Masking Level Differences Encountered in Clinical Populations

Methods for measuring masking level differences (MLDs) at 500 Hz and for spondees were used with 290 subjects: 50 persons with normal hearing and 240 patients with various diseases. Of particular interest was whether techniques currently in clinical use could be used with ease, dispatch, and profit in determining MLD size. The methods selected, which were variations of Békésy audiometry and speech reception threshold procedures, proved clinically feasible

Results revealed differences in behavior from one group of subjects to another. Although MLDs were not affected by cortical lesions, they were very often abnormally small for patients with eighth-nerve tumor, Menière's disease, or multiple sclerosis

The high incidence of abnormally small MLDs in populations with normal sensitivity to pure tones and speech but with evidence of subcortical central lesions, such as patients with multiple sclerosis, suggests that the MLD tasks can be of diagnostic value in detecting retrocochlear lesions. However, in persons with hearing loss or significant interaural differences in threshold sensitivity, or both, the MLD tests are not always reliable in differentiating cochlear from retrocochlear disease     

Variable Venting Valve for Earmolds

The frequency response and loudness reduction characteristics of earmolds with variable venting valves (VVV) were investigated. Both side-branch and laterally vented earmolds were employed. Sound pressures were measured at 44 frequencies from 100 to 4 000 Hz in a modified HA-2 coupler with the VVV in four stages of opening: closed; ? open; ? open and 3/3 open

The effect of venting is primarily in the low frequencies. Little or no reduction in intensity is observed in the ‘speech frequency’ range and a modest amount is noted in the higher frequencies. The side-branch vented earmolds were more effective than the laterally vented earmolds. Calculated loudness reductions in phons were small. The effectiveness of the VVV, whether assessed by the frequency response or loudness reduction characteristics, is achieved within the first ? of opening: further opening has little effect. The utility of the VVV, especially to the geriatric hearing aid user, is questionable     

Assessment of intracellular cytokines and regulatory cells in patients with autoimmune diseases and primary immunodeficiencies — Novel tool for diagnostics and patient follow-up

Serum and intracytoplasmic cytokines are mandatory in host defense against microbes, but also play a pivotal role in the pathogenesis of autoimmune diseases by initiating and perpetuating various cellular and humoral autoimmune processes.     

Surgical management of pelvic organ prolapse

Pelvic organ prolapse is a common condition which can have a profound effect on health-related quality of life. The lifetime risk of surgery for pelvic organ prolapse for all women is around 10–12%, making prolapse surgery one of the most commonly performed operations of all. Surgery is generally offered only to women to do not respond to conservative measures such as physiotherapy and/or vaginal pessaries. It is very important to ensure excellent clinical governance around the decision-making process for this elective surgical problem, and this may include the use of written information, face to face and telephone consultations, patient reported outcome measures and patient decision aids. This chapter will cover all the different techniques for prolapse surgery including conventional approaches using native tissue, uterus conserving prolapse surgery and surgery for post-hysterectomy vault prolapse. This will also include laparoscopic prolapse surgery. The role of mesh in prolapse surgery will also be discussed and this chapter will cover important topics including patient selection and preparation for prolapse surgery, shared decision making and how best to facilitate this, patient preparation before prolapse surgery and follow-up post operation.     

Hearing in Congenital Hypothyroidism

The hearing profile of children with congenital hypothyroidism was studied in 45 patients with thyroid gland agenesis, hypogenesis or dyshormogenesis, during adequate substitution therapy. Preliminary, secretory otitis media was found in 6 patients under the age of 6 years; in these children, hearing assessment was performed after cure of the middle ear effusion. Hearing threshold was measured either by conventional pure-tone audiometry or conditioned orientation reflex audiometry according to the patient's age (above and below 4 years). In 36 patients (80%) the auditory thresholds were normal; in the remaining 9 patients (20%) a sensorineural hearing loss of different degree was detected; in 5 cases (11%) the deafness was important and required auditory rehabilitation, with the use of a hearing aid in 4 of them. No relation could be found between hearing acuity and bone age at diagnosis of hypothyroidism or aetiology of thyroid dysfunction. It is concluded that in about one tenth of the children with congenital hypothyroidism a substantial deafness persists. The sensorineural nature of the hearing loss is in agreement with reported histological findings in congenital hypothyroid animals, where an immature development of the organ of Corti including hair cells and tectorial membrane has been observed.     

Outcome assessment alternatives for young children during the first 12 months after pediatric hearing-aid fittings

Abstract

Objective: Perform longitudinal evaluations of young children during the first 12 months after initial hearing-aid fitting. Document evidence of early prelingual auditory development (EPLAD), identify factors that affect EPLAD, and define performance milestones that can guide best practices. Design: Unblinded, prospective, within-subject, repeated-measures design. Audiological measures and measures of EPLAD were taken at baseline, 3, 6, and 12 months after hearing-aid fitting. Study sample: Subjects were 45 pediatric patients initially fitted with hearing aids between 1 and 5.5 years of age. Four groups were formed for analysis purposes based on severity of hearing loss (moderate-to-severe and profound) and initial fitting age (≤?30 months and >?30 months). Results: All groups exhibited statistically significant increases in EPLAD within six months of hearing-aid fitting, and those with profound losses exhibited further statistically significant improvement between six and 12 months. Similar EPLAD levels were reached at 12 months regardless of severity of hearing loss. The EPLAD trajectory is similar to that following early cochlear implantation. Conclusions: Measures of EPLAD provide a means of evaluating outcomes following early pediatric hearing-aid intervention, supplementing behavioral audiological measures.     

