Supplementary formulas and tables for calculating and interconverting speech recognition scores in transformed arcsine units

Formulas that convert speech recognition scores, in percent or proportions, into units based on the arcsine transform have been described previously. This report reviews that work and presents various supplementary equations and tables for calculating and interconverting the proposed units. The relative merits of these data and their application to scores from closed-set tests are also discussed.     

Effect of Botulinum Toxin Type A on Nasal Symptoms in Patients with Allergic Rhinitis: A Double-blind,Placebo-controlled Clinical Trial

Objective—To investigate the possible beneficial effects of botulinum toxin type A (BTX-A) on nasal symptoms in patients with allergic rhinitis (AR).

Material and Methods—Thirty-four patients (21 females, 13 males; mean age 28 years) were included in the study. AR was diagnosed by means of history, clinical examination and skin prick test. Patients were randomly divided into 3 subgroups a follows: in Group A, 20 units of BTX-A was injected into each nasal cavity (total 40 units); in Group B, 30 units of BTX-A was injected into each nasal cavity (total 60 units); and in Group C, 2 ml of isotonic saline was injected as placebo. The symptoms of AR (rhinorrhea, nasal obstruction, sneezing, itching) were scored by the patient on a six-point scale (from 0 to 5). All of the patients were followed up at Weeks 1, 2, 4, 6 and 8; at each visit an anterior rhinoscopic examination was done and symptom scores were recorded.

Results—There was no statistically significant difference between Groups A and B in terms of average symptom scores. Rhinorrhea, nasal obstruction and sneezing scores in Groups A and B were significantly better than those in Group C at all time points. Although itching scores were significantly lower at Weeks 1 and 2, there was no difference in the Week 4,6 and 8 scores in Groups A and B. When total symptom scores were evaluated, the results for Groups A and B were similar but significantly better than those for Group C.

Conclusion—In selected cases, injection of 40 units of BTX-A into the turbinates, as a single agent, may help the symptomatic control of AR for up to 8 weeks.     

Effect of botulinum toxin type A on nasal symptoms in patients with allergic rhinitis: a double-blind, placebo-controlled clinical trial

OBJECTIVE: To investigate the possible beneficial effects of botulinum toxin type A (BTX-A) on nasal symptoms in patients with allergic rhinitis (AR). MATERIAL AND METHODS: Thirty-four patients (21 females, 13 males; mean age 28 years) were included in the study. AR was diagnosed by means of history, clinical examination and skin prick test. Patients were randomly divided into 3 subgroups a follows: in Group A, 20 units of BTX-A was injected into each nasal cavity (total 40 units); in Group B, 30 units of BTX-A was injected into each nasal cavity (total 60 units); and in Group C, 2 ml of isotonic saline was injected as placebo. The symptoms of AR (rhinorrhea, nasal obstruction, sneezing, itching) were scored by the patient on a six-point scale (from 0 to 5). All of the patients were followed up at Weeks 1, 2, 4, 6 and 8; at each visit an anterior rhinoscopic examination was done and symptom scores were recorded. RESULTS: There was no statistically significant difference between Groups A and B in terms of average symptom scores. Rhinorrhea, nasal obstruction and sneezing scores in Groups A and B were significantly better than those in Group C at all time points. Although itching scores were significantly lower at Weeks 1 and 2, there was no difference in the Week 4, 6 and 8 scores in Groups A and B. When total symptom scores were evaluated, the results for Groups A and B were similar but significantly better than those for Group C. CONCLUSION: In selected cases, injection of 40 units of BTX-A into the turbinates, as a single agent, may help the symptomatic control of AR for up to 8 weeks.     

