Research News in Speech Language and Hearing Disorders

Research News in Speech,
Language, and Hearing Disorders
August 2007

Note: These news items are gleaned from over 450 sources on the Internet and are provided as a service to our patrons. The University of Texas at Dallas does not guarantee the veracity, reliability or completeness of any information provided on this page, or in any hyperlink appearing on this page

August 27, 2007

Long-term Results with Tracheoesophageal Voice Prosthesis: Primary versus secondary TEP

from the European Archives of Oto-Rhino-Laryngology

Abstract The aim of this study was to evaluate the influence of timing of tracheoesophageal puncture (TEP)with indwelling voice prosthesis insertion regarding long-term success rate and postoperative complication. We conducted a Retrospective clinical study at tertiary academic center. There were 75 patients with primary TEP (80.6%) and 18 with secondary TEP (19.3%). Long-term success rate was 81.7%, with 80.0% in primary TEP and 88.9% in secondary TEP. No significant difference in Harrison-Robillard-Schultz Rating Scale success assessment were observed between patients with primary and secondary TEP (P = .596). The use of postoperative radiotherapy did not significantly influence the success rate. The age of patients who were older or younger than 60 years significantly influence the success rate in primary TEP (P = .012). The higher rate of complications in primary TEP was not statistically significant. These findings suggest that primary and secondary TEP are equally safe and effective procedures. Primary TEP should be prefered because of avoiding a second surgical intervention and allowing early voice restoration with a considerable psychological impact.

Analytic view to concordance between electrocochleography and caloric test in Meniere’s disease

from the European Archives of Oto-Rhino-Laryngology

Abstract We aimed to investigate if there is a concordance between summation potential (SP)/action potential (AP) ratio and unilateral weakness in patients with definite-Meniere’s disease. There were two groups, a group of unilateral definite-Meniere patients who received no treatment and another group of control subjects. Twenty-six patients were identified as complying with the defined criteria. Fifteen healthy subjects with no hearing and balance disorders were assigned to the control group. Arithmetic mean of the four-tone average of thresholds at 0.5, 1, 2, and 3 or 4 kHz, SP/AP ratio and degree of unilateral weakness were calculated. The number of patients was tabulated based on the presence of abnormal SP/AP ratio and unilateral weakness. Co-occurrence of unilateral weakness and elevated-SP/AP ratio was investigated with reference to the stage of the disease. A correlation was sought among pure-tone average, SP/AP ratio and degree of unilateral weakness in a pair-wise manner. Unilateral weakness and abnormal SP/AP ratio were identified in 53.8% and 38.4% of the patients, respectively. Co-occurrence of unilateral weakness and abnormal SP/AP ratio was observed in 34.6% of the patients. However, it was noticed that this co-occurrence gradually increased when the disease progressed. Mean SP/AP ratio also gradually increased as the stage progressed. Of pair-wise correlations among pure-tone average, SP/AP ratio and degree of unilateral weakness, a weak correlation (r = 0.383) was found only between SP/AP ratio and degree of unilateral weakness with marginal significance (P = 0.053). We concluded that co-occurrence of unilateral weakness and elevated SP/AP ratio increases when the disease progresses. This co-occurrence is less encountered in earlier stages. This difference might be resulted from a difference in distension capability of the endolymphatic space of the cochlea and the vestibule. Albeit weak, there was a correlation between mean SP/AP ratio and degree of unilateral weakness, which suggests that the disease parallelly disturbs the lateral semicircular or cochlear functions especially in advanced stages.

Do children with Williams syndrome really have good vocabulary knowledge? Methods for comparing cognitive and linguistic abilities in developmental disorders

from Clinical Linguistics and Phonetics

The comparison of cognitive and linguistic skills in individuals with developmental disorders is fraught with methodological and psychometric difficulties. In this paper, we illustrate some of these issues by comparing the receptive vocabulary knowledge and non-verbal reasoning abilities of 41 children with Williams syndrome, a genetic disorder in which language abilities are often claimed to be relatively strong. Data from this group were compared with data from typically developing children, children with Down syndrome, and children with non-specific learning difficulties using a number of approaches including comparison of age-equivalent scores, matching, analysis of covariance, and regression-based standardization. Across these analyses children with Williams syndrome consistently demonstrated relatively good receptive vocabulary knowledge, although this effect appeared strongest in the oldest children.

Comprehension of spatial language in Williams syndrome: Evidence for impaired spatial representation of verbal descriptions

from Clinical Linguistics and Phonetics

Individuals with the rare genetic disorder, Williams syndrome, have an unusual cognitive profile with relatively good language abilities but poor non-verbal and spatial skills. This study explored the interaction between linguistic and spatial functioning in Williams syndrome by investigating individuals' comprehension of spatial language. A group of 17 individuals with Williams syndrome and a control group of typically developing children were given two types of picture-matching task in which they were asked to select a picture to match a spoken sentence describing the spatial relation between two items. In the first task this matching could be done on the basis of existing semantic knowledge. In the second, we argue that a mental representation of the spatial relations was required. Results demonstrated that individuals with Williams syndrome were selectively impaired on the second task relative to controls. The study therefore provides support for previous work demonstrating impaired comprehension of spatial language in this population. Furthermore, the results suggest that such impairments reflect a fundamental problem with processing spatial descriptions rather than merely a poor understanding of the semantics of spatial terms, which in turn has implications for the interaction between spatial abilities and language processing in general.

Complex grammar in Williams syndrome

from Clinical Linguistics and Phonetics

This study investigated knowledge of binding and raising in two groups of children with Williams syndrome (WS), 6-12 and 12-16-years-old, compared to typically developing (TD) controls matched on non-verbal MA, verbal MA, and grammar. In typical development, difficulties interpreting pronouns, but not reflexives, persist until the age of around 6, while raising is not mastered until about the age of 8 or 9. If grammar in WS is delayed, but develops in a fashion parallel to TD population, similar patterns of difficulties may be expected, although it has not been established whether the grammatical development is ever complete in the individuals with this disorder. Knowledge of the principle of binding which states that a reflexive must have a c-commanding antecedent, was found to be intact in all the participants, in line with previous reports in the literature. In contrast, children with WS younger than 12 showed a poorer performance on personal pronouns, like two groups of younger matched TD controls, suggesting a previously unreported delay in the acquisition of constraints regulating coreferential interpretation of pronouns. Both groups of children with WS showed an extremely limited comprehension of raised, as opposed to unraised structures. The revealed patterns indicate that, like in unimpaired populations, different aspects of grammar mature at distinct stages of language development in WS: reflexive binding is acquired earlier than constraints governing coreference. However, development of raising seems exceptionally delayed, and perhaps even unattainable, as data from several adults with WS studied in Perovic and Wexler (2006) show. If, as hypothesized by Hirsch and Wexler, the late development of raising is related in TD children to lack of maturation of the knowledge of A-chains or defective phases, it seems reasonable to hypothesize that the even later development of these structures in WS is related to an even later (if ever) maturation of the knowledge of these grammatical forms.

Study Sheds Light On Vocal Chord Dysfunction And Treatment

from Medical News Today.com

Doctors at Columbus Children's Hospital performed a clinical research study using spirometry in Children's Emergency Department to try to identify adolescents who had findings suggestive of VCD compared to an acute asthma attack. The year-long study (February 2005-February 2006) included patients 12-21-years-old who suffered from acute episodes of respiratory distress. The manuscript was published in the July issue of Pediatric Pulmonology.

Vestibular Rehabilitation in Individuals with Inner-Ear Dysfunction: A Pilot Study

from Audiology & Neuro-Otology

A randomised control prospective study was carried out examining patient outcomes after performing a 10-week vestibular home exercise programme. Thirty-two adults with vestibular dysfunction who reported vestibular symptoms negatively affecting daily life were enrolled. Test subjects were provided with an individualised vestibular rehabilitation programme designed by a physiotherapist. Control subjects received a set of strength and endurance exercises only. All subjects performed their exercises 3 times a day for 10 weeks. Subjective and objective patient measures were collected at 0, 6, 10 and 26 weeks. Results showed that both groups improved after beginning exercise, and that test subjects significantly benefited compared to the controls. These benefits were long term and measurable 6 months later. This study provides evidence that individualised vestibular exercises promote better outcomes for patients with vestibular dysfunction.

The Effects of Electrode Montage on the Amplitude of Wave V in the Auditory Brainstem Response to Maximum Length Sequence Stimuli

from Audiology & Neuro-Otology

The use of maximum length sequence (MLS) stimuli to elicit an auditory brainstem response (ABR) has been limited, in part, by the observation that these stimuli reduce ABR wave amplitudes. This study recorded ABR waveforms from 14 normally hearing adults using MLS click stimuli (maximum stimulus rate = 250 clicks per second) at stimulus levels of 70, 60, 50, 40, 30 and 20 dB nHL, with a vertical and then an ipsilateral electrode montage. The vertical electrode montage produced significantly larger (p < 0.05) wave V amplitudes, with no change in wave V latencies (p > 0.05), at all stimulus levels. This result suggests a vertical electrode montage could be used to counter some of the loss in wave V amplitude observed when using MLS stimuli.

Facioscapulohumeral Muscular Dystrophy: A Multicenter Study on Hearing Function

from Audiology & Neuro-Otology

Facioscapulohumeral muscular dystrophy (FSHD) is an autosomal dominant progressive myopathy, characteristically associated with a 4q35 deletion. In the unusual infantile-onset form of this degenerative disease, sensorineural hearing loss is a frequent clinical manifestation, whereas in patients with typical late-onset FSHD, investigations regarding hearing impairment yielded controversial results. We describe the findings of a multicenter investigation on possible auditory impairment in a series of 73 FSHD patients with a genetically confirmed diagnosis. Among them, 49 cases with no risk factors for deafness, aside from the disease, were identified by a clinical questionnaire and otoscopic examination (mean age 37.8 years, 31 males and 18 females). These subjects were evaluated by pure-tone audiometry. None were aware of hearing loss, while 4 had raised unilateral or bilateral pure-tone audiometric thresholds at 4000 and 8000 Hz, when evaluated by standardized tables. However, the mean raw pure-tone audiometric threshold values for these 49 cases were not significantly different from those of 55 controls (mean age 37.1 years, 32 males and 23 females). Moreover, by statistical analysis, age of onset, degree of muscular weakness and 4q35 EcoRI fragment size made no significant difference to auditory thresholds in our FSHD patients. Overall, the results of our multicenter study suggest that hearing loss in typical FSHD is not more prevalent than in the normal population.

