Hearing Health in College Instrumental Musicians and Prevention of Hearing Loss.

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Hearing Health in College Instrumental Musicians and Prevention of Hearing Loss.

Med Probl Perform Art. 2016 Mar;31(1):29-36

Authors: Olson AD, Gooding LF, Shikoh F, Graf J

Abstract
OBJECTIVE: College musicians exhibit greater declines in hearing than the general population and are at particular risk because they rehearse and perform daily in loud environments. Also, they engage in use of personal listening devices which increases the amount of "exposure" time. Despite increased risk, many do not use hearing protection devices (HPD). The purpose of this study was to (1) to identify the present level of education about hearing health, (2) identify the perceived advantages and disadvantages of using HPD, and (3) evaluate results among different musical instrument groups.
METHODS: A mixed-methods group design was used including both quantitative and qualitative instruments. SPSS was used to generate descriptive statistics, and non-parametric statistical analysis was performed on quantitative data. NVivo software was used to evaluate qualitative responses.
RESULTS: Of the 90 college instrumental music students who participated, 12% reported a history of hearing loss, and over one-third reported tinnitus. Seventy-seven percent of participants had never received any training about hearing health and only a small percentage of students used HPD. The most cited reason for lack of protection use was its negative impact on sound quality. However, group differences were noted between brass, woodwind, and percussion musicians in terms of HPD uptake.
CONCLUSION: Improving the type of information disseminated to college musicians may reduce the risk of ear-related deficits. Noise dosage information, HPD information, and prevention education grounded in theories like the Health Belief Model may increase awareness and promote greater use of HPDs in this population.

PMID: 26966962 [PubMed - as supplied by publisher]

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How can the audiogram be more useful?

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How can the audiogram be more useful?

J Otolaryngol Head Neck Surg. 2016;45(1):18

Authors: Harrison RV

Abstract
The Canadian Hearing and Auditory Research Translation (CHART) group is a newly formed taskforce to develop collaborative research initiatives. Initial discussions centered on diagnostic improvements for middle ear disease, auditory neuropathy spectrum disorder, tinnitus and presbycusis. Central to these discussions was the widely held view that the standard audiogram and its interpretation is inadequate to for describing many forms of hearing problems that we now recognize. This letter is designed to create awareness and to seek feedback from hearing healthcare professionals on their experience regarding the adequacy (or otherwise) of the audiogram in its present form.

PMID: 26965445 [PubMed - in process]

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Rapid Automatized Naming in Children with Dyslexia: Is Inhibitory Control Involved?

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Rapid Automatized Naming in Children with Dyslexia: Is Inhibitory Control Involved?

Dyslexia. 2015 Aug;21(3):212-34

Authors: Bexkens A, van den Wildenberg WP, Tijms J

Abstract
Rapid automatized naming (RAN) is widely seen as an important indicator of dyslexia. The nature of the cognitive processes involved in rapid naming is however still a topic of controversy. We hypothesized that in addition to the involvement of phonological processes and processing speed, RAN is a function of inhibition processes, in particular of interference control. A total 86 children with dyslexia and 31 normal readers were recruited. Our results revealed that in addition to phonological processing and processing speed, interference control predicts rapid naming in dyslexia, but in contrast to these other two cognitive processes, inhibition is not significantly associated with their reading and spelling skills. After variance in reading and spelling associated with processing speed, interference control and phonological processing was partialled out, naming speed was no longer consistently associated with the reading and spelling skills of children with dyslexia. Finally, dyslexic children differed from normal readers on naming speed, literacy skills, phonological processing and processing speed, but not on inhibition processes. Both theoretical and clinical interpretations of these results are discussed.

PMID: 25530120 [PubMed - indexed for MEDLINE]

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A Closer Look at Phonology as a Predictor of Spoken Sentence Processing and Word Reading.

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A Closer Look at Phonology as a Predictor of Spoken Sentence Processing and Word Reading.

