JAAA CEU Program.

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JAAA CEU Program.

J Am Acad Audiol. 2015 Nov-Dec;26(10):889-90

Authors:

PMID: 26554493 [PubMed - in process]

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Index to Volume 26.

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Index to Volume 26.

J Am Acad Audiol. 2015 Nov-Dec;26(10):885-8

Authors:

PMID: 26554492 [PubMed - in process]

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Construct Validity of the Ecological Momentary Assessment in Audiology Research.

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Construct Validity of the Ecological Momentary Assessment in Audiology Research.

J Am Acad Audiol. 2015 Nov-Dec;26(10):872-84

Authors: Wu YH, Stangl E, Zhang X, Bentler RA

Abstract
BACKGROUND: Ecological momentary assessment (EMA) is a methodology involving repeated assessments/surveys to collect data describing respondents' current or very recent experiences and related contexts in their natural environments. The use of EMA in audiology research is growing.
PURPOSE: This study examined the construct validity (i.e., the degree to which a measurement reflects what it is intended to measure) of EMA in terms of measuring speech understanding and related listening context. Experiment 1 investigated the extent to which individuals can accurately report their speech recognition performance and characterize the listening context in controlled environments. Experiment 2 investigated whether the data aggregated across multiple EMA surveys conducted in uncontrolled, real-world environments would reveal a valid pattern that was consistent with the established relationships between speech understanding, hearing aid use, listening context, and lifestyle.
RESEARCH DESIGN: This is an observational study.
STUDY SAMPLE: Twelve and twenty-seven adults with hearing impairment participated in Experiments 1 and 2, respectively.
DATA COLLECTION AND ANALYSIS: In the laboratory testing of Experiment 1, participants estimated their speech recognition performance in settings wherein the signal-to-noise ratio was fixed or constantly varied across sentences. In the field testing the participants reported the listening context (e.g., noisiness level) of several semicontrolled real-world conversations. Their reports were compared to (1) the context described by normal-hearing observers and (2) the background noise level measured using a sound level meter. In Experiment 2, participants repeatedly reported the degree of speech understanding, hearing aid use, and listening context using paper-and-pencil journals in their natural environments for 1 week. They also carried noise dosimeters to measure the sound level. The associations between (1) speech understanding, hearing aid use, and listening context, (2) dosimeter sound level and self-reported noisiness level, and (3) dosimeter data and lifestyle quantified using the journals were examined.
RESULTS: For Experiment 1, the reported and measured speech recognition scores were highly correlated across all test conditions (r = 0.94 to 0.97). The field testing results revealed that most listening context properties reported by the participants were highly consistent with those described by the observers (74-95% consistency), except for noisiness rating (58%). Nevertheless, higher noisiness rating was associated with higher background noise level. For Experiment 2, the EMA results revealed several associations: better speech understanding was associated with the use of hearing aids, front-located speech, and lower dosimeter sound level; higher noisiness rating was associated with higher dosimeter sound level; listeners with more diverse lifestyles tended to have higher dosimeter sound levels.
CONCLUSIONS: Adults with hearing impairment were able to report their listening experiences, such as speech understanding, and characterize listening context in controlled environments with reasonable accuracy. The pattern of the data aggregated across multiple EMA surveys conducted in a wide range of uncontrolled real-world environment was consistent with the established knowledge in audiology. The two experiments suggested that, regarding speech understanding and related listening contexts, EMA reflects what it is intended to measure, supporting its construct validity in audiology research.

PMID: 26554491 [PubMed - in process]

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Evaluation of a BICROS System with a Directional Microphone in the Receiver and Transmitter.

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Evaluation of a BICROS System with a Directional Microphone in the Receiver and Transmitter.

J Am Acad Audiol. 2015 Nov-Dec;26(10):856-71

Authors: Valente M, Oeding K

Abstract
BACKGROUND: The bilateral contralateral routing of signals (BICROS) system has provided limited benefit for speech recognition in noise for patients with asymmetric sensorineural hearing loss, even when an automatic adaptive multichannel directional microphone (DM) is in the receiver (Rx) and an omnidirectional microphone (OM) is in the transmitter (Tx). A recent BICROS system was introduced that can be programmed with a DM in the Rx and an OM or a DM in the Tx.
PURPOSE: To examine if significant differences in sentence recognition in noise and subjective preferences are present between an OM and an adaptive broadband DM programmed in the Tx of a BICROS system with an automatic adaptive multichannel DM programmed in the Rx.
RESEARCH DESIGN: A randomized crossover single-blind design was used to assess differences between the OM and DM programmed in the Tx.
STUDY SAMPLE: Eighteen adult experienced BICROS system users were recruited.
DATA COLLECTION AND ANALYSIS: The BICROS system was fit using real-ear insertion gain measures. The Tx was programmed with an OM and a DM and the Rx was always programmed with an automatic adaptive multichannel DM. The order of microphone condition in the Tx was counterbalanced. Participants acclimatized to the BICROS system for 4 weeks and returned and completed the Abbreviated Profile of Hearing Aid Benefit (APHAB) for the respective microphone condition. The Tx was then programmed with the other microphone condition and participants acclimatized for another four weeks. At the final visit, the APHAB was completed for the respective microphone condition. After eight weeks of acclimatization, Hearing in Noise Test sentences were presented in the R-Space™ system with the Tx in either the OM or DM condition for three listening conditions: (1) speech from 90° to the Rx and noise from 0°, 90°, and 180° to the Tx (Sp Rx/N Tx), (2) speech from 90° to the Tx and noise from 0°, 90°, and 180° to the Rx (Sp Tx/N Rx), and (3) speech from 0° and noise from eight surrounding loudspeakers separated by 45° (diffuse).
RESULTS: A two-factor repeated measures analysis of variance revealed no significant differences between the OM and DM microphone conditions for Sp Rx/N Tx listening condition. A significant mean disadvantage of 1.9 dB (p < 0.01) was revealed for the DM compared to the OM for Sp Tx/N Rx listening condition and a mean advantage of 2.6 dB (p < 0.001) for the DM compared to the OM in a diffuse listening condition. There were no significant differences in the APHAB aided problem and resulting benefit scores between the OM and DM for the following subscales: ease of communication, background noise, reverberation, and aversiveness of sounds.
CONCLUSIONS: No significant differences were revealed between OM and DM for Sp Rx/N Tx. The DM performed significantly poorer than OM for the Sp Tx/N Rx listening condition. Results revealed significant benefit for the DM compared to OM for the diffuse listening condition. No significant differences were revealed between the OM and DM on the APHAB.

PMID: 26554490 [PubMed - in process]

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Benefits of Nonlinear Frequency Compression in Adult Hearing Aid Users.

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Benefits of Nonlinear Frequency Compression in Adult Hearing Aid Users.