Effects of Sex, Age and Hearing Asymmetry on the Interaural Differences of Auditory Brainstem Responses

from Audiology & Neuro-Otology

Healthy patients with asymmetric sensorineural hearing loss who had received examination of auditory brainstem responses (ABR) were gathered for retrospective analysis. The effects of sex, age and hearing asymmetry on the interaural differences of ipsilateral ABR were determined by multivariant linear regression. Our results showed that the interaural differences of ABR wave III and wave V latencies were significantly affected by hearing asymmetry but not by sex or age. However, in female subjects younger than 50 years, differences of III-V intervals could be negatively correlated with hearing asymmetry. We suggest that plasticity in the auditory brainstem in younger females might account for asymmetrical peripheral hearing in this group.

Effects of Ambient Acoustic Noise on the Auditory Steady-State Response Thresholds in Normally Hearing Adults

from Audiology & Neuro-Otology

The effect of noise on auditory steady-state response (ASSR) has not been systematically studied, despite the fact that ASSR thresholds are sometimes measured in noisy environments. This study examined the effects of noise (speech babble) on the ASSR thresholds obtained from 31 normal hearing adults aged from 17 to 36 years (mean = 25 years). The ASSR thresholds at 0.5, 1, 2 and 4 kHz were measured in the right ear only using the Biologic MASTER system twice in quiet and in the presence of 55 dB A and 75 dB A of speech babble. The results showed no change in mean ASSR thresholds across the test-retest conditions in quiet. The mean ASSR thresholds obtained in the quiet conditions were 23.8, 22.5, 18.2 and 20.4 dB HL at 0.5, 1, 2 and 4 kHz, respectively. No significant shift in ASSR thresholds across all test frequencies was found when 55 dB A of speech babble was presented. However, when 75 dB A of noise was applied, the mean ASSR thresholds were significantly shifted by 9.5, 3.8, 4.2 and 5.8 dB at 0.5, 1, 2 and 4 kHz, respectively.

Variability in cortical representations of speech sound perception

from Clinical Linguistics and Phonetics

Recent brain mapping studies have provided new insights into the cortical systems that mediate human speech perception. Electrocortical stimulation mapping (ESM) is a brain mapping method that is used clinically to localize cortical functions in neurosurgical patients. Recent ESM studies have yielded new insights into the cortical systems that mediate speech perception and how these systems vary as a function of individual differences. ESM methods are described and findings from recent ESM studies of speech perception are reviewed. The clinical implications of these findings are discussed as they relate to current understanding of how individual differences in listening abilities are reflected in the underlying cortical representations.

Dislocations as a developmental marker in French language: A preliminary study

from Clinical Linguistics and Phonetics

In a previous study, Parisse suggested that subject dislocations in French language (e.g. "la fille elle dort") could be considered as a marker of morphosyntactic development in children with normal language development. The present study aimed to develop this proposition and to confirm it with experimental data, more specifically the fact that this development would go through a four-step process. Our prediction was that children could produce forms that correspond to successive steps in the developmental process (for example, forms [1] and [2], or [2] and [3]), but not forms that were very different (for example, forms [1] and [4], or [2] and [4]). In order to test this hypothesis, a sentence repetition task was administrated to 27 children aged 4 to 5. The results confirm the presence of a developmental trend in the use of dislocation in spontaneous language. At age 4, dislocations were frequent (30%), and tended to respect the gender (stage 3 and 4). At age 5, dislocations were rare (stage 4). Previous stages (1 and 2) would be observed in younger children.

Timed Essay Writing: Implications for High-Stakes Tests

from Journal of Learning Disabilities

The majority of high-stakes tests from elementary school through postsecondary education include the timed impromptu essay as a measure of writing performance. For adolescents with writing disorders, this type of evaluation often presents a significant barrier. The purpose of the current study was twofold. First, we investigated the influence of handwritten, typed, and typed/edited formats of an expository essay on the quality scores received by students with (n = 65) and without (n = 65) dyslexia. Second, we examined the contribution of spelling, handwriting, fluency, and vocabulary complexity to the quality scores that students with and without dyslexia received on the same writing task. Analyses indicated that vocabulary complexity, verbosity, spelling, and handwriting accounted for more variance in essay quality scores for writers with dyslexia than for their typically achieving peers. Both group and individual student outcomes are reported to better understand the needs of struggling writers with dyslexia. Implications for assessment, instruction, and accommodations are discussed with an eye toward reform efforts that target improved teaching and learning.

Evaluation of the Double-Deficit Hypothesis Subtype Classification of Readers in Spanish

from Journal of Learning Disabilities

The double-deficit hypothesis acknowledges both phonological processing deficits and serial naming speed deficits as two dimensions associated with reading disabilities. The purpose of this study was to examine these two dimensions of reading as they were related to the reading skills of 29 Spanish average readers and poor readers (mean age 9 years 7 months) who met the criteria for either single phonological deficit (PD), double deficit (DD), or no deficit. DD children were the slowest readers and had the weakest orthography processing skills. No significant differences were found between PD and DD groups on word and pseudoword reading. Word reading and reading comprehension skills were average or above average in the three studied groups. As in previous studies in transparent orthographies, word reading was not a salient problem for Spanish poor readers, whereas for the DD group, reading speed and orthographic recognition skills were significantly affected.

Can Differences in the Ability to Recognize Words Cease to Have an Effect Under Certain Reading Conditions?

from Journal of Learning Disabilities

In this study, we aimed to ascertain whether it is possible to create reading contexts that eliminate the impact of word recognition on reading comprehension and permit pupils with reading disabilities (RD) to attain a level of comprehension similar to that of their peers without RD. Specifically, the study compared a traditional reading situation with one of reading with aids (joint reading). In both situations, pupils' comprehension level was assessed by means of a summary and a series of inferential questions, and we controlled the effect on comprehension of word recognition, previous knowledge, rhetorical competence, and working memory. The results showed that the aids provided during reading do not eliminate the effect of word recognition, but they do permit readers with RD to attain a comprehension level similar to that of their peers.

N1 and P2 components of auditory event-related potentials in children with and without reading disabilities

from Clinical Neurophysiology

Objective The effects of within stimulus presentation rate and rise time on basic auditory processing were investigated in children with reading disabilities and typically reading children. Methods Children with reading disabilities (RD; N = 19) and control children (N = 20) were studied using event-related potentials (ERPs). Paired stimuli were used with two different within-pair-intervals (WPI; 10 and 255 ms) and two different rise times (10 and 130 ms). Each stimulus was presented with equal probability and long between-pair inter-stimulus intervals (1–5 s). The study focused on N1 and P2 components. Results The P2 responses to the first tone in the pair showed differences between children with RD and control children. Also, children with RD had larger N1 response than control children to stimuli with short WPI and long rise time. Conclusions These results provide evidence for basic auditory processing abnormalities in children with RD. This processing difference could be related to extraction of stimulus features from sounds or to attentional mechanisms. Significance Our results show support for behavioral findings that children with RD and control children process rise times differently. More than half of children with RD showed atypical auditory processing.

Spatial and cross-modal attention alter responses to unattended sensory information in early visual and auditory human cortex

from the Journal of Neurosphysiology

Attending to a visual or auditory stimulus often requires irrelevant information to be filtered out, both within the modality attended, and in other modalities. For example, attentively listening to a phone conversation can diminish our ability to detect visual events. We used functional magnetic resonance imaging to examine brain responses to visual and auditory stimuli while subjects attended visual or auditory information. Although early cortical areas are traditionally considered uni-modal, we found that brain response to the same ignored information depended on the modality attended. In early visual area V1, responses to ignored visual stimuli were weaker when attending another visual stimulus, as compared to attending an auditory stimulus. The opposite was true in more central visual area MT+, where responses to ignored visual stimuli were weaker when attending an auditory stimulus. Furthermore, fMRI responses to the same ignored visual information depended on the location of the auditory stimulus, with stronger responses when the attended auditory stimulus shared the same side of space as the ignored visual stimulus. In early auditory cortex, responses to ignored auditory stimuli were weaker when attending a visual stimulus. A simple parameterization of our data can describe the effects of redirecting attention across space within a modality (spatial attention) or across modalities (cross-modal attention), and the influence of spatial attention across modalities (cross-modal spatial attention). Our results suggest that the representation of unattended information depends on whether attention is directed to another stimulus in the same modality, or the same region of space.

Vestibular Schwannoma Volume as a Predictor of Hearing Outcome After Surgery

from Otology and Neurotology

"Objectives: To validate the prognostic capacity of several preoperative and intraoperative parameters of hearing preservation after vestibular schwannoma surgery. Study Design: A retrospective study of a consecutive series of 29 patients treated with the enlarged middle cranial fossa approach. Quantitative parameters were tumor volume, linear tumor size, pure-tone and speech audiometry, pure-tone average, speech discrimination score, speech reception threshold, auditory brainstem response (ABR; intra-aural interpeak latency I-V, interaural wave V latency difference), and the vestibular caloric test (speed and frequency). Qualitative parameters were fundus involvement by the tumor (in magnetic resonance imaging and surgical record), nerve of tumor origin (in magnetic resonance imaging and surgical record), ABR parameters (well-shaped ABRs: waves I, III, and V present; presence of wave V). Methods: All patients were divided into 2 groups on the basis of postoperative hearing: preserved hearing (55%) or nonpreserved hearing (45%). The Kolmogorov-Smirnov test was used to evaluate normality of distribution for continuous data. The t test was applied for normally distributed continuous data and the Mann-Whitney test for nonnormally distributed continuous data. The [chi]2 test was used for comparisons of categoric data. Results: Tumor volume was found to be the only statistically significant prognostic parameter for hearing preservation (p = 0.007). The cutoff point for the "critical" tumor volume for hearing preservation was calculated to 0.20 cm3. None of the other parameters reached statistical significance. Conclusion: Tumor size is a predictive factor for hearing preservation after vestibular schwannoma surgery, and patients with smaller tumors, based on volume measurement, have significantly better chances for retaining hearing. This has an impact on decision making and timing of surgery."

Vestibular Rehabilitation Outcomes in Chronic Vertiginous Patients Through Computerized Dynamic Visual Acuity and Gaze Stabilization Test

from Otology and Neurotology

"Objective: To evaluate the efficiency of the rehabilitative protocols in patients with labyrinthine hypofunction, focusing on computerized dynamic visual acuity test (DVAt) and Gaze stabilization test (GST) specifically evaluating the vestibulo-oculomotor reflex (VOR) changes due to vestibular rehabilitation. Design: Consecutive sample study. Setting: Day hospital in Ears, Nose, and Throat Rehabilitation Unit. Subjects: Thirty-two patients with chronic dizziness with a mean age of 60.74 years. Intervention: Patients performed one cycle of 12 daily rehabilitation sessions (2 h each) consisting of exercises aimed at improving VOR gain. The rehabilitation program included substitutional and/or habitudinal exercises, exercises on a stability platform, and exercises on a moving footpath with rehabilitative software. Main Measures: Dizziness Handicap Inventory and Activities-specific Balance Confidence Scale. Computerized dynamic posturography, computerized DVAt, and GST. Results: The patients significantly improved in all the tests. Conclusion: Vestibular rehabilitation improved the quality of life by reducing the handicap index and improving the ability in everyday tasks. The recovery of the vestibular-ocular reflex and vestibular-spinal reflex efficiency was objectively proven by instrumental testing. The DVAt and the GST allow to objectively quantify the fixation ability at higher frequencies and speeds (main VOR function). Moreover, these new parameters permit to completely evaluate vestibular rehabilitation outcomes, adding new information to the generally used tests that only assess vestibulospinal reflex."