Prediction and statistical evaluation of speech recognition test scores

A speech test evaluation and presentation system is described. The test presentation subsystem has the flexibility and speed of live-voice testing while using recorded test materials. The speech test evaluation subsystem compares an individual subject's test performance on a monosyllabic word test with that of an average person with the same hearing loss. The elements needed to make such evaluations are discussed. Also, a trial of the procedure is described. The primary purpose of the trial was to obtain data that would provide a basis for statistical probability statements about individual monosyllabic word test results obtained in clinical settings. Data were collected from three audiology clinics in three different types of settings. Except for a few cases with highly asymmetric speech scores, all nonconductive hearing losses were included. Subject ages ranged from 8 to 92 years. Importance-weighted average pure-tone hearing losses ranged from 0.4 to 97.6 dB HL. Fifty-word recognition scores and audiograms for 2609 ears were included in the main analysis. Twenty-five-word recognition scores and audiograms for another 932 ears from one clinic were used in a subsidiary analysis. Results indicated that distributions of absolute speech recognition scores in hearing-impaired samples are highly skewed. However, after transformation of the scores into rationalized arcsine units (rau), the differences between individual subject scores and scores predicted from the audiogram were reasonably well described by the normal distribution. The standard deviation of this distribution of differences, for the data combined across the three audiology clinics, was approximately 13 rau.     

Evidence for correlation of objective and subjective measures of nasal airflow in patients with common cold

Objectives: To utilize posterior rhinomanometry and conductance, as units of measurement, to further investigate the relationship between subjective and objective measures of nasal airflow. Design: A prospective, observational study. Setting: Common Cold Research Centre. Participants: Sixty healthy volunteers from the staff and student population of Cardiff University with an upper respiratory tract infection. Main outcomes measures: To determine correlations between visual analogue scores (VAS) and posterior rhinomanometry for total, unilateral, high and low conductance groups. Results: No correlation was found between total VAS and total conductance (r = 0.17, P = 0.10). A substantially significant correlation was found between unilateral VAS and unilateral conductance (ρ = 0.50, P < 0.001). The unilateral VAS and conductance were highly correlated for the low total conductance group (ρ = 0.61, P < 0.001). Conclusions: Posterior rhinomanometry allows actual measurement of the combined and unilateral conductance of nasal passages. The units of conductance, as opposed to resistance, allow totally obstructed nasal passages to be included in analysis. Visual analogue scores and conductance correlate strongly in unilateral measures for participants with a low total nasal conductance. Posterior rhinomanometry and units of conductance are recommended for future studies investigating the relationship between objective and subjective measures of nasal airflow.     

Fatigue improvement following endoscopic sinus surgery: a systematic review and meta-analysis

BACKGROUND: Fatigue is a common symptom of chronic rhinosinusitis (CRS), yet the response of fatigue to endoscopic sinus surgery (ESS) has not been systematically evaluated. METHODS: Studies published in any language were retrieved by searching MEDLINE, EMBASE, Web of Science, Cochrane databases, and additional Web-based sources (from 1980-2007); by examining bibliographies of retrieved articles; and by contacting investigators in the field. Studies consisting of more than 10 adult patients analyzing the response of fatigue, vitality, energy, or malaise following ESS were included. Two authors independently evaluated studies for inclusion, rated the methods, and summarized relevant data using a standardized protocol. RESULTS: Using within-subject comparisons, 28 identified observational studies noted substantial improvement in fatigue after ESS. A subgroup analysis of 11 studies measuring outcomes using the 36-Item Short Form Health Survey (SF-36) demonstrated a moderate-sized combined effect of 0.47 (95% confidence interval, 0.38-0.56; I = 0%), corresponding to a mean +/- standard deviation improvement of 9.7 +/- 3.4 units on the SF-36 vitality domain scores. In studies measuring outcomes using symptom rating scores, the preoperative severity scores and improvement after surgery for fatigue were similar to the respective values for other pooled CRS symptoms. CONCLUSIONS: All 28 studies described substantial improvement in fatigue following ESS based on presurgery and postsurgery comparisons. A subgroup analysis of 11 studies reporting results by the SF-36 vitality domain scores demonstrated a moderate-sized combined effect. Preoperative fatigue severity scores and improvement noted after surgery were similar to the respective values for other pooled CRS symptoms.     

