Research News in Speech,
Language, and Hearing Disorders
for December 2006

December 21, 2006

• Analysis of Mastoid Findings at Surgery to Treat Middle Ear Cholesteatoma
  from the current issue of Archives of Otolaryngology--Head and Neck Surgery
  "Objectives To analyze mastoid findings, such as facial nerve dehiscence (FND), labyrinthine fistula, and dural exposure; to review its incidence at cholesteatoma surgery; to analyze its association with semicircular canal fistula; and to elucidate its relationship with dural exposure. Design One hundred fifty-two patients (65 males and 87 females; 155 ears) were enrolled in a retrospective study of tympanoplasty with or without mastoidectomy. Setting Medical university center hospital. Results The incidence of FND after exenteration of disease was 29.7% (46/155 ears) for total surgical procedures, 29.7% (43/145 ears) for initial procedures, and 30% (3/10 ears) for revision procedures. The prevalence of FND in the tympanic segment only was 87%, with 8.7% in the vertical segment only and 4.3% in both segments. Three patients (2.0%) developed facial palsy postoperatively, with 8 lateral semicircular canal fistulas (5.2% of total ears operated on), half of these with concomitant FND. The incidence of dural exposure of the mastoid tegmen in the entire surgical group was 16.8% (26 ears), 38.5% with concomitant FND. Conclusions The overall incidence of FND in our sample was high at 29.7%, with rates of lateral semicircular canal fistula and dural exposure of 5.2% and 16.8%, respectively. The relationship between FND incidence and presence of lateral semicircular canal fistula was positive in our study. The surgeon should bear in mind that the location of FND with cholesteatoma coincides with the most common area of iatrogenic facial nerve injury during otologic surgery."

• Changes in the Cricoarytenoid Joint Induced by Intubation in Neonates
  from the current issue of Archives of Otolaryngology--Head and Neck Surgery
  "Objective To characterize the histopathologic characteristics of the cricoarytenoid joint (CAJ) as a means to understand the mechanisms of vocal cord fixation in children after prolonged intubation. Design Histologic analysis of laryngeal specimens obtained from infants who had died secondary to various causes and who had been intubated from 1 to 30 days. Main Outcome Measure Histopathologic characteristics of CAJ. Results Laryngeal specimens from infants who had been intubated for prolonged periods of time demonstrated evidence of hemorrhage, infection, inflammation, and fibrosis within the CAJ. Furthermore, a statistical correlation was found between the length of intubation and the presence of these histologic abnormalities. Conclusions To our knowledge, this is the first study to demonstrate histologic changes in the CAJ in laryngeal specimens of children who have been intubated for prolonged periods of time. Such histological changes in the CAJ could explain the mechanism of vocal cord immobility in children after intubation."

• Clinical Factors Of Tinnitus Influence Perceived Loudness And Annoyance
  from ScienceDaily.com
  "Clinical characteristics of tinnitus such as duration, consistency and other factors influence the way individuals perceive loudness and annoyance associated with the condition, according to a report in the December issue of Archives of Otolaryngology-Head & Neck Surgery, one of the JAMA/Archives journals."

• Developmental neurotoxicity of industrial chemicals
  from a PubMed abstract of an article in the Lancet
  "Neurodevelopmental disorders such as autism, attention deficit disorder, mental retardation, and cerebral palsy are common, costly, and can cause lifelong disability. Their causes are mostly unknown. A few industrial chemicals (eg, lead, methylmercury, polychlorinated biphenyls [PCBs], arsenic, and toluene) are recognised causes of neurodevelopmental disorders and subclinical brain dysfunction. Exposure to these chemicals during early fetal development can cause brain injury at doses much lower than those affecting adult brain function. Recognition of these risks has led to evidence-based programmes of prevention, such as elimination of lead additives in petrol. Although these prevention campaigns are highly successful, most were initiated only after substantial delays. Another 200 chemicals are known to cause clinical neurotoxic effects in adults. Despite an absence of systematic testing, many additional chemicals have been shown to be neurotoxic in laboratory models. The toxic effects of such chemicals in the developing human brain are not known and they are not regulated to protect children. The two main impediments to prevention of neurodevelopmental deficits of chemical origin are the great gaps in testing chemicals for developmental neurotoxicity and the high level of proof required for regulation. New, precautionary approaches that recognise the unique vulnerability of the developing brain are needed for testing and control of chemicals."

• Differential Distribution of Stem Cells in the Auditory and Vestibular Organs of the Inner Ear
  from the current issue of JARO -- Journal of the Association for Research in Otolaryngology
  "Abstract The adult mammalian cochlea lacks regenerative capacity, which is the main reason for the permanence of hearing loss. Vestibular organs, in contrast, replace a small number of lost hair cells. The reason for this difference is unknown. In this work we show isolation of sphere-forming stem cells from the early postnatal organ of Corti, vestibular sensory epithelia, the spiral ganglion, and the stria vascularis. Organ of Corti and vestibular sensory epithelial stem cells give rise to cells that express multiple hair cell markers and express functional ion channels reminiscent of nascent hair cells. Spiral ganglion stem cells display features of neural stem cells and can give rise to neurons and glial cell types. We found that the ability for sphere formation in the mouse cochlea decreases about 100-fold during the second and third postnatal weeks; this decrease is substantially faster than the reduction of stem cells in vestibular organs, which maintain their stem cell population also at older ages. Coincidentally, the relative expression of developmental and progenitor cell markers in the cochlea decreases during the first 3 postnatal weeks, which is in sharp contrast to the vestibular system, where expression of progenitor cell markers remains constant or even increases during this period. Our findings indicate that the lack of regenerative capacity in the adult mammalian cochlea is either a result of an early postnatal loss of stem cells or diminishment of stem cell features of maturing cochlear cells."

• Factors Influencing Tinnitus Loudness and Annoyance
  from the current issue of Archives of Otolaryngology--Head and Neck Surgery
  "Objective To evaluate the 2 major components of tinnitus severity, loudness and annoyance, and their degree of dependence on characteristics of tinnitus manifestation, history, and etiology. Design Cross-sectional survey performed during the first months of 2004. Setting Nonclinical population. Participants A total of 4995 members of the German Tinnitus League. Main Outcome Measures Comprehensive screening questionnaire, including the Klockhoff and Lindblom loudness grading system and the miniversion of the Tinnitus Questionnaire. Results A moderate correlation of 0.45 was found between tinnitus loudness and annoyance. Both factors were generally higher in men, those older than 50 years, those with binaural and centrally perceived tinnitus, those with increased noise sensitivity, and those who had continuous tinnitus without interruptions. Tinnitus that lasted 12 months or less had a stronger influence on annoyance (odds ratio [OR], 1.96) than on loudness (OR, 0.45), whereas the contrary was found for tinnitus of more than 5 years' duration (ORs, 0.72 and 2.11, respectively). Loudness and annoyance were increased in subjects with coexisting hearing loss, vertigo, and hyperacusis. The impact of hyperacusis on annoyance was clearly stronger than on loudness (ORs, 21.91 vs 9.47). Conclusions Several clinical factors of tinnitus influence perceived loudness and annoyance. Both are distinguishable components of tinnitus severity."

• Neurobiology: Auditory fidelity
  from the current issue of Nature
  "Detailed investigation of a molecule involved in an inherited type of deafness reveals a fresh facet to the mammalian auditory system — a hitherto unknown way for synapses to put calcium in a bind."

• Radiographic Classification of Temporal Bone Fractures
  from the current issue of Archives of Otolaryngology--Head and Neck Surgery
  "Objective To compare the traditional system of radiographic classification of temporal bone fractures (transverse vs longitudinal vs oblique) with a newer system (otic capsule violating vs otic capsule sparing) with respect to their ability to predict sequelae of temporal bone trauma. Design Retrospective chart and radiology review. Setting University trauma center and Department of Otolaryngology–Head and Neck Surgery. Patients Patients with temporal bone fractures. Interventions Clinic records and computed tomographic scans were reviewed to evaluate the clinical predictability of complications of temporal bone fractures. Main Outcome Measures Complications of temporal bone fractures (ie, sensorineural hearing loss, conductive hearing loss, cerebrospinal fluid leakage, and facial nerve weakness) were recorded. Two classification schemes for temporal bone fractures were statistically analyzed and compared as to their ability to predict each complication. Results A total of 234 temporal bone fractures were identified; 30 cases met our strict criteria for inclusion. The traditional classification system of temporal bone fractures did not significantly predict temporal bone complications (P = .71). On the other hand, the otic capsule–based system did demonstrate statistically significant predictive ability (P < .001). Patients with otic capsule–violating fractures were 5 times more likely to have facial nerve injury, 25 times more likely to have sensorineural hearing loss, and 8 times more likely to have cerebrospinal fluid otorrhea than those with otic capsule–sparing fractures. Conclusions The traditional radiographic classification system failed to demonstrate clinical predictability in our series. Furthermore, the newer system of classification (otic capsule sparing vs otic capsule violating) demonstrated statistically significant predictive ability for serious clinical outcomes associated with temporal bone fractures."

• Reading and spelling abilities in children with severe speech impairments and cerebral palsy at 6, 9, and 12 years of age in relation to cognitive development: a longitudinal study
  from the current issue of Child: Care, Health and Development
  "Reading and spelling abilities in children with severe speech impairments and cerebral palsy at 6, 9, and 12 years of age in relation to cognitive development: a longitudinal study."

December 19, 2006

• Caregiver Education as a Prevention Strategy for Communication Disorders in South Africa
  from the current issue of Infants and Young Children
  "Abstract: Many early interventionists in clinical practice still do not appear to be wholeheartedly committed to participating in the prevention of communication disorders and the promotion of optimal development, which have been identified as primary roles for all professionals ( ASHA, 1991). Owing to the prevalence of risk factors such as HIV/AIDS and poverty, infants and young children in developing countries such as South Africa are at an even higher risk for developing communication disorders, resulting in a greater need for early interventionists to focus on the prevention of communication disorders and the tools needed to achieve this. The purpose of this article is to (1) highlight the need for prevention of communication disorders and discuss the different types of prevention strategies used with special reference made to the needs within South Africa; (2) to highlight the potential benefits of caregiver education programs on communication development, including a discussion on a South African study that developed a tool that could be used for caregiver education; and (3) to encourage early interventionists to participate in prevention actions through the provision of practical guidelines and strategies."

• Developmental Outcomes of Children Born After Assisted Reproductive Technologies
  from the current issue of Infants and Young Children
  "Abstract: Since the birth of Louise Brown in England more than 25 years ago, an estimated 2 million children have been born worldwide through in vitro fertilization and related assisted reproduction technology (ART) procedures. Most children born after ART are healthy and develop without complications. Largely because of multiple births (twins, triplets, etc), however, some ART offspring experience developmental problems. In addition, recent studies suggest increased risk of prematurity and smaller birth weight after ART. Regular periodic screening and careful developmental follow-up of ART offspring are recommended as well as rigorous follow-up studies of children conceived after these procedures."