Collaborative Research on Tinnitus (R01)

from NIH

The purpose of this RFA is to promote multidisciplinary collaborative research teams to investigate tinnitus, and not research that consists of only one discipline. Applications that do not demonstrate a collaborative approach across two or more disciplines are not being solicited under this RFA and will be returned.

Reducing False Positives in Newborn Hearing Screening Program: How and Why

from Otology and Neurotology

Objective: To compare the initial referral rate, the accurate identification rate of congenital hearing loss, and the cost between one step with transient evoked otoacoustic emissions (TEOAEs), two steps with TEOAE and automated auditory brainstem response (AABR), and one step with AABR in newborn hearing screening program. The aim of this study is to compare their efficacy between our three different protocols and to see which one is most cost-effective. Study Design: From November 1998 to April 2006, 25,588 healthy newborns were screened for hearing loss in Mackay Memorial Hospital, Taipei. In the periods from November 1998 to January 2004, from February 2004 to February 2005, and from March 2005 to April 2006, the screening tools used were TEOAE alone (n = 18,260), TEOAE plus AABR (n = 3,540), and AABR (n = 3,788), respectively. Results: A statistically significant decrease in referral rate was achieved in the group using AABR as screening tools when compared with TEOAE plus AABR and TEOAE alone (0.8 versus 1.6 versus 5.8%). The accurate identification rate of congenital hearing loss was 0.42% in AABR protocol, 0.25% in TEOAE and AABR protocol, and 0.45% in TEOAE protocol, which was not statistically significant. The total direct costs (including predischarge screening and postdischarge follow-up costs) per screening were US $10.04 for the program using TEOAE alone, US $8.60 for TEOAE plus AABR, and US $7.33 for AABR. The intangible cost (parental anxiety) was much higher in the earlier program due to higher referral rate. Conclusion: In the efficacy of the hearing screening program using the one-step TEOAE, two-step TEOAE and AABR, and one-step AABR programs, the latter significantly decreased the referral rate from 5.8, to 1.6, and to 0.8%. No significant difference was noted between their accurate identification rates of congenital hearing loss. The total costs, including expenditures and intangible cost, were much lower in the protocol with AABR due to reduction in false positives.

Positional Vertigo and Cochlear Implantation

from Otology and Neurotology

Objective: To identify patients developing positional vertigo after cochlear implantation. Study Design: Prospective study on a cohort of patients undergoing cochlear implantation. Setting: Academic tertiary referral center. Patients: The study included 70 consecutive patients who underwent vestibular evaluation before and after cochlear implantation. Intervention: Medical record review. Main Outcome Measure: Recorded vestibular symptoms after cochlear implantation. Patients with positional vertigo were considered case subjects, whereas those without vestibular symptoms were considered case controls. Results: Benign paroxysmal positional vertigo (BPPV) occurred in 8 patients (on the cochlear implant [CI] side in 7 patients, and in the other ear in 1). One patient had BPPV of the lateral semicircular canal on the implanted side, and 7 patients had BPPV of the posterior semicircular canal (on the same CI side in 6 patients, and on the opposite side in 1), which were detected and presented during the last examination. In 5 patients, the onset of symptoms varied from 7 to 130 days after implant activation; in 2 patients, the onset occurred before activation. Conclusion: Three different mechanisms are proposed for the occurrence of BPPV in patients with CI. The first focuses on the fall of bone dust particles into the cochlea during cochleostomy. In the second, the vibration caused by drilling the cochlea would be sufficient to dislodge otoconia into the labyrinth. The third hypothesis suggests dislodging of an otolith because of the electric stimulation. In our patients, conservative approaches have been used with a minimal invasive cochleostomy and without perilymph suction. Thus, the vibratory trauma affecting the cochlea during cochleostomy seems to play a fundamental role in the development of paroxysmal vertigo in patients with implant.

Otoacoustic Emissions in Early Noise-Induced Hearing Loss

from Otology and Neurotology

Objectives: To follow changes in transient evoked and distortion product otoacoustic emissions (TEOAEs, DPOAEs) as they relate to pure-tone audiometry (PTaud) thresholds during the first 2 years of occupational noise exposure. Design: Prospective controlled. Methods: Pure-tone audiometry thresholds, TEOAE and DPOAE amplitudes, and contralateral medial olivocochlear reflex strength were repeatedly evaluated during 2 years and compared between and within a cohort of 135 ship engine room recruits and a control group of 100 subjects with no noise exposure. Results: Pure-tone audiometry thresholds for 2,000, 3,000 and 4,000 Hz in both ears were significantly elevated in the study group after 2 years of noise exposure. Significantly lower TEOAE amplitudes were found at 2,000 Hz in the right ear and 2,000 and 4,000 Hz in the left ear. Longitudinal intrasubject analysis of the study group revealed significant reductions of TEOAE amplitudes at 2,000 to 4,000 Hz in both ears and reduced DPOAE amplitudes for 5,957 Hz in the right ear and 3,809, 4,736, and 5,957 Hz in the left ear in the second follow-up evaluation. Baseline medial olivocochlear reflex strength showed no correlation to PTaud thresholds after 2 years of noise exposure. Poor to moderate negative linear correlations (r = -0.07 to -0.37) were found between the DPOAE-averaged amplitudes at 2,979 to 5,957 Hz and PTaud threshold means at 3,000 to 6,000 Hz. Abnormal TEOAE parameters after the first year of noise exposure had high sensitivity (86-88%) and low specificity (33-35%) for the prediction of noise-induced hearing loss (NIHL) after 2 years. Conclusion: The DP-gram is not significantly correlated with PTaud and cannot be used as an objective measure of pure-tone thresholds in early NIHL. Medial olivocochlear reflex strength before the beginning of chronic exposure to occupational noise has no relation to individual vulnerability to NIHL. Although TEOAEs changes after 1 year showed high sensitivity in predicting NIHL after 2 years of exposure, they cannot be recommended as an efficient screening tool due to high false-positive rates.

Comparison of Pure-Tone Audiometry Analysis in Sudden Hearing Loss Studies: Lack of Agreement for Different Outcome Measures

from Otology and Neurotology

Hypothesis: Different methods of pure-tone audiometry analysis in sudden hearing loss studies show a lack of agreement with respect to outcome, and the choice of outcome measure influences sample size calculation. Background: There is an increasing number of clinical reports on the treatment of sudden hearing loss. For comparison of efficacy between different therapies and for meta-analysis, it is important to consider the outcome measures in different studies. Statistical analysis for comparison of different outcome measures is used in this study. Materials and Methods: Controlled clinical studies on the therapy for idiopathic sudden sensorineural hearing loss (ISSHL) were reviewed with respect to their choice of measurement method for the primary endpoint based on pure-tone audiometry. A selection of outcome measures, including different frequencies evaluated, absolute and relative hearing improvement, and different criteria for success, were compared by applying them on the same patient population treated for ISSHL. Agreement between different clinical outcome measures was assessed by using a method described by Bland and Altman. Based on the change in hearing level in the patient population, sample sizes were calculated for various outcome measures and for different criteria of hearing improvement. Results: In 52 controlled studies on the systemic treatment of ISSHL, more than 40 different outcome measures for the primary endpoint were identified. Comparison of measurement methods showed no acceptable agreement between most absolute and relative measures of hearing improvement and between endpoints on the basis of different criteria of success. The differences in outcome in the treatment of ISSHL were more affected by the definition of success than by frequencies included in the pure-tone average. Estimated sample sizes for controlled clinical trials varied substantially with the choice of outcome measure. Conclusion: The lack of an acceptable agreement between most measurement methods assessed in this report prevents a meaningful comparison of published clinical studies on ISSHL. For comparison of efficacy between different treatments in ISSHL and for the planning of controlled clinical trials, it is necessary to agree on standardized outcome measures, including the frequencies averaged and the criteria of success.

Cochlear Implant Fixation in Children Using Periosteal Sutures

from Otology and Neurotology

Objective: To describe a simple technique for implant receiver/stimulator (ICS) fixation that uses a seat for the device and suture fixation through the native cranial periosteum. This technique has been used through minimal-access surgical techniques in children since 2003. Patients: One hundred sixty pediatric cochlear implant recipients. Intervention: Implantation using the described technique for ICS fixation. Main Outcome Measure: Postoperative complications related to ICS fixation. Results: No complications have been observed. Conclusion: This report describes a simple and effective technique to secure the ICS package for pediatric cochlear implant surgery.

Bone-Anchored Hearing Aid in Patients With Moderate Mental Retardation: Impact and Benefit Assessment

from Otology and Neurotology

Objective: To assess the impact and the subjective benefit of Bone-anchored Hearing Aid (BAHA) implementation in patients with hearing impairment combined with moderate mental retardation. Study Design: Case control study using two validated patient-oriented instruments. Setting: Tertiary referral center. Patients: Twenty-two patients with moderate mental retardation and conductive or mixed hearing loss. Intervention: Rehabilitative. Main Outcome Measures: Subjective benefit, listening and learning capabilities. Results: BAHA implementation in patients with moderate mental retardation, by using the Glasgow Children's Benefit Inventory and the Listening Inventory for Education, showed a subjective benefit, which was comparable with that of the control group and was consistent with the results of earlier studies. Conclusion: The use of BAHA proved beneficial in most patients with hearing impairment and moderate mental retardation. Extending the indications for BAHA application to this special patient group shows to be a very valuable option.

