Children in educational programs for the hearing impaired whose impairment was caused by mumps.

Mumps was reported to be a cause of hearing loss in 259 persons from a sample of 43,946 students enrolled in special educational programs for the hearing impaired. Males and young children appear to be more prone to deafening by mumps, and there may be a relationship between age of onset and degree of hearing loss. Overall, those deafened by mumps appear to have characteristics quite different from those of children deafened by other causes.     

Giant ameloblastoma: report of an extreme case and a description of its treatment.

Ameloblastoma is an odontogenic tumor that usually occurs in the mandible. It is an aggressive but benign tumor of epithelial origin that is rarely metastatic. We report the case of a 53-year-old woman who had a massive ameloblastoma of the mandible. The tumor measured 15.2 x 11.4 x 12.0 cm. The patient had oral bleeding that required a transfusion. The workup included three-dimensional imaging, arteriography, and embolization to control bleeding. Surgical management entailed the resection of the entire left mandible and right symphysis, followed by reconstruction with a free fibular flap. To our knowledge, this is the largest reported ameloblastoma managed with three-dimensional imaging, radical resection, and free-flap reconstruction. This article also reviews aspects of the differential diagnosis, pathology, and management of jaw tumors.     

Chronic bacterial rhinosinusitis: description of a mouse model

OBJECTIVES: To survey normal murine sinonasal anatomy and to create a mouse model for chronic bacterial rhinosinusitis. DESIGN: Anatomic, histologic, and pathophysiologic study displaying normal murine sinonasal anatomy and surgically created unilateral sinonasal inflammation. SUBJECTS: Twenty-one 6-week-old, male C57BL/6 mice. INTERVENTIONS: Animals that underwent unilateral maxillary sinus ostial obstruction using Merocel nasal packing, animals with unilateral Bacteroides fragilis inoculation alone, and animals with both ostial obstruction and bacterial inoculation were examined at 4 weeks for histologic evidence of chronic sinonasal inflammation. Experimental interventions were compared with contralateral control sinuses within each animal and with normal and sham-operated controls. RESULTS: Normal mouse paranasal sinuses include maxillary sinuses, ethmoid air cells, and respiratory-type epithelium. In experimental animals, the lateral maxillary sinus wall, nasal septum, and superior turbinelle of the maxillary sinus were examined histologically. Epithelial thickening and disarray, goblet cell hyperplasia, inflammatory infiltrates, and sinonasal fibrosis were present in the experimental sinuses of animals packed with Merocel alone or Merocel with bacterial inoculation. Changes seen with Merocel and bacteria were more dramatic than those with Merocel alone. Sham-operated controls and sinuses inoculated with bacteria alone did not differ significantly from the sinuses of normal animals. CONCLUSION: Unilateral maxillary sinus ostial obstruction using Merocel nasal packing along with B fragilis inoculation results in a persistent, localized bacterial rhinosinusitis in mice.     

Cognition in the hearing impaired and deaf as a bridge between signal and dialogue: a framework and a model

This paper focuses on the role of cognition in visual language processing in the deaf and hard of hearing. Although there are modality-specific cognitive findings in the literature on comparisons across speech communication modes and language (sign and speech), there is an impressive bulk of evidence that supports the notion of general modality-free cognitive functions in speech and sign processing. A working-memory framework is proposed for the cognitive involvement in language understanding (sign and speech). On the basis of multiple sources of behavioural and neuroscience data, four important parameters for language understanding are described in some detail: quality and precision of phonology, long-term memory access speed, degree of explicit processing, and general processing and storage capacity. Their interaction forms an important parameter space, and general predictions and applications can be derived for both spoken and signed language conditions. The model is mathematically formulated at a general level, hypothetical ease-of-language-understanding (ELU) functions are presented, and similarities and differences from current working-memory and speech perception formulations are pointed out.     

"Linear" and "derived" otoacoustic emissions in newborns: a comparative study.