J Am Acad Audiol. 2015 Nov-Dec;26(10):838-55

Authors: Kokx-Ryan M, Cohen J, Cord MT, Walden TC, Makashay MJ, Sheffield BM, Brungart DS

Abstract
BACKGROUND: Frequency-lowering (FL) algorithms are an alternative method of providing access to high-frequency speech cues. There is currently a lack of independent research addressing: (1) what functional, measureable benefits FL provides; (2) which, if any, FL algorithm provides the maximum benefit, (3) how to clinically program algorithms, and (4) how to verify algorithm settings.
PURPOSE: Two experiments were included in this study. The purpose of Experiment 1 was to (1) determine if a commercially available nonlinear frequency compression (NLFC) algorithm provides benefit as measured by improved speech recognition in noise when fit and verified using standard clinical procedures; and (2) evaluate the impact of acclimatization. The purpose of Experiment 2 was to (1) evaluate the benefit of using enhanced verification procedures to systematically determine the optimal application of a prototype NLFC algorithm, and (2) determine if the optimized prototype NLFC settings provide benefit as measured by improved speech recognition in quiet and in noise.
RESEARCH DESIGN: A single-blind, within-participant repeated measures design in which participants served as their own controls.
STUDY SAMPLE: Experiment 1 included 26 participants with a mean age of 68.3 yr and Experiment 2 included 37 participants with a mean age of 68.8 yr. Participants were recruited from the Audiology and Speech Pathology Center at Walter Reed National Military Medical Center in Bethesda, MD.
INTERVENTION: Participants in Experiment 1 wore bilateral commercially available hearing aids fit using standard clinical procedures and clinician expertise. Participants in Experiment 2 wore a single prototype hearing aid for which FL settings were systematically examined to determine the optimum application. In each experiment, FL-On versus FL-Off settings were examined in a variety of listening situations to determine benefit and possible implications.
DATA COLLECTION AND ANALYSIS: In Experiment 1, speech recognition measures using the QuickSIN and Modified Rhyme Test stimuli were obtained at initial bilateral fitting and 3-5 weeks later during a follow-up visit. In Experiment 2, Modified Rhyme Test, /sə/, /∫ə/ consonant discrimination task, and dual-task cognitive load speech recognition performance measures were conducted. Participants in Experiment 2 received four different systematic hearing aid programs during an initial visit and speech recognition data were collected over 2-3 follow-up sessions.
RESULTS: Some adults with hearing loss obtained small-to-moderate benefits from implementation of FL, while others maintained performance without detriment in both experiments. There was no significant difference among FL-On settings systematically obtained in Experiment 2. There was a modest but significant age effect in listeners of both experiments that indicated older listeners (>65 yr) might benefit more on average from FL than younger listeners. In addition, there were reliable improvements in the intelligibility of the phonemes /ŋ/ and /b/ for both groups, and /ð/ for older listeners from the FL in both experiments.
CONCLUSIONS: Although the optimum settings, application, and benefits of FL remain unclear at this time, there does not seem to be degradation in listener performance when FL is activated. The benefits of FL should be explored in older adult (>65 yr) listeners, as they tended to benefit more from FL applications.

PMID: 26554489 [PubMed - in process]

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What Can We Learn about Auditory Processing from Adult Hearing Questionnaires?

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What Can We Learn about Auditory Processing from Adult Hearing Questionnaires?

J Am Acad Audiol. 2015 Nov-Dec;26(10):824-37

Authors: Bamiou DE, Iliadou VV, Zanchetta S, Spyridakou C

Abstract
BACKGROUND: Questionnaires addressing auditory disability may identify and quantify specific symptoms in adult patients with listening difficulties.
PURPOSE: (1) To assess validity of the Speech, Spatial, and Qualities of Hearing Scale (SSQ), the (Modified) Amsterdam Inventory for Auditory Disability (mAIAD), and the Hyperacusis Questionnaire (HYP) in adult patients experiencing listening difficulties in the presence of a normal audiogram. (2) To examine which individual questionnaire items give the worse scores in clinical participants with an auditory processing disorder (APD).
RESEARCH DESIGN: A prospective correlational analysis study.
STUDY SAMPLE: Clinical participants (N = 58) referred for assessment because of listening difficulties in the presence of normal audiometric thresholds to audiology/ear, nose, and throat or audiovestibular medicine clinics. Normal control participants (N = 30).
DATA COLLECTION AND ANALYSIS: The mAIAD, HYP, and the SSQ were administered to a clinical population of nonneurological adults who were referred for auditory processing (AP) assessment because of hearing complaints, in the presence of normal audiogram and cochlear function, and to a sample of age-matched normal-hearing controls, before the AP testing. Clinical participants with abnormal results in at least one ear and in at least two tests of AP (and at least one of these tests to be nonspeech) were classified as clinical APD (N = 39), and the remaining (16 of whom had a single test abnormality) as clinical non-APD (N = 19).
RESULTS: The SSQ correlated strongly with the mAIAD and the HYP, and correlation was similar within the clinical group and the normal controls. All questionnaire total scores and subscores (except sound distinction of mAIAD) were significantly worse in the clinical APD versus the normal group, while questionnaire total scores and most subscores indicated greater listening difficulties for the clinical non-APD versus the normal subgroups. Overall, the clinical non-APD group tended to give better scores than the APD in all questionnaires administered. Correlation was strong for the worse-ear gaps-in-noise threshold with the SSQ, mAIAD, and HYP; strong to moderate for the speech in babble and left-ear dichotic digit test scores (at p < 0.01); and weak to moderate for the remaining AP tests except the frequency pattern test that did not correlate. The worse-scored items in all three questionnaires concerned speech-in-noise questions. This is similar to worse-scored items by hearing-impaired participants as reported in the literature. Worse-scored items of the clinical group also included quality aspects of listening questions from the SSQ, which most likely pertain to cognitive aspects of listening, such as ability to ignore other sounds and listening effort.
CONCLUSIONS: Hearing questionnaires may help assess symptoms of adults with APD. The listening difficulties and needs of adults with APD to some extent overlap with those of hearing-impaired listeners, but there are significant differences. The correlation of the gaps-in-noise and duration pattern (but not frequency pattern) tests with the questionnaire scores indicates that temporal processing deficits may play an important role in clinical presentation.

PMID: 26554488 [PubMed - in process]

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Perception of Hearing Aid-Processed Speech in Individuals with Late-Onset Auditory Neuropathy Spectrum Disorder.

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Perception of Hearing Aid-Processed Speech in Individuals with Late-Onset Auditory Neuropathy Spectrum Disorder.