Balance Impairment After Acoustic Neuroma Surgery

from Otology and Neurotology

Objective: The aim of this study was to assess the incidence of balance problems after acoustic neuroma surgery, evaluating whether disequilibrium is disabling. Study Design: Retrospective observational study. Setting: Rehabilitation center. Patients: A group of 386 patients who underwent acoustic neuroma surgery. Interventions: Patients were selected from a population of 459 subjects who had undergone surgery for acoustic neuroma. Mean Outcome Measures: The Dizziness Handicap Inventory, The Activities-specific Balance Confidence Scale (ABC), and a specific questionnaire on oscillopsia. Results: The specific questionnaire emphasized that 39 patients (10.10%) perceived disequilibrium as disabling, and the oscillopsia handicap score result was moderate in 73.32% of the sample, mild in 21.50%, and severe in 5.18% of patients. The Dizziness Handicap Inventory and ABC scales revealed the presence of handicap and disability due to disequilibrium and the influence of some variables such as sex and a higher oscillopsia handicap score. Dizziness Handicap Inventory and ABC scores were higher in symptomatic patients. Conclusion: Disequilibrium influences handicap and disability after acoustic neuroma surgery. This symptom is also present after several years since surgery, and some patients perceived disequilibrium as disabling.

Autonomic Nervous System Function in Chronic Dizziness

from Otology and Neurotology

Objective: The goals of this study were to validate the clinical diagnosis of autonomic dizziness as a cause of chronic nonvertiginous dizziness that may be exacerbated by physical exertion or orthostatic challenges, estimate its prevalence in a tertiary referral population, and investigate the usefulness of three autonomic challenges as objective tests for this condition. Study Design: Laboratory investigation of autonomic activity. Setting: Tertiary care balance center. Patients: Fifteen men and women with symptoms indicative of autonomic dizziness. Subjects with other causes of dizziness, histories of syncope, or psychiatric disorders were excluded. Interventions: Autonomic tests included 45 minutes of head upright tilt (HUT), 20 minutes of 5% CO2 inhalation and then HUT, and 2 minutes of voluntary hyperventilation and then HUT. Main Outcome Measures: Patterns of cardiovascular and respiratory responses and subjective ratings of dizziness, autonomic symptoms, and anxiety during autonomic challenges. Results: Twelve subjects had evidence of autonomic dysfunction, including 10 with abnormal heart rate, blood pressure, or respiratory responses to HUT. Two other subjects had prolonged hypocarbia after voluntary hyperventilation. Many of these abnormalities would have been missed by current autonomic testing paradigms. In one subject, CO2 inhalation revealed latent anxiety. In two subjects, the presence of high symptom ratings without objective autonomic dysfunction prompted a successful search for other diagnoses. Conclusion: Study results validated the clinical syndrome of autonomic dizziness. Autonomic testing protocols may have to be updated to detect clinically relevant abnormalities in patients with dizziness.

August 23, 2007

ADHD and dysgraphia: underlying mechanisms

from Cortex

Multiple complaints in the domain of writing are common among children with Attention Deficit Hyperactivity Disorder (ADHD). In this work we sought to characterize the writing disorder by studying dysgraphia in twenty 6th grade boys with ADHD and normal reading skills matched to 20 healthy boys who served as a comparison group. Dysgraphia, defined as deficits in spelling and handwriting, was assessed according to neuropsychological explanatory processes within 3 primary domains: linguistic processing, motor programming and motor kinematics. Children with ADHD made significantly more spelling errors, but showed a unique pattern introducing letter insertions, substitutions, transpositions and omissions. This error type, also known as graphemic buffer errors, can be explained by impaired attention aspects needed for motor planning. Kinematic manifestations of writing deficits were fast, inaccurate and an inefficient written product accompanied by higher levels of axial pen pressure. These results suggest that the spelling errors and writing deficits seen in children with ADHD and normal reading skills stem primarily from non-linguistic deficits, while linguistic factors play a secondary role. Recommendations for remediation include educational interventions, use of word processing and judicious use of psychostimulants.

Brain structure correlates of component reading processes: implications for reading disability

from Cortex

Brain structures implicated in developmental dyslexia (reading disability - RD) vary greatly across structural magnetic resonance imaging (MRI) studies due to methodological differences regarding the definition of RD and the exact measurements of a specific brain structure. The current study attempts to resolve some of those methodological concerns by examining brain volume as it relates to components of proposed RD subtypes. We performed individual regression analyses on total cerebral volume, neocortical volume, subcortical volume, 9 neo-cortical structures and 2 sub-cortical structures. These analyses used three dimensions of reading, phonemic ability (PA), orthographic ability, and rapid naming (RN) ability, while accounting for total cerebral volume, age, and performance IQ (PIQ). Primary analyses included membership to a group (poor reader vs. good reader) in the analysis. The result was a significant interaction between PA and reading ability as it predicts total cerebral volume. Analyses revealed that poor readers lacked a relationship between PA and brain size, but that good readers had a significant positive relationship. This pattern of interaction was not present for the other two reading component factors. These findings bring into question the general belief that individuals with RD are at the low end of a reading ability distribution and do not have a unique disorder. Additional analyses revealed only a few significant relationships between brain size and task performance, most notably a positive correlation between orthographic ability and the angular gyrus (AG), as well as a negative correlation between RN ability and the parietal operculum (PO).

Executive function following focal frontal lobe lesions: impact of timing of lesion on outcome

from Cortex

While it is generally agreed that outcome following cerebral insult during childhood differs from that seen following similar pathology in adulthood, the specific relationship between timing of cerebral lesion and outcome, and the mechanism associated with observed neurobehavioral changes, remains controversial. Data from children with focal lesions suggests a non-linear relationship between age at injury and language function (e.g., Bates et al., 1999). With respect to executive function, animal models also demonstrate a non-linear relationship, and suggest that outcome is tightly linked to underlying neuronal changes (e.g., Kolb et al., 2000). Whether these models easily translate to humans, where brain morphology, cognitive function and environmental influences are more complex, is not clear. To date, focal lesion research in children has been restricted to individual case studies or, to samples of children with lesions to regions subsuming language function, or those who have undergone hemispherectomy for the treatment of intractable epilepsy. This study aimed to build on current knowledge, investigating executive function in 38 children with focal lesions involving prefrontal cortex. Aetiology and timing of lesions was diverse. Results are consistent with animal research suggesting a non-linear relationship between age at injury and outcome, with "critical periods" during development when the frontal lobes are particularly vulnerable to insult, and others when outcome is more optimal. Our findings indicate that children with prenatal lesions are at greatest risk of neurobehavioral deficits. Children with lesions sustained in middle childhood demonstrate least severe impairments across executive domains, possibly due to a period of peak synaptogenesis and dendritic arborization during this developmental stage, in keeping with animal models and research investigating frontal lobe development.

Non-word repetition in children with specific language impairment: a deficit in phonological working memory or in long-term verbal knowledge?

from Cortex

In this study we investigated the effects of long-term memory (LTM) verbal knowledge on short-term memory (STM) verbal recall in a sample of Italian children affected by different subtypes of specific language impairment (SLI). The aim of the study was to evaluate if phonological working memory (PWM) abilities of SLI children can be supported by LTM linguistic representations and if PWM performances can be differently affected in the various subtypes of SLI. We tested a sample of 54 children affected by Mixed Receptive-Expressive (RE), Expressive (Ex) and Phonological (Ph) SLI (DSM-IV - American Psychiatric Association, 1994) by means of a repetition task of words (W) and non-words (NW) differing in morphemic structure [morphological non-words (MNW), consisting of combinations of roots and affixes - and simple non-words - with no morphological constituency]. We evaluated the effects of lexical and morpho-lexical LTM representations on STM recall by comparing the repetition accuracy across the three types of stimuli. Results indicated that although SLI children, as a group, showed lower repetition scores than controls, their performance was affected similarly to controls by the type of stimulus and the experimental manipulation of the non-words (better repetition of W than MNW and NW, and of MNW than NW), confirming the recourse to LTM verbal representations to support STM recall. The influence of LTM verbal knowledge on STM recall in SLI improved with age and did not differ among the three types of SLI. However, the three types of SLI differed in the accuracy of their repetition performances (PMW abilities), with the Phonological group showing the best scores. The implications for SLI theory and practice are discussed.

Multichannel Vestibular Prosthesis Shows Promise

from MedGadget.com

Defenseless chinchillas, poisoned by gentamicin and, as a result, suffering from impaired sense of balance, were outfitted with a multichannel vestibular prosthesis that was developed by biomed engineers at Johns Hopkins' Vestibular Neuroengineering Laboratory. The animals showed an improved sense of balance in a study that was published in the June 2007 edition of the journal I.E.E.E. Transactions on Biomedical Engineering.

Current practice, accuracy, effectiveness and cost-effectiveness of the school entry hearing screen

from Health Technology Assessment

Objectives: To describe and analyse in detail current practice of school entry hearing screening (SES) in the UK. Data sources: Main electronic databases were searched up to May 2005. Review methods: A national postal questionnaire survey was addressed to all leads for SES in the UK, considering current practice in terms of implementation, protocols, target population and performance data. Primary data from cohort studies in one area of London were examined. A systematic review of alternative SES tests, test performance and impact on outcomes was carried out. Finally, a review of published studies on costs, plus economic modelling of current and alternative programmes was prepared. Results: The survey suggested that SES is used in most of England, Wales and Scotland; just over 10% of respondents have abandoned the screen; others are awaiting national guidance. Coverage of SES is variable, but is often over 90% for children in state schools. Referral rates are variable, with a median of about 8%. The test used for the screen is the pure tone sweep test but with wide variation in implementation, with differing frequencies, pass criteria and retest protocols; written examples of protocols were often poor and ambiguous. There is no national approach to data collection, audit and quality assurance, and there are variable approaches at local level. The screen is performed in less than ideal test conditions and resources are often limited, which has an impact on the quality of the screen. The primary cohort studies show that the prevalence of permanent childhood hearing loss continues to increase through infancy. Of the 3.47 in 1000 children with a permanent hearing loss at school screen age, 1.89 in 1000 required identification after the newborn screen. Newborn hearing screening is likely to reduce significantly the yield of SES for permanent bilateral and unilateral hearing impairments; yield had fallen from about 1.11 in 1000 before newborn screening to about 0.34 in 1000 for cohorts that had had newborn screening, of which only 0.07 in 1000 were unilateral impairments. Just under 20% of permanent moderate or greater bilateral, mild bilateral and unilateral impairments, known to services as 6-year-olds or older, remained to be identified around the time of school entry. No good-quality published comparative trials of alternative screens or tests for SES were identified and studies concerned with the relative accuracy of alternative tests are difficult to compare and often flawed by differing referral criteria and case definitions; with full pure tone audiometry as the reference test, the pure tone sweep test appears to have high sensitivity and high specificity for minimal, mild and greater hearing impairments, better than alternative tests for which evidence was identified. There is insufficient evidence regarding possible harm of the screen. There were no published studies identified that examined the possible effects of SES on longer term outcomes. No good-quality published economic evaluations of SES were identified and a universal SES based on pure tone sweep tests was associated with higher costs and slightly higher quality-adjusted life-years (QALYs) compared with no screen and other screen alternatives; the incremental cost-effectiveness ratio for such a screen is around £2500 per QALY gained; the range of expected costs, QALYs and net benefits was broad, indicating a considerable degree of uncertainty. Targeted screening could be more cost-effective than universal school entry screening; however, the lack of primary data and the wide limits for variables in the modelling mean that any conclusions must be considered indicative and exploratory only. A national screening programme for permanent hearing impairment at school entry meets all but three of the criteria for a screening programme, but at least six criteria are not met for screening for temporary hearing impairment. Conclusions: The lack of good-quality evidence in this area remains a serious problem. Services should improve quality and audit screen performance for identification of previously unknown permanent hearing impairment, pending evidence-based policy decisions based on the research recommendations. Further research is needed into a number of important areas including the evaluation of an agreed national protocol for services delivering SES to make future studies and audits of screen performance more directly comparable.