• Factors Influencing Tinnitus Loudness and Annoyance
  from the current issue of Archives of Otolaryngology--Head and Neck Surgery
  "Objective To evaluate the 2 major components of tinnitus severity, loudness and annoyance, and their degree of dependence on characteristics of tinnitus manifestation, history, and etiology. Design Cross-sectional survey performed during the first months of 2004. Setting Nonclinical population. Participants A total of 4995 members of the German Tinnitus League. Main Outcome Measures Comprehensive screening questionnaire, including the Klockhoff and Lindblom loudness grading system and the miniversion of the Tinnitus Questionnaire. Results A moderate correlation of 0.45 was found between tinnitus loudness and annoyance. Both factors were generally higher in men, those older than 50 years, those with binaural and centrally perceived tinnitus, those with increased noise sensitivity, and those who had continuous tinnitus without interruptions. Tinnitus that lasted 12 months or less had a stronger influence on annoyance (odds ratio [OR], 1.96) than on loudness (OR, 0.45), whereas the contrary was found for tinnitus of more than 5 years' duration (ORs, 0.72 and 2.11, respectively). Loudness and annoyance were increased in subjects with coexisting hearing loss, vertigo, and hyperacusis. The impact of hyperacusis on annoyance was clearly stronger than on loudness (ORs, 21.91 vs 9.47). Conclusions Several clinical factors of tinnitus influence perceived loudness and annoyance. Both are distinguishable components of tinnitus severity."

• Foreign Body Reaction to Calcium Hydroxylapatite Vocal Fold Augmentation
  from the current issue of Archives of Otolaryngology--Head and Neck Surgery
  "INTRODUCTION We report a case of inflammation with foreign body cell reaction following injection of the true vocal folds (TVFs) with Radiesse (Bioform Inc, San Mateo, Calif), a synthetic calcium hydroxylapatite (CaHA) material. The patient underwent injection laryngoplasty for a 10-year history of persistent hoarseness and documented bilateral vocal fold paresis. Initial postoperative examination revealed overaugmentation with migration of the material. The material was removed in 2 successive procedures. Results of histological examination revealed the presence of chronic inflammation and foreign body giant cells (FBGCs). This is, to our knowledge, the first published case of an apparent FBGC reaction to vocal fold augmentation with Radiesse and leads us to conclude that rare CaHA rejection reactions can occur in human subjects."

• Meniett Clinical Trial: Long-term Follow-up
  from the current issue of Archives of Otolaryngology--Head and Neck Surgery
  "Objective To delineate 2-year efficacy of Meniett device therapy in people with classic, unilateral, Ménière's disease unresponsive to traditional medical treatment. Design A 2-year long-term unblinded follow-up after a prior randomized, placebo-controlled, multicenter clinical trial of the Meniett device for Ménière's disease. Setting Follow-up was performed remotely by using diaries and questionnaires mailed to the data coordinating center by the participants. Those who failed to mail their diaries were interviewed by telephone. Participants Sixty-one study participants agreed to use the Meniett device and report their symptoms for 2 years. All had active, unilateral cochleovestibular disease. Outcomes are available for 58 participants; 2 were unavailable for follow-up and 1 was excluded because of a concurrent condition that precluded Meniett device use. Interventions Participants were advised to adhere to a low-sodium diet, use the Meniett device 3 times daily, and maintain a patent tympanostomy tube in the affected ear. Diuretic and vestibular suppressant medications were used as needed. Main Outcome Measures Outcomes were based on the participants' daily diary, questionnaires, and telephone interviews. Three different analyses were prepared: tracking of vertigo frequency throughout the study, comparison of vertigo frequency before and at the end of Meniett device use (American Academy of Otolaryngology-Head and Neck Surgery Foundation reporting guideline), and Kaplan-Meier estimates of vertigo remission and recurrence. Results Vertigo levels gradually improved for most but not all participants. American Academy of Otolaryngology-Head and Neck Surgery Foundation class A (remission) or class B (greatly improved) results occurred in 67% (39/58) of participants, and class F (dropped out to receive surgical therapy) results occurred in 24%. Of the 44 nondropout participants, 39 (89%) had American Academy of Otolaryngology-Head and Neck Surgery Foundation group A or B outcomes. People who went into remission were highly likely (80%) to remain in remission long term; participants who achieved remission (20/43; 47%) did so within the first year of follow-up. Conclusions Use of the Meniett device was associated with a significant reduction in vertigo frequency in about two thirds of the participants, and this improvement was maintained long term. Therapy with the Meniett device is a safe and effective option for people with substantial vertigo uncontrolled by medical therapy."

• Ofloxacin Otic Drops vs Neomycin–Polymyxin B Otic Drops as Prophylaxis Against Early Postoperative Tympanostomy Tube Otorrhea
  from the current issue of Archives of Otolaryngology--Head and Neck Surgery
  "Objectives To evaluate the incidence of tympanostomy tube (TT) sequelae, tube otorrhea, and tube obstruction immediately postoperatively in patients receiving TT for otitis media and to compare patients receiving postoperative otic drops with controls. Design Blinded randomized control trial. Setting A tertiary pediatric otolaryngology practice. Subjects The study population comprised 306 patients undergoing TT placement. Interventions The 306 patients were enrolled into the following 3 groups: (1) those receiving no postoperative otic drop prophylaxis (control group), (2) those receiving ofloxacin otic drops (FLOX group), and (3) those receiving neomycin sulfate–polymyxin B sulfate–hydrocortisone otic drops (COS group). Results Overall otorrhea rates postoperatively were 14.9% for the control group, 8.1% for the FLOX group, and 5.5% for the COS group. When controlling for disease severity, the rate of otorrhea was significantly higher for the control group than for both the FLOX (P = .04) and COS (P = .01) groups. Nonpatent, plugged, tube rates were added to otorrhea rates for a TT failure analysis postoperatively. The control group demonstrated a significantly greater failure rate (29.9%) than both the FLOX (12.1%) and COS (7.7%) groups. The only differences between the patients in the 2 groups receiving drops were that ofloxacin was more well liked by patients (P = .04) and caused less pain (P = .004). Conclusions Nonpatency and otorrhea are the most frequent sequelae immediately following TT placement. Few studies have compared different treatment regimens in a randomized controlled trial. These results demonstrate that otic drops clearly provide benefit postoperatively in preventing TT plugging and otorrhea but primarily in patients who have middle ear fluid at the time of TT placement. In addition, consideration of drop choice should be based on patient tolerance and medication safety profiles."

• Radiographic Classification of Temporal Bone Fractures
  from the current issue of Archives of Otolaryngology--Head and Neck Surgery
  "Objective To compare the traditional system of radiographic classification of temporal bone fractures (transverse vs longitudinal vs oblique) with a newer system (otic capsule violating vs otic capsule sparing) with respect to their ability to predict sequelae of temporal bone trauma. Design Retrospective chart and radiology review. Setting University trauma center and Department of Otolaryngology–Head and Neck Surgery. Patients Patients with temporal bone fractures. Interventions Clinic records and computed tomographic scans were reviewed to evaluate the clinical predictability of complications of temporal bone fractures. Main Outcome Measures Complications of temporal bone fractures (ie, sensorineural hearing loss, conductive hearing loss, cerebrospinal fluid leakage, and facial nerve weakness) were recorded. Two classification schemes for temporal bone fractures were statistically analyzed and compared as to their ability to predict each complication. Results A total of 234 temporal bone fractures were identified; 30 cases met our strict criteria for inclusion. The traditional classification system of temporal bone fractures did not significantly predict temporal bone complications (P = .71). On the other hand, the otic capsule–based system did demonstrate statistically significant predictive ability (P < .001). Patients with otic capsule–violating fractures were 5 times more likely to have facial nerve injury, 25 times more likely to have sensorineural hearing loss, and 8 times more likely to have cerebrospinal fluid otorrhea than those with otic capsule–sparing fractures. Conclusions The traditional radiographic classification system failed to demonstrate clinical predictability in our series. Furthermore, the newer system of classification (otic capsule sparing vs otic capsule violating) demonstrated statistically significant predictive ability for serious clinical outcomes associated with temporal bone fractures."

• Soldiers Exposed To Gunshot Noise Need Better Hearing Protection
  from Newswise.com
  "A new study published in the January issue of the medical journal Otolaryngology- Head and Neck Surgery strongly recommends better hearing protection for soldiers to prevent permanent long-term hearing loss that can be caused by exposure to the sound of gunshots."

December 18, 2006

• Devices help give voice to students who are autistic
  from the Dec. 13 issue of the Mercury News
  "It looks like an ordinary computer keyboard with a narrow display screen running across the top. Boxy. Plain. Nothing extraordinary. But this drab device translates keystrokes into spoken words -- a concept familiar to anyone who has heard the clipped yet engaging computer-generated speech of eminent scientist Stephen Hawking. The technology offers hope of faster and easier communication for some people with autism, a neurological disorder characterized by difficulty in verbal communication."

• Evaluation of hearing in children with autism by using TEOAE and ABR
  from the current issue of Autism
  "Assessment of auditory abilities is important in the diagnosis and treatment of children with autism. The aim was to evaluate hearing objectively by using transient evoked otoacoustic emission (TEOAE) and auditory brainstem response (ABR). Tests were performed on 30 children with autism and 15 typically developing children, following otomicroscopy and tympanometry. The children with autism were sedated before the tests. Positive emissions and normal hearing level at ABR were obtained in both ears of all children in the control group and of 25 children with autism. TEOAE and ABR results varied in the remaining five children with autism. The mean III–V interpeak latencies (IPLs) in both ears of children with autism were longer than those in the control group. Hearing loss may be more common in children with autism than in typically developing children."

• Neuropathic and cerebrovascular correlates of hearing loss in Fabry disease
  from the current issue of Brain
  "Fabry disease, OMIM 301500 [OMIM] , is a progressive multisystem storage disorder due to the deficiency of -galactosidase A (GALA). Neurological and vascular manifestations of this disorder with regard to hearing loss have not been analysed quantitatively in large cohorts. We conducted a retrospective cross sectional analysis of hearing loss in 109 male and female patients with Fabry disease who were referred to and seen at the Clinical Center of the National Institutes of Health, Bethesda, MD, USA on natural history and enzyme replacement study protocols. There were 85 males aged 6–58 years (mean 31 years, SD 13) and 24 females aged 22–72 years (mean 42 years, SD 12). All patients underwent a comprehensive audiological evaluation. In addition, cerebral white matter lesions, peripheral neuropathy, and kidney function were quantitatively assessed. HL95, defined as a hearing threshold above the 95th percentile for age and gender matched normal controls, was present in 56% [95% CI (42.2–67.2)] of the males. Prevalence of HL95 was lower in the group of patients with residual GALA enzyme activity compared with those without detectable activity (33% versus 63%) HL95 was present in the low-, mid- and high-frequency ranges for all ages. Male patients with HL95 had a higher microvascular cerebral white matter lesion load [1.4, interquartile range (IQR) 0–30.1 ± versus 0, IQR 0–0], more pronounced cold perception deficit [19.4 ± 5.5 versus 13.5 ± 5.5 of just noticeable difference (JND) units] and lower kidney function [creatinine: 1.6 ± 1.2 versus 0.77 ± 0.2 mg/dl; blood urea nitrogen (BUN): 20.1 ± 14.1 versus 10.3 ± 3.28 mg/dl] than those without HL95 (P < 0.001). Of the females, 38% had HL95. There was no significant association with cold perception deficit, creatinine or BUN in the females. Word recognition and acoustic reflexes analyses suggested a predominant cochlear involvement. We conclude that hearing loss involving all frequency regions significantly contributes to morbidity in patients with Fabry disease. Our quantitative analysis suggests a correlation of neuropathic and vascular damage with hearing loss in the males. Residual GALA activity appears to have a protective effect against hearing loss."