J Am Acad Audiol. 2015 Nov-Dec;26(10):815-23

Authors: Mathai JP, Appu S

Abstract
BACKGROUND: Auditory neuropathy spectrum disorder (ANSD) is a form of sensorineural hearing loss, causing severe deficits in speech perception. The perceptual problems of individuals with ANSD were attributed to their temporal processing impairment rather than to reduced audibility. This rendered their rehabilitation difficult using hearing aids. Although hearing aids can restore audibility, compression circuits in a hearing aid might distort the temporal modulations of speech, causing poor aided performance. Therefore, hearing aid settings that preserve the temporal modulations of speech might be an effective way to improve speech perception in ANSD.
PURPOSE: The purpose of the study was to investigate the perception of hearing aid-processed speech in individuals with late-onset ANSD.
RESEARCH DESIGN: A repeated measures design was used to study the effect of various compression time settings on speech perception and perceived quality.
STUDY SAMPLE: Seventeen individuals with late-onset ANSD within the age range of 20-35 yr participated in the study.
DATA COLLECTION AND ANALYSIS: The word recognition scores (WRSs) and quality judgment of phonemically balanced words, processed using four different compression settings of a hearing aid (slow, medium, fast, and linear), were evaluated. The modulation spectra of hearing aid-processed stimuli were estimated to probe the effect of amplification on the temporal envelope of speech. Repeated measures analysis of variance and post hoc Bonferroni's pairwise comparisons were used to analyze the word recognition performance and quality judgment.
RESULTS: The comparison between unprocessed and all four hearing aid-processed stimuli showed significantly higher perception using the former stimuli. Even though perception of words processed using slow compression time settings of the hearing aids were significantly higher than the fast one, their difference was only 4%. In addition, there were no significant differences in perception between any other hearing aid-processed stimuli. Analysis of the temporal envelope of hearing aid-processed stimuli revealed minimal changes in the temporal envelope across the four hearing aid settings. In terms of quality, the highest number of individuals preferred stimuli processed using slow compression time settings. Individuals who preferred medium ones followed this. However, none of the individuals preferred fast compression time settings. Analysis of quality judgment showed that slow, medium, and linear settings presented significantly higher preference scores than the fast compression setting.
CONCLUSIONS: Individuals with ANSD showed no marked difference in perception of speech that was processed using the four different hearing aid settings. However, significantly higher preference, in terms of quality, was found for stimuli processed using slow, medium, and linear settings over the fast one. Therefore, whenever hearing aids are recommended for ANSD, those having slow compression time settings or linear amplification may be chosen over the fast (syllabic compression) one. In addition, WRSs obtained using hearing aid-processed stimuli were remarkably poorer than unprocessed stimuli. This shows that processing of speech through hearing aids might have caused a large reduction of performance in individuals with ANSD. However, further evaluation is needed using individually programmed hearing aids rather than hearing aid-processed stimuli.

PMID: 26554487 [PubMed - in process]

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Refining Stimulus Parameters in Assessing Infant Speech Perception Using Visual Reinforcement Infant Speech Discrimination: Sensation Level.

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Refining Stimulus Parameters in Assessing Infant Speech Perception Using Visual Reinforcement Infant Speech Discrimination: Sensation Level.

J Am Acad Audiol. 2015 Nov-Dec;26(10):807-14

Authors: Uhler KM, Baca R, Dudas E, Fredrickson T

Abstract
BACKGROUND: Speech perception measures have long been considered an integral piece of the audiological assessment battery. Currently, a prelinguistic, standardized measure of speech perception is missing in the clinical assessment battery for infants and young toddlers. Such a measure would allow systematic assessment of speech perception abilities of infants as well as the potential to investigate the impact early identification of hearing loss and early fitting of amplification have on the auditory pathways.
PURPOSE: To investigate the impact of sensation level (SL) on the ability of infants with normal hearing (NH) to discriminate /a-i/ and /ba-da/ and to determine if performance on the two contrasts are significantly different in predicting the discrimination criterion.
RESEARCH DESIGN: The design was based on a survival analysis model for event occurrence and a repeated measures logistic model for binary outcomes. The outcome for survival analysis was the minimum SL for criterion and the outcome for the logistic regression model was the presence/absence of achieving the criterion. Criterion achievement was designated when an infant's proportion correct score was >0.75 on the discrimination performance task.
STUDY SAMPLE: Twenty-two infants with NH sensitivity participated in this study. There were 9 males and 13 females, aged 6-14 mo.
DATA COLLECTION AND ANALYSIS: Testing took place over two to three sessions. The first session consisted of a hearing test, threshold assessment of the two speech sounds (/a/ and /i/), and if time and attention allowed, visual reinforcement infant speech discrimination (VRISD). The second session consisted of VRISD assessment for the two test contrasts (/a-i/ and /ba-da/). The presentation level started at 50 dBA. If the infant was unable to successfully achieve criterion (>0.75) at 50 dBA, the presentation level was increased to 70 dBA followed by 60 dBA. Data examination included an event analysis, which provided the probability of criterion distribution across SL. The second stage of the analysis was a repeated measures logistic regression where SL and contrast were used to predict the likelihood of speech discrimination criterion.
RESULTS: Infants were able to reach criterion for the /a-i/ contrast at statistically lower SLs when compared to /ba-da/. There were six infants who never reached criterion for /ba-da/ and one never reached criterion for /a-i/. The conditional probability of not reaching criterion by 70 dB SL was 0% for /a-i/ and 21% for /ba-da/. The predictive logistic regression model showed that children were more likely to discriminate the /a-i/ even when controlling for SL.
CONCLUSIONS: Nearly all normal-hearing infants can demonstrate discrimination criterion of a vowel contrast at 60 dB SL, while a level of ≥70 dB SL may be needed to allow all infants to demonstrate discrimination criterion of a difficult consonant contrast.

PMID: 26554486 [PubMed - in process]

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Easy Access to Hearing Health Care: Are We Closer Than We Think?

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Easy Access to Hearing Health Care: Are We Closer Than We Think?

J Am Acad Audiol. 2015 Nov-Dec;26(10):806

Authors: McCaslin DL

PMID: 26554485 [PubMed - in process]

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Treatment of Hemorrhagic Vocal Polyps by Pulsed Dye Laser-Assisted Laryngomicrosurgery.

Treatment of Hemorrhagic Vocal Polyps by Pulsed Dye Laser-Assisted Laryngomicrosurgery.

Biomed Res Int. 2015;2015:820654

Authors: Byeon HK, Han JH, Choi BI, Hwang HJ, Kim JH, Choi HS

Abstract
Objective. Conventional surgical techniques of laryngomicrosurgery (LMS) on hemorrhagic vocal polyps are often difficult due to obscuration of the surgical field by inadvertent bleeding from the lesion, and there are often significant amounts of mucosal epithelium loss. Here, we introduce our surgical technique using pulsed dye laser (PDL), which can effectively resect the polyp with vocal fold mucosa preservation. Methods. Patients who were diagnosed with hemorrhagic vocal polyp and who were surgically managed using PDL from March 2013 to October 2014 were retrospectively reviewed. Preoperative and postoperative clinical outcomes and surgical findings were evaluated. Results. A total of 39 patients were treated with PDL-assisted enucleation LMS. The average age was 43.7 years (range 20-73), and there were 20 males and 19 females (17 professional voice users). In all cases, the hemorrhagic polyp was successfully enucleated after application of PDL, thereby preserving the overlying epithelium. Postoperative voice outcomes were favorable with clear preservation of the vocal fold mucosal wave. Conclusion. PDL-assisted enucleation LMS for the treatment of hemorrhagic vocal polyps can be a safe and effective surgical technique. It can be considered a promising treatment option for hemorrhagic vocal polyps.

PMID: 26557700 [PubMed - as supplied by publisher]

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Do you hear the noise? The German matrix sentence test with a fixed noise level in subjects with normal hearing and hearing impairment.

Do you hear the noise? The German matrix sentence test with a fixed noise level in subjects with normal hearing and hearing impairment.