J Psycholinguist Res. 2015 Aug;44(4):399-415

Authors: Myers S, Robertson EK

Abstract
The goal of this study was to tease apart the roles of phonological awareness (pA) and phonological short-term memory (pSTM) in sentence comprehension, sentence production, and word reading. Children 6- to 10-years of age (N = 377) completed standardized tests of pA ('Elision') and pSTM ('Nonword Repetition') from the Comprehensive Test of Phonological Processing. Concepts and Following Directions (CFD) and Formulated Sentences (FS) were taken from the Clinical Evaluation of Language Fundamentals-Fourth Edition, as measures of sentence comprehension and production, respectively. Children also completed the Word Identification (Word Id) and Word Attack (Word Att) subtests of the Woodcock Reading Mastery Test-Third Edition. Hierarchical multiple regression analyses controlling for age and nonverbal IQ revealed that Elision was the only significant predictor of CFD and FS. While Elision was the strongest predictor of Word Id and Word Att, Nonword Repetition accounted for additional variance in both reading measures. These results emphasize the usefulness of breaking down phonological processing into multiple components and they also have implications language and reading disordered populations.

PMID: 24627225 [PubMed - indexed for MEDLINE]

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Transtympanic balloon dilatation of the eustachian tube: systematic review.

Transtympanic balloon dilatation of the eustachian tube: systematic review.

J Laryngol Otol. 2016 Mar 11;:1-6

Authors: Jufas N, Patel N

Abstract
OBJECTIVE: To investigate the evidence for balloon dilatation of the eustachian tube using a transtympanic approach.
METHODS: A systematic search of several databases was conducted (using the search terms 'dilation' or 'dilatation', and 'balloon' and 'eustachian tube'). Only studies that used a transtympanic approach for the procedure were included. These studies were then assessed for risk of bias.
RESULTS: Three studies were included. Each of these studies was a limited case series, with two performed on human subjects and one on human cadavers. Results of safety and efficacy are conflicting. There is a high risk of bias overall.
CONCLUSION: At present, there is a very narrow evidence base for transtympanic balloon dilatation of the eustachian tube. There are a number of advantages and disadvantages of the technique. Previously identified and theoretical safety concerns will need to be addressed thoroughly in future studies prior to wider clinical use.

PMID: 26965576 [PubMed - as supplied by publisher]

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Snare technique for the remodeling of the redundant arachnoid pouch to prevent cerebrospinal fluid rhinorrhea and hematoma collection during transsphenoidal surgery for suprasellar-extended pituitary tumors.

Snare technique for the remodeling of the redundant arachnoid pouch to prevent cerebrospinal fluid rhinorrhea and hematoma collection during transsphenoidal surgery for suprasellar-extended pituitary tumors.

J Neurosurg. 2016 Mar 11;:1-8

Authors: Moon JH, Kim EH, Kim SH

Abstract
OBJECTIVE Transsphenoidal surgery (TSS) is considered a most effective treatment for pituitary tumors with huge suprasellar extension. However, the chance of developing CSF leakage is relatively high, because tearing of the arachnoid membrane is common and there could be multiple tear points during the dissection of suprasellar tumors from the overlying arachnoid membrane. If there are multiple leaking points in the arachnoid membrane packing methods such as using fat or multilayered fascia graft may not be sufficient to seal off the leaking points. Moreover, the packing material may not provide sufficient tamponade to stop bleeding, and thus generates postoperative hematoma formation in the tumor resection cavity. To prevent these complications, the authors have developed a new technique for remodeling the redundant arachnoid pouch (the so-called snare technique) to reconstruct the diaphragm, seal off the CSF leak points completely, and reduce the dead space in the tumor resection cavity. METHODS In 9 patients with huge macroadenomas (> 2.5 cm in diameter) with suprasellar extension, the snare technique was used to remodel the arachnoid pouch after tumor removal via standard TSS between July 2009 and August 2014. Complications were investigated, including postoperative CSF rhinorrhea, postoperative hematoma collection, and visual compromise. RESULTS During the resection of the tumor, CSF leakage was encountered in 8 cases, all of which were sealed off using the snare technique. In 1 case without intraoperative CSF leakage, the snare technique was also applied after intentional puncturing of the arachnoid membrane to reduce the volume and tension of the arachnoid pouch. None of the 9 patients experienced postoperative CSF rhinorrhea. Lumbar CSF drainage was not required in any case. Magnetic resonance imaging studies performed 24 hours after surgery revealed a remarkable reduction in the height of the diaphragm in all cases. Visual deficits improved in all patients immediately after surgery. CONCLUSIONS Remodeling of the arachnoid pouch using the snare technique is simple and effective for completely sealing off the CSF leak point and preventing hematoma collection in the tumor resection cavity after TSS for huge pituitary tumors with suprasellar extension.