• Paradoxical recovery in a bilingual patient with aphasia after right capsuloputaminal infarction
  from the current issue of the Journal of Neurology, Neurosurgery, and Psychiatry
  " ABSTRACT We report the case of a bilingual dextral patient, who presented with an uncommon pattern of aphasic deficit following a right capsulo-putaminal infarction. In this patient, the linguistic deficit concerned the use of her mother tongue (Galician, L1) much more than the lesser practised second language (Spanish, L2). Our patient presented spontaneous fluent speech in L2 but not in L1, automatic translation into L2, and impaired repetition in L1, whereas comprehension was spared in both L1 and L2. Reading and writing were less valuable due to educational interference (reduced schooling). Spontaneous speech 16 months after the stroke showed the stability of the impairment."

• A pilot study of the effects of a social-pragmatic intervention on the communication and symbolic play of children with autism
  from the current issue of Autism
  "The acquisition of social communication skills is a major challenge faced by children with autism. This pilot study investigated the effects of the Stronger Families Project, a social-pragmatic intervention, on the communication and symbolic abilities of 16 children aged 2–4 years with autism. Standardized measures of the child's communication and symbolic behaviour were conducted by independent observers at a university clinic pre and post-intervention, and parents were interviewed to determine the impact of variables such as maternal stress and competence on the child's social communication. Changes in some communication and symbolic behaviours occurred following the Stronger Families Project intervention according to parent report. However, improvements based on ratings by independent observers were not significant. Results are discussed in relation to the assessment of changes in the social communication and symbolic play of children with autism following intervention using clinical observation and parent report."

• Social services support and expenditure for children with autism
  from the current issue of Autism
  "This article provides information about children with autism who are supported by English social services departments based on the Children in Need Survey 2001 (CIN2001). In 119 authorities, 6310 children were recorded as having a diagnosis of autism or related conditions, probably about one-quarter of all children with such diagnoses and about half of those actually supported. Demographically, this group appears similar to children with autism generally: there are more boys than girls, and learning, communication and behaviour difficulties are common. CIN2001 shows that mean social services support costs tend to be quite high, particularly compared with other disabled children. There are very considerable variations between social services departments in reported numbers and spending. It is unlikely that this variation can be attributed to the prevalence of autism, and more likely that it reflects the case recognition and service provision policies of local agencies."

December 15, 2006

• Abnormal Eye Movements Associated with Unilateral Loss of Vestibular Function
  from the current issue of the New England Journal of Medicine
  No abstract available.

• Breast-Feeding Overcomes A Genetic Tendency Toward Ear Infections, Scientists Discover
  from Medical News Today.com
  "Breast-feeding protects children otherwise made susceptible to ear infections by abnormalities in specific human genes, researchers at the University of Texas Medical Branch at Galveston have discovered."

• Cleft palate research receives £200,000 award
  from Medical News Today.com
  "Pioneering research that could lead to a breakthrough in understanding the causes of cleft palate in newborn babies has begun in Manchester, UK."

• Clinical trials bureaucracy: unintended consequences of well-intentioned policy
  from the current issue of Clinical Trials
  "Conclusion The current system of regulatory bureaucracy in clinical trials has led to an extremely expensive research paradigm that, in spite of complex systems of oversight and exhaustive data collection, cannot be shown to adequately ensure the integrity of the research process and the protection of human research subjects. Some parts of the system, including Research Ethics Review Boards, may not be well-suited to carrying out their core mission of overseeing research conduct, and other aspects of clinical trials regulatory structure, such as monitoring/auditing review and adverse event reporting, may constitute a waste of money and resources. Misdirected data collection and adverse events reporting divert valuable resources and hamper development of large, simple clinical trials powered to definitively answer important research questions. Careful scrutiny of the utility of current or proposed regulatory schemes is required to ensure the integrity of human subjects research and to enhance the effectiveness of research dollars."

• Deaf and Proud to Use Sign Language
  from ABC News.com
  "Many Refuse Cochlear Implants and Other Medical Advances."

• The Effect of Gaussian Noise on the Threshold, Dynamic Range, and Loudness of Analogue Cochlear Implant Stimuli
  from the current issue of JARO -- Journal of the Association for Research in Otolaryngology
  "Abstract The deliberate addition of Gaussian noise to cochlear implant signals has previously been proposed to enhance the time coding of signals by the cochlear nerve. Potentially, the addition of an inaudible level of noise could also have secondary benefits: it could lower the threshold to the information-bearing signal, and by desynchronization of nerve discharges, it could increase the level at which the information-bearing signal becomes uncomfortable. Both these effects would lead to an increased dynamic range, which might be expected to enhance speech comprehension and make the choice of cochlear implant compression parameters less critical (as with a wider dynamic range, small changes in the parameters would have less effect on loudness). The hypothesized secondary effects were investigated with eight users of the Clarion cochlear implant; the stimulation was analogue and monopolar. For presentations in noise, noise at 95% of the threshold level was applied simultaneously and independently to all the electrodes. The noise was found in two-alternative forced-choice (2AFC) experiments to decrease the threshold to sinusoidal stimuli (100 Hz, 1 kHz, 5 kHz) by about 2.0 dB and increase the dynamic range by 0.7 dB. Furthermore, in 2AFC loudness balance experiments, noise was found to decrease the loudness of moderate to intense stimuli. This suggests that loudness is partially coded by the degree of phase-locking of cochlear nerve fibers. The overall gain in dynamic range was modest, and more complex noise strategies, for example, using inhibition between the noise sources, may be required to get a clinically useful benefit."

• Electrical Excitation of the Acoustically Sensitive Auditory Nerve: Single-Fiber Responses to Electric Pulse Trains
  from the current issue of JARO -- Journal of the Association for Research in Otolaryngology
  "Abstract Nearly all studies on auditory-nerve responses to electric stimuli have been conducted using chemically deafened animals so as to more realistically model the implanted human ear that has typically been profoundly deaf. However, clinical criteria for implantation have recently been relaxed. Ears with “residual” acoustic sensitivity are now being implanted, calling for the systematic evaluation of auditory-nerve responses to electric stimuli as well as combined electric and acoustic stimuli in acoustically sensitive ears. This article presents a systematic investigation of single-fiber responses to electric stimuli in acoustically sensitive ears. Responses to 250 pulse/s electric pulse trains were collected from 18 cats. Properties such as threshold, dynamic range, and jitter were found to differ from those of deaf ears. Other types of fiber activity observed in acoustically sensitive ears (i.e., spontaneous activity and electrophonic responses) were found to alter the temporal coding of electric stimuli. The electrophonic response, which was shown to greatly change the information encoded by spike intervals, also exhibited fast adaptation relative to that observed in the “direct” response to electric stimuli. More complex responses, such as “buildup” (increased responsiveness to successive pulses) and “bursting” (alternating periods of responsiveness and unresponsiveness) were observed. Our findings suggest that bursting is a response unique to sustained electric stimulation in ears with functional hair cells."

• Evaluation of hearing in children with autism by using TEOAE and ABR
  from the current issue of Autism
  "Assessment of auditory abilities is important in the diagnosis and treatment of children with autism. The aim was to evaluate hearing objectively by using transient evoked otoacoustic emission (TEOAE) and auditory brainstem response (ABR). Tests were performed on 30 children with autism and 15 typically developing children, following otomicroscopy and tympanometry. The children with autism were sedated before the tests. Positive emissions and normal hearing level at ABR were obtained in both ears of all children in the control group and of 25 children with autism. TEOAE and ABR results varied in the remaining five children with autism. The mean III–V interpeak latencies (IPLs) in both ears of children with autism were longer than those in the control group. Hearing loss may be more common in children with autism than in typically developing children."

• Generalizing results of randomized trials to clinical practice: reliability and cautions
  from the current issue of Clinical Trials
  "Conclusions Complex therapies need careful consideration before they can be applied routinely from trials into practice, and applying results from one health care environment to a different one should be carried out with caution. Generalizing results from well conducted trials to clinical practice can mostly be carried out with confidence, especially for simple therapies with good evidence of benefit."

• Independent design and conduct of clinical trials
  from the current issue of Clinical Trials
  "Randomized clinical trials (RCTs) have justifiably become the cornerstone for the evaluation of virtually any kind of intervention: drugs, surgical or diagnostic procedures, behavioural modifications, health policies and even systems of care. This commentary focuses on two issues related to independence in clinical trials: first, the independence to ask important questions, and second, independence from bias in the conduct, analysis and reporting of trials, which can lead to misleading conclusions. The most frequent type of RCT are those evaluating therapies, and much of this commentary will be focused on issues relevant to such trials, although the principles apply generally."

• Neural Mechanisms in Dyslexia
  from the current issue of Current Directions in Psychological Science
  "ABSTRACT—Within the last two decades, evidence from many laboratories has converged to indicate the cognitive basis for dyslexia: Dyslexia is a disorder within the language system and, more specifically, within a particular subcomponent of that system, phonological processing. Converging evidence from a number of laboratories using functional brain imaging indicates that there is a disruption of left-hemisphere posterior neural systems in child and adult dyslexic readers when they perform reading tasks. The discovery of a disruption in the neural systems serving reading has significant implications for the acceptance of dyslexia as a valid disorder—a necessary condition for its identification and treatment. Brain-imaging findings provide, for the first time, convincing, irrefutable evidence that what has been considered a hidden disability is "real," and these findings have practical implications for the provision of accommodations, a critical component of management for older children and young adults attending postsecondary and graduate programs. The utilization of advances in neuroscience to inform educational policy and practices provides an exciting example of translational science being used for the public good."

• New dyslexia theory blames 'noise': Poor filtering of unwanted data may be the root cause of common disorder
  from EurekAlert.org
  "The dyslexic brain struggles to read because even small distractions can throw it off, according to a new model of dyslexia emerging from a group of recent studies. The studies contradict an influential, 30-year-old theory that blamed dyslexia on a neural deficit in processing the fast sounds of language. Instead, the studies suggest that children with dyslexia have bad filters for irrelevant data. As a result, they struggle to form solid mental categories for identifying letters and word sounds."