Int J Audiol. 2015 Nov 10;:1-9

Authors: Wardenga N, Batsoulis C, Wagener KC, Brand T, Lenarz T, Maier H

Abstract
OBJECTIVE: The aim of this study was to determine the relationship between hearing loss and speech reception threshold (SRT) in a fixed noise condition using the German Oldenburg sentence test (OLSA).
DESIGN: After training with two easily-audible lists of the OLSA, SRTs were determined monaurally with headphones at a fixed noise level of 65 dB SPL using a standard adaptive procedure, converging to 50% speech intelligibility.
STUDY SAMPLE: Data was obtained from 315 ears of 177 subjects with hearing losses ranging from - 5 to 90 dB HL pure-tone average (PTA, 0.5, 1, 2, 3 kHz).
RESULTS: Two domains were identified with a linear dependence of SRT on PTA. The SRT increased with a slope of 0.094 ± 0.006 dB SNR/dB HL (standard deviation (SD) of residuals = 1.17 dB) for PTAs < 47 dB HL and with a slope of 0.811 ± 0.049 dB SNR/dB HL (SD of residuals = 5.54 dB) for higher PTAs.
CONCLUSION: The OLSA can be applied to subjects with a wide range of hearing losses. With 65 dB SPL fixed noise presentation level the SRT is determined by listening in noise for PTAs < ∼47 dB HL, and above it is determined by listening in quiet.

PMID: 26555195 [PubMed - as supplied by publisher]

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Osteosarcoma of the larynx.

Osteosarcoma of the larynx.

Contemp Oncol (Pozn). 2015;19(3):246-9

Authors: Sawicki P, Każmierczak W, Szylberg Ł, Marszałek A

Abstract
Malignant neoplasms of the larynx are divided into epithelial and non-epithelial. Non-epithelial neoplasms include, among others, mesenchymal chondrosarcomas and osteosarcomas. Few cases of laryngeal osteosarcomas described in the literature were usually treated by surgery without the need to use adjuvant radio- or chemotherapy. Few authors propose the initial application of radiotherapy or high-dose chemotherapy. Our study presents a very rare case of a woman treated due to laryngeal osteosarcoma. We have also presented diagnostic difficulties preceding a decision to perform radical surgery. The patient had been eligible for radical surgical treatment, even though there were no features of malignancy in a histopathological examination of the biopsy material. Complete laryngectomy was carried out without the surgery of the cervical lymphatic system. Laryngeal osteosarcoma was diagnosed based on the postoperative histopathological examination using vimentin and Ki67. The patient remains under the care of the Otolaryngology and Laryngological Oncology Department and Oncology Centre in Bydgoszcz. There were no reports on local recurrence or distant metastases during regular check-ups.

PMID: 26557767 [PubMed]

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Relation between the level of lymph node metastasis and survival in locally advanced head and neck squamous cell carcinoma.

Relation between the level of lymph node metastasis and survival in locally advanced head and neck squamous cell carcinoma.

Cancer. 2015 Nov 10;

Authors: Xing Y, Zhang J, Lin H, Gold KA, Sturgis EM, Garden AS, Lee JJ, William WN

Abstract
BACKGROUND: The current head and neck squamous cell carcinoma (HNSCC) staging system may not capture the full prognostic implications of regional lymph node involvement. This study investigated the impact of the level of lymph node metastasis (LNM) on survival.
METHODS: The Surveillance, Epidemiology, and End Results registry was queried for oral cavity (OC), oropharynx (OP), larynx (LAR), and hypopharynx (HP) HNSCC. A multivariate Cox proportional hazards model was used to evaluate whether the level of LNM was an independent prognostic factor. Site-specific recursive-partitioning analysis was performed to classify patients into different risk groups.
RESULTS: In all, 14,499 patients, including OC (n = 2463), OP (n = 8567), LAR (n = 2332), and HP patients (n = 1137), were analyzed. Both the American Joint Committee on Cancer (AJCC) N classification and the level of LNM showed significant effects on overall survival (OS) in patients with OC, OP, or LAR HNSCC but not in patients with HP HNSCC. In patients with N2 disease, the AJCC subclassification (N2a, N2b, or N2c) was significantly associated with the OS of patients with OP and LAR HNSCC but not with the OS of patients with OC or HP HNSCC, whereas the level of LNM (primary, secondary, or tertiary) was significantly associated with the OS of patients with OC, OP, and LAR HNSCC but not HP HNSCC. With recursive-partitioning analysis, a simple, primary site-specific prognostic tool integrating the AJCC T and N classifications and the level of LNM was designed, and it could be easily used by health care providers in clinic.
CONCLUSIONS: The level of LNM is an independent prognostic factor for patients with locally advanced HNSCC and could add to the prognostic value of AJCC T and N classifications in patients with locally advanced HNSCC. Cancer 2015. © 2015 American Cancer Society.

PMID: 26554754 [PubMed - as supplied by publisher]

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New Onset Diplopia in Patients with Nasopharyngeal Carcinoma following Concurrent Chemoradiotherapy: Clinical Features and Etiology.

New Onset Diplopia in Patients with Nasopharyngeal Carcinoma following Concurrent Chemoradiotherapy: Clinical Features and Etiology.

Biomed Res Int. 2015;2015:735173

Authors: Kau HC, Tsai CC

Abstract
Purpose. To investigate the clinical features and etiology of nasopharyngeal carcinoma (NPC) patients with new onset diplopia after concurrent chemoradiotherapy. Methods. We retrospectively reviewed the medical records of NPC patients with new onset diplopia after concurrent chemoradiotherapy from 1998 to 2012 in a cancer center. Their clinical manifestations of ocular motor dysfunction in relation to etiology were investigated. Results. Twenty-three NPC patients with diplopia after concurrent chemoradiotherapy were enrolled in this study. Unilateral cranial VI palsy (91%) was the most common ocular motor dysfunction in these patients. The new onset diplopia in these patients was secondary to tumor recurrence in 12 cases (52%), radiation neuropathy in 8 cases (35%), and skull base osteoradionecrosis in 3 cases (13%). Patients with tumor recurrence and skull base osteoradionecrosis tended to present a rapid progression of the nerve palsy or severe ocular duction deficit. Patients with radiation neuropathy were often manifested by incomplete nerve palsy with insidious onset and slow progression. Patients with osteoradionecrosis were associated with poor prognosis. Conclusions. A new onset diplopia in NPC patients could be caused by tumor recurrence or treatment complications such as radiation neuropathy and osteoradionecrosis, and they show diverse clinical symptoms, course, and outcome.

PMID: 26558279 [PubMed - as supplied by publisher]

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A case of unilateral coronal synostosis from Medieval Hungary (9(th) century A.D.).

A case of unilateral coronal synostosis from Medieval Hungary (9(th) century A.D.).

Anthropol Anz. 2015 Nov 4;

Authors: Évinger S, Hajdu T, Biró G, Zádori P, Marcsik A, Molnár E, Wolff K

Abstract
SUMMARY: A unique single suture craniosynostosis case from the 9(th) century is presented in this paper. Although craniosynostosis is a fairly common pediatric anomaly nowadays, its occurrence in archaeological collections is an uncommon precedent. Since the diagnosis and treatment of premature cranial suture closure usually happens at an early age, evaluation of the whole developmental process is a rare opportunity. The right-sided coronal suture synostosis of this 30-35 years old woman gives an interesting opportunity to observe the effect of this phenomenon in adulthood. Only slight distortion of the viscerocranium and no bony signs of elevated intracranial pressure can be seen on the skull. The women suffered remarkable bending of the whole face and cranial base of the midsagittal plane. Besides the aesthetic disorder, the condition might have contributed to a chronic headache and visual disturbances. The lack of any other typical symptom suggests the diagnosis of isolated craniosynostosis or a milder type of syndromic craniosynostosis, the possibility of an underlying causative mutation cannot be ruled out.

