary care center recruited families of youth ages 5–19 years with unilateral hearing loss from January 2014 through October 2015. Parents of all youths completed a 36-item survey, and some youth ages 11–19 years participated in hour-long interviews. We assessed patterns of hearing device usage among participants, and performed qualitative data analysis to understand factors considered by youths when deciding whether or not to use a hearing device.ResultsSurvey information was collected for 50 patients. Distribution of hearing loss severity in affected ear was mild 14%, moderate 26%, severe 22%, and profound 38%. The majority of children had sensorineural hearing loss (57%), followed by mixed (32%), and then conductive (11%). 34 children (68%) had tried a hearing device; 20 continued to use the device. Retention rates were similar among children with different degrees of hearing loss: mild 66%, moderate 50%, severe 60%, profound 64%. Sixteen children tried a wireless contralateral routing of signal (CROS) device, and 15 tried a behind-the-ear (BTE) hearing aid. Retention rates for CROS and BTE devices were 69% and 47%, respectively. The most common reason for cessation of use was discomfort, followed by lack of benefit.ConclusionA majority of children with unilateral hearing loss who tried a hearing device continued to use it, and retention rates were similar across all degrees of hearing loss. These findings suggest that personal hearing devices should be included in management protocols.     

Abnormal orientation of Amplatzer PDA device on a chest radiogram masking foreign body aspiration

Foreign body aspiration and consequent atelectasis of the lower lobe of the left lung with rotation of the heart resulted in an unusual radiographic appearance in a young girl who had recently undergone transcatheter closure of a patent arterial duct and coil embolization of an aortopulmonary collateral. The patient's chest radiography, who was originally admitted at a center with no echocardiography availability, was interpreted as showing embolization of one or both devices. Only clinical evaluation and echocardiography confirmed appropriate device position. Subsequently, foreign body aspiration was suspected and confirmed at bronchoscopy, and successfully treated. Atelectasis resolved within few days.     

蓝牙技术与无线调频系统对健听青年人听觉辅助作用的比较

目的 通过比较受试者在噪声环境下使用蓝牙传输系统和无线调频系统(FM系统)的言语识别率改善情况,了解蓝牙传输系统和无线调频系统在听觉辅助作用上的差异.方法 选择听力正常的青年人40名,在信噪比为-5 dB的室内分别测试受试者在不使用听觉辅助装置、使用蓝牙传输系统、使用接收方式为FM接收器的FM系统和使用接收方式为感应线圈的FM系统时的言语识别率,并记录受试者感受.结果 受试者使用蓝牙传输系统、使用感应线圈接收方式的FM系统和使用FM接收器接收方式的FM系统3种情况下的言语识别率分别是78.3%、82.2%、88.1%,均好于未使用听觉辅助装置时44.3%的言语识别率.使用FM系统时的言语识别率好于使用蓝牙传输系统,两者之间的差异有显著性(P＜0.05) 结论蓝牙传输系统和FM系统均具有良好的听觉辅助作用,FM系统的助听效果更好,但从经济角度来看蓝牙传输系统有一定的优势.     

Safe and reliable sound threshold measures with direct vibration of the ossicular chain

OBJECTIVES: The aim of the study was to evaluate the safety and feasibility of piezoelectric malleus vibration audiometer (MVA), which presents micromechanical vibrations to the umbo membranae tympani. STUDY DESIGN: Phase I study performed in a tertiary referral center (University Hospital). METHODS: The coupling rod of the MVA was moved slowly through the outer ear canal toward the eardrum with a micromanipulator. Coupling was completed when the rod tip touched the umbo membranae tympani. Basic audiologic measures of sound threshold obtained with direct stimulation of the malleus are presented. We used MANOVA (multivariate repeated measures ANOVA) to investigate the repeatability of MVA thresholds from one day to the other and when decoupling and retracting the coupling rod 2 mm off the umbo. We also selected the MANOVA to test for unwanted bone-conduction threshold shifts after MVA application. We assessed normality of the data by quantile-quantile plots of the residuals. RESULTS: Twenty-eight male and 10 female subjects with normal hearing, 22.2 to 34.6 years old (median age, 27.2 yr) underwent an examination. Thirty-six subjects underwent MVA, because 2 of the 38 subjects who volunteered for the study have not undergone the procedure due to the external auditory canal anatomy preventing application of the MVA. The results show that it is possible to safely and reliably measure thresholds of direct vibration of the ossicular chain. Using pure tone audiograms, no pure tone bone- and/or air-conduction threshold shifts occurred after the procedure. None of the subjects reported any other ear-related symptoms such as vertigo, tinnitus, or dizziness. Geometric mean vibratory displacements at threshold ranged from 0.55 nm at 250 Hz to 0.03 nm at 6 kHz. MANOVA demonstrated a repeatability of MVA thresholds. CONCLUSION: Malleus vibration audiometry will not allow exact linkage of actual implantable hearing aid. But the present study demonstrates that MVA can provide an audiometric tool for assessing ossicular function and integrity prior to implantation of an electronic hearing amplifier.     