• On ethics and deafness: research, pedagogy and politics
  from the current issue of Deafness and Education International
  "This paper considers ethical issues surrounding the education of students with significant hearing losses. Rather than focusing on history or current challenges, it looks ahead to the not-too-distant future to examine the likely collision of ethics, pedagogy and politics. To a large extent, ethical issues looming on the horizon can be tied back to older challenges, not in any causal sense, but in the sense of recognising that forces which drove disagreements and barriers to educational progress in the past are likely to continue or re-emerge in new forms in the future. In one sense, this prospective analysis reflects the frustration of many educators, parents and researchers. Rather than being pessimistic, however, it argues that if we are cognisant of our less than stellar progress in the past, we have the potential to make great strides in deaf education in the future. Only by being fully informed by objective evidence and setting aside philosophical and emotional considerations can we best serve deaf and hard-of-hearing students of tomorrow. Copyright © 2006 John Wiley & Sons, Ltd."

• A pilot study of the effects of a social-pragmatic intervention on the communication and symbolic play of children with autism
  from the current issue of Autism
  "The acquisition of social communication skills is a major challenge faced by children with autism. This pilot study investigated the effects of the Stronger Families Project, a social-pragmatic intervention, on the communication and symbolic abilities of 16 children aged 2–4 years with autism. Standardized measures of the child's communication and symbolic behaviour were conducted by independent observers at a university clinic pre and post-intervention, and parents were interviewed to determine the impact of variables such as maternal stress and competence on the child's social communication. Changes in some communication and symbolic behaviours occurred following the Stronger Families Project intervention according to parent report. However, improvements based on ratings by independent observers were not significant. Results are discussed in relation to the assessment of changes in the social communication and symbolic play of children with autism following intervention using clinical observation and parent report."

• Should research ethics triumph over clinical ethics?
  from the current issue of the Journal of Evaluation in Clinical Practice
  "Evidence-based medicine (EBM) and its main strategy, randomized clinical trials, have had less impact on medical practice than might be expected. Of the various reasons that make practitioners wary of applying research results, this paper explores some consequences of scientists' and research sponsors' adamant insistence that reliable science can only be achieved if protocols adhere exclusively to the ethics of investigation basically reduced to obtaining informed consent and avoiding risks as far as possible. This means, and has been explicitly contended, that neither patients nor doctors should fall prey to the therapeutic fallacy which leads them to expect that research will also take care of patient-subjects' medical welfare. Doctors would betray their profession if they allowed clinical research to disregard their therapeutic obligations in favour of strict scientific methodology, as is bound to happen when using placebos in spite of existing therapy, disregarding equipoise, disallowing benefit claims, emphasizing the distinction between research ethics and clinical ethics but denying any difference between therapeutic and non-therapeutic trials. That scientists and practitioners should not agree on needs and priorities in the medical context, constitutes an additional factor in the less than optimal reception of EBM by the health care professions."

• The voice of emotion: an FMRI study of neural responses to angry and happy vocal expressions
  from the current issue of Social Cognitive and Affective Neuroscience
  "The human voice is one of the principal conveyers of social and affective communication. Yet relatively little is known about the neural circuitry that supports the recognition of different vocally expressed emotions. We conducted an FMRI study to examine the brain responses to vocal expressions of anger and happiness, and to test whether specific brain regions showed preferential engagement in the processing of one emotion over the other. We also tested the extent to which simultaneously presented facial expressions of the same or different emotions would enhance brain responses, and to what degree such responses depend on attention towards the vocal expression. Forty healthy individuals were scanned while listening to vocal expressions of anger or happiness, while at the same time watching congruent or discrepant facial expressions. Happy voices elicited significantly more activation than angry voices in right anterior and posterior middle temporal gyrus (MTG), left posterior MTG and right inferior frontal gyrus. Furthermore, for the left MTG region, happy voices were related to higher activation only when paired with happy faces. Activation in the left insula, left amygdala and hippocampus, and rostral anterior cingulate cortex showed an effect of selectively attending to the vocal stimuli. Our results identify a network of regions implicated in the processing of vocal emotion, and suggest a particularly salient role for vocal expressions of happiness."

December 13, 2006

• Antibiotic Ear Drops Favored Over Popular Oral Antibiotics for Ear Infections
  from Newswise.com
  "Newswise — A multicenter study on treating common ear infections in children with ear tubes adds to a growing body of evidence that favors antibiotic ear drops over antibiotics swallowed in pill or liquid form in such cases, a UT Southwestern Medical Center researcher reports. The latest study, involving 80 children, showed that antibiotic ear drops performed better and faster in treating middle ear infections in children with ear tubes than merely taking oral antibiotics such as swallowing a pill or liquid. The findings are available online in the journal Pediatrics."

• European Researchers Team Up to Probe Genetic, Environmental Links in Dyslexia
  from the current issue of JAMA
  "Researchers from 9 European countries have teamed up to determine the genetic, neuroscientific, and behavioral factors implicated in dyslexia. Children recruited to participate in the different genetic, epidemiologic, and neuroimaging studies will come from many countries, "which should allow researchers to take account of the specific aspects of each language as well as the general causes of dyslexia," said Franck Ramus, PhD, the leader of the French group at the Laboratory of Cognitive Sciences and Psycholinguistics in Paris. The Neurodys project, funded by the European Commission and launched in late September, is a 3-year multicenter and multidisciplinary collaboration among 15 top scientific and clinical research groups, representing scientists who have contributed to the field's knowledge of dyslexia in various European languages. The project covers the languages of most of the 2.5 million European dyslexic children."

• Hearing Innovation
  from Ivanhoe.com
  A news report (with video) on the Envoy implantable hearing aid.

• How does the brain mediate interpretation of incongruent auditory emotions? The neural response to prosody in the presence of conflicting lexico-semantic cues
  from the current issue of European Journal of Neuroscience
  "We frequently encounter conflicting emotion cues. This study examined how the neural response to emotional prosody differed in the presence of congruent and incongruent lexico-semantic cues. Two hypotheses were assessed: (i) decoding emotional prosody with conflicting lexico-semantic cues would activate brain regions associated with cognitive conflict (anterior cingulate and dorsolateral prefrontal cortex) or (ii) the increased attentional load of incongruent cues would modulate the activity of regions that decode emotional prosody (right lateral temporal cortex). While the participants indicated the emotion conveyed by prosody, functional magnetic resonance imaging data were acquired on a 3T scanner using blood oxygenation level-dependent contrast. Using SPM5, the response to congruent cues was contrasted with that to emotional prosody alone, as was the response to incongruent lexico-semantic cues (for the 'cognitive conflict' hypothesis). The right lateral temporal lobe region of interest analyses examined modulation of activity in this brain region between these two contrasts (for the 'prosody cortex' hypothesis). Dorsolateral prefrontal and anterior cingulate cortex activity was not observed, and neither was attentional modulation of activity in right lateral temporal cortex activity. However, decoding emotional prosody with incongruent lexico-semantic cues was strongly associated with left inferior frontal gyrus activity. This specialist form of conflict is therefore not processed by the brain using the same neural resources as non-affective cognitive conflict and neither can it be handled by associated sensory cortex alone. The recruitment of inferior frontal cortex may indicate increased semantic processing demands but other contributory functions of this region should be explored."

• Mandarin language is music to the brain
  from EurekAlert.org
  "Irvine, Calif., Dec. 12, 2006 -- It’s been shown that the left side of the brain processes language and the right side processes music; but what about a language like Mandarin Chinese, which is musical in nature with wide tonal ranges" UC Irvine researcher Fan-Gang Zeng and Chinese colleagues studied brain scans of subjects as they listened to spoken Mandarin. They found that the brain processes the music, or pitch, of the words first in the right hemisphere before the left side of the brain processes the semantics, or meaning, of the information."

• Periodicity and frequency coding in human auditory cortex
  from the current issue of European Journal of Neuroscience
  "Understanding the neural coding of pitch and frequency is fundamental to the understanding of speech comprehension, music perception and the segregation of concurrent sound sources. Neuroimaging has made important contributions to defining the pattern of frequency sensitivity in humans. However, the precise way in which pitch sensitivity relates to these frequency-dependent regions remains unclear. Single-frequency tones also cannot be used to test this hypothesis as their pitch always equals their frequency. Here, temporal pitch (periodicity) and frequency coding were dissociated using stimuli that were bandpassed in different frequency spectra (centre frequencies 800 and 4500 Hz), yet were matched in their pitch characteristics. Cortical responses to both pitch-evoking stimuli typically occurred within a region that was also responsive to low frequencies. Its location extended across both primary and nonprimary auditory cortex. An additional control experiment demonstrated that this pitch-related effect was not simply caused by the generation of combination tones. Our findings support recent neurophysiological evidence for a cortical representation of pitch at the lateral border of the primary auditory cortex, while revealing new evidence that additional auditory fields are also likely to play a role in pitch coding."

• Sound of Laughter Tickles the Brain
  from WebMD.com
  "Dec. 12, 2006 -- The sound of laughter may make you smile and laugh, British researchers report. "It seems that it's absolutely true that 'laugh and the whole world laughs with you,'" Sophie Scott, PhD, says in a news release. Scott is a professor at University College London's Institute of Cognitive Neuroscience. Scott's team says when people hear the sound of laughter, their brain areas that control smiling and laughing become active."

December 12, 2006

• An fMRI Study of Semantic Priming: Modulation of Brain Activity by Varying Semantic Distances
  from a recent issue of Cognitive and Behavioral Neurology
  "Objective: Our purpose was to study the effect of semantic priming at varying semantic distances on brain activation during a lexical decision experiment, using functional magnetic resonance imaging (fMRI). Background: Neuroimaging studies have demonstrated decreased brain activation for primed versus unprimed stimuli in language areas due to semantic priming, suggesting facilitated semantic retrieval. However, the effect of varying semantic distances on brain activation has not been studied. Therefore we examined direct and indirect priming effects on cerebral activation to provide information regarding spread of activation in the semantic network. Methods: Participants were presented with closely, distantly, and unrelated word pairs during fMRI, and asked to make a lexical decision on the second word. Results: Behavioral measurements demonstrated significant priming effects for all semantic distances. Imaging results showed modulation of brain activation due to different semantic relationships in the left inferior frontal gyrus, bilateral middle frontal gyrus and anterior temporal lobe, and consisted of decreased magnitude of activation when primed stimuli were processed compared with unprimed stimuli, with the greatest effect observed for closely related words. Conclusions: This study demonstrates graduated effects of semantic priming on fMRI in semantic but not attentional brain regions, contributing to explain how semantic knowledge is organized and retrieved. These findings support the network model for organization of the semantic lexicon."