PMID: 26555924 [PubMed - as supplied by publisher]

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Use of Tranexamic Acid Is Associated with Reduced Blood Product Transfusion in Complex Skull Base Neurosurgical Procedures: A Retrospective Cohort Study.

Use of Tranexamic Acid Is Associated with Reduced Blood Product Transfusion in Complex Skull Base Neurosurgical Procedures: A Retrospective Cohort Study.

Anesth Analg. 2015 Nov 9;

Authors: Mebel D, Akagami R, Flexman AM

Abstract
BACKGROUND: Compared with other procedures, complex skull base neurosurgery has the potential for increased intraoperative blood loss yet coagulation near eloquent cranial structures should be minimized. The safety and efficacy of the antifibrinolytic, tranexamic acid in elective neurosurgical procedures is not known. Our primary objective was to determine the relationship between the use of tranexamic acid and transfusion at our institution. Our secondary objective was to determine the incidence of adverse events associated with the use of tranexamic acid.
METHODS: In this retrospective cohort study, we included all patients who underwent complex skull base neurosurgical procedures at our institution between 2001 and 2013. Tranexamic acid was introduced during these procedures in 2006. Patient and surgical variables, transfusion data, and adverse events in the perioperative period were abstracted from the medical record. The rates of transfusion and adverse events were compared between patients who did and did not receive tranexamic acid. Multivariate regression was used to identify independent predictors of perioperative transfusion.
RESULTS: We compared 245 patients who received tranexamic acid with 274 patients who did not receive the drug during the study period. The 2 groups were similar, with the exception that patients who received tranexamic acid had larger tumors (mean, 3.5 vs 2.9 cm; P < 0.001) and longer procedures (mean, 7.2 vs 6.2 hours, P < 0.001). The rate of perioperative transfusion in patients who received tranexamic acid was lower (7% vs 13%, P = 0.04). After adjusting for preoperative hemoglobin, tumor diameter, and surgical procedure category, the use of tranexamic acid was independently predictive of perioperative transfusion (adjusted odds ratio, 0.32; 95% confidence interval, 0.15-0.65, P = 0.002). The rates of thromboembolic events and seizure were similar between the 2 groups.
CONCLUSIONS: Our results demonstrate that tranexamic acid use is associated with reduced transfusion rates in our study population, with no apparent increase in seizure or thrombotic complications. Our data support the need for further randomized clinical trials to evaluate the efficacy and safety of tranexamic acid on perioperative blood loss during complex skull base neurosurgery.

PMID: 26554461 [PubMed - as supplied by publisher]

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Author Self-Citation in the Otolaryngology Literature: A Pilot Study.

Author Self-Citation in the Otolaryngology Literature: A Pilot Study.

Otolaryngol Head Neck Surg. 2015 Nov 10;

Authors: Tolisano AM, Song SA, Cable BB

Abstract
OBJECTIVE: To determine the prevalence of author self-citation in the field of otolaryngology.
STUDY DESIGN AND SETTING: A retrospective review of bibliographic references in 5 otolaryngology journals.
SUBJECTS AND METHODS: Five high-impact otolaryngology journals were reviewed over a 3-month period between January and March 2014 to identify the pattern of author self-citations. Data included study type, otolaryngology topic, authorship, total citations, author self-citations, and country of origin.
RESULTS: Nearly two-thirds of articles contained at least 1 self-citation, with an average of 2.6 self-citations per article. Self-citations represented nearly 10% of total citations. Articles with at least 1 self-citation had more authors (5.8 vs 4.9, P < .01) and more citations (30.4 vs 22.2, P < .01) per article than did those without self-citations. There was no difference in self-citation practices between articles originating within the United States and abroad (P = .65). Last authors were the most frequent self-citers and were more likely than lead authors to cite themselves (P < .01). Original reports contained the highest percentage of self-citations per article as compared with reviews and case reports (P < .01).
CONCLUSION: Author self-citation in the otolaryngology literature is common and compares similarly to other medical specialties previously studied. Self-citation should not be considered inappropriate, as it is often done to expand on earlier research. Nevertheless, editors, researchers, and readers should be aware of this increasingly recognized phenomenon and its associated potential implications to the process of scientific inquiry.

PMID: 26556466 [PubMed - as supplied by publisher]

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Quality Improvement in Otolaryngology Residency: Survey of Program Directors.

Quality Improvement in Otolaryngology Residency: Survey of Program Directors.

Otolaryngol Head Neck Surg. 2015 Nov 10;

Authors: Bowe SN

Abstract
OBJECTIVES: The Clinical Learning Environment Review focuses on the responsibility of the sponsoring institution for quality and patient safety. Very little information is known regarding the status of quality improvement (QI) education during otolaryngology training. The purpose of this survey is to evaluate the extent of resident and faculty participation in QI and identify opportunities for both resident curriculum and faculty development.
STUDY DESIGN: Cross-sectional survey SUBJECTS AND METHODS: A 15-item survey was distributed to all 106 otolaryngology program directors. The survey was developed after an informal review of the literature regarding education in QI and patient safety. Questions were directed at the format and content of the QI curriculum, as well as barriers to implementation.
RESULTS: There was a 39% response rate. Ninety percent of responding program directors considered education in QI important or very important to a resident's future success. Only 23% of responding programs contained an educational curriculum in QI, and only 33% monitored residents' individual outcome measures. Barriers to implementation of a QI program included inadequate number of faculty with expertise in QI (75%) and competing resident educational demands (90%). Every program director considered morbidity and mortality conferences as an integral component in QI education.
CONCLUSIONS: Program directors recognize the importance of QI in otolaryngology practice. Unfortunately, this survey identifies a distinct lack of resources in support of these educational goals. The results highlight the need to generate a comprehensive and stepwise approach to QI for faculty development and resident instruction.

PMID: 26556465 [PubMed - as supplied by publisher]

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Amblyaudia: Review of Pathophysiology, Clinical Presentation, and Treatment of a New Diagnosis.

Amblyaudia: Review of Pathophysiology, Clinical Presentation, and Treatment of a New Diagnosis.

Otolaryngol Head Neck Surg. 2015 Nov 10;

Authors: Kaplan AB, Kozin ED, Remenschneider A, Eftekhari K, Jung DH, Polley DB, Lee DJ

Abstract
OBJECTIVE: Similar to amblyopia in the visual system, "amblyaudia" is a term used to describe persistent hearing difficulty experienced by individuals with a history of asymmetric hearing loss (AHL) during a critical window of brain development. Few clinical reports have described this phenomenon and its consequent effects on central auditory processing. We aim to (1) define the concept of amblyaudia and (2) review contemporary research on its pathophysiology and emerging clinical relevance.
DATA SOURCES: PubMed, Embase, and Cochrane databases.
REVIEW METHODS: A systematic literature search was performed with combinations of search terms: "amblyaudia," "conductive hearing loss," "sensorineural hearing loss," "asymmetric," "pediatric," "auditory deprivation," and "auditory development." Relevant articles were considered for inclusion, including basic and clinical studies, case series, and major reviews.
CONCLUSIONS: During critical periods of infant brain development, imbalanced auditory input associated with AHL may lead to abnormalities in binaural processing. Patients with amblyaudia can demonstrate long-term deficits in auditory perception even with correction or resolution of AHL. The greatest impact is in sound localization and hearing in noisy environments, both of which rely on bilateral auditory cues. Diagnosis and quantification of amblyaudia remain controversial and poorly defined. Prevention of amblyaudia may be possible through early identification and timely management of reversible causes of AHL.
IMPLICATIONS FOR PRACTICE: Otolaryngologists, audiologists, and pediatricians should be aware of emerging data supporting amblyaudia as a diagnostic entity and be cognizant of the potential for lasting consequences of AHL. Prevention of long-term auditory deficits may be possible through rapid identification and correction.