PMID: 26967785 [PubMed - as supplied by publisher]

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Exclusive endoscopic transcanal transpromontorial approach: a new perspective for internal auditory canal vestibular schwannoma treatment.

Exclusive endoscopic transcanal transpromontorial approach: a new perspective for internal auditory canal vestibular schwannoma treatment.

J Neurosurg. 2016 Mar 11;:1-8

Authors: Marchioni D, Alicandri-Ciufelli M, Rubini A, Masotto B, Pavesi G, Presutti L

Abstract
OBJECTIVE The aim of this study was to describe the first case series in which an exclusive endoscopic transcanal transpromontorial approach (EETTA) was used to treat small vestibular schwannomas (VSs) and meningiomas of the internal auditory canal (IAC). METHODS The authors performed a retrospective review of patients who had undergone surgery using an EETTA to the IAC at 2 university tertiary care referral centers during the period from November 2011 to January 2015. RESULTS Ten patients underwent surgery via an EETTA for the treatment of VS in the IAC at the University Hospital of Modena or the University Hospital of Verona. The patients had Koos Grade I or II tumors and American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Class D hearing status preoperatively. Gross-total resection was achieved in all patients. No major complications such as cerebrospinal fluid leakage or hemorrhage were reported. In 7 of 10 (70%) patients, facial nerve function was normal immediately after surgery (Rough Grading System [RGS] Grade I). Two patients presented with a transitory facial palsy immediately after surgery (RGS Grade II-III) but experienced complete recovery during the follow-up period. The mean follow-up was 10 months. CONCLUSIONS The EETTA proved to be successful for the removal of VS or meningioma involving the cochlea, fundus, and IAC, with possible lower complication rates and less invasive procedures than those for traditional microscopic approaches. The potential for the extensive and routine use of this approach in lateral and posterior skull base surgery will depend on the development of technology and surgical refinements and on the diffusion of skull base endoscopic skills among the otolaryngological and neurosurgical communities.

PMID: 26967786 [PubMed - as supplied by publisher]

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Treatment of traumatic dislocation of the mandibular condyle into the cranial fossa: development of a probable treatment algorithm.

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Treatment of traumatic dislocation of the mandibular condyle into the cranial fossa: development of a probable treatment algorithm.

Int J Oral Maxillofac Surg. 2015 Jul;44(7):864-70

Authors: He Y, Zhang Y, Li ZL, An JG, Yi ZQ, Bao SD

Abstract
This study summarizes our experience of treating three rare cases of traumatic superior dislocation of the mandibular condyle into the cranial fossa and provides a potential treatment algorithm. Between the years 2002 and 2012, three patients with traumatic superior dislocation of the mandibular condyle into the cranial fossa were admitted to our department. After evaluating the interval from injury to treatment, the associated facial injuries including neurological complications, and the computed tomography imaging findings, an individualized treatment plan was developed for each patient. One patient underwent closed reduction under general anaesthesia. Two patients underwent open reduction with craniotomy and glenoid fossa reconstruction. All three patients were followed up for 1 year. Mouth opening and occlusal function recovered well, but all patients had mandibular deviation during mouth opening. Closed reduction under general anaesthesia, open surgical reduction with craniotomy, and mandibular condylotomy are the three main treatment methods for traumatic superior dislocation of the mandibular condyle into the cranial fossa. The treatment method should be selected on the basis of the interval from injury to treatment, associated facial injuries including neurological complications, and computed tomography imaging findings.

PMID: 25670388 [PubMed - indexed for MEDLINE]

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Silent sinus syndrome an acquired condition and the essential role of otorhinolaryngologist consultation: a retrospective study.

Silent sinus syndrome an acquired condition and the essential role of otorhinolaryngologist consultation: a retrospective study.