• Comparison of the Produced and Perceived Voice Range Profiles in Untrained and Trained Classical Singers
  from the current issue of the Journal of Voice
  "Frequency and intensity ranges (in true decibel sound pressure level, 20 µPa at 1 m) of voice production in trained and untrained vocalists were compared with the perceived dynamic range (phons) and units of loudness (sones) of the ear.next term Results were reported in terms of standard voice range profiles (VRPs), perceived VRPs (as predicted by accepted measures of auditory sensitivities), and a new metric labeled as an overall perceptual level construct. Trained classical singers made use of the most sensitive part of the hearing range (around 3–4 kHz) through the use of the singer's formant. When mapped onto the contours of equal loudness (depicting nonuniform spectral and dynamic sensitivities of the auditory system), the formant is perceived at an even higher sound level, as measured in phons, than a flat or A-weighted spectrum would indicate. The contributions of effects like the singer's formant and the sensitivities of the auditory system helped the trained singers produce 20% to 40% more units of loudness, as measured in sones, than the untrained singers. Trained male vocalists had a maximum overall perceptual level construct that was 40% higher than the untrained male vocalists. Although the A-weighted spectrum (commonly used in VRP measurement) is a reasonable first-order approximation of auditory sensitivities, it misrepresents the most salient part of the sensitivities (where the singer's formant is found) by nearly 10 dB."

• Genotype-phenotype associations for ARX gene duplication in X-linked mental retardation
  from the current issue of Neurology
  "We screened 165 mentally retarded patients for ARX gene 428-451 base pair (bp) duplication. Eighteen individuals from five families were found to carry the duplication, and all had intellectual impairment. Twelve presented with focal hand dystonia, while six patients had EEG abnormalities including seizures. Other symptoms included speech difficulties (4/18), testis enlargement (4/18), lower limb spasticity or foot dystonia (4/18), and facial telangiectasia (3/18). These features confirm the pleiotropic effect of the duplication."

• Hypoglycemia reduces the blood-oxygenation level dependent signal in primary auditory and visual cortex: A functional magnetic resonance imaging study

  from the current issue of the Journal of Neuroscience Research

  "Studies of the effects of hypoglycemia on the brain using neurocognitive testing have suggested that mainly complex functions subserved by secondary and tertiary cortex are affected by mild to moderate hypoglycemia and that intensively treated patients with Type I diabetes mellitus (T1DM) may have altered sensitivity to the central nervous system effects of hypoglycemia. Functional magnetic resonance imaging provides a sensitive, regionally-specific probe of possible neurophysiologic changes related to hypoglycemia in the brain. Eleven intensively-treated T1DM patients and 11 matched non-diabetic controls took part in a 2-day protocol in which functional magnetic resonance imaging (MRI) was used to measure changes in the patterns of brain activation produced by simple auditory and visual stimuli in different conditions. On one day, participants were euglycemic the entire time. On the other day, an initial 50-min euglycemic period was followed by a 50-min hypoglycemic period. Results indicated that hypoglycemia reduced the amplitude of the blood-oxygenation level dependent response in primary auditory and visual cortex to simple auditory and visual stimuli. The latency and duration of the transient hemodynamic response function were not affected. Responses to hypoglycemia were similar in diabetic and non-diabetic participants. These results suggest that mild to moderate hypoglycemia may alter the balance of blood flow and oxygen extraction when glucose levels are lowered. Intensively-treated T1DM, with its attendant frequent hypoglycemic episodes, did not seem to alter hypoglycemic responses in primary visual and auditory cortex. © 2006 Wiley-Liss, Inc."

• Identity and attitudes towards cochlear implant among deaf and hard of hearing adolescents
  from the current issue of Deafness and Education International
  "This study examined the relationships between identity orientations and attitudes toward cochlear implant (CI). A total of 115 deaf and hard of hearing (D/HH) adolescents completed a demographic questionnaire, the Deaf Identity Developmental Scale (DIDS) and an attitudes toward CI questionnaire. The DIDS results showed that participants' bicultural identity was strongest and marginal identity was weakest. In general, participants expressed positive attitudes toward CI. Stronger Deaf identity was associated with less positive attitudes regarding expected CI effects while stronger bicultural identity was associated with more positive attitudes. Also, bicultural identity did not contradict the acceptance of CI technology. It was concluded that exposure of D/HH youngsters to both Deaf culture and the advantages of CI seems desirable. Copyright © 2006 John Wiley & Sons, Ltd."

• The impact of strategies used in the balanced literacy approach on story grammar acquisition of three Turkish students with hearing loss: an action research study
  from the current issue of Deafness and Education International
  "This action research study investigated the impacts of teaching strategies based on the balanced literacy approach on story grammar acquisition of three Turkish students with hearing loss. Data were collected from students' work, archival information, interviews and observations during lessons which were audio- and video-recorded. The pre- and post-test results and student portfolios were analysed quantitatively and qualitatively. Results indicated that, although the students seemed to need further intervention, they all progressed in their acquisition of story grammar. Copyright © 2006 John Wiley & Sons, Ltd."

• A rapid screening battery to identify frontal dysfunction in patients with ALS
  from the current issue of Neurology
  "We studied the relationship between verbal associative fluency, verbal abstract reasoning, and judgment in ALS using a 20-minute screening evaluation. Deficiencies in these measures were found in 20.0%, 18.6%, and 35.7% of patients with limb-onset ALS and in 37.5%, 25.0%, and 60.0% of patients with bulbar-onset ALS. This simple screen identifies deficits that affect discussions of treatment interventions and end-of-life issues."

• The Semantic Object Retrieval Test (SORT) in Normal Aging and Alzheimer Disease.
  from a recent issue of Cognitive and Behavioral Neurology
  "Objective: To characterize performance on a test of semantic object retrieval (Semantic Object Retrieval Test-SORT) in healthy, elderly subjects and patients with Alzheimer disease (AD). Background: Although the initial presentation of patients with AD often reflects impairment in delayed recall for verbally encoded memory, common complaints of patients with early AD are actually related to semantic memory impairment. Design: Thirty-eight AD patients and 121 healthy aging controls enrolled in an Alzheimer's Disease Center received a battery of standard neuropsychologic tests including the SORT. Results: Compared with normal controls, AD patients had SORT memory impairments with significantly more false positive memory errors, fewer correctly produced names, and more substitutions in the name production aspect of the test. SORT had robust test-retest reliability in normals. Conclusions: The SORT task provides a direct, specific assessment of semantic memory, and has now been administered to 121 healthy, aging controls for normative ranges of performance, and to AD patients. The task detected semantic memory deficits in approximately half of patients with mild-moderate AD, which is comparable to other studies assessing semantic deficits in AD with less specific measures."

• Sports-Arena Noise Can Damage Hearing
  from CBS News.com
  "Six minutes of sports-arena noise gives fans 81 times their daily allowable dose of noise. The finding comes from a hearing expert who went to the 2006 Stanley Cup hockey playoff games in Edmonton, Canada. The expert measured the noise levels to which he and his wife were exposed. Then they had their hearing checked. The brave expert is Richard Liu, M.D., of the University of Alberta. The tests showed that Liu and his wife suffered significant hearing loss after attending three hockey playoff games. Fortunately, the damage was temporary."

• Study reveals noisy Christmas toys can damage hearing
  from EurekAlert.org
  "Many toys available this Christmas could damage your child’s hearing according to the UK-based charity Deafness Research UK. Working with researcher Dr. Brad Backus from University College London (UCL), the charity tested the noise levels produced by a selection of toys available to buy this Christmas. Almost all (14 out of 15) of the toys tested produced noise levels above the recommended safety limit of 85dB(A) when held close to the ear. Half of the toys tested had levels above or very near recommended safety limits when measured at 25cm - about an arm’s length away."

December 8, 2006

• Alpha Phase Reset Contributes to the Generation of ERPs
  from a recent issue of Cerebral Cortex
  "An unresolved question in electroencephalogram (EEG) research is whether event-related potentials (ERPs) are generated by phase-reset or evoked response. We analyzed data of a visual feature detection task and will show 1) phase concentration in the alpha frequency range, 2) ongoing alpha activity prior to stimulus onset, 3) evoked alpha oscillation in the ERP, 4) lack of power increase during phase concentration, 5) decrease in amplitude variance during early evoked components preceding a decrease in power, and 6) the same cortical sources for induced prestimulus power and evoked poststimulus power. Because none of these data provide unequivocal evidence for phase reset, we additionally tested the basic assumption of the evoked model, which is the additivity of the evoked response on the basis of a simulation approach. Our findings suggest that nonadditive processes—typical for a phase reset—are involved in the generation of the ERP. Thus, together with the other findings this study provides unequivocal evidence for phase resetting in the human EEG."

• American Annals of the Deaf
  Table of Contents for Volume 151, Number 4, Fall 2006

• Automatic and Intrinsic Auditory "What" and "Where" Processing in Humans Revealed by Electrical Neuroimaging
  from a recent issue of Cerebral Cortex
  "The auditory system includes 2 parallel functional pathways—one for treating sounds' identities and another for their spatial attributes (so-called "what" and "where" pathways). We examined the spatiotemporal mechanisms along auditory "what" and "where" pathways and whether they are automatically engaged in differentially processing spatial and pitch information of identical stimuli. Electrical neuroimaging of auditory evoked potentials (i.e., statistical analyses of waveforms, field strength, topographies, and source estimations) was applied to a passive "oddball" paradigm comprising 2 varieties of blocks of trials. On "what" blocks, band-pass–filtered noises varied in pitch, independently of perceived location. On "where" blocks, the identical stimuli varied in perceived location independently of pitch. Beginning 100 ms poststimulus, the electric field topography significantly differed between conditions, indicative of the automatic recruitment of distinct intracranial generators. A distributed linear inverse solution and statistical analysis thereof revealed activations within superior temporal cortex and prefrontal cortex bilaterally that were common for both conditions, as well as regions within the right temporoparietal cortices that were selective for the "where" condition. These findings support models of automatic and intrinsic parallel processing of auditory information, such that segregated processing of spatial and pitch features may be an organizing principle of auditory function."

• Children face danger from car airbags inflating
  from News.Scotsman.com
  "Children should always sit in the back of cars because modern airbags could cause them to suffer tinnitus and breathing problems if travelling in the front, according to a new medical study."

December 7, 2006

• Aerodynamic and Sound Intensity Measurements in Tracheoesophageal Voice
  from a recent issue of ORL: Journal of Oto-Rhino-Laryngology
  "Background: In laryngectomized patients, tracheoesophageal voice generally provides a better voice quality than esophageal voice. Understanding the aerodynamics of voice production in patients with a voice prosthesis is important for optimizing prosthetic designs and successful voice rehabilitation. Objectives: To measure the aerodynamics and sound intensity in tracheoesophageal voice production. Study Design and Methods: We built a special setup, which consisted of a Pentium 200 MHz computer with an AD-DA interface card and Labview 4.01 software. In an oral/nasal mask we constructed several mass flow sensors and a microphone. This measured both the oral airflow and the level of sound. For the measurement of endotracheal pressure, which is the driving force behind the airflow, we used a transducer which was connected to the tracheostoma. The endoesophageal pressure was measured at the level of the prosthesis in the esophagus by a Mikrotip transducer. Using this we could determine how much the voice prosthesis contributes to the overall pressure drop of the phonatory tract. Furthermore, the average airflow rate as a function of the sound pressure levels could be determined. Results: In our population, 6 out of 7 patients showed a positive relationship between trans-source airflow and generated sound intensity. We compared our prosthesis pressure drop values with in vitro data and found that there are some differences, possibly due to difference in age of the prosthesis and physiological circumstances in vivo. The overall contribution of the voice prosthesis to the airway resistance depends on the level of phonation and the type of device. In our patient group it is apparent that the pharyngoesophageal (PE) segment has the greatest share of the total pressure drop, especially at higher airflow rates. We measured a 27% pressure drop in airflow over the voice prosthesis. Different tracheostoma occlusion methods did not have any effect on the aerodynamics and sound intensity. One patient that had had a jejunal graft for reconstruction showed, not unexpectedly, extremely different aerodynamic values. We were unable to define optimal airflow rates or optimal resistance values for sound production in the PE segment. Conclusion: The aerodynamic characteristics of voice production in laryngectomized patients with voice prostheses are determined by both prosthetic factors and PE segment tissue factors. In our patient group the PE segment is responsible for the greatest pressure drop. We found no significant difference in pressure drop and sound intensity for different tracheostoma occlusion methods."