OBJECTIVE: To investigate the effects of a specific aspect of the acquisition procedure, the averaging technique, on the evaluation of click-evoked otoacoustic emissions (CEOAEs) in newborns. DESIGN: CEOAEs were recorded by an Otodynamic ILO88 system from 89 full-term newborns at the third day after delivery. For each ear and in the same test session, CEOAEs were evoked by 75 to 85 dB pSPL acoustic clicks and averaged according to two different modes: the "linear" (classic average) and the "derived" mode, which allows the cancellation of linear behaving components (such as acoustic artifacts). All examined ears had a normal auditory function as assessed by conventional ABR between the ages of 2 and 4 mo. CEOAEs obtained by both averaging techniques were compared on the basis of several quantitative parameters: the waveform similarity; the levels of signal and noise and the inter-test reproducibility of the broadband response and of four different frequency bands centered at 1.6, 2.4, 3.2, and 4 kHz; the amplitude as a function of time; the test time. To eliminate the contribution of the stimulus artifact, linear CEOAEs were windowed 6 to 20 msec, whereas derived emissions were windowed using the default ILO88 window (2.5 to 20 msec). Additionally, CEOAEs were classified as "pass" or "fail" accordingly to screening criteria used in the daily clinical practice. RESULTS: Linear and derived emissions had very similar wave shapes and no time shifts during the first 12.5 msec. On the contrary, clear differences in the waveforms and time shifts were observed at longer latencies. The use of both averaging techniques resulted in identical CEOAE levels for both the broadband response and for the first two tested frequencies. For the last two frequencies, emission levels were lower when averaged with the linear technique owing to the use of the time window 6 to 20 msec, which reduces the amplitudes of high-frequency components. The residual noise in derived traces is 6 dB higher than that from linear traces. Also, derived CEOAEs had a lower inter-test reproducibility in both the broadband compound emission and in the four frequency bands examined here. The greatest difference in reproducibility was observed at the lowest band (1.2 to 2 kHz). Scoring of emissions was influenced by the averaging technique: 14% CEOAEs obtained with linear averaging and scored as passes were classified as fails when averaged with the derived mode. Moreover, if a CEOAE was scored as pass when using the derived technique, it also was scored as pass when using linear averaging. The increased number of false positives most likely was due to the higher noise floor/lower signal to noise ratio (SNR) of CEOAEs obtained with the derived technique. CONCLUSIONS: In the tested newborns and at the levels of stimulation used in this study, the emissions obtained with the derived technique were noisier than those obtained with the linear technique, this being intrinsically due to the type of averaging. Therefore, screening criteria based on the evaluation of the SNR (or similar parameters) could be influenced by the type of averaging used during the acquisition.     

Hyperkeratotic inverted seborrheic keratosis of the outer auditory canal : a first description

Seborrheic keratosis is one of the most common benign neoplasms seen at the trunk, extremities, head and neck of older individuals which rarely occurs in the auditory canal. Even rarer is the occurrence of an inverted or hyperkeratotic variant in this localization. We present the clinical picture of a 74-year-old man with a recurrent hyperkeratotic, partially inverted seborrheic keratosis of the right external auditory canal. This disease is sometimes difficult to diagnose, particulary to mark down malignant lesions. An uncritical diagnosis must be avoided, since these lesions and especially the irritated subtype might be falsely assessed as basal cell carcinomas which they may resemble histologically.     

Genetics content in the graduate audiology curriculum: a survey of academic programs

Astounding progress has been made in the identification and characterization of genes for hearing loss, which has led to an increasing role of genetics evaluation and testing in the diagnostic process for children with hearing loss. The importance of health professionals such as audiologists gaining core competencies in genetics has been recognized. The current report describes a survey of academic programs in audiology designed to determine the extent to which genetics content is included in the curriculum. Responses from 56% of existing academic programs indicate that 95% include some genetics content in their programs, with the total number of classroom hours ranging from 2 to 65. Most programs included information on basic genetic mechanisms, syndromes, and interpreting family history information, while many fewer reported covering the molecular basis of hearing loss, genetic testing, or ethical or legal issues. The results of this survey demonstrate the need to incorporate more genetics content into audiology curricula and suggest strategies for assisting audiology faculty with this process.     

Craniofacial and mandibular osseous contour reconstruction: the use of a new "combination" graft.

The use of autogenous bone graft to repair major defects is most feasible biologically. When the bone could not be shaped or carved to fit a given defect, the use of solid alloplastic biomaterial implants gained wide popularity. We are describing a new method wherein a "combination" graft is used. It possesses the advantage of the dependence on autogenous cancellous bone graft, and the added bone inducing capability of a recently developing biomaterial implant (Polyurethane-Terephthalate). The results obtained in the repair of major defects in patients after ablative surgery, or as sequelae of trauma, document the advantages of this new mode of treatment. In selected patients with major defects due to deficiency or absence of the osseous framework of the face, the use of "combination" grafts has proven to be the most appropriate form of repair.     

The auditory midbrain implant: a new auditory prosthesis for neural deafness-concept and device description.

The auditory midbrain implant (AMI) is a new central auditory prosthesis designed for penetrating stimulation of the human inferior colliculus. The major group of candidates for the AMI consists of neurofibromatosis type 2 (NF2) patients who develop neural deafness because of growth and/or surgical removal of bilateral acoustic neuromas. Because of the absence of a viable auditory nerve, these patients cannot benefit from cochlear implants. An alternative solution has been the auditory brainstem implant (ABI), which stimulates the cochlear nucleus. However, speech perception performance in NF2 ABI patients has been limited. The fact that the ABI is able to produce high levels of speech perception in nontumor patients (with inaccessible cochleae or posttraumatic damage to the cochlear nerve) suggests that limitations in ABI performance in NF2 patients may be associated with cochlear nucleus damage caused by the tumors or the tumor removal process. Thus, stimulation of the auditory midbrain proximal to the damaged cochlear nucleus may be a better alternative for hearing restoration in NF2 patients. We propose the central nucleus of the inferior colliculus (ICC) as the potential site. A penetrating electrode array aligned along the well-defined tonotopic gradient of the ICC should selectively activate different frequency regions, which is an important elementfor supporting good speech understanding. The goal of this article is to present the ICC as an alternative site for an auditory implant for NF2 patients and to describe the design of the first human prototype AMI. Practical considerations for implementation of the AMI will also be discussed.     