Quality of life and olfactory outcomes following frontal sinus drill-out procedures

ObjectiveExtensive endoscopic frontal sinus surgery requires drilling of the bone close to the olfactory epithelium and exposing the first olfactory fiber. This study assesses long-term quality of life (QoL) and olfactory outcomes following endoscopic endonasal frontal sinus drill-out procedures.MethodsAll patients who underwent endoscopic endonasal frontal sinus surgery (Draf IIa or Draf III) for chronic rhinosinusitis (CRS) without nasal polyp in 2017 at a single tertiary center were included in the study. Pre- and postoperative scores of SNOT-22, odor identification, discrimination, and threshold were noted.ResultsOf the 31 patients included in this study, Draf IIa and Draf III were performed in 12 (38.7 %) and 19 (61.3 %) patients, respectively. A general assessment of QoL changes was carried out by evaluating pre- and postoperative SNOT-22 scores. A statistically significant difference was found between pre- and postoperative SNOT scores (p < 0.001): SNOT scores decreased by 9.13 units postoperatively. Comparing differences in SNOT-22 and olfactory test scores between Draf IIa and Draf III patients, we did not detect any statistically significant difference between the two procedures (p > 0.05). Draf IIa and Draf III did not display a statistically significant difference in SNOT-22 scores (p = 0.484) and did not have a significant effect on differences in pre- and postoperative identification (p = 0.675), discrimination (p = 0.535), and threshold (p = 0.141) scores.ConclusionsOur study demonstrated that extensive drill-out procedures have not a negative effect on olfactory functions, including threshold scores, in the long term. Patients who underwent frontal sinus procedures for persistent CRS have a better QoL postoperatively. However, more prospective double-blind studies are needed to support our results.     

The assessment of reading readiness using multidimensionally scored time-compressed speech

Normal-hearing children (39 M, 36 F) from a monolingual environment, aged 5 yrs 10 mo to 7 yrs 2 mo, of average or better intelligence, were selected as being at high, average, or low risk of reading readiness according to scores on the Lindamood Auditory Conceptualization (LAC) test. Ss were also given the Stephens Oral Language Screening Test (SOLST), emphasizing syntactical development. Ss were then tested for verbal respeating of taped 5-word sentences and 5-word 1st-order sentential approximations at 32 db SL re SRT. Stimuli were presented at 0, 40, or 60% time compression (TC). Responses were scored right/wrong and also by Porch's multidimensional system involving repeats and cues. For both systems significant effects were obtained between a number of TC conditions vs both the LAC and SOLST. The LAC appeared to emphasize phonetic units, the SOLST linguistic units in real sentences. The TC condition appeared to emphasize linguistic units at both word and sentence levels, less so with increasing TC. Results supported the usefulness of the TC stimuli in assessing reading readiness and it was suggested that the various stimuli assess different aspects of auditory processing.     

Three measures of language production for Cantonese-speaking school-age children in a story-retelling task.

Little is known about language development in school-age children in Asian countries. This research reports on 3 measures of language development in 100 Cantonese-speaking children age 5 to 9 years. Word scores, structure scores, and the mean length of communication units (MLCU) were derived from a story-retelling task. The structure score was significantly different for all, except the 8- and 9-year-old groups. The word score and MLCU were significantly different in groups separated by 2 or more years of age. All 3 measures were strongly and significantly correlated with age. The structure score and word score accounted for 64% and 5% of the variance in age, respectively. The order of development of the 6 grammatical structures (e.g., subordinate clauses) included in this study is also reported.     

Biofilm formation in vivo on perfluoro-alkylsiloxane-modified voice prostheses

OBJECTIVE: To study the influence of perfluoroalkylsiloxane (PA) surface modification of silicone rubber voice prostheses on biofouling. DESIGN: Placebo-controlled clinical trial. SETTING: Tertiary referral center, with specialization in head and neck cancer treatment. PATIENTS: Eighteen consecutive patients with laryngectomies and experienced in the use of a voice prosthesis who visited the outpatient clinic for prosthesis replacement. MATERIAL: Eighteen partially surface-modified voice prostheses (3 with short-chain PAs [1 fluorocarbon unit] and 15 with long-chain PAs [8 fluorocarbon units]) were inserted via the patients' tracheoesophageal shunts and remained in place for 2 to 8 weeks. INTERVENTION: Replacement of the prostheses. MAIN OUTCOME MEASURES: Evaluation of biofilm formation on short- and long-chain PA-modified and original silicone rubber surfaces on the esophageal side of the voice prosthesis. RESULTS: The planimetrical biofilm scores of the surfaces of all 3 short-chain PA-treated voice prostheses indicated more biofouling on the treated surfaces than on the untreated surfaces of the same prostheses. For the long-chain PA-treated prostheses, the planimetrical biofilm scores, as well as the numbers of colony-forming units per cm(-2) for bacteria and yeasts, indicated less biofouling on the treated side than on the control side for 9 of the 13 prostheses that could be analyzed (2 were lost to analysis). Identical fungal strains, mainly Candida sp, were isolated from biofilms on each side of the esophageal flange. CONCLUSIONS: Chemisorption of long-chain PAs by the silicone rubber used for voice prostheses reduces biofilm formation in vivo and therefore can be expected to prolong the life of these prostheses. Chemisorption of short-chain PAs by silicone rubber seems to have an adverse effect.     