PMID: 26556464 [PubMed - as supplied by publisher]

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Potential Benefits of Combination Therapy as Primary Treatment for Sudden Sensorineural Hearing Loss.

Potential Benefits of Combination Therapy as Primary Treatment for Sudden Sensorineural Hearing Loss.

Otolaryngol Head Neck Surg. 2015 Nov 10;

Authors: Lee JB, Choi SJ

Abstract
OBJECTIVE: We analyzed the effectiveness of combination therapy (CT) for idiopathic sudden sensorineural hearing loss (ISSNHL) and the utility of intratympanic dexamethasone injection (ITDI) reapplication as salvage treatment for ISSNHL refractory to CT.
STUDY DESIGN: Case series with chart review.
SETTING: Academic university hospital.
SUBJECTS AND METHODS: We reviewed 229 patients with ISSNHL and divided these patients into 2 groups according to treatment: systemic steroid therapy (SST) and CT groups. The SST group received prednisolone therapy. The CT group also received ITDI daily. Patients who demonstrated no recovery (<10 dB) after initial treatment were defined as refractory and received salvage ITDI therapy: ITDI reapplication in the CT group and ITDI application in the SST group.
RESULTS: Hearing recovery rates were 77.8% (77/99) in the CT group and 60.8% (79/130) in the SST group. The difference was statistically significant (P = .011). Initial pure-tone audiometry and vertigo were affective factors on hearing recovery rates in the CT group. After salvage therapy, hearing improvement of 10 dB or greater was noted in 6 of the 22 (27.3%) patients in the CT group and 16 of the 51 (31.4%) patients in the SST group. The difference in efficacy of salvage therapy between the CT and SST groups was simply not significant (P = .612).
CONCLUSIONS: Combination therapy was more effective for ISSNHL in achieving hearing gain than SST alone. Furthermore, ITDI reapplication for ISSNHL refractory to CT was as effective as salvage ITDI for ISSNHL refractory to SST.

PMID: 26556463 [PubMed - as supplied by publisher]

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Short-term Quality-of-Life Outcomes following Transoral Diverticulotomy for Zenker's Diverticulum: A Prospective Single-Group Study.

Short-term Quality-of-Life Outcomes following Transoral Diverticulotomy for Zenker's Diverticulum: A Prospective Single-Group Study.

Otolaryngol Head Neck Surg. 2015 Nov 10;

Authors: Van Abel KM, Tombers NM, Krein KA, Moore EJ, Price DL, Kasperbauer JL, Hinni ML, Lott DG, Ekbom DC

Abstract
OBJECTIVE: To prospectively analyze quality-of-life outcomes following transoral diverticulotomy with cricopharyngeal myotomy (DCPM) for Zenker's diverticulum (ZD).
STUDY DESIGN: Prospective single-group study.
SETTINGS: Tertiary academic institution.
SUBJECTS AND METHODS: A prospective multicenter study performed from January 1, 2012, to July 1, 2014, included 18 patients presenting with ZD undergoing DCPM. Standardized questionnaires-including the 10-item Eating Assessment Tool (EAT-10), Functional Outcome of Swallowing Scale (FOSS), and the Reflux Symptom Index (RSI)-were completed preoperatively and at 3 and 6 months postoperatively. Videofluoroscopic studies were obtained and analyzed by our senior speech-language pathologist, who was blinded to the clinical outcomes.
RESULTS: Eighteen patients were included (11 women; mean age, 72.6 years; range, 53-86 years). All patients had ZD on preoperative videofluoroscopic swallowing studies. The most common comorbidities included hypertension (10 of 18, 55.6%), dyslipidemia (8 of 18, 44.4%), hiatal hernia (6 of 18, 33.3%), and gastroesophageal reflux disease (5 of 18, 27.8%). Median preoperative RSI was 27 (interquartile range [IQR], 22.5-31.5); FOSS, 2 (IQR, 2-3); and EAT-10, 21.5 (IQR, 13.5-27.5). The 3-month questionnaire (88.9% completion) demonstrated an improved median RSI of 5 (IQR, 1-7.5; P < .001), FOSS of 0 (IQR, 0; P < .001), and EAT-10 of 0 (IQR, 0-3; P < .001). Fourteen patients (77.8%) completed the 6-month questionnaire, demonstrating a median RSI of 4 (IQR, 0-8), FOSS of 0 (IQR, 0-0.5), and EAT-10 of 1 (IQR, 0-3). While regurgitation decreased following surgery (P = .007), nighttime cough did not (P = .25).
CONCLUSION: This study supports an improvement in functional outcome and quality of life in patients with ZD undergoing DCPM.

PMID: 26556462 [PubMed - as supplied by publisher]

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Triticeous Cartilage CT Imaging Characteristics, Prevalence, Extent, and Distribution of Ossification.

Triticeous Cartilage CT Imaging Characteristics, Prevalence, Extent, and Distribution of Ossification.

Otolaryngol Head Neck Surg. 2015 Nov 10;

Authors: Alqahtani E, Marrero DE, Champion WL, Alawaji A, Kousoubris PD, Small JE

Abstract
OBJECTIVE: The triticeous cartilage is a small ovoid cartilaginous structure variably present as a component of the laryngeal skeleton. This structure has received scant attention in the literature and has yet to be described adequately on cross-sectional imaging.
STUDY DESIGN AND SETTING: Retrospective study in a tertiary medical center.
SUBJECTS AND METHODS: We investigated triticeous cartilage prevalence in a large population utilizing computed tomography images. The cases of all patients with computed tomography angiography images of the neck from October 1, 2013, to September 31, 2014, were examined. A total of 663 patients were included in this study (age: range, 18-97 years; mean ± SD, 65 ± 15 years), 58.4% men and 41.6% women. The presence of a triticeal cartilage and its site, number, and degree of ossification were recorded.
RESULTS: A total of 53.1% of patients had at least 1 triticeous cartilage (352 of 663). Prevalence was 57.4% (222 of 387) among men and 47.1% (130 of 276) among women. The presence of bilateral triticeous cartilages was more common than unilateral (63.1%, 222 of 352). A minority of patients (4.5%, 16 of 352) had a cartilaginous triticeous with no appreciable ossification, and more than half (54.0%, 190 of 352) had mild triticeal ossification. Moderate ossification was found in 34.9% of patients (123 of 352) and marked ossification in 6.5% (23 of 352).
CONCLUSION: The presence of a triticeous cartilage is common and of variable appearance. As the clinical and surgical significance of this anatomic structure may be misinterpreted, it is important for imaging interpreters to be familiar with this seldom-recognized anatomic structure and recognize its variable appearance on cross-sectional imaging to avoid a misdiagnosis.