"Adenocarcinoma, not otherwise specified": a diminishing group of salivary carcinomas.

As refinements in classification with clinicopathologic correlations proceed, the "adenocarcinomas, not otherwise specified" (NOS) of salivary tissue are reduced in number. Clinicopathologic entities such as salivary duct carcinoma, terminal duct carcinoma, and epimyoepithelial carcinoma, formerly in the NOS category, are examples of this process. There remain, however, adenocarcinomas of salivary tissues that cannot be accommodated in conventional classifications. They are the least common of salivary carcinomas and manifest a cytoarchitecture ranging from a well-differentiated, low-grade appearance to high-grade, invasive lesions. This report addresses this group of carcinomas for which the NOS designation is still applicable.     

Multi-specialty knowledge on surgical a management: Implementation of an educational initiative

Purpose

Deficiencies in airway management knowledge can result in harm, especially in tracheostomy patients. Our objective is to assess the degree of knowledge in different medical specialties, before and after targeted airway education.

Effectiveness of counseling-based adult group aural rehabilitation programs: a systematic review of the evidence

A systematic evidence-based review was conducted to examine the effectiveness of counseling and communication strategy-oriented group adult aural rehabilitation (AR) programs. The literature search for relevant articles focused on studies that (1) employed adults with hearing impairment; (2) used a group aural rehabilitation program that emphasized counseling and communication strategies; (3) utilized a randomized controlled trial, quasi-experimental, or non-intervention cohort design; (4) employed an outcome measure that assessed some aspect of personal adjustment, perceived hearing handicap, or hearing aid benefit and/or satisfaction; and (5) were published in a refereed journal. Twelve articles were found that met these inclusion criteria. Analysis of the 12 studies led to the following conclusion: there is reasonably good evidence that participation in an adult AR program provides short-term reduction in self-perception of hearing handicap and potentially better use of communication strategies and hearing aids. It is less clear whether this advantage over provision of hearing aids alone persists over time.     

Toward a representative set of "real-life" noises.

The focus of this study was to create a database containing a large number of background noises. These noises were analysed on the basis of their spectral and temporal behaviour. The most important dimensions have been determined by using a factor analysis, which reduced the total number of dimensions from 14 (7 octave bands in the spectral domain and 7 in the temporal domain) to 4. One dimension provides information about the amount of amplitude modulation present in the signal. The other dimensions provide spectral information. Based on the output of the factor analysis, a cluster analysis was carried out to reduce the total number of signals (144) to 15 anchor points (i.e., the noise forming the median of the cluster). A selection of these anchor points can be used for fitting of so-called comfort programs in multi-program hearing aids and for the evaluation of signal-processing schemes in specific background noise conditions.     

Two-flap palatoplasty: description of the surgical technique and reporting of results at a single center

Two-flap palatoplasty is commonly used to treat cleft palate defects, but only a few reports on outcomes have been published in the literature. We conducted a retrospective analysis of 257 cases of cleft palate treated with two-flap palatoplasty at a single center in Greece over a 13-year period. Our outcomes data included surgical complication rates, the results of speech assessments, midface development, and other parameters. We found a low rate of short- and long-term complications that required revision surgery, such as symptomatic fistula (5.4%) and velopharyngeal insufficiency (5.3%). Speech outcomes in relation to intelligibility, hypernasality, and nasal emissions were satisfactory in 70 to 86% of patients. Dental arch relationships, as estimated by the 5-Year-Olds Index, were judged to be either good or excellent in 62% of those evaluated. A considerable proportion of patients (45%) who had otitis media with effusion experienced a spontaneous resolution without the use of tympanostomy tubes 2 to 8 months after their operation. We conclude that two-flap palatoplasty is an effective procedure that warrants further attention. We describe the surgical technique in detail. Our technique includes a modified intravelar veloplasty that incorporates near-total muscle retropositioning.     

Development of a multimedia educational programme for first-time hearing aid users: a participatory design

Objective: To develop content for a series of interactive video tutorials (or reusable learning objects, RLOs) for first-time adult hearing aid users, to enhance knowledge of hearing aids and communication.

Design: RLO content was based on an electronically-delivered Delphi review, workshops, and iterative peer-review and feedback using a mixed-methods participatory approach.

Study sample: An expert panel of 33 hearing healthcare professionals, and workshops involving 32 hearing aid users and 11 audiologists. This ensured that social, emotional and practical experiences of the end-user alongside clinical validity were captured.

Results: Content for evidence-based, self-contained RLOs based on pedagogical principles was developed for delivery via DVD for television, PC or internet. Content was developed based on Delphi review statements about essential information that reached consensus (≥90%), visual representations of relevant concepts relating to hearing aids and communication, and iterative peer-review and feedback of content.

Conclusions: This participatory approach recognises and involves key stakeholders in the design process to create content for a user-friendly multimedia educational intervention, to supplement the clinical management of first-time hearing aid users. We propose participatory methodologies are used in the development of content for e-learning interventions in hearing-related research and clinical practice.