Simple evaluation of CT findings in the paranasal sinuses for chronic sinusitis

The CT scores and scoring for improvement based on them, which we proposed previously, is a simple and highly reproducible method of evaluation of sinus units before and after an operation for chronic sinusitis. We compared this evaluation method with the results of quantitative assay and showed its advantages and disadvantages. The subjects were 258 sinuses in patients who underwent endonasal sinus surgery (ESS) in the department of otolaryngology, Kyoto Prefectural University of Medicine Hospital from April 1996 to April 1997. The subjects were evaluated according to the following 4 grades negligible shadow in the paranasal sinus CT scored 0, less than 50% shadow scored 1, more than 50% of shadow scored 2, and mostly filled with shadow scored 3. Furthermore, the preoperative and postoperative CT scores were compared and the rate of improvement was rated in the following 3 grades: score 0 for unchanged or aggravated subjects, score 1 for subjects showing improved CT score by 1 grade, and score 2 for those showing improved CT score by 2 grades or a postoperative CT score of 0. Quantitative image analysis was input into a personal computer and the ratio occupied by the shadow was calculated, as the shadow ratio. While some discrepancies were seen in parts in the comparison of the quantitative image analysis and CT scores as the former captures minute shadows, a positive correlation was obtained overall. Attention is needed to accurately evaluate small paranasal sinuses such as the frontal sinus, and small amounts of shadow, which are areas where errors may occur. A satisfactory correlation was obtained between the score for the improvement rate and the difference in the shadow ratios before and after surgery. The CT scores and the scores for the improvement rate showed no difference from the results of other evaluation methods reported in the past, and evaluation of similar precision was possible. It was thought that this simple evaluation method of CT findings in the paranasal sinuses, which we examined in the present study, was quite useful as a simple stage-classification method that could be utilized in everyday practice considering its facility, reproducibility and satisfactory precision.     

Correlation of pneumonia score with electronic nose signature: A prospective study

OBJECTIVES: Ventilator-associated pneumonia (VAP) is a frequent complication in patients in surgical intensive care units. Pneumonia scores, chest radiography, and bronchoscopy are all employed, but there is no gold standard test for the diagnosis of VAP. The electronic nose, a sensor of volatile molecules, is well suited to testing the breath of mechanically ventilated patients. Our objective was to determine the potential use of an electronic nose as a diagnostic adjunct in the detection of VAP. METHODS: We performed a prospective study of mechanically ventilated patients in a surgical intensive care unit. Clinical data, including temperature, white blood cell count, character and quantity of tracheal secretions, ratio of partial pressure of arterial oxygen to fraction of inspired oxygen, and chest radiographs, were collected, and a pneumonia score between 0 and 10 was calculated. Exhaled gas was sampled from the expiratory limb of the ventilator circuit. The gases were assayed with a commercially available electronic nose. Multidimensional data reduction analysis was used to analyze the results. RESULTS: Forty-four patients were studied. Fifteen patients had pneumonia scores of 7 or greater, and 29 patients had scores of 6 or less. With Fisher discriminant analysis and K-nearest neighbor analysis, the electronic nose was able to discriminate between the two groups. CONCLUSIONS: The electronic nose is a new technology that is inexpensive, noninvasive, and portable. We demonstrate its ability to predict pneumonia, based on a well-recognized scoring system. This technology promises to serve as a diagnostic adjunct in the management of VAP.     