August 22, 2007

Audiological findings in cleft palate patients attending speech camp

from the Indian Journal of Medical Research

BACKGROUND & OBJECTIVE: Hearing impairment is one of the associated problems seen particularly in children with cleft palate rather than cleft lip alone. This has received very little attention in the area of cleft care although research shows that hearing impairment affects language development The present study was carried not to find out the type and pattern of audiogram in cases attending a speech camp, average degree of hearing loss and its relation to the side of cleft, and the acoustic immittance findings and its relation to the otological evaluation. The parental awareness about the hearing problem was also assessed. METHODS: The study was conducted on cleft palate patients attending a speech camp. In all, there were 43 patients (19 males and 24 females) in the age range of 3-22 yr. All had undergone audiological assessment, speech and language evaluation, and otological evaluation using standard procedures. RESULTS: Hearing loss was seen in 38 (88.38%) patients. It was the first audiological assessments they ever had. The average pure tone Thresholds revealed a reverse-ski pattern with a wide air-bone gap. The degree of hearing loss ranged from 25 to 68 dB indicating that untreated otitis media resulted in moderate to moderately severe degree of hearing loss. The immittance findings supported the extent of extracranial complications identified on otoscopic examination. There were more patients with unilateral cleft of the left side with greater hearing loss in the ear alongside the cleft. INTERPRETATION & CONCLUSION: Hearing loss is prevalent in more than three - forth of the patients attending the speech camp. There is a need for early identification and intervention of middle ear effusion for all cleft palate cases.

Brain dynamics in the active vs. passive auditory oddball task: Exploration of narrow-band EEG phase effects

from Clinical Neurophysiology

Abstract Objective We aimed to examine relationships between the phase of narrow-band electroencephalographic (EEG) activity at stimulus onset and the resultant event-related potentials (ERPs) in active vs. passive auditory oddball tasks, using a novel conceptualisation of orthogonal phase effects. Methods This study focused on the operation of three recently-reported phase-influenced mechanisms, and ERP responses to the standard stimuli were analysed. Prestimulus narrow-band EEG activity (in 1 Hz bands from 1 to 13 Hz) at Cz was assessed for each trial using digital filtering. For each frequency, the cycle at stimulus onset was used to sort trials into four phases, for which ERPs were derived from both the filtered and unfiltered EEG activity at Fz, Cz and Pz. Results Preferred brain states at various frequencies were indicated by approximately 20% differential occurrence within the orthogonal phase dimensions explored. Conclusions The preferred states were associated with more efficient processing of the stimulus, as reflected in differences in latency and/or amplitude of various ERP components, and provided evidence for the operation of the three separate phase-influenced mechanisms. Significance Both the occurrence of preferred brain states, and the mechanisms linking them to ERP outcomes focused on here, appeared relatively invariant across tasks, suggesting that they largely reflect reflexive brain processes

Noun-verb naming in aphasia: a voxel-based lesion-symptom mapping study

from NeuroReport

Abstract: Single case and anatomo-correlative studies of aphasic participants have indicated that lesions in temporal regions cause predominant noun impairment, whereas lesions in frontal areas affect verb processing. These studies, however, relied mostly on arbitrary cut-offs, grouping participants according to whether or not they showed a noun or a verb deficit. Here, instead, we applied a recent anatomo-correlation technique, voxel-based lesion symptom mapping (VLSM) to a group of 16 left-hemisphere stroke participants tested on noun and verb naming tasks. Behavioral and lesion data were collected continuously without establishing a priori two different groups of participants. Noun naming was associated with regions located in the left superior temporal areas, whereas verb naming involved a larger region extending from the left prefrontal to the superior temporal areas. The differences and similarities of the two networks are discussed.

Mother’s Time with Children: Does Time Matter?

from Docuticker

Despite the theoretical importance mother’s time with children plays in the literature on children’s intellectual development, few studies have identified a significant relationship between the time children spend with mothers and their cognitive outcomes. This study uses children’s time diaries from the Child Development Supplement of the Panel Study of Income Dynamics to investigate the effect of the quantity and intensity of maternal care during early childhood on children’s later cognitive test scores (N = 1,008). Results show that the time mothers spend with children is positively correlated with verbal scores for children with verbally skilled mothers and that the influence of early maternal care has a persistent effect on later test scores even after lagged tests are controlled. The intensity of care or the percentage of total care devoted to active engagement is positively associated with development of analytic skills for children with skilled mothers. The findings suggest that children of mothers with better verbal skills benefit the most from spending more time with mothers. The findings also suggest that children can acquire verbal skills through passive interaction with verbally skilled mothers as well as through active interactions. On the other hand, the development of analytical skills may require more intense and direct involvement. Taken together, the results point to time use as a means of social reproduction—time with children is a pathway though which highly skilled mothers impart their human capital to their children.

‘Does Broca’s area exist?’ Christofredo Jakob’s 1906 response to Pierre Marie’s holistic stance

from Brain and Language

In 1906, Pierre Marie triggered a heated controversy and an exchange of articles with Jules Déjerine over the localization of language functions in the human brain. The debate spread internationally. One of the timeliest responses, that appeared in print 1 month after Marie’s paper, came from Christofredo Jakob, a Bavarian-born neuropathologist working in Buenos Aires. The present study comprises an English translation of Jakob’s 1906 paper and a discussion of Jakob’s ideas on the localizationist–holistic approach regarding the role of Broca’s area. This issue is still at the core of scientific debate in the light of current neuropsychological and neuroimaging findings.

Stress assignment in aphasia: Word and non-word reading and non-word repetition

from Brain and Language

This paper investigates stress assignment in Dutch aphasic patients in non-word repetition, as well as in real-word and non-word reading. Performance on the non-word reading task was similar for the aphasic patients and the control group, as mainly regular stress was assigned to the targets. However, there were group differences on the real-word reading and non-word repetition tasks. Unlike the non-brain-damaged group, the patients showed a strong regularization tendency in their repetition of irregular patterns. The patients’ stress error patterns suggest an impairment in retention or retrieval of targets with irregular stress patterns. Limited verbal short-term memory is proposed as a possible underlying cause for the stress difficulties.

Etiologies of hearing impairment among infants and toddlers: 1986–1987 versus 2001

from the International Journal of Pediatric Otorhinolaryngology

Objective This study compares etiological factors for hearing loss, relevant neuro-sensory impairments and demographics between two groups of children referred for early hearing habilitation in Israel. Group I was referred in the years 1986–1987 (n = 73) and group II was referred during 2001 (n = 73). Methods Family history, pregnancy, risk factors, developmental milestones, medical history, auditory brainstem response, tympanometry, otoacoustic emissions and behavioral audiometric results were retrospectively retrieved in 2003 from medical records at the MICHA Society for Deaf Children in Israel. Results New referrals per year have doubled themselves over the 15 years that elapsed between 1986–1987 and 2001. No changes in gender and age at time of admission were found. The prevalence of mild-to-moderate hearing loss was higher in Group II while severe and profound hearing loss was more prevalent in Group I. Assisted reproductive technologies were involved only in Group II. There were more twin births and post-natal hypoxia in Group II. Rh incompatibility was reported only in Group I. Severe hearing loss was associated with younger age at admission. No significant associations were found between age at admission and etiology with the exception of the fact that children with genetic background were admitted at an earlier age. Since no significant association between genetic background and severity of hearing loss was found, it is conclude that the association between severity of hearing loss and age at admission did not account for changes in etiology in our sample. Conclusions Classic risk factors for hearing loss among infants and toddlers have not changed much over time, and the few changes that have been noticed are probably due to expanded medical knowledge and improved technologies.

Recovery from cisplatin-induced ototoxicity: A case report and review

from the International Journal of Pediatric Otorhinolaryngology

We present a pediatric case report of cisplatin-induced ototoxicity with subsequent recovery. The patient experienced tinnitus and fluctuating mild high-frequency sensorineural hearing loss (SNHL) with a concomitant decrease in distortion product otoacoustic emissions (DPOAE). There was recovery of hearing loss and return of DPOAE at 1 year after completion of cisplatin therapy. Reports of recovery from cisplatin-induced ototoxicity in humans are limited in the literature, especially in the pediatric population. A review of cisplatin ototoxicity and mechanisms of recovery are discussed, with an emphasis on the particular chemotherapy regimen and dosing schedule in this case, given at 4–11 week intervals.

Learning strategy determines auditory cortical plasticity

from Neurobiology of Learning and Memory

Learning modifies the primary auditory cortex (A1) to emphasize the processing and representation of behaviorally relevant sounds. However, the factors that determine cortical plasticity are poorly understood. While the type and amount of learning are assumed to be important, the actual strategies used to solve learning problems might be critical. To investigate this possibility, we trained two groups of adult male Sprague–Dawley rats to bar-press (BP) for water contingent on the presence of a 5.0 kHz tone using two different strategies: BP during tone presence or BP from tone-onset until receiving an error signal after tone cessation. Both groups achieved the same high levels of correct performance and both groups revealed equivalent learning of absolute frequency during training. Post-training terminal “mapping” of A1 showed no change in representational area of the tone signal frequency but revealed other substantial cue-specific plasticity that developed only in the tone-onset-to-error strategy group. Threshold was decreased 10 dB and tuning bandwidth was narrowed by 0.7 octaves. As sound onsets have greater perceptual weighting and cortical discharge efficacy than continual sound presence, the induction of specific learning-induced cortical plasticity may depend on the use of learning strategies that best exploit cortical proclivities. The present results also suggest a general principle for the induction and storage of plasticity in learning, viz., that the representation of specific acquired information may be selected by neurons according to a match between behaviorally selected stimulus features and circuit/network response properties.