PMID: 26556461 [PubMed - as supplied by publisher]

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Cervical subtotal en-bloc spondylectomy of C6 mesenchymal chondrosarcoma.

Cervical subtotal en-bloc spondylectomy of C6 mesenchymal chondrosarcoma.

Eur Spine J. 2015 Nov 10;

Authors: Lee CH, Min WK

Abstract
INTRODUCTION: We present a case of C6 mesenchymal chondrosarcoma and discuss safe posterior to anterior approach subtotal en-bloc spondylectomy.
MATERIALS AND METHODS: A 29-year-old male consulted for our department with severe posterior neck pain doing exercise. CT scan demonstrated a primary osteolytic lesion on C6 left transverse foramen and MRI demonstrated the tumor involved C6 vertebra from layers B, C and F sectors 4-6 encasing left vertebral artery. Preoperatively neurointerventional radiology service occluded the left vertebral artery and tumor feeding artery using coil embolization. Posterior approach consist of C5-C7 laminectomy, left sided C6 and C7 nerve root sacrifice, posterior disc removal and release of C5-6-7 and posterior reconstruction. Then, position was changed to supine, and the anterior approach was followed as C5-6, C6-7 discectomy, left vertebral artery ligation and cut, longus coli resection and C6 subtotal spondylectomy with en-bloc resection of mass, mesh cage insertion and C5-C7 anterior plate fixation. During operation, frozen biopsy was performed on 8 areas (longus coli, lateral margin, anteroinferior margin, posterior margin, posterosuperior margin, C5 transverse foramen, posteroinferior margin, inferior margin) after wide resection. Tumor free margin was confirmed.
RESULTS: After operation, he complained of tingling sensation of left thumb and forearm medial side, and elbow extensor motor grade was checked to 4/5 postoperatively. In the followed-up radiograph, the tumor was completely removed, and the instability of joint was not seen. As a result of observing follow-up CT at a year after the surgery, recurrence findings have not been shown up to now, and the progression of neurologic symptoms has not been shown either.
CONCLUSION: Based on the Grand Round case and relevant literature, we discuss the case of mesenchymal chondrosarcoma occurring from the C6 cervical spine treated with cervical subtotal en-bloc spondylectomy. Successful en-bloc resection of the tumor was achieved using posterior to anterior approach.

PMID: 26556438 [PubMed - as supplied by publisher]

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Do you hear the noise? The German matrix sentence test with a fixed noise level in subjects with normal hearing and hearing impairment.

Do you hear the noise? The German matrix sentence test with a fixed noise level in subjects with normal hearing and hearing impairment.

Int J Audiol. 2015 Nov 10;:1-9

Authors: Wardenga N, Batsoulis C, Wagener KC, Brand T, Lenarz T, Maier H

Abstract
OBJECTIVE: The aim of this study was to determine the relationship between hearing loss and speech reception threshold (SRT) in a fixed noise condition using the German Oldenburg sentence test (OLSA).
DESIGN: After training with two easily-audible lists of the OLSA, SRTs were determined monaurally with headphones at a fixed noise level of 65 dB SPL using a standard adaptive procedure, converging to 50% speech intelligibility.
STUDY SAMPLE: Data was obtained from 315 ears of 177 subjects with hearing losses ranging from - 5 to 90 dB HL pure-tone average (PTA, 0.5, 1, 2, 3 kHz).
RESULTS: Two domains were identified with a linear dependence of SRT on PTA. The SRT increased with a slope of 0.094 ± 0.006 dB SNR/dB HL (standard deviation (SD) of residuals = 1.17 dB) for PTAs < 47 dB HL and with a slope of 0.811 ± 0.049 dB SNR/dB HL (SD of residuals = 5.54 dB) for higher PTAs.
CONCLUSION: The OLSA can be applied to subjects with a wide range of hearing losses. With 65 dB SPL fixed noise presentation level the SRT is determined by listening in noise for PTAs < ∼47 dB HL, and above it is determined by listening in quiet.

PMID: 26555195 [PubMed - as supplied by publisher]

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Hyperacusis Questionnaire as a Tool for Measuring Hypersensitivity to Sound in a Tinnitus Research Population.

Hyperacusis Questionnaire as a Tool for Measuring Hypersensitivity to Sound in a Tinnitus Research Population.

Biomed Res Int. 2015;2015:290425

Authors: Fackrell K, Fearnley C, Hoare DJ, Sereda M

Abstract
Hypersensitivity to external sounds is often comorbid with tinnitus and may be significant for adherence to certain types of tinnitus management. Therefore, a clear measure of sensitivity to sound is important. The aim of this study was to evaluate the validity and reliability of the Hyperacusis Questionnaire (HQ) for use as a measurement tool using data from a sample of 264 adults who took part in tinnitus research. We evaluated the HQ factor structure, internal consistency, convergent and discriminant validity, and floor and ceiling effects. Internal consistency was high (Cronbach's alpha = 0.88) and moderate correlations were observed between the HQ, uncomfortable loudness levels, and other health questionnaires. Confirmatory factor analysis revealed that the original HQ three-factor solution and a one-factor solution were both a poor fit to the data. Four problematic items were removed and exploratory factor analysis identified a two-factor (attentional and social) solution. The original three-factor structure of the HQ was not confirmed. All fourteen items do not accurately assess hypersensitivity to sound in a tinnitus population. We propose a 10-item (2-factor) version of the HQ, which will need to be confirmed using a new tinnitus and perhaps nontinnitus population.

PMID: 26557658 [PubMed - as supplied by publisher]

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Validation of Screening Questions for Hyperacusis in Chronic Tinnitus.

Validation of Screening Questions for Hyperacusis in Chronic Tinnitus.

Biomed Res Int. 2015;2015:191479

Authors: Schecklmann M, Lehner A, Schlee W, Vielsmeier V, Landgrebe M, Langguth B

Abstract
Background. We investigated the validity of the two hyperacusis items of the TSCHQ (Tinnitus Sample Case History Questionnaire) from the TRI (Tinnitus Research Initiative) database by comparing them with the German hyperacusis questionnaire GÜF. Methods. We investigated the association of the GÜF with the TSCHQ screening questions for both the sum score and the single items with correlation, contrast, principal component, and discriminant analysis in a sample of 161 patients with chronic tinnitus. Results. TSCHQ items and the GÜF total score were significantly associated with a special focus on fear and pain related hyperacusis. Factor analysis of the GÜF revealed the three factors "fear and pain related hyperacusis," "hearing related problems," and "problems in quality of life." A discriminant analysis showed a sensitivity of 64% and a specificity of 71% of the TSCHQ items for the establishment of tinnitus patient subgroups with and without hyperacusis. Discussion. Both hyperacusis TSCHQ items can serve as screening questions with respect to self-reported hyperacusis in chronic tinnitus with a specific focus on fear and pain related hyperacusis. However, the multiple dimensions of hyperacusis should be considered for diagnosis and treatment in both scientific and clinical contexts.

PMID: 26557654 [PubMed - as supplied by publisher]

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Repetitive transcranial magnetic stimulation induces oscillatory power changes in chronic tinnitus.

Repetitive transcranial magnetic stimulation induces oscillatory power changes in chronic tinnitus.