Relation of binaural interaction and spectro-temporal characteristics in the auditory midbrain of the grassfrog

The relation between binaural interaction type and spectro-temporal characteristics was studied for single units in the auditory midbrain of the grassfrog. Tonal and continuous wideband noise ensembles have been used as stimuli. Spectro-temporal sensitivities were determined for ipsi-, contra- and bilateral stimulus presentation by a closed sound system. Binaural interaction was classified in monaural EO (one ear excitatory), binaural EE (both ears excitatory) and EI (one ear excitatory, the other inhibitory) and purely inhibitory categories. Binaural interaction appeared to be rather invariant to alterations in stimulus intensity and type. A very clear correlation was observed between best frequency and binaural interaction type: EE units are predominantly of high best frequency, whereas EI units are predominantly of low best frequency. The correlation with latency was less significant: EE units tended to have somewhat shorter latencies that EI units. EO units take an intermediate position. Comparisons of ipsi-, contra- and bilateral spectro-temporal sensitivities, revealed differences in best frequency, latency and temporal discharge pattern. In some units a complex interplay of excitatory and inhibitory monaural influences was demonstrated. A number of units was recorded, which were characterized by multiple activation or suppression areas. The majority of these units exhibited frequency-dependent binaural interaction types. In some units it was noticed that binaural interaction type can be dependent on state of adaptation. A comparison of binaural interaction types of neighbouring units provided only weak evidence for a binaural organization in the anuran auditory midbrain, since simultaneously recorded pairs shared the same binaural interaction type only slightly more than expected by mere chance (chi 2-test, P less than 0.10).     

Response properties of type II and type III units in dorsal cochlear nucleus

Type II and type III units in the dorsal cochlear nucleus (DCN) of unanesthetized (decerebrate) cats are those with excitatory responses to best frequency (BF) tones at all levels above threshold. They are distinguished from type IV units which give predominantly inhibitory responses to tones. Type II and type III units are distinguished from one another by their rates of spontaneous activity. Type II units have low rates of spontaneous activity (below 2.5 spikes/s), whereas type HI units are spontaneously active at rates up to 95 spikes/s. In this paper we show that segregation of units according to spontaneous activity produces a segregation of several other properties as well. A typical type II unit responds vigorously to BF tones (median maximum rate of 242 spikes/s), has a slightly nonmonotonic rate versus level function, and responds weakly or not at all to broadband noise. These units tend to be located in the deep layer of the DCN. Type III units tend to respond to BF tones at moderate rates (median maximum driven rate of 124 spikes/s), have monotonie or nonmonotonic rate versus level functions, and respond to noise at rates comparable to their tone rates. They are distributed somewhat more uniformly in all DCN layers, but a majority were found in the fusiform cell and molecular layers. Most evidence indicates that type II units are recorded from inhibitory interneurons in the DCN.     

Actual and predicted word-recognition performance of elderly hearing-impaired listeners

Word-recognition scores in quiet and in noise were obtained from both ears of 101 elderly listeners demonstrating sensorineural hearing loss. These performance scores were compared to word-recognition scores predicted using Articulation Index analysis procedures. Negative difference scores (actual performance less predicted performance) would reflect aspects of the hearing impairment and/or the aging process that extend beyond the simple speech audibility constraints imposed by the hearing loss and masking noise. The distributions for both the left and right ears of difference scores in quiet revealed the majority of scores to be grouped near 0. In contrast, both distributions of difference scores in noise were normally distributed around means of approximately -25. These results suggest that the typical elderly hearing-impaired listener should be expected to demonstrate word-recognition performance in quiet similar to that of a normally hearing listener, given the same level of audibility of the speech material. On the other hand, in noise, this typical listener may be expected to demonstrate some word-recognition performance decrement, even after accounting for the audibility constraints of the hearing loss and noise.     

Comparative outcomes of endoscopic sinus surgery in patients with chronic sinusitis and nasal polyps