Evidence of progression and fluctuation of hearing impairment in branchio-oto-renal syndrome

We retrospectively analysed long-term serial audiometry data from patients with branchio-oto-renal (BOR) syndrome to show the features of progression and fluctuation in hearing impairment and relate the findings to age and magnetic resonance imaging (MRI) findings in the petrosal bones. Thirty-two clinically affected BOR patients from six Dutch families (A–F) were included. Audiograms were available in 24 cases, covering followup intervals of between 3 and 30 years, and suitable for individual statistical analysis in 16 cases; 14 cases also had MRI findings. Significant progression in hearing impairment was found in 10 cases, while findings of significant fluctuation were made in seven cases. These findings did not clearly correlate with MRI findings. Substantial fluctuation occurred only in cases followed at a relatively young age. Patients with an enlarged endolymphatic duct and/or sac showed significantly higher sensorineural hearing thresholds than those with either normal MRI findings or cochlear/labyrinthine hypoplasia with or without enlarged duct or sac. We conclude that progressive, fluctuant hearing loss occurred in some BOR patients; however, only young patients showed substantial threshold fluctuation. BOR patients with an enlarged endolymphatic duct and/or sac on MRI seemed to be predisposed to developing more severe hearing impairment.     

Compensated active noise cancellation earphone for audiometric screening tests in noisy environments

Abstract

Objective: This study investigated hearing screening tests by using a custom-designed compensated hybrid active noise cancellation (ANC) earphone and compared it with TDH39 and Audiocups audiometric earphones under conditions of quiet, 45?dB HL masking narrowband, wideband speech-shaped, and white noise.

Design: The hearing screening tests were conducted to characterise the shifts of screening results under noisy conditions, and real-ear attenuations at thresholds were assessed to quantify real-ear noise reduction performance.

Study sample: Twenty-four normal-hearing adults, aged 20–25?years, participated in this study.

Results: The ANC earphone exhibited significantly lower/better mean screening results than those of the TDH39 earphone at 250 and 500?Hz and those of the Audiocups earphone at 250?Hz under conditions of narrowband, speech-shaped, and white noise. Compared with the TDH39 earphone at 250 and 500?Hz, applying a hybrid ANC earphone reduced the shifts in screening results by 14.2 and 12.3?dB, respectively, under the narrowband noise condition.

Conclusion: This study demonstrated that the compensated hybrid ANC earphone provided lower shifts of screening results than the TDH39 and Audiocups earphones and that it was capable of screening at 250 and 500?Hz from 20?dB HL under 45?dB HL masking narrowband and wideband noise.     

Prevalence of auditory neuropathy spectrum disorder in an auditory health care service

Auditory neuropathy spectrum disorder (ANSD) is characterized by impairment of the auditory nerve associated with preservation of outer hair cell function.ObjectiveTo establish the prevalence of ANSD in subjects with sensorineural hearing loss (SNHL).MethodThis retrospective study was carried out between 2010 and 2012 and included the charts of 2,292 individuals with SNHL. Data from otolaryngological and audiological examinations based on pure-tone and speech audiometry, impedance tests, otoacoustic emissions (OAEs), and brainstem auditory evoked potentials (BAEPs) were collected. Inclusion criteria: presence of OAEs and/or cochlear microphonic (CM); absent or altered BAEPs, and normal MRI scans of the brain.ResultsTwenty-seven (1.2%) of the 2,292 subjects with SNHL had ANSD (37% males; 63% females). Mild SNHL was seen in 29.6% of the individuals with ANSD; 55.5% had moderate SNHL; 7.4% had severe SNHL; and 7.5% had profound SNHL. In terms of age, 14.8% were aged between zero and 20 years, 44.1% were 41 to 60 years old, and 7.4% were above the age of 60.ConclusionANSD was seen in 1.2% of the individuals with SNHL included in this study.     

A comparison of the efficacy of weight-shift vs. joystick control of a robotic mobility device by infants ages 5 to 10 months

The onset of crawling in infants contributes to cognitive, perceptual, social, and emotional development. Conversely, infants with motor impairment that delays or prevents autonomous mobility often have associated developmental delays. Evidence suggests that providing mobility may have positive developmental outcomes, however powered wheelchairs may not be recommended for very young children, due to safety concerns and the child’s level of cognitive maturity. The WeeBot is a mobility device controlled by infant weight shifting while seated; infants as young as 5 months have learned to use it. This study compares the efficacy of using the WeeBot vs. using the traditional manual joystick to control a robotic mobility device. Participants were 20 typically developing infants between 5 and 10 months who had not yet achieved independent mobility. A quasi-experimental two-group design was used: The first 10 participants recruited used the WeeBot (weight-shift); the next 10 used the joystick. Results showed that infants learned to use weight-shift control more easily and more skilfully than did infants using the joystick. The ability of infants to use the WeeBot suggests that an intuitive alternative control might allow very early powered mobility for children with disabilities, which might have implications for various aspects of their development.