Front Cell Neurosci. 2015;9:421

Authors: Schecklmann M, Lehner A, Gollmitzer J, Schmidt E, Schlee W, Langguth B

Abstract
Chronic tinnitus is associated with neuroplastic changes in auditory and non-auditory cortical areas. About 10 years ago, repetitive transcranial magnetic stimulation (rTMS) of auditory and prefrontal cortex was introduced as potential treatment for tinnitus. The resulting changes in tinnitus loudness are interpreted in the context of rTMS induced activity changes (neuroplasticity). Here, we investigate the effect of single rTMS sessions on oscillatory power to probe the capacity of rTMS to interfere with tinnitus-specific cortical plasticity. We measured 20 patients with bilateral chronic tinnitus and 20 healthy controls comparable for age, sex, handedness, and hearing level with a 63-channel electroencephalography (EEG) system. Educational level, intelligence, depressivity and hyperacusis were controlled for by analysis of covariance. Different rTMS protocols were tested: Left and right temporal and left and right prefrontal cortices were each stimulated with 200 pulses at 1 Hz and with an intensity of 60% stimulator output. Stimulation of central parietal cortex with 6-fold reduced intensity (inverted passive-cooled coil) served as sham condition. Before and after each rTMS protocol 5 min of resting state EEG were recorded. The order of rTMS protocols was randomized over two sessions with 1 week interval in between. Analyses on electrode level showed that people with and without tinnitus differed in their response to left temporal and right frontal stimulation. In tinnitus patients left temporal rTMS decreased frontal theta and delta and increased beta2 power, whereas right frontal rTMS decreased right temporal beta3 and gamma power. No changes or increases were observed in the control group. Only non-systematic changes in tinnitus loudness were induced by single sessions of rTMS. This is the first study to show tinnitus-related alterations of neuroplasticity that were specific to stimulation site and oscillatory frequency. The observed effects can be interpreted within the thalamocortical dysrhythmia model assuming that slow waves represent processes of deafferentiation and that high frequencies might be indicators for tinnitus loudness. Moreover our findings confirm the role of the left temporal and the right frontal areas as relevant hubs in tinnitus related neuronal network. Our results underscore the value of combined TMS-EEG measurements for investigating disease related changes in neuroplasticity.

PMID: 26557055 [PubMed]

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The effect of Transcranial Direct Current Stimulation in addition to Tinnitus Retraining Therapy for treatment of chronic tinnitus patients: a study protocol for a double-blind controlled randomised trial.

The effect of Transcranial Direct Current Stimulation in addition to Tinnitus Retraining Therapy for treatment of chronic tinnitus patients: a study protocol for a double-blind controlled randomised trial.

Trials. 2015;16(1):514

Authors: Rabau S, Van Rompaey V, Van de Heyning P

Abstract
BACKGROUND: Currently, there still is no treatment that eliminates tinnitus in all patients. Recent studies have shown that Tinnitus Retraining Therapy (TRT) significantly improves quality of life for tinnitus patients. Also, several studies have reported that transcranial Direct Current Stimulation (tDCS) has a positive effect on attention, working memory, long-term memory and other cognitive processes. The aim of this randomised placebo-controlled double-blind study is to evaluate the added effect of tDCS to TRT in chronic tinnitus patients. To our knowledge, this is the first study to combine both methods.
METHODS: Patients with chronic, non-pulsatile tinnitus will be randomised in two treatment groups: TRT and real tDCS versus TRT and sham tDCS. Evaluations will take place at baseline before therapy starts, at the end of the TRT and 3 months after therapy starts. The Tinnitus Functional Index will be used as the primary outcome measurement. Secondary outcome measurements will be the Visual Analogue Scale of Loudness, Hospital Anxiety and Depression Scale (HADS), Hyperacusis Questionnaire, psychoacoustic measurements and Event-related potential (ERP).
DISCUSSION: To our knowledge this is the first study to combine TRT and tDCS. The objective is to evaluate whether tDCS can provide faster and/or more relief from the annoyance experienced in chronic tinnitus patients' daily lives. The advantage of the study is that it is double-blind and placebo-controlled.
TRIAL REGISTRATION: The present study protocol was registered on 31 October 2014 at Clinicaltrials.gov: NCT02285803 .

PMID: 26554670 [PubMed - as supplied by publisher]

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Monosialotetrahexosylganglioside Inhibits the Expression of p-CREB and NR2B in the Auditory Cortex in Rats with Salicylate-Induced Tinnitus.

Monosialotetrahexosylganglioside Inhibits the Expression of p-CREB and NR2B in the Auditory Cortex in Rats with Salicylate-Induced Tinnitus.

Clin Lab. 2015;61(9):1113-8

Authors: Song RB, Lou WH

Abstract
BACKGROUND: This study investigated the effects of monosialotetrahexosylganglioside (GM1) on the expression of N-methyl-D-aspartate receptor subunit 2B (NR2B) and phosphorylated (p)-cyclic AMP response element-binding protein (CREB) in the auditory cortex of rats with tinnitus.
METHODS: Tinnitus-like behavior in rats was tested with the gap prepulse inhibition of acoustic startle paradigm. We then investigated the NR2B mRNA and protein and p-CREB protein levels in the auditory cortex of tinnitus rats compared with normal rats.
RESULTS: Rats treated for 4 days with salicylate exhibited tinnitus. NR2B mRNA and protein and p-CREB protein levels were upregulated in these animals, with expression returning to normal levels 14 days after cessation of treatment; baseline levels of NR2B and p-CREB were also restored by GM1 administration.
CONCLUSIONS: These data suggest that chronic salicylate administration induces tinnitus via upregulation of p-CREB and NR2B expression, and that GM1 can potentially be used to treat tinnitus.

PMID: 26554229 [PubMed - in process]

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Classifying eating-related problems among institutionalized people with dementia.

Classifying eating-related problems among institutionalized people with dementia.

Psychiatry Clin Neurosci. 2015 Nov 10;

Authors: Shinagawa S, Honda K, Kashibayashi T, Shigenobu K, Nakayama K, Ikeda M

Abstract
AIM: Various eating-related problems are commonly observed among people with dementia, and these problems place a huge burden on the caregivers. An appropriate classification of these problems is important to understand their underlying mechanisms and to develop a therapeutic approach for managing them. The aim of this study is to develop a possible classification of eating-related problems and to reveal the background factors affecting each of these problems across various conditions causing dementia.
METHODS: The participants were 208 institutionalized patients with a diagnosis of dementia. Care staff were asked to report all kinds of eating-related problems that they observed. After the nurses' responses were analyzed, 24 items relating to eating-related problems were extracted. A factor analysis of these 24 items was conducted, followed by a logistic regression analysis to investigate the independent variables that most affected each of the eating-related factors.
RESULTS: Four factors were obtained. Factor 1 was overeating, factor 2 was swallowing problems, factor 3 was decrease in appetite, and factor 4 was obsession with food. Each factor was associated with different background variables including the Mini-Mental State Examination (MMSE) scores, Clinical Dementia Ratings (CDR), and neuropsychiatric symptoms.
CONCLUSION: This study suggested that eating-related problems are common across conditions causing dementia and should be separately considered in order to understand their underlying mechanisms.

PMID: 26556570 [PubMed - as supplied by publisher]

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