• Anatomical characterisation of voltage gated sodium channels in the mammalian cochlear nerve spiral ganglia
  from the current issue of Clinical Otolaryngology
  "Introduction. There is evidence that Voltage Gated Sodium Channels (VGSC) may represent novel therapeutic targets for treatment of certain types of tinnitus and hearing loss. It is also known that the different VGSC types vary in their affinity for differing VGSC blockers. Parallels have been drawn with certain types of tinnitus, chronic pain and epilepsy (1) These conditions are thought to arise from pathological VGSC activity (2) There has also been empirical interest in the use of VGSC blockers as tinnitolytics, with the best known of these being intravenous lignocaine. Aim. The aim of this study was first begin to characterise VGSCs in the mammalian cochlear nerve spiral ganglion. Method. After sacrifice, guinea pigs were perfused with heparin and then 2% paraformaldehyde. The bony matrix of the cochleae was decalcified in buffer containing EGTA (8%). Decalcified tissues were embedded; frozen and 20-micron cryosections were made through the cochleae. Immunocytochemistry was then carried out using antibodies that selectively bind to individual sodium channel a-subunits. Sections were then analysed and photographed using either an epifluorescence or a confocal microscope. Results and Conclusions. Sodium channel type 1.6 and 1.7 were shown to be expressed in the cochlear nerve spiral ganglion. Further work is being carried out to see if there are changes in the expression of these VGSC after ototrauma. These findings may help us to target our therapy to treat certain types of tinnitus and hearing loss."

• Auditory Sensory Memory and Working Memory Processes in Children with Normal Hearing and Cochlear Implants
  from a recent issue of Audiology & Neurotology
  "There can be wide variation in the level of oral/aural language ability that prelingually hearing-impaired children develop after cochlear implantation. Automatic perceptual processing mechanisms have come under increasing scrutiny in attempts to explain this variation. Using mismatch negativity methods, this study explored associations between auditory sensory memory mechanisms and verbal working memory function in children with cochlear implants and a group of hearing controls of similar age. Whilst clear relationships were observed in the hearing children between mismatch activation and working memory measures, this association appeared to be disrupted in the implant children. These findings would fit with the proposal that early auditory deprivation and a degraded auditory signal can cause changes in the processes underpinning the development of oral/aural language skills in prelingually hearing-impaired children with cochlear implants and thus alter their developmental trajectory."

• Bone Conduction in a Three-Dimensional Model of the Cochlea
  from a recent issue of ORL: Journal of Oto-Rhino-Laryngology
  "Hearing sensations are caused by air- and bone-guided sound. Of course, other biological materials like tendons, muscles and tissue are also involved during conduction of sound. To study the influence of bone conduction, a formerly developed finite element model was excited by harmonic pressure signals at the cochlea wall. The clinical finding during middle ear surgery, namely the increase in bone conduction sensitivity with removed footplate, was confirmed. Other psychoacoustic effects with bone conduction are described in the early experiments by Bárány, who proved the cancellation of air- and bone-conducted sound in humans. The simultaneous stimulation of the cochlea wall and the phase-reversed stimulation of the stapes footplate in the finite element model confirmed his findings. Further clues to the solution of unsolved problems in audiology and middle ear pathology are given."

• Brain's Fear Center Likely Shrinks In Autism's Most Severely Socially Impaired
  from ScienceDaily.com
  "The brain's fear hub likely becomes abnormally small in the most severely socially impaired males with autism spectrum disorders, researchers funded by the National Institutes of Health's (NIH) National Institute of Mental Health (NIMH) and National Institute on Child Health and Human Development (NICHD) have discovered. Teens and young men who were slowest at distinguishing emotional from neutral expressions and gazed at eyes least -- indicators of social impairment -- had a smaller than normal amygdala, an almond-shaped danger-detector deep in the brain. The researchers also linked such amygdala shrinkage to impaired nonverbal social behavior in early childhood."

• Can objective parameters derived from videofluoroscopic assessment of post-laryngectomy valved speech replace current subjective measures? An e-tool-based analysis
  from the current issue of Clinical Otolaryngology
  "Objectives: The primary purpose of this study was to assess the pharyngoesophageal segment in total laryngectomy patients using a videofluoroscopy e-tool. Study design: Cross-sectional study. Setting: Head and Neck Oncology Unit, Tertiary Referral Centre. Patients: Forty-two patients following total laryngectomy. Intervention: Videofluoroscopy using an e-tool (JRuler). Main outcome measures: Subjective and objective videofluoroscopy parameters correlated with the GRBAS scale and treatment variables. Results: Of 32 men and 10 women, mean age 63.5 years (10.8) the majority (64.3%) had a reasonable voice (good = 11 and poor = 4 patients). Comparing subjective and objective parameters, significant correlations were only seen with a smaller minimal neoglottic distance at phonation with no regurgitation of barium at phonation (P = 0.05) and a type 1 shape of neoglottis at phonation (P = 0.02). There were also significant correlations between smaller maximum sub-neoglottic distance at phonation and type 1 shape of neoglottis (P = 0.02), smaller maximum sub-neoglottic distance at rest and absence of stasis of barium at phonation (P = 0.05) and the length of neoglottis at phonation and type 1 shape of neoglottis (P = 0.01). For perceptual evaluation, significant correlation was seen only between G1 voice and a smaller minimal neoglottic distance at phonation (P = 0.03) amongst the subjective and objective parameters. There were no correlations between visual parameters and the clinical parameters. Conclusions: Our observations suggest that this interesting concept has limitations. While objective and quantifiable data can be obtained using videofluoroscopy in laryngectomees, only a few correlate with each other and with voice quality."

• Contralateral Normal Ear after Mastoid Surgery: Evaluation by Otoacoustic Emissions (Mastoid Drilling and Hearing Loss
  from a recent issue of ORL: Journal of Oto-Rhino-Laryngology
  "Mastoid drilling can cause transient hearing loss in the contralateral normal hearing ear. A study was designed to evaluate hearing in the contralateral normal ear before and after the mastoid surgery in a longitudinal manner and find out the duration of this temporary hearing loss. Twenty-two patients requiring mastoid surgery in their diseased ears, having contralateral normal ear were included. Pure tone audiometry and otoacoustic emissions (OAEs) were utilized for baseline evaluation. OAEs were repeated during the immediate postoperative period and daily up to the 6th postoperative day. The amplitudes of the OAEs of contralateral normal ears were found affected immediately after surgery and progressive improvement was detected with full recovery at 72-96 h. None of the patients had permanent deterioration in OAE amplitudes. The burs used during mastoid surgery can cause temporary hearing threshold changes in the contralateral ears. This adverse effect recovers spontaneously within 72-96 h postoperatively."

• A Downloadable Three-Dimensional Virtual Model of the Visible Ear
  from a recent issue of ORL: Journal of Oto-Rhino-Laryngology
  "Purpose: To develop a three-dimensional (3-D) virtual model of a human temporal bone and surrounding structures. Methods: A fresh-frozen human temporal bone was serially sectioned and digital images of the surface of the tissue block were recorded (the 'Visible Ear'). The image stack was resampled at a final resolution of 50 × 50 × 50/100 µm/voxel, registered in custom software and segmented in PhotoShop® 7.0. The segmented image layers were imported into Amira® 3.1 to generate smooth polygonal surface models. Results: The 3-D virtual model presents the structures of the middle, inner and outer ears in their surgically relevant surroundings. It is packaged within a cross-platform freeware, which allows for full rotation, visibility and transparency control, as well as the ability to slice the 3-D model open at any section. The appropriate raw image can be superimposed on the cleavage plane. The model can be downloaded at https://research.meei.harvard.edu/Otopathology/3dmodels/"

• Middle Ear Admittance and Hearing Abnormalities in Individuals with Osteoarthritis
  from a recent issue of Audiology & Neurotology
  "In osteoarthritis, the joint cartilage breaks down. Cartilage exists within the incudomalleolar and incudostapedial joints. In addition, the cartilage-covered base of the stapes footplate is bound to the cartilage-covered rim of the oval window by the annular ligament. Thus, higher prevalence of middle ear abnormalities and hearing loss can be expected in osteoarthritis due to degeneration of the cartilage and the subsequent abnormal repair response. In this study, tympanometric and audiometric data were obtained from 15 individuals diagnosed with osteoarthritis and 15 gender- and age-matched individuals without the diagnosis of arthritis. Results showed a significantly higher prevalence of middle ear abnormalities and hearing loss in ears with arthritis when compared to the control group. Interestingly, osteoarthritis and hearing loss are considered among the top chronic health concerns in older individuals although the connection between these two conditions has not been previously reported."

• Multidimensional assessment of female tracheoesophageal prosthetic speech
  from the current issue of Clinical Otolaryngology
  "Objective: The objective of this study was to undertake a multidimensional assessment of female tracheoesophageal prosthetic speech. Study Design: A cross-sectional cohort study. Setting: Head and Neck Unit in a tertiary oncology referral centre. Patients: Ten female and 10 male total laryngectomy patients with no signs of recurrence and using voice prosthesis were compared to 10 normal female speakers. Intervention(s): Electroglottographic and acoustic analysis of voice parameters for both sustained vowel /i/ and connected speech, perceptual evaluation using GRBAS (with 2 experienced raters) and questionnaire assessment using the University of Washington Quality of Life and the Voice Handicap Index. Statistical analysis was done using the Statistical Package for Social Sciences, (v. 14, SPSS Inc., Chicago III). Results: Median age of the female larygectomy patiemts was 65 years (range: 41-81), that of male laryngectomees was 66.5 years (range: 40-79) and that of the normal female subjects was 47.5 years (range: 35-72). All electroglottographic, acoustic parameters and GRBAS ratings of the female laryngectomy patients were significantly worse as compared with the normal female subjects. The median fundamental frequency (111.8 Hz) was comparable to male tracheoesophageal speakers (115.8 Hz). Mean composite University of Washington Quality of Life score and overall Voice Handicap Index score was 79.3(12.5) and 47.5(27.6) for the female laryngectomy patients and for the males was 81.2 (9.6) and 39.4(18.7). Conclusions: Gender frequency differences as seen in normal subjects are lost following a laryngectomy operation as evidenced by electroglottographic and perceptual data. Although the quality of life scores are comparable to the male tracheoesophageal speakers, they exhibit a greater voice handicap as compared to their male counterparts."