Effects of industrial solvents on hearing and balance: A review.

from Noise and Health

Industrial hearing loss has generally been associated with noise exposure, but there is a growing awareness that industrial solvents can have an adverse effect on the auditory and vestibular systems in man. Both animal experiments and human studies point to an ototoxic effect of industrial solvents, as well as some central auditory and vestibular disturbances. This review examines the research from the last four decades in an attempt to get an overview of the available evidence. Research shows that industrial solvents are ototoxic in rats. The majority of the solvents studied cause a loss of auditory sensitivity in the mid-frequencies in rats, affecting outer hair cells in the order OHC 3 > OHC 2 > OHC 1 . Inner hair cells are generally unaffected. Spiral ganglion cells are most vulnerable to trichloroethylene. Simultaneous exposure to solvents and noise results in a synergistic effect; the pattern of trauma mirrors that due to solvent exposure rather than noise, but is more enhanced. There is a critical level when synergy occurs. The effects of solvents on the vestibular system are neurotoxic and influence the vestibulo-oculomotor system in both animals and humans; humans also present with problems in postural sway. There is a strong suggestion from human studies that solvents are ototoxic in man, but findings show that both the peripheral and central auditory pathways can be affected. Hearing losses can be in the high frequency region or can affect a wider range of frequencies. Hearing loss and balance disturbances can occur at levels below permitted levels of exposure. The synergistic effect of combined exposure to solvents and noise has also been noted in humans, resulting in greater hearing losses than would be expected from exposure to noise and solvents alone. The findings from both human and animal studies indicate that exposure to industrial solvents or to industrial solvents and noise can have an adverse effect on hearing and balance. The implications for industry and hearing conservation are far reaching.

An Adaptive Speech Enhancement System Based on Noise Level Estimation and Lateral Inhibition

from Acta Acoustica united with Acustica

In speech recognition under a noisy environment, a system is needed that can reduce noise, while enhancing speech. The human auditory system has an excellent analytical spectrum mechanism for speech enhancement. Accordingly, this paper proposes an adaptive method which is inspired by known human auditory mechanism, called lateral inhibition. This method first estimates noise intensity using a neural network, then adjusts frame by frame the coefficients of both the lateral inhibition and the amplitude component according to the noise intensity for each input frame. The proposed system is compared with the results of a conventional spectral subtraction method and minimum mean-square error log-spectral amplitude (MMSE-LSA) estimator at different noise levels. Experiments confirm that the proposed system is effective for speech degraded by various noises using objective (global SNR and spectral distortion) and subjective mean opinion score (MOS) evaluations.

Quark Pharmaceuticals Extends Research Agreement With State University Of New York For Proprietary SiRNA Compounds For Acute Hearing Loss

from Medical News Today.com

Quark Pharmaceuticals, Inc., a clinical-stage biopharmaceutical company focused on discovering and developing novel RNA interference-based therapeutics, announced that it has expanded its relationship with the State University of New York at Buffalo, Center for Hearing & Deafness, which is the Company's primary site for the pre-clinical studies of its product candidate, AHLi-11, for the treatment of acute hearing loss. Quark initiated its collaboration with the State University of New York in 2005.

Progressive Nonfluent Aphasia Associated With a New Mutation V363I in Tau Gene

from the American Journal of Alzheimer's Disease and Other Dementias

Reported here is a new missense mutation V363I in exon 12 of the microtubule-associated protein tau (MAPT) gene associated with progressive nonfluent aphasia, with onset at the age of 69 years in a woman. Although near mute, she maintained complex activities and had no discernible deficits outside of language until the age of 75 years, when progressive gait and swallowing disturbances appeared. There was a history of late-onset aphasia and apraxia in her father. All of her children were asymptomatic adults, but psycholinguistic abnormalities were detected in those bearing the mutation, consisting of difficulties in comprehension, both reading (symbol discrimination and comprehension of oral spelling) and oral (matching sentences to pictures and comprehension of locative relationships). A mutation-bearing sibling showed no abnormalities at 70 years old, consistent with the limited penetrance expected in late-onset disease. The mutation, corresponding to a highly conserved residue in the fourth tubulin-binding repeat, was not present in 194 normal individuals with the same genetic background.

Baby talk is universal

from EurekAlert.org

A major function of speech is the communication of intentions. In everyday conversation between adults, intentions are conveyed through multiple channels, including the syntax and semantics of the language, but also through nonverbal vocal cues such as pitch, loudness, and rate of speech. The same thing occurs when we talk to infants. Regardless of the language we speak, most adults, for example, raise their voices to elicit the infant’s attention and talk at a much slower rate to communicate effectively. In the scientific community, this baby talk is termed “infant-directed speech.”

Depression in Primary Progressive Aphasia

from the Journal of Geriatric Psychiatry and Neurology

Primary Progressive Aphasia (PPA) is a clinical dementia syndrome in which language functions decline over time while other cognitive domains remain relatively preserved for at least 2 years. Because PPA patients suffer progressive interference with communication despite relatively preserved memory, reasoning, and insight, there is reason to believe they may experience depression. Geriatric Depression Scale (GDS) scores from PPA patients and normal controls were compared, the relationship between GDS and neuropsychological test scores was examined, and responses to items on the GDS were explored and grouped by the GDS factor structure. A significant proportion of PPA patients scored in the clinically depressed range. Although PPA patients as a group were not clinically depressed, they reported more symptoms of depression than controls, and the number of symptoms correlated with severity of naming impairment in depressed PPA patients. Symptoms of social withdrawal and lack of mental and physical energy were most common, suggesting that patients with PPA should be evaluated for depression so that they may be appropriately treated. (J Geriatr Psychiatry Neurol 2007;20:153-160)

Advances in Cochlear Implant Telemetry: Evoked Neural Responses, Electrical Field Imaging, and Technical Integrity

from Trends in Amplification

During the last decade, cochlear implantation has evolved into a well-established treatment of deafness, predominantly because of many improvements in speech processing and the controlled excitation of the auditory nerve. Cochlear implants now also feature telemetry, which is highly useful to monitor the proper functioning of the implanted electronics and electrode contacts. Telemetry can also support the clinical management in young children and difficult cases where neural unresponsiveness is suspected. This article will review recent advances in the telemetry of the electrically evoked compound action potential that have made these measurements simple and routine procedures in most cases. The distribution of the electrical stimulus itself sampled by "electrical field imaging" reveals general patterns of current flow in the normal cochlea and gross abnormalities in individual patients; models have been developed to derive more subtle insights from an individual electrical field imaging. Finally, some thoughts are given to the extended application of telemetry, for example, in monitoring the neural responses or in combination with other treatments of the deaf ear.

Binaural-Bimodal Fitting or Bilateral Implantation for Managing Severe to Profound Deafness: A Review

from Trends in Amplification

There are now many recipients of unilateral cochlear implants who have usable residual hearing in the non-implanted ear. To avoid auditory deprivation and to provide binaural hearing, a hearing aid or a second cochlear implant can be fitted to that ear. This article addresses the question of whether better binaural hearing can be achieved with binaural/bimodal fitting (combining a cochlear implant and a hearing aid in opposite ears) or bilateral implantation. In the first part of this article, the rationale for providing binaural hearing is examined. In the second part, the literature on the relative efficacy of binaural/bimodal fitting and bilateral implantation is reviewed. Most studies on comparing either mode of bilateral stimulation with unilateral implantation reported some binaural benefits in some test conditions on average but revealed that some individuals benefited, whereas others did not. There were no controlled comparisons between binaural/bimodal fitting and bilateral implantation and no evidence to support the efficacy of one mode over the other. In the third part of the article, a crossover trial of two adults who had binaural/bimodal fitting and who subsequently received a second implant is reported. The findings at 6 and 12 months after they received their second implant indicated that binaural function developed over time, and the extent of benefit depended on which abilities were assessed for the individual. In the fourth and final parts of the article, clinical issues relating to candidacy for binaural/ bimodal fitting and strategies for bimodal fitting are discussed with implications for future research.

Perceptual Learning and Auditory Training in Cochlear Implant Recipients

from Trends in Amplification

Learning electrically stimulated speech patterns can be a new and difficult experience for cochlear implant (CI) recipients. Recent studies have shown that most implant recipients at least partially adapt to these new patterns via passive, daily-listening experiences. Gradually introducing a speech processor parameter (eg, the degree of spectral mismatch) may provide for more complete and less stressful adaptation. Although the implant device restores hearing sensation and the continued use of the implant provides some degree of adaptation, active auditory rehabilitation may be necessary to maximize the benefit of implantation for CI recipients. Currently, there are scant resources for auditory rehabilitation for adult, postlingually deafened CI recipients. We recently developed a computer-assisted speech-training program to provide the means to conduct auditory rehabilitation at home. The training software targets important acoustic contrasts among speech stimuli, provides auditory and visual feedback, and incorporates progressive training techniques, thereby maintaining recipients' interest during the auditory training exercises. Our recent studies demonstrate the effectiveness of targeted auditory training in improving CI recipients' speech and music perception. Provided with an inexpensive and effective auditory training program, CI recipients may find the motivation and momentum to get the most from the implant device.

DPOAE Changes in Young Children With Confirmed Hearing Loss Due to Ototoxicity

from the Australian and New Zealand Journal of Audiology

The aim of this study was to examine the pattern of changes in distortion product otoacoustic emissions (DPOAEs) in children with ototoxic hearing loss during chemotherapy. The participants included a control group of 15 normal hearing children (3–12 years) and an experimental group of 7 paediatric oncology patients (1–13 years). Participants were tested using pure tone audiometry (PTA), tympanometry, and DPOAEs (primaries 65/55 dB SPL). The results revealed no perfect match between PTA and DPOAE results with respect to frequency and pattern of decrease/increase of DPOAE amplitudes. Further analysis of DPOAEs in the experimental group revealed three main patterns of change: (1) Concurrent decreases in DPOAEs that matched pure tone threshold (PTT) changes at approximately the same frequencies; (2) DPOAE changes prior to PTT change, suggesting possible predictive power in DPOAE testing and (3) DPOAE and PTT changes not related in terms of test frequency and direction of change, noted in a patient with a high cumulative carboplatin dose.

The ‘Hearing Aid Effect’ in Northern Territory Indigenous Australian Children as Perceived by Their Peers

from the Australian and New Zealand Journal of Audiology

Otitis media and associated hearing loss is endemic in Northern Territory Indigenous Australian children. While this ear disease is often preventable, it continues at prevalence rates estimated as high as 80%. In many cases, the use of a hearing aid is the best-practice intervention and often allows the wearer to hear family, friends and teachers. Yet, the use of hearing aids among Indigenous Australians is extremely low. This is the first study to investigate the ‘Hearing Aid Effect’ (HAE), which is the stigma associated with wearing a hearing aid, in an Indigenous Australian population. Participants in this study included 5 to 12-year-old Indigenous Australian children. Children viewed pictures of Indigenous children, of similar age, with and without visible hearing aids, and then rated their perceptions on an attitude scale. Participants were also involved in a learning-based intervention on the importance of wearing hearing aids. The results indicated a strong HAE. Indigenous Australian children had a more negative attitude towards peers who wore hearing aids in comparison to peers who did not wear hearing aids. Additionally, females tended to rate males more negatively than females on most questions. Males rated females more negatively on questions regarding friendship, sport and whether they can attend the same school. The intervention had a significant effect on the children's attitude toward hearing aids. The study results indicate that children of this early age have constructed characteristic stigmatisations concerning their peer's use of hearing aids.