Eur Arch Otorhinolaryngol. 2016 Mar 10;

Authors: Martínez-Capoccioni G, Varela-Martínez E, Martín-Martín C

Abstract
The silent sinus syndrome (SSS) is a rare clinical entity characterized by painless spontaneous enophthalmos, hypoglobus, and facial deformities secondary to chronic maxillary sinus atelectasis. The aim of this study was to present an SSS diagnostic feature and evaluate the relationship between nasal septum deviation and maxillary sinus volume. A retrospective chart review of the clinical characteristics of 20 patients diagnosed with SSS between January 2013 and July 2014 were analyzed by the Department of Otorhinolaryngology of University Hospital Complex of Santiago de Compostela. 14 patients were females and six males. The mean age was 43 years (range 28-67 years). The right maxillary sinus was involved in 12 patients and the left maxillary sinus in eight patients. There was no statistical difference between gender and the presence of SSS. Maxillary sinus sizes were significantly smaller on the same side as the deviation (p < 0.01). 14 patients were treated with functional endoscopic sinus surgery (FESS) with maxillary antrostomy. We concluded that patients with SSS usually present with facial asymmetry, and the best approach to document and show all facial asymmetries for these patients are the frontal and craneo-caudal photographs. The present study demonstrates that, in adult patients, SSS generally presents a septal deviation to the affected maxillary sinus. We recommend performing a paranasal sinus CT scan when the patient has a deviated nasal septum, retraction of the malar eminence (evidenced from the viewpoint cranio-caudal facial) and hypoglobus. FESS performing postero-anterior uncinectomy and enlargement of the maxillary ostium is recommended to restore sinus pressure and prevent progression of the enophthalmos, hypoglobus and facial deformities.

PMID: 26965897 [PubMed - as supplied by publisher]

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The experience of gasless endoscopic-assisted thyroidectomy via the anterior chest approach for Graves' disease.

The experience of gasless endoscopic-assisted thyroidectomy via the anterior chest approach for Graves' disease.

Eur Arch Otorhinolaryngol. 2016 Mar 10;

Authors: Hong Y, Yu ST, Cai Q, Liang FY, Han P, Huang XM

Abstract
The aim of this study was to evaluate the safety, feasibility, effectiveness, and cosmesis of a gasless endoscopic-assisted thyroidectomy via the anterior chest in patients with Graves' disease. We retrospectively reviewed 38 patients with Graves' disease treated with thyroidectomy from November 2007 to June 2015. We analyzed clinical characteristics of patients, type of operation, operative indications, operative duration, length of postoperative hospital stay, and postoperative complications. The thyroidectomies were classified as total thyroidectomy (n = 12) or near-total thyroidectomy with a remnant of <1 g (n = 26). Surgical indications were recurrence after antithyroid drugs (ATDs) and unwillingness to undergo radioiodine therapy (n = 27), local compressive symptoms (n = 2), adverse drug reactions to ATDs (n = 5), and patient's preference (n = 4). Mean resection weight was 71.7 ± 16.2 g (range 44-109 g), mean operative duration 87.7 ± 17.3 min (range 66-136 min), intraoperative blood loss 70.6 ± 11.3 mL (range 43-92 mL), and drainage was 42.0 ± 8.5 mL (range 20-62 mL). Temporary postoperative recurrent laryngeal nerve palsy and temporary hypoparathyroidism occurred in 3 cases (7.89 %) each. Mean hospital stay was 2.5 ± 0.3 days (range 2-4 days). There was no recurrence of hyperthyroidism over the follow-up period of for 68.1 ± 5.6 months (range 6-89 months). All patients were satisfied with their cosmetic results. Gasless endoscopic-assisted thyroidectomy via the anterior chest approach for Graves' disease is a safe, feasible, and effective and provides an excellent cosmetic outcome procedure. It is a valid option in appropriately selected patients.

PMID: 26965896 [PubMed - as supplied by publisher]

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Oropharyngeal dysphagia in older persons - from pathophysiology to adequate intervention: a review and summary of an international expert meeting.

Oropharyngeal dysphagia in older persons - from pathophysiology to adequate intervention: a review and summary of an international expert meeting.

Clin Interv Aging. 2016;11:189-208

Authors: Wirth R, Dziewas R, Beck AM, Clavé P, Hamdy S, Heppner HJ, Langmore S, Leischker AH, Martino R, Pluschinski P, Rösler A, Shaker R, Warnecke T, Sieber CC, Volkert D

Abstract
Oropharyngeal dysphagia (OD) is a highly prevalent and growing condition in the older population. Although OD may cause very severe complications, it is often not detected, explored, and treated. Older patients are frequently unaware of their swallowing dysfunction which is one of the reasons why the consequences of OD, ie, aspiration, dehydration, and malnutrition, are regularly not attributed to dysphagia. Older patients are particularly vulnerable to dysphagia because multiple age-related changes increase the risk of dysphagia. Physicians in charge of older patients should be aware that malnutrition, dehydration, and pneumonia are frequently caused by (unrecognized) dysphagia. The diagnosis is particularly difficult in the case of silent aspiration. In addition to numerous screening tools, videofluoroscopy was the traditional gold standard of diagnosing OD. Recently, the fiberoptic endoscopic evaluation of swallowing is increasingly utilized because it has several advantages. Besides making a diagnosis, fiberoptic endoscopic evaluation of swallowing is applied to evaluate the effectiveness of therapeutic maneuvers and texture modification of food and liquids. In addition to swallowing training and nutritional interventions, newer rehabilitation approaches of stimulation techniques are showing promise and may significantly impact future treatment strategies.