In-ear medical devices for acoustic therapies in tinnitus treatments,state of the art

Cochrane reviews indicate there is very limited support for all forms of sound therapy and cognitive behavioral therapy has the strongest support. American Academy of Otolaryngology (AAO) recently published some guidelines which recommends Cognitive Behavioral Therapy (CBT) for tinnitus intervention, and only indicates that sound therapy should be considered an “option” for intervention.Nevertheless, acoustic therapy could lead to cause changes in the tinnitus perception and has been appreciated by the affected people for years. In the last decades, the use of sound or sound enrichment has become a central part of many tinnitus management programs used by audiologists, whether the intention was to mask tinnitus, suppress tinnitus, or interrupt the tinnitus generating neural activity.Several acoustic therapies have been developed and implemented in the last 40 years, but how can we determine which one is the most effective? We can determine the effects based on the results reported in many research studies, but in those studies are many factors that differ from one study to another, like in-ear medical devices used to apply acoustic therapy for tinnitus treatment.In this article, we review and analyze the different types of in-ear medical devices used in the most recently acoustic therapies in treatments against tinnitus, allowing us to identify the pros and cons. By our analysis, an optimal medical device could be characterized to enhance the application of acoustic therapies and in consequence the global results of the sound therapies that already exist. In this review, it was considered acoustic therapies, the technology implemented in medical devices and the clinical needs.     

Fully implantable hearing device with transducer on the round window as a treatment of mixed hearing loss

Objective

To demonstrate the safety and efficacy of the Otologics Carina Middle Ear Transducer for treatment of mixed hearing loss through a case report.

Methods

A Carina fully implantable device with the MET transducer for conductive applications was implanted in a 48-year-old woman suffering from right mixed hearing loss (mean PTA loss: 80 dB). A facial recess approach was used to access the middle ear. Sclerotic tissue obliterated the stapes footplate so the approach selected was to place the transducer directly on the round window. The mounting bracket was placed on the mastoid and the prosthesis was advanced toward the round window until the Otologics surgical software indicated contact. Effective stimulation of the cochlea was confirmed intraoperatively by ABR monitoring.

Results

Postoperative unaided PTA thresholds were unchanged after surgery. When the implant was activated, the mean PTA functional gain was 39 dB.

Discussion-conclusion

The capability of the Carina MET Ossicular stimulator to provide appropriate gain relative to the degree of hearing loss indicates that the device offers a viable treatment option for mixed hearing loss. However, these promising initial results establish the need for future work on two fronts: (1) further studies are needed including a greater number of patients to confirm these preliminary results; (2) a long term follow-up must be carried out to detect any possible cochlear adverse effects on the cochlea, in particular on the basilar membrane.     

Magnetic resonance imaging compatibility and safety of the SOUNDTEC Direct System

OBJECTIVE/HYPOTHESIS: The purpose of this study was to evaluate magnetic resonance imaging (MRI) compatibility and safety of an electromagnetic implanted hearing device (the SOUNDTEC Direct System; SOUNDTEC, Inc., Oklahoma City, OK) implant during a 0.3-Tesla open MRI imaging examination of the head and neck and to develop an MRI protocol that maximizes patient safety while minimizing the need for implant removal. The current literature regarding MRI compatibility of implantable hearing devices was reviewed. STUDY DESIGN: Linear and torsional forces, heating, and implant magnetization were evaluated in vitro. Implanted fresh-frozen human temporal bones were used to evaluate image distortion. A prospective study of 11 volunteers previously implanted with the SOUNDTEC Direct System was conducted to evaluate MRI compatibility and safety. A MEDLINE search of the literature between 1980 and July 2005 was reviewed to summarize MRI compatibility testing of implantable hearing devices. METHODS: Torsional and linear forces experienced by eight implant magnets were measured using calibrated neurologic Von Frey Hairs and compared with finite element analysis predictions as well as forces required to separate the incudostapedial joints of 12 fresh-frozen human temporal bones. Implant heating was determined by measuring the temperature change of eight implant vials compared with saline controls immediately after a head MRI scan. Implant magnetization was evaluated after repeated exposure to a 0.3-Tesla magnetic field. An 11-patient prospective study was performed to evaluate MRI compatibility in a 0.3-Tesla open MRI environment using adult volunteers previously implanted with the SOUNDTEC Direct System. A modified MRI protocol was developed to maximize patient safety. Each individual underwent an audiometric and otologic examination immediately before and after MRI. RESULTS: Peak linear force at the MRI entry measured 0.5 g +/- 0.2 standard deviation (SD). Maximum torque occurred at isocenter and measured 11.4 g-cm +/- 1.2 SD. The mean torque required to separate the incudostapedial joint was 33.8 g-cm +/- 20.4 SD. The average increase in temperature of the eight implant vials was 0.45 degrees C +/- 0.11 SD, whereas the increase in temperature of the three saline controls measured 0.47 degrees C +/- 0.11 SD. The average change in magnetic flux density of the 14 implant magnets tested was 22.0 gauss. Maximum image distortion occurred during the gradient echo sequence and measured 8.6 cm in diameter with a volume of 5,096 mm. Eleven patients completed a total of 12 head, one shoulder, and three lumbar 0.3-Tesla open MRI scans without patient- or device-related complications other than degradation of the MR image. There was no report of discomfort, tinnitus, dizziness, change in hearing, or change in device performance. All post-MRI changes in pure-tone thresholds, speech discrimination, soundfield thresholds, and aided soundfield thresholds were within the range of test-retest variability. CONCLUSION: When considering MRI of implantable ferromagnetic hearing devices, issues related to mechanical forces, implant heating, current induction, implant demagnetization, image degradation, and acoustic trauma must be considered. The SOUNDTEC Direct System is both MRI-compatible and safe in a 0.3-Tesla open MRI environment when a modified protocol is used. Degradation of the head MRI image may impair visualization of the ipsilateral temporal bone and adjacent structures within a 2.5- to 4.3-cm radius of the implant and is minimized by using a fast spin echo sequence.     