The Ages of Intervention in Regions With and Without Universal Newborn Hearing Screening and Prevalence of Childhood Hearing Impairment in Australia

from the Australian and New Zealand Journal of Audiology

This article aims to (1) examine the impact of newborn hearing screening on age of hearing aid fitting, and (2) estimate the prevalence of permanent childhood hearing impairment and its profile across age and degree of impairment in Australia. The data were drawn from the Australian Hearing national database on all aided children under 21 years of age as at December 2006. The results indicated that children who were screened and diagnosed soon after birth were fitted by a median age of 3.4 months in New South Wales. The prevalence of moderate and more severe hearing loss (three-frequency average in the better ear of = 40 dB HL) rises from 1.04/1000 live births at 3 years of age to 1.57/1000 live births for children between 9 and 16 years of age. The prevalence of mild degrees of hearing loss (three-frequency average in the better ear < 40 dB HL) rises from 0.28/1000 live births at 3 years of age to 1.68/1000 live births at 9 years of age and older. The findings show that early detection leads to early amplification. The change in prevalence with age implies that newborn hearing screening needs to be supplemented by hearing screening at later ages of early childhood so that timely amplification can be provided.

The Effect of Sleep on the Fast and Slow Components of the Auditory Brainstem Response: A Case Study

from the Australian and New Zealand Journal of Audiology

This study examined the effects of sleep on the slow and fast components of the auditory brainstem response (ABR) in a human subject. ABR waveforms, electroencephalogram and rectal temperature were recorded from 1 adult male during overnight sleep, and the slow and fast components of the ABR were extracted using a six-level over-complete discrete wavelet transform (OCDWT). Initial results suggested ABR wave V, and its corresponding slow and fast components, increased in latency during sleep stages 2 and 4 relative to the awake state, but autoregressive integrated moving average (ARIMA) time series analyses showed these increases were best explained by decreases in body temperature. These results support suggestions that decreases in body temperature during sleep result in an increase in both synaptic transmission and axonal conduction times in the 8th cranial nerve and auditory brainstem, and that these changes are reversible.

The Effect of Stimulus Duration and Inter-Stimulus Interval on Cortical Responses in Infants

from the Australian and New Zealand Journal of Audiology

Cortical auditory evoked potentials (CAEP) were recorded from ten normal-hearing infants, aged 3 to 7 months, using the natural speech segments /m/ and /t/. The aim was to investigate the effect of selected stimulus durations and inter-stimulus intervals (ISIs) on infant responses. In the first experiment, various stimulus durations were used but the ISI was fixed. Results showed no significant difference in the latency of the first positive peak (P1) with changes in stimulus duration, but there was a minor increase in amplitude when duration increased from short to medium length. In the second experiment, medium length stimuli were presented with various ISIs. Results showed that as the ISI increased, P1 latency was constant but its amplitude increased nonlinearly for /t/ only. It appears therefore, that for the selected speech stimuli there was no clear advantage in using stimulus durations beyond 35 ms and ISIs beyond 1125 ms in infant assessments.

The Outcomes of Bone Anchored Hearing Aid (BAHA) Fitting in a Paediatric Cohort

from the Australian and New Zealand Journal of Audiology

To date, most studies of bone anchored hearing Aid (BAHA) fitting in children have focused on long-term maintenance of osseointegration and objective audiological outcomes, with little attention given to more qualitative outcomes relating to day-to-day use. This study involved 8 participants, aged between 12 and 21 years, all of whom had worn a unilateral BAHA for at least 1 year. The aims of the study were to examine audiological, physical and psychosocial outcomes. Evaluation included audiometric testing, a semistructured interview, and two questionnaires (i.e., Glasgow Benefit Inventory and International Outcomes Inventory–Hearing Aids). Results revealed improvements in speech discrimination, sound quality and comfort for all participants. Improvements in confidence, self-image, and socialisation were also experienced. Participants expressed some dissatisfaction with localisation abilities, phone usage, and the lack of availability of ongoing service and support. Findings indicate that the BAHA offers audiological, physical and psychosocial benefits for paediatric wearers, resulting in high levels of satisfaction.

Hearing Results After Stapedotomy With a Nitinol Piston Prosthesis

from Archives of Otolaryngology--Head and Neck Surgery

Objective To compare the hearing results in patients with otosclerosis who underwent a stapedotomy with either a platinum wire prosthesis or a commercially available, heat-activated nitinol stapes piston prosthesis. Design Retrospective medical chart review. Setting Academic tertiary care medical center. Patients Seventy-nine consecutive patients diagnosed as having otosclerosis who underwent primary stapedotomy (33 men and 46 women) were included in this study (41 ears per group). Intervention Stapedotomy. Main Outcome Measures The operative records of the senior surgeon (B.J.G.) were retrospectively reviewed, and hearing results were obtained. The hearing results of the patients who received a platinum wire prosthesis were compared with those who received a nitinol prosthesis. Results Results for the platinum wire prosthesis group revealed a postoperative mean (SD) air-bone gap (ABG) of 7 (6) dB, a mean (SD) ABG closure of 21 (12) dB, and a postoperative mean (SD) speech reception threshold of 25 (16) dB. Results for the nitinol prosthesis group revealed a postoperative ABG of 8 (6) dB, an ABG closure of 25 (10) dB, and a postoperative speech reception threshold of 25 (12) dB. Conclusions These data show that the nitinol prosthesis is equivalent to the platinum wire prosthesis in closing the ABG in patients with otosclerosis. Comparable efficacy combined with the ease and safety of heat-activated crimping supports the continued use of this prosthesis for stapes surgery.

Stress assignment in aphasia: Word and non-word reading and non-word repetition

from Brain and Language

August 20, 2007

Simultaneous and Sequential Bilateral Sudden Sensorineural Hearing Loss: Are They Different from Unilateral Sudden Sensorineural Hearing Loss?

from ORL--Journal for Oto-Rhino-Laryngology and Its Related Specialties

Aim: To compare bilateral (BSSHL) with unilateral (USSHL) sudden sensorineural hearing loss. Methods and Subjects: Two hundred and thirty-two patients with USSHL, 11 with simultaneous BSSHL and 7 with sequential BSSHL, who were older than 15 years had onset of hearing loss <30 days, no head injuries or history of acoustic trauma. All patients received the same treatment (prednisolone). Results: Hearing loss was more severe in simultaneous BSSHL in comparison to sequential BSSHL (p = 0.01) or USSHL (p = 0.03). Autoimmune diseases were far more common in simultaneous BSSHL (36% of patients) than USSHL. Positive antinuclear antibody was found in half of BSSHL patients and in only 8% of unilateral cases (p = 0.01). The frequency of hearing improvement was much lower in simultaneous BSSHL than in USSHL (p = 0.001). Complete or partial improvement was noted in 74% of unilateral cases versus 27% in simultaneous bilateral cases. Patients with sequential BSSHL improved in a similar way to unilateral cases. Conclusions: Simultaneous BSSHL, sequential BSSHL and USSHL may have a completely different profile and should not be managed as one disease. Hearing loss, underlying autoimmune diseases, antinuclear antibodies, and improvement/recovery of hearing loss vary in a degree that implies different pathophysiology and prognosis.

A case study of parent—child interactions of a child with autistic spectrum disorder (3—48 months) and comparison with typically-developing peers

from Child Language Teaching and Therapy

Early triadic interaction, the reciprocal action between mother—father—child, is described in the family of a girl diagnosed with autistic spectrum disorder (DSM 299.00) and learning difficulties at seven years. By chance, the family participated in a longitudinal study examining triadic interaction in 20 Swedish families using the Lausanne Triadic Play method. Quantitative and qualitative observations were made when the children were three, nine, 18 and 48 months of age. Compared with the other families, deviation was noted in early triadic synchronization, most clearly when the girl was nine months old. At three months, the girl took more turns and participated in more turn-taking sequences than the other children. However, at nine months, she gave more attention to objects. At 18 months, she had less eye contact with her parents and less shared focus and at 48 months her language skills were poorly developed. The mother showed more frequent contributions and more frequent turns at the two observations during infancy. The father showed deviations in attention to the child and affirmation at nine months and negative vocalization at 18 months. These findings are discussed in terms of their importance with regard to early intervention. Assessment of the family interaction using home observations seems to be of special importance.

Developing successful collaborative working practices for children with speech and language difficulties: a pilot study

from Child Language Teaching and Therapy

The importance of collaborative practice between those who provide services to children with special educational needs is now regarded as essential and is supported strongly by the UK government. However, joint working is often difficult to implement, despite the goodwill of all involved. This paper describes a pilot study aimed at developing collaboration between a local education authority and a National Health Service (NHS) Trust. It reports on the results of the evaluation and discusses aspects of the project that facilitated collaborative working between the various parties involved.

Documenting changes in communication behaviours using a Structured Observation System

from Child Language Teaching and Therapy

The Structured Observation System (SOS) is a data collection method developed to document changes in the communication behaviours of children identified with speech and language delays. The system employs a rating scale which reflects the occurrence of communication behaviours as well as the amount of assistance needed for behaviours to occur. Pre- and post-treatment rating scores may be compared to measure changes in communication behaviours. The Structured Observation System is an effective, efficient and practical method to record clinical data. It was designed to be used frequently during a treatment programme and it may be adapted by others for the same purpose.

Teacher ratings of children's listening difficulties

from Child Language Teaching and Therapy

Children with developmental disorders may present with listening and/or speech discrimination difficulties. This study explores whether teachers can identify these difficulties, using a questionnaire that rates children's listening, speech discrimination and comprehension abilities. The questionnaire was given to class-teachers of 52 pupils, aged four to five years, who had failed at least one of two formal assessments of comprehension and speech discrimination. Results showed significant correlation between teacher ratings of verbal comprehension and attentive listening and test scores for verbal comprehension. There was no significant correlation between ratings and test scores for speech discrimination skills. The questionnaire's internal consistency was found to be reliable overall, but validity in measuring speech discrimination was poor.