• Multifrequency Immittancemetry in Experimentally Induced Stapes, Round Window and Cochlear Lesions
  from a recent issue of Audiology & Neurotology
  "Objectives: To establish that admittance (Y) and susceptance (B) conductance (G) tympanograms at 2 kHz can reflect the status of the annular ligament and the cochlear pressure. Methods: Seven experiments were set up in 22 guinea pigs: ventilation of the bulla, blockage of the stapes and round window membrane (RWM), fistula, fluid removal from the cochlea, injection of saline in the scala tympani and acoustic trauma. Resonance frequency, Y, B and G at 2 kHz and curve shapes were analyzed before and after lesions. Results: A supplementary peak was observed in Y/G tympanograms in all RWM fistulas and in some cases of acoustic trauma; injection of saline into the scala tympani induced constant, immediate and reproducible changes; RWM and stapes blockages induced foreseeable peaking at 2 kHz; fluid removal from the cochlea induced multiple peak curves. Conclusion: Experimentally induced modifications at the AL result in noticeable, constant and reproducible changes in tympanogram curves at 2 kHz and seem to reflect inner ear pressure."

• Orthographic analysis of words during fluency training promotes reading of new similar words
  from the current issue of the Journal of Research in Reading
  "Remediation of a serious lack in reading fluency often takes the form of repeated reading exercises. The present study examines whether transfer of training effects to untrained (neighbour) words can be enhanced by training with an orthographic focus as compared with emphasising semantics. The effect of oral versus silent reading during training is studied as well. Two groups of reading-disabled children (mean age=7 years, 11 months) were given repeated reading training with limited exposure duration (350 ms) in which 15 target words were repeated 20 times in exercises focused on either orthography (N=26) or semantics (N=25). The children were required to either read the target words aloud or perform the exercises silently, but this requirement appeared to have no effect on the training results. The results show that untrained neighbour words benefited more from training targets with an orthographic focus than from exercises with a semantic emphasis."

• Psychologist to study how we put stress into words
  from EurekAlert.org
  "How does a child learn that the stress is on the second syllable of giraffe, and on the first of zebra? Is it memory, the structure of the word itself or clues provided by the sounds in the word?"

• Quality of Life following Total Laryngectomy: Assessment Using the UW-QOL Scale
  from a recent issue of ORL: Journal of Oto-Rhino-Laryngology
  "Objectives: To determine the quality of life (QOL) in patients using valved speech following total laryngectomy with a validated patient self-report scale. Study Design: Cross-sectional cohort study. Patients: 63 patients following total laryngectomy using valved speech. Intervention: University of Washington Quality of Life (UW-QOL) questionnaire. Main Outcome Measures: Patient perception of the QOL over the last 7 days following total laryngectomy in response to specific questions and correlated with sociodemographic and treatment factors. Results: Responses were received from 44 males and 11 females (response rate: 87.3%) with a median age of 66 years (range: 40-84). The mean (SD) composite score of the QOL in our series of patients with total laryngectomy was 81.3 (10.9). As regards the overall QOL, 80% of our patients cited it as very good (45.5%) to good (34.5%). Patients identified speech, appearance, and activity as the most important issues following total laryngectomy. Only age and pharyngo-oesophageal segment closure were significant predictors of QOL scores (Student t test, p < 0.05) and not other demographic and treatment variables. Conclusions: The composite score and overall QOL were high in our series of total laryngectomy patients and this possibly reflects adequate multidisciplinary management. We strongly urge the use of prospective longitudinal studies that will adequately identify any QOL changes over time. Although the UW-QOL questionnaire is a simple and brief scale, it has limitations that can curtail its effective use in laryngectomy patients and we advise supplementing it with the use of domain-specific questionnaires."

• Questionnaire analysis of the swallowing-related outcomes following total laryngectomy
  from the current issue of Clinical Otolaryngology
  "Objective: To determine the effects of a total laryngectomy on the swallow and subsequent quality of life in head and neck cancer patients. Design: Cross-sectional single centre cohort study. Setting: Head and Neck Oncology Unit, Tertiary Referral Unit. Patients: Sixty-two patients who underwent total laryngectomy at our centre participated in the study. Methods: Subjects were stratified by age, sex, tumour stage, other procedures such as myotomy and nerve re-implantation. Pharyngectomy, glossectomy, flap reconstruction, neck dissection and previous radio- and chemotherapy were also assessed to see if they affected swallow and subsequent quality of life. Main outcome was measured using the MD Anderson Dysphagia Inventory questionnaire. Results: Responses were received from 46 males and 16 females (response rate of 80.5%) with a mean age of 64.7 years (SD 9.4). Median follow-up in patients was 90 months (range 1–276). The mean MD Anderson Dysphagia Inventory total score in our series of patients was 77.7 (SD 16.6). MD Anderson Dysphagia Inventory global score was 79.4 (SD 22.6), Emotional score was 77.7 (SD 17.8), Functional score 81.3 (SD 15.9) and Physical score was 74.1(SD 18). Statistically significant differences were seen between the emotional scores of glossectomised and non-glossectomised patients (Mann Whitney, P = 0.04). No significant correlation was seen between the subscale scores and the remaining treatment variables such as age, gender, site, tumour stage, myotomy, nerve implantation, radiotherapy, reconstruction and major complications. Conclusion: This questionnaire study is the largest of its type to assess the swallow of patients who have undergone laryngectomy at a single centre. The overall result confirmed that most patients had a subjectively good swallow. Only glossectomy and the method of PE segment closure were shown to significantly affect swallowing outcomes following surgery. We recommend further work especially prospective studies pre and post surgery using this or similarly validated instruments to fully assess swallow in the laryngectomy population."

• Recalls and safety alerts: possible association between lamictal and cleft lip/palate
  from the Food and Drug Administration
  "FDA is alerting health care professionals and patients that infants exposed to Lamictal (lamotrigine) during the first trimester of pregnancy may have an increased risk of being born with a cleft lip or palate. Lamictal is used to treat certain patients with seizures or bipolar disorder. FDA’s caution was based on preliminary data from the North American Antiepileptic Drug (NAAED) Pregnancy Registry."

• Relationship between Intraoperative eCAP Thresholds and Postoperative Psychoacoustic Levels as a Prognostic Tool in Evaluating the Rehabilitation of Cochlear Implantees
  from a recent issue of Audiology & Neurotology
  "A sufficient correlation between objective (e.g. eCAP of the auditory nerve) and psychoacoustic data has not yet been possible due to high interindividual variability in cochlear implantees. Therefore, the application of objective data in the evaluation of speech rehabilitation after cochlear implantation was investigated. eCaps of all electrodes were measured intraoperatively. The 'threshold' and 'comfort' levels, speech recognition and pure tone thresholds were determined at follow-up. The correlation coefficient was calculated between eCap thresholds and psychoacoustic levels. This correlation coefficient was ranked with other individual items in relation to their influence on the development of speech recognition. Only the duration of preimplant deafness, the pure tone hearing threshold and the correlation between eCAP and psychoacoustic levels have a significant influence on the rehabilitation within this selection of variables. Based on these results, an individualized mathematical modeling approach was introduced to predict the development of postoperative speech recognition by incorporating objective data."

• Relationships among Speech Perception, Self-Rated Tinnitus Loudness and Disability in Tinnitus Patients with Normal Pure-Tone Thresholds of Hearing
  from a recent issue of ORL: Journal of Oto-Rhino-Laryngology
  "Exactly how speech perception and tinnitus perception are related remains unclear. This study investigated how tinnitus alone affects speech perception and the relationship between speech perception, tinnitus loudness, and tinnitus disability. The Mandarin Speech Perception in Noise Test (MSPIN), Tinnitus Loudness Scaling (TLS), and Tinnitus Handicap Inventory (THI) were utilized to assess 20 tinnitus patients with normal hearing. The tinnitus group had a significantly lower MSPIN score than the control group (p < 0.01). TLS and THI scores were strongly correlated (r2: 0.534~0.627, p < 0.05). Correlations between MSPIN and TLS or THI scores were not significant. Tinnitus loudness correlated well with tinnitus-related disability. Neither tinnitus loudness nor disability was strongly correlated with speech perception. In noisy environments, tinnitus sufferers had significantly poorer ability to recognize speech than control subjects."

• The symmetry of paediatric tympanograms
  from the current issue of Clinical Otolaryngology
  "Objectives. The poorer outcome of myringoplasty in children in comparison with adults is commonly attributed to poor Eustachian tube function. The only routine test giving an indication of Eustachian tube function is tympanometry. It is common practice to look at the contralateral tympanogram as a predictor of the child's Eustachian tube function when deciding whether to proceed with myringoplasty. This relies on the assumption that Eustachian tube function is symmetrical. This study seeks to assess whether this assumption is correct. Method. We collected copies of 297 pairs of tympanograms carried out in a paediatric ENT clinic over a ten-month period. We compared the symmetry of tympanograms of children aged from 5 to 16 years. Results. We looked at the association between normal Eustachian tube functions (type A) or abnormal Eustachian tube function (type B, C1 or C2) in one ear and Eustachian tube function in the other ear. A type-A tympanogram in one ear predicted a type-A tympanogram in the other ear with a sensitivity of 0.81 (95% CI 0.74–0.86) and specificity of 0.75 (0.66–0.82). The positive predictive value of a type-A tympanogram was 0.82 (0.75–0.87) and the negative predictive value was 0.73 (0.65–0.81). Conclusions. There is a good correlation of Eustachian tube function, as demonstrated by tympanometry, between the ears of a child. If Eustachian tube function does have an impact on myringoplasty outcome then the contralateral tympanogram should provide some help in the decision on timing of myringoplasty."

December 6, 2006

• Clinical Implications of Research on Language Development and Disorders in Bilingual Children
  from a recent issue of Topics in Language Disorders
  "Abstract: Assessing and treating bilingual children with speech and language disorders is difficult given the relative paucity of data on the speech and language skills of typically developing bilingual children and those with speech and language disorders. The purpose of this article is to review the research that is available with regard to clinical implications for bilingual children with suspected speech and language disorders. Existing studies indicate that speech and language development in bilingual children is similar, although not identical, to that of their monolingual peers. Studies of bilingual children with speech and language disorders, though even more limited in number and scope, also point to similarities. On the other hand, research provides evidence that language skills are not distributed equally in the bilingual child's 2 languages and that sociolinguistic factors influence the bilingual child's language skills in predictable ways. Such patterns lead to recommendations for clinicians to move beyond questions of language dominance in assessment and intervention to focus on both languages to determine the contribution of each language to the child's overall language skills and the contexts in which they should be encouraged. Specifically, 3 themes emerge from the research literature on bilingual language development and disorders that have specific clinical implications and will be discussed in this article: (1) complete a comprehensive assessment examining skills in both languages; (2) consider sociolinguistic variables by examining the interaction between those variables and bilingual children's language skills; and (3) provide intervention in both languages, thus supporting development of the child's 2 languages."