Bone conductive implantation in asymmetric hearing loss (AHL)

Abstract

Background: Bone conductive implants (BCI) represent one possible solution for rehabilitation of single-sided deafness (SSD).

Aims: The aim of the present study was to verify the efficacy of bone conduction implantation in subjects with unilateral severe-to-profound hearing loss and contralaterally impaired hearing, that is, asymmetric hearing loss (AHL), and to compare it with known BCI indications for SSD.

Material and methods: Twenty-one subjects received BCI for either SSD or AHL. All of the subjects underwent a battery of audiological and subjective tests, Data were collected and statistically evaluated within and between the SSD group and the AHL group.

Results: A PTA threshold gain was observed in AHL patients along with improved values in speech audiometry in quiet and noise. The two visual analogue scale evaluations (QoL and QoS) and the GBI showed significantly better scores in AHL patients compared to SSD patients.

Conclusions: BCI provided improvement for auditory or speech recognition in AHL subjects, as compare to SSD. From these findings, it is possible to predict a positive role of BCI for some audiological aspects of AHL subjects that are generally not present or not detectable in SSD cases.     

Validation of a new TEOAE-AABR device for newborn hearing screening

Abstract

Objective: Because newborn hearing screening (NHS) programs are currently implemented in an increasing number of countries, physiological NHS technologies have to be continuously optimized. This study validates a new TEOAE-AABR screening device. Design: TEOAE and AABR screenings were performed in 299 ears with both the new NHS device and a well-established and validated one. Furthermore, 49 ears, suspected of having a hearing loss, underwent the screenings and an additional diagnostic ABR. Study sample: One hundred and fifty newborns and infants were included in the study (median age 1.0 months, range 0–54 months; among them 39 babies from neonatal intensive care units). Results: Screening with both devices resulted in a concordance of κ =.98 for TEAOE measurements and .96 for AABR measurements. The mean measurement durations were significantly shorter for the new device than for the established one for both TEOAE (15.4 vs. 17.2 s) and AABR (26.6 vs. 32.7 s). Conclusions: The algorithm of the new screening device is as valid as that for the established one. The shorter test durations with the new device facilitate hearing screenings and allow for a higher number of valid measurements in restless children than with former comparable procedures.     

Snoring assessment: do home studies and hospital studies give different results?

We have developed a device (Glan Clwyd Snore Box) suitable for the objective measurement of the loudness and duration of snoring. The device is simple for the patient to operate, portable, battery powered, and able to produce objective results. We have used the Snore Box to record the snoring at home and during sleep studies in the hospital. Twenty-nine patients were studied. Overall the Snore Index recorded in the home was greater than in the hospital (P < 0.001), the average difference being 67 snores/h. We conclude that snoring is more appropriately assessed at home than in the hospital. We suggest the deficit arises from sleeping in an unfamiliar environment and the presence of several wires connecting the patient to the recording monitor which interfere natural sleep in the hospital setting.     

Meniett低压脉冲治疗仪治疗梅尼埃病的系统评价

目的：系统评价Meniett低压脉冲治疗仪对治疗梅尼埃病的影响。方法计算机检索Pubmed、Web of Science、Cochrane Library、CNKI及万方数据库,搜索限于建库至2015年12月。按照纳入和排除标准筛选文献,由2位评价员独立进行资料评价、提取、剔除/引用、最后再进行核对,应用review manager 5.2版软件对最后纳入研究进行Meta分析。结果按照纳入标准,最终纳入英文文献14篇,中文文献1篇,共474例病例。符合Meta分析文献13篇,结果显示对平均纯音听阈的影响[MD=3.31,95%CI（1.29,5.33）],眩晕发作频率的影响[MD=6.81,95%CI（4.62,9.01）],AAO-HNS功能评分的影响[MD=0.63,95%CI （-4.13,5.39）]。结论对于传统药物治疗无效的梅尼埃病,Meniett低压脉冲治疗仪是一种微创性、非结构破坏性和安全有效的治疗方法。