Dissociating object familiarity from linguistic properties in mirror word reading

from Behavioral and Brain Functions

Background It is known that the orthographic properties of linguistic stimuli are processed within the left occipitotemporal cortex at about 150-200 ms. We recorded event-related potentials (ERPs) to words in standard or mirror orientation to investigate the role of visual word form in reading. Word inversion was performed to determine whether rotated words lose their linguistic properties. Methods About 1300 Italian words and legal pseudo-words were presented to 18 right-handed Italian students engaged in a letter detection task. EEG was recorded from 128 scalp sites. Results ERPs showed an early effect of word orientation at ~150 ms, with larger N1 amplitudes to rotated than to standard words. Low-resolution brain electromagnetic tomography (LORETA) revealed an increase in N1 to rotated words primarily in the right occipital lobe (BA 18), which may indicate an effect of stimulus familiarity. N1 was greater to target than to non-target letters at left lateral occipital sites, thus reflecting the first stage of orthographic processing. LORETA revealed a strong focus of activation for this effect in the left fusiform gyrus (BA 37), which is consistent with the so-called visual word form area (VWFA). Standard words (compared to pseudowords) elicited an enhancement of left occipito/temporal negativity at about 250-350 ms, followed by a larger anterior P3, a reduced frontal N400 and a huge late positivity. Lexical effects for rotated strings were delayed by about 100 ms at occipito/temporal sites, and were totally absent at later processing stages. This suggests the presence of implicit reading processes, which were pre-attentive and of perceptual nature for mirror strings. Conclusions The contrast between inverted and standard words did not lead to the identification of a purely linguistic brain region. This finding suggests some caveats in the interpretation of the inversion effect in subtractive paradigms.

Acoustic injury and TRPV1 expression in the cochlear spiral ganglion

from the International Tinnitus Journal

Acoustic trauma not only produces temporary and permanent hearing loss but is a common cause of chronic tinnitus. Recent work indicated a possible role for the transient receptor potential channel vanilloid subfamily type 1 (TRPV1) in modulating the effects of cochlear injury. In our research, we investigated the effects of acoustic damage on TRPV1 expression in spiral ganglion neurons of adult rats. After exposing them unilaterally to noise, we extracted cochleas and processed the spiral ganglion for TRPV1 expression at four posttrauma intervals (2 hours, 24 hours, 12 days, and 16.9 months). We measured TRPV1 immunodensity in the apical, middle, and basal turns of the cochlea. We found a significant interaction (p = .039) between posttrauma interval and regional cochlear receptor expression: For survival intervals between 24 hours and 2 weeks, TRPV1 density increased in all cochlear regions; at the longest survival interval (16.9 months), TRPV1 density was dramatically reduced in the basal region. We also psychophysically tested the long-survival subjects, which showed evidence of 20-kHz tonal tinnitus. These results suggest that TRPV1 may participate after cochlear injury in a signal cascade that is responsible for the neuroplastic events leading to tinnitus and hyperacusis.

Applications of the marchbanks transcranial-cerebral sonography technique in neurootology: preliminary report

from the International Tinnitus Journal

Transcranial-cerebral sonography (TCCS) is a noninvasive technique that allows clinicians to detect nanoliter (billionths of a liter) displacements of the tympanic membrane. This technique was developed to assess cerebrospinal fluid (CSF) pressure in cases of shunted hydrocephalus; it takes advantage of the CSF connection to the inner ear through the cochlear aqueduct. The movements of the tympanic membrane that are observed in TCCS are those evoked by the acoustic stapedius reflex and those spontaneous movements generated by intracranial arterial, venous, and respiratory pulses transmitted through the inner ear to the stapes and thence to the tympanic membrane. Analysis of the amplitude and direction of these displacements has enabled neurosurgeons and neurologists to estimate CSF pressures accurately in patients evaluated by TCCS. TCCS allows for applications in neurootology, particularly in those patients who present with symptoms of pulsating tinnitus, dizziness and imbalance, or hearing loss. This preliminary report describes the test and its application in a series of patients whose diagnoses included pulsating tinnitus, idiopathic intracranial hypertension, Ménière's disease, perilymphatic fistula, perilymphatic hypertension, arterial stenosis, and Arnold-Chiari syndrome. We conclude that TCCS is a valuable addition to the armamentarium of neurootologists.

Cholesteatoma of the tympanic part of the temporal bone

from the International Tinnitus Journal

This article presents accounts of two patients with cholesteatoma of the tympanic part of the temporal bone, located immediately lateral to the tympanic annulus (and with an intact tympanic membrane). The lesions were located deep in the anterior and inferior walls of the canal, especially in the vaginal process of the tympanic part. These more severe cases required surgical correction (removal of the sac of cholesteatoma) with very good results. Pathogenesis and differential diagnosis are discussed.

Clear Tinnitus, middle-ear pressure, and tinnitus relief: a prospective trial

from the International Tinnitus Journal

GOAL: Our goal was to establish the efficacy, in a 12-week period, of Clear Tinnitus for tinnitus relief in patients with tinnitus of the severe, disabling type. HYPOTHESIS: We hypothesized that tinnitus relief with Clear Tinnitus reflects improvement in the sensory component of the tinnitus complaint by controlling the factor of aeration of the middle ears and improving eustachian tube function. METHOD: In a prospective clinical trial of a homeopathic preparation--Clear Tinnitus--we attempted to identify in 15 tinnitus patients (14 male, 1 female; mean age, 47.6 years) its clinical efficacy for establishing tinnitus relief for a 3-month period. We employed a descriptive data analysis method across dimensions of risk to evaluate a base of multidimensional evidence and establish support for our hypothesis. A medical-audiological tinnitus patient protocol completed by each patient identified the clinical type of tinnitus as predominantly cochlear, with a central and middle-ear component bilaterally. We identified fluctuation in middle-ear pressure (MEP) via patients' clinical history, supported by physical examination and established with tympanometry, as a factor influencing the clinical course of the tinnitus in each patient. RESULTS: Eleven of 15 patients completed the study. Seven responders reported tinnitus relief; four did not respond. Descriptive data analysis failed to detect any trends in a change in response with audiometric tests across the hearing spectrum; thus, we could derive no coefficients of hearing change. Evaluation revealed high-frequency tinnitus in 11 patients. The Feldmann masking curve comparison at the start and end of the study showed no significant change in the 11 patients. There was no significant alteration in the minimum masking levels or loudness discomfort levels before and after the study. Tympanometry and MEP measurement indicated a significant difference in MEP with an improvement on average of -58.18 in the right ear and -40.90 in the left ear for the 11 patients. Quantitative electroencephalography analysis revealed a marked difference in the number of significant abnormal recordings between the different frequency bands, with the delta band significantly higher than the theta, alpha, and beta bands for both the overall cohort of patients (n = 11) and those reporting tinnitus relief (n = 7). The tinnitus outcome questionnaires--the tinnitus intensity index, the tinnitus annoyance index, and the tinnitus reaction questionnaire--revealed a significant difference for the patients (7 of 11) obtaining tinnitus relief. Results of the tinnitus stress test, the tinnitus handicap index, and the measurement of depression scale before and after the study were not statistically significant. CONCLUSIONS: Patients who completed the study demonstrated with tympanometry a statistical and clinical significance in MEP improvement or maintenance of MEP (or both). Patients with tinnitus of the severe disabling type selected for this study and responding to Clear Tinnitus reported tinnitus relief accompanied by improvement in or maintenance of MEP of the middle ears. The statistical and clinical significance of Clear Tinnitus for establishing tinnitus relief remains to be established with a larger cohort of tinnitus patients.

Effective maneuver of the positional test: turning head and body together

from the International Tinnitus Journal

We performed three maneuvers of the positional test in supine patients: (1) body maneuver, in which patients turned only the body to one side while keeping the head as still as possible; (2) head-only maneuver, in which patients turned only the head to one side while keeping the body still; and (3) head and body maneuver, in which patients turned the head and body together to one side. The nystagmus provocation rates of those three maneuvers among 86 vertiginous patients were 9% in the body maneuver, 16% in the head-only maneuver, and 33% in the head and body maneuver, respectively. We proved that performing the positional test by turning the head and body together is very effective in provoking positional nystagmus.

Eyes as fenestrations to the ears: a novel mechanism for high-frequency and ultrasonic hearing

from the International Tinnitus Journal

Intense airborne ultrasound has been associated with hearing loss, tinnitus, and various nonauditory subjective effects, such as headaches, dizziness, and fullness in the ear. Yet, when people detect ultrasonic components in music, ultrasound adds to the pleasantness of the perception and evokes changes in the brain as measured in electroencephalograms, behavior, and imaging. How does the airborne ultrasound get into the ear to create such polar-opposite human effects? Surprisingly, ultrasound passes first through the eyes; thus, the eye becomes but another window into the inner ear.

High-frequency hearing threshold in adult women with multiple sclerosis

from the International Tinnitus Journal

Our objective was to determine the high-frequency hearing thresholds of women with multiple sclerosis (MS) and to investigate the presence of side dominance for high-frequency perception. We submitted 19 affected and 106 nonaffected women (controls) to high-frequency audiometry and classified them in subgroups according to their age (30-40, 40-50, and 50-60 years). We analyzed data through selected statistical tests. We could detect no consistent effect of side dominance and observed a general increase in the hearing sensitivity for high frequencies in MS patients. We concluded that high-frequency sounds seemed to be detected more easily by MS patients than by controls.

Monocular electronystagmographic analysis of caloric nystagmus

from the International Tinnitus Journal

We compared the horizontal component of nystagmus of the right and left eyes using monocular recording of electronystagmography. We examined the eye movements of 135 patients during bithermal caloric testing and those of 50 patients during the rotation test. We measured the number of nystagmic beats, the slow-phase velocities, and the amplitudes during 10 seconds of the culmination phase of caloric response. We also measured the number of nystagmic beats during the first 30 seconds in postrotatory nystagmus. The eye on the cold-irrigated side moved significantly more strongly than did the eye on the nonirrigated side, whereas a warm irrigation did not induce a significant difference between the irrigated and nonirrigated eyes. The summated activities of each eye during the four different stimulations under bithermal caloric testing did not show any significant differences. The activities of postrotatory nystagmus were almost equal in both eyes in 50 patients. We concluded that the inhibitory effect of cold caloric stimulation is probably transmitted more intensively to the eye on the irrigated side.

Neurootological aspects of juvenile vertigo

from the International Tinnitus Journal

Pathologies from childhood to adolescence carry physical, cognitive, motor, linguistic, perceptual, social, emotional, and neurosensory characteristics. The ages between 8 and 14 or 15 especially carry very special traits of a rollover in data processing with respect to balance regulation. Data acquisition of neurootological function prov

Research News in Speech, Language, and Hearing Disorders August 2007

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Research News in Speech,
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August 2007