• The effectiveness and cost-effectiveness of cochlear implants for severe to profound deafness in children and adults 
  from the NHS Health Technology Assessment Programme
  "The purpose of this technology assessment is to appraise the clinical and cost-effectiveness of cochlear implants for severe to profound deafness in children and adults. Since cochlear implants may be placed in either one or both ears, and because having one cochlear implant may be an intermediate step between having none and having two, there are in fact two decision problems: (1) should people without a cochlear implant have one implanted, and (2) should people already with one (unilateral) cochlear implant receive a second one in their other ear (i.e. ‘bilateral cochlear implantation’). More fully therefore, the policy questions to be answered are: 1.For severely or profoundly deaf people (who may be either using or not using hearing aids), is it effective and cost-effective to implant a first (i.e. unilateral) cochlear implant? 2.For severely or profoundly deaf people with a single cochlear implant (either unilateral or unilateral with a hearing aid, is it effective and cost-effective to implant a second (i.e. bilateral) cochlear implant? It is expected that the outcome measures will vary according to the adult and child populations. If possible outcome measures will include: -Audiological outcomes (e.g. sound perception, speech recognition, sound localisation) -Language and communication outcomes (e.g. intelligibility, sentence comprehension) -Psychosocial development/adjustment -Adverse effects of treatment -Health-related quality of life -Cost and cost-effectiveness (if possible, as a cost-utility analysis) -Educational outcomes (e.g. achievement, school placement) THE HTA PROGRAMME COMMISSIONED THIS TECHNOLOGY ASSESSMENT REPORT ON BEHALF OF THE NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE."

• Literacy Development in Elementary School Second-Language Learners
  from a recent issue of Topics in Language Disorders
  "Abstract: This article describes a series of studies that examine the development of literacy in elementary school Spanish-speaking second-language learners. Findings from the research that addresses our first question-regarding cross-language relationships-indicate that first-language reading skills are related to second-language reading skills, but that children must have first-language literacy in the skill for this relationship to exist; oral proficiency in the first language is not sufficient. In our studies that address the second research questions-bilinguals' early literacy development in kindergarten and first grade-Spanish-instructed bilinguals were more likely than English-instructed bilinguals or English monolinguals to treat diphthongs as 2 units, reflecting the influence of Spanish language instruction on English phonological analysis. Moreover, both English vocabulary and literacy instruction made unique, positive contributions to English spelling, whereas Spanish literacy instruction played a more important role than Spanish vocabulary in the production of Spanish-influenced spelling in English. Only bilingual students in Spanish literacy instruction exhibited Spanish-influenced spelling, indicating a powerful effect of language of literacy instruction. Our findings related to the third question-the role of home literacy and language environment on bilinguals' English and Spanish vocabulary development-suggest that becoming or staying proficient in English does not require parental use of English in the home. Spanish, not English, is the at-risk language for children of Hispanic heritage living in the United States. Students need early instruction in Spanish and home support in that language to become and remain proficient in Spanish."

• The Role of Oracy in Developing Comprehension in Spanish-Speaking English Language Learners
  from a recent issue of Topics in Language Disorders
  "Abstract: Components of first-grade intervention programs that addressed oral language and listening comprehension instruction within an intensive literacy intervention for native Spanish-speaking students struggling with reading difficulties are described. Findings for the intervention are based on 4 large-scale experimental studies (published elsewhere) in which the intervention was provided to struggling first-grade English language learners (ELLs) in the same language as the core reading instruction (Spanish or English). Interventions taught children the alphabetic principle with letter-sound correspondences and how to read words quickly and accurately as well as providing practices that enhanced the language skills needed to understand word and text meaning. Thus, explicit instruction was provided in oral language, phonemic awareness, alphabetic knowledge, fluency, vocabulary, and comprehension strategies. The essential features of the intervention that addressed oral language were a shared storybook reading routine in addition to enhanced language acquisition instruction. Findings indicate that students in the intervention made progress in the areas of phonological awareness, letter-sound identification, word attack, and comprehension skills. Our intervention studies empirically informs us on the instructional components of effective reading and oral language interventions for Spanish-speaking ELLs who are at risk for reading difficulties."

December 5, 2006

• Articulation rate in preschool children: a 3-year longitudinal study
  "Background: Speaking rate has implications for both clinical practice and an understanding of normal and disordered communication processes. Fundamental information on speaking rate is required by the clinician for the appropriate management of those disorders with disturbances of rate or those in which rate modification strategies are applied. One measure of speaking rate, articulation rate, excludes pause time and measures the speed with which articulators move. A developmental assessment of articulation rate is of particular interest because of its implications for changes in temporal motor aspects of speech production in development. Aims: The fundamental aim was to provide longitudinal and normative data on articulation rate in a group of preschool children. The following questions were asked. What are the articulation rates and variability in rate at ages 4, 5 and 6, and is there a developmental trend? Are speaking context, utterance length and gender significant variables? Methods & Procedures: Speech samples from four speaking contexts, spontaneous, imitated, automatic (represented by nursery rhyme narration) and repetition, were elicited from 16 normally developing children (eight boys and eight girls) at ages 4, 5 and 6. Utterances were measured in syllables per second for runs of speech without pauses within each speaking context. Outcomes & Results: In contrast to expectation, articulation rate did not increase significantly with age. Neither did variability of rate decrease with age. Results suggest that the course of development is non-linear. Automatic speech and repetition were significantly faster than imitated speech. An interaction between imitated speech and variability was found at age 4. Considerable individual differences in rate were identified. There were no gender differences and no correlations between articulation rate and utterance length. Conclusions: Unique information is provided on the development of speaking rate in preschool children together with additional normative data. The results have both theoretical and clinical implications. The data should assist the clinician in the assessment and diagnosis of rate and in rate modification management. Caution should be exercised in generalizing the results of the study in view of the small sample size and other factors."

• Audiological Evaluation of Affected Members from a Dutch DFNA8/12 (TECTA) Family
  from the current issue of JARO -- Journal of the Association for Research in Otolaryngology
  "In DFNA8/12, an autosomal dominantly inherited type of nonsyndromic hearing impairment, theTECTAgene mutation causes a defect in the structure of the tectorial membrane in the inner ear. Because DFNA8/12 affects the tectorial membrane, patients with DFNA8/12 may show specific audiometric characteristics. In this study, five selected members of a Dutch DFNA8/12 family with a TECTA sensorineural hearing impairment were evaluated with pure-tone audiometry, loudness scaling, speech perception in quiet and noise, difference limen for frequency, acoustic reflexes, otoacoustic emissions, and gap detection. Four out of five subjects showed an elevation of pure-tone thresholds, acoustic reflex thresholds, and loudness discomfort levels. Loudness growth curves are parallel to those found in normal-hearing individuals. Suprathreshold measures such as difference limen for frequency modulated pure tones, gap detection, and particularly speech perception in noise are within the normal range. Distortion otoacoustic emissions are present at the higher stimulus level. These results are similar to those previously obtained from a Dutch DFNA13 family with midfrequency sensorineural hearing impairment. It seems that a defect in the tectorial membrane results primarily in an attenuation of sound, whereas suprathreshold measures, such as otoacoustic emissions and speech perception in noise, are preserved rather well. The main effect of the defects is a shift in the operation point of the outer hair cells with near intact functioning at high levels. As most test results reflect those found in middle-ear conductive loss in both families, the sensorineural hearing impairment may be characterized as acochlear conductive hearing impairment."

• Auditory processing tests for Spanish-speaking adults: An initial study
  from a recent issue of the International Journal of Audiology
  "There is no standardized material to assess auditory processing (AP) in Spanish-speaking adults. The purpose of this research was to develop and obtain initial normative data for AP tests for Spanish-speaking adults. The AP tests comprised the Hong Kong CAPA (Hong Kong central auditory processing assessment) including speech-in-noise, binaural fusion, filtered speech, and dichotic digit tests. In addition five tests already developed by other authors, but with no normative data reported for the target population, were included in the study. These tests were staggered spondaic words, random gap detection, pitch pattern sequence, duration pattern sequence, and masking level difference. Forty normal hearing Chilean adults were assessed to obtain the initial normative data. Several correlations were found between tests and between subtests within the same test category. 90^th percentiles are suggested as initial normative data."

• Auditory startle reaction in primary blepharospasm
  from the current issue of Movement Disorders
  "Primary dystonia is associated with abnormal brainstem function, as shown by abnormalities of the blink reflex in blepharospasm (BSP) and of the auditory startle reaction in cervical dystonia. We examined the auditory startle reaction - a brainstem reflex elicited by an unexpected loud stimulus - in patients with primary BSP to expand knowledge on brainstem pathophysiology in primary focal dystonia. Thirteen patients with primary BSP were included and 13 age- and sex-matched healthy volunteers served as controls. Auditory startle responses (ASRs) were elicited by binaural high-intensity auditory stimuli, and reflex electromyographic activity was recorded simultaneously with surface electrodes bilaterally from masseter, orbicularis oculi, sternocleidomastoid, and biceps brachii muscles. Patients with BSP showed higher ASR probabilities (masseter, sternocleidomastoid, biceps brachii), shorter ASR onset latencies (masseter, orbicularis oculi, sternocleidomastoid), and larger ASR area-under-the-curve (masseter, sternocleidomastoid) as compared with normal controls. Habituation of ASRs did not differ significantly between patients and controls. These results corroborate previous findings of increased brainstem excitability in primary BSP but point to a different pattern of brainstem dysfunction compared to cervical dystonia, indicating that different pathophysiological mechanisms are involved in the two types of focal dystonia. © 2006 Movement Disorder Society"

• The Behavior Assessment Battery: a preliminary study of non-stuttering Pakistani grade-school children
  from a recent issue of the International Journal of Language and Communication Disorders
  "Background: In recent years, the importance of a multimodal approach to the assessment of the person who stutters (PWS) has become increasingly recognized. The Behavior Assessment Battery (BAB), which is a normed test procedure developed by G. Brutten, makes it possible to assess the multidimensional facets of this disorder. The emotional and speech-disruptive components that differentiate one who stutters from one who does not (PWNS) are evaluated by means of the Speech Situation Checklist (SSC), their use of behaviours secondary to stuttering are assessed through the Behavior Checklist (BCL) and the person's speech-related attitude is determined via the Communication Attitude Test (CAT). Each of these BAB tests has been shown to be a reliable and valid measure whose obtained normative data are essentially equivalent in Western countries. Aims: Because of the lack of normative data on children from non-Western cultures, the present preliminary study was aimed to investigate if the affective, behavioural and cognitive reports of non-stuttering Pakistani children on the BAB measures are like those of their Western peers. Methods & Procedures: Forty-five non-stuttering Pakistani children between the ages of 8 and 11 were administered the SSC, BCL and CAT. Outcomes & Results: As in previous studies, the mean score of the normally fluent children on each of