This study was carried out to compare the outcomes of endoscopic sinus surgery in patients with chronic sinusitis without nasal polyps (CRS) and those with nasal polyps (NP). We also sought to determine the correlation between preoperative computed tomography (CT) findings and postoperative endoscopy and symptom score improvement. Data were collected from two groups of patients diagnosed as CRS with and without nasal polyps that underwent functional endoscopic sinus surgery with a 1-year postoperative follow up. Preoperative symptoms, CT scores, and endoscopic scores were recorded. Postoperative symptom and endoscopic scores were recorded at 1, 6, and 12 months. Assessment of symptoms was performed subjectively using visual analogue scoring (VAS). CT scan findings were scored using the Lund–Mackay system. Endoscopic examination findings were scored according to the staging system proposed by Lanza and Kennedy. The correlations between the CT score, endoscopic scores and VAS scores were calculated. There was a statistically significant correlation between the preoperative CT, symptom, and endoscopic scores. Postoperative symptom and endoscopic scores also showed a significant correlation. Total CT scores of the CRS group were significantly lower than the scores of the NP group. Also preoperative endoscopy and symptom scores were statistically lower in CRS group compared to NP group. Endoscopy total scores and symptom total scores of both groups were significantly decreased at postoperative 12th month. Statistically significant difference was observed between the preoperative and postoperative symptom and endoscopy scores. The patients with polyps had higher symptom scores and worse objective findings compared to the patients with CRS. In all patients groups, objective and subjective scores seemed to correlate well preoperatively and postoperatively. These data suggest that endoscopic sinus surgery provides significant symptomatic relief and endoscopic healing in patients with CRS and NP.     

A study of out-of-hours facilities in otolaryngology: current provision and problems

'Action on ENT' has recently published advice as to the minimum requirements for equipment required to provide a safe and suitable out-of-hours service in ENT. Our objectives were to determine the availability of a dedicated ENT treatment room for seeing patients out of hours, appropriately maintained specialized ENT equipment and availability of appropriate assistance. In addition, the mechanism for disinfection of nasoendoscopes out of hours was determined. Telephone questionnaires of 106 ENT units in England, which provide an out-of-hours ENT service, were taken. At each unit the standard questionnaire was answered by the first on-call ENT doctor. One hundred and one units (95 percent) had access to a dedicated treatment room out of hours. The number of units with a microscope was 91 (86 percent), headlight/lamp and mirror was 105 (99 percent), flexible nasoendoscope was 86 (81 percent) and cautery (electrical or chemical) was 105 (99 percent). Seventy-nine units (75 percent) found that their treatment rooms were adequately stocked, and 62 units (58 per cent) had assistance available when needed. Twenty-four units (23 percent) sterilized their scopes adequately, 22 units (21 percent) used endosheaths, 26 units (24 percent) used a variety of inadequate cleaning methods, and 34 respondents (32 percent) were unsure how their scopes were cleaned. This survey has shown that not all ENT units have appropriately equipped out-of-hours facilities. There is a need for nationally agreed guidelines stating the minimum equipment and assistance required to provide a safe, adequate and suitable out-of-hours service. National guidelines on out-of-hours disinfection of flexible nasoendoscopes are also required.     

Story structure and retelling of narratives by aphasic and non-brain-damaged adults

Aphasic and non-brain-damaged subjects listened to and retold two narrative stories three times in succession. Both aphasic and non-brain-damaged subjects were affected by story structure--they retold a greater proportion of information units that were central to the story structure than information units that were peripheral to the story structure. Both aphasic and non-brain-damaged subjects increased the amount of information retold across three retellings, although only the increases from Retelling 1 to Retelling 2 were statistically significant. Non-brain-damaged subjects consistently retold slightly more information units than aphasic subjects, but the differences were not statistically significant. In all three retellings, both groups of subjects retold information in the same order that it occurred in the stories.     

Aphasic and non-brain-damaged adults' descriptions of aphasia test pictures and gender-biased pictures

Twelve aphasic and 12 non-brain-damaged adult males described the speech elicitation pictures from the Boston Diagnostic Aphasia Examination (BDAE), the Minnesota Test for Differential Diagnosis of Aphasia (MTDDA), the Western Aphasia Battery (WAB), and six pictures representing male-biased or female-biased daily-life situations. For each speech sample we calculated number of words, words per minute, number of correct information units, percentage of words that were correct information units, and percentage of correct information units that were nouns or adjectives (amount of enumeration or naming). The WAB picture elicited more enumeration than the BDAE or MTDDA pictures, and information was produced at a slower rate in response to the WAB picture than the other two pictures. These differences were statistically significant and appear to be clinically important. Gender bias had statistically significant effects on two measures. Male-biased pictures elicited significantly more words and significantly more correct information units than female-biased pictures. However, these differences were small and do not appear to be clinically important. Two of the five measures (words per minute and percentage of words that were correct information units) differentiated non-brain-damaged speakers from aphasic speakers. The magnitude of these differences suggests that these measures provide clinically important information about the problems aphasic adults may have when they produce narrative discourse.