Macrophage inflammatory proteins in cytomegalovirus-related inner ear injury.

OBJECTIVE: Inner ear inflammation triggered by CMV infection may play a role in CMV-related auditory pathogenesis. The purpose of the study was to determine if a virally encoded macrophage inflammatory protein played a role in CMV-related hearing loss. DESIGN: Mutagenesis was performed with deletion of a guinea pig CMV macrophage inflammatory protein. Intracochlear inoculations were performed on three groups of animals (n = 18). Group 1 received sterile viral media, Group 2 received wild-type CMV virus, and Group 3 received "knockout" (KO) virus with a deleted immunomodulation gene. Baseline and postinoculation ABRs were obtained. ELISA and PCR were performed and temporal bones examined. SUBJECTS: Eighteen guinea pigs. RESULTS: The KO group had significantly better hearing than the WT group. There were no significant differences between the KO and sham groups. The WT group had significant hearing loss at all frequencies. Inflammation and fibrosis were noted in the WT temporal bones only. CONCLUSIONS: Virally encoded macrophage inflammatory proteins appear to play a significant role in CMV-related hearing loss.     

Wideband acoustic immittance in children with Down syndrome: prediction of middle-ear dysfunction,conductive hearing loss and patent PE tubes

Objective: The purpose of this study was to evaluate pressurised wideband acoustic immittance (WAI) tests in children with Down syndrome (DS) and in typically developing children (TD) for prediction of conductive hearing loss (CHL) and patency of pressure equalising tubes (PETs). Design: Audiologic diagnosis was determined by audiometry in combination with distortion-product otoacoustic emissions, 0.226?kHz tympanometry and otoscopy. WAI results were compared for ears within diagnostic categories (Normal, CHL and PET) and between groups (TD and DS). Study sample: Children with DS (n?=?40; mean age 6.4 years), and TD children (n?=?48; mean age 5.1 years) were included. Results: Wideband absorbance was significantly lower at 1–4?kHz in ears with CHL compared to NH for both TD and DS groups. In ears with patent PETs, wideband absorbance and group delay (GD) were larger than in ears without PETs between 0.25 and 1.5?kHz. Wideband absorbance tests were performed similarly for prediction of CHL and patent PETs in TD and DS groups. Conclusions: Wideband absorbance and GD revealed specific patterns in both TD children and those with DS that can assist in detection of the presence of significant CHL, assess the patency of PETs, and provide frequency-specific information in the audiometric range.     

A randomized trial of clinician-delivered interventions promoting barrier contraception for sexually transmitted disease prevention

OBJECTIVE: The objective of this study was to compare 2 interventions promoting condoms and vaginal microbicides to prevent sexually transmitted disease (STD). STUDY: Women (N = 427) attending an STD clinic were randomly assigned to 2 clinician-delivered interventions and followed up monthly to assess condom/microbicide use and incidence of gonorrhea, chlamydia, and syphilis. RESULTS: During follow up, condom use rates were 69% (enhanced) and 49% (basic) and microbicide use rates were 44% and 29%, respectively. STD rates did not significantly differ between intervention groups. Perfect condom use (regardless of intervention arm) was associated with a 3-fold decrease in STD rates (relative risk [RR], 0.3; 95% confidence interval [CI], 0.1-0.8). Using a vaginal microbicide during > or =50% of the acts of intercourse was associated with reduced STD rates (RR, 0.5; 95% CI, 0.3-1.0) across intervention groups and condom use categories. CONCLUSIONS: The enhanced intervention increased use of condoms and vaginal microbicide; however, STD rates did not decrease because a protective effect was seen only among perfect barrier users, and the enhanced intervention only modestly increased perfect use.     

Perceived qualitative benefits of cochlear implants in children with multi-handicaps

OBJECTIVE: To determine families' perceived benefits of cochlear implants in children with multiple-handicaps. METHODS: Parents/guardians of a child with a cochlear implant for at least 3 months, under the age of 18 years and had least one additional disability were recruited for participation through rehabilitation therapists. Families who did not have a child enrolled in therapy at the study center were contacted by mail. Families were asked a number of open-ended and close-ended questions. Interviews were audiotaped and transcribed, with answers to open-ended questions coded by themes. RESULTS: We interviewed 19 families of 20 children and included 15 families of 16 children who had had at least 6 months of cochlear implant experience for this study. The mean time between implantation and study was 3 years (S.D.+/-2.2) with a range of 0.5-8 years. Children were highly compliant in wearing their device. Sixty-eight percent (11/16) of the children were enrolled in additional therapies beyond speech and aural rehabilitation therapies. Fifty percent of families (8/16) indicated they had no obstacles to accessing therapies. Insurance was the most common barrier to accessing therapies (18% of respondents). All children made communication progress post-implant as described by their families. All families felt that the cochlear implant team provided enough information prior to receiving the implant to help families make the appropriate decision about implanting their child. All families said that if they were to make the decision again, they would choose to have their child implanted. CONCLUSION: More children with multiple-handicaps are receiving cochlear implants. Very young children may undergo cochlear implantation only to be subsequently diagnosed with an additional impairment or disability at later ages. As a result, it is important to understand the specific needs of this population and the parental perceptions of benefit in order to provide the best services and opportunities for success with a cochlear implant. Although not all of the children gained gold standard speech and language outcomes, all children broadened their communication skills. In motivated families of children with additional disabilities, it is appropriate to provide them with the same opportunity to access audition and expand their communication abilities as any other child with a hearing impairment.