PMID: 26966356 [PubMed - in process]

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[In Process Citation].

[In Process Citation].

HNO. 2015 Dec;63(12):880-1

Authors: Dietz A, Lordick F

PMID: 26966745 [PubMed - in process]

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The Pathogenesis and Management of Achalasia: Current Status and Future Directions.

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The Pathogenesis and Management of Achalasia: Current Status and Future Directions.

Gut Liver. 2015 Jul;9(4):449-63

Authors: Ates F, Vaezi MF

Abstract
Achalasia is an esophageal motility disorder that is commonly misdiagnosed initially as gastroesophageal reflux disease. Patients with achalasia often complain of dysphagia with solids and liquids but may focus on regurgitation as the primary symptom, leading to initial misdiagnosis. Diagnostic tests for achalasia include esophageal motility testing, esophagogastroduodenoscopy and barium swallow. These tests play a complimentary role in establishing the diagnosis of suspected achalasia. High-resolution manometry has now identified three subtypes of achalasia, with therapeutic implications. Pneumatic dilation and surgical myotomy are the only definitive treatment options for patients with achalasia who can undergo surgery. Botulinum toxin injection into the lower esophageal sphincter should be reserved for those who cannot undergo definitive therapy. Close follow-up is paramount because many patients will have a recurrence of symptoms and require repeat treatment.

PMID: 26087861 [PubMed - indexed for MEDLINE]

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Using the Real-Ear-to-Coupler Difference within the American Academy of Audiology Pediatric Amplification Guideline: Protocols for Applying and Predicting Earmold RECDs.

Using the Real-Ear-to-Coupler Difference within the American Academy of Audiology Pediatric Amplification Guideline: Protocols for Applying and Predicting Earmold RECDs.

J Am Acad Audiol. 2016 Mar;27(3):264-275

Authors: Moodie S, Pietrobon J, Rall E, Lindley G, Eiten L, Gordey D, Davidson L, Moodie KS, Bagatto M, Haluschak MM, Folkeard P, Scollie S

Abstract
BACKGROUND: Real-ear-to-coupler difference (RECD) measurements are used for the purposes of estimating degree and configuration of hearing loss (in dB SPL ear canal) and predicting hearing aid output from coupler-based measures. Accurate measurements of hearing threshold, derivation of hearing aid fitting targets, and predictions of hearing aid output in the ear canal assume consistent matching of RECD coupling procedure (i.e., foam tip or earmold) with that used during assessment and in verification of the hearing aid fitting. When there is a mismatch between these coupling procedures, errors are introduced.
PURPOSE: The goal of this study was to quantify the systematic difference in measured RECD values obtained when using a foam tip versus an earmold with various tube lengths. Assuming that systematic errors exist, the second goal was to investigate the use of a foam tip to earmold correction for the purposes of improving fitting accuracy when mismatched RECD coupling conditions occur (e.g., foam tip at assessment, earmold at verification).
STUDY SAMPLE: Eighteen adults and 17 children (age range: 3-127 mo) participated in this study.
DATA COLLECTION AND ANALYSIS: Data were obtained using simulated ears of various volumes and earmold tubing lengths and from patients using their own earmolds. Derived RECD values based on simulated ear measurements were compared with RECD values obtained for adult and pediatric ears for foam tip and earmold coupling.
RESULTS: Results indicate that differences between foam tip and earmold RECDs are consistent across test ears for adults and children which support the development of a correction between foam tip and earmold couplings for RECDs that can be applied across individuals.
CONCLUSIONS: The foam tip to earmold correction values developed in this study can be used to provide improved estimations of earmold RECDs. This may support better accuracy in acoustic transforms related to transforming thresholds and/or hearing aid coupler responses to ear canal sound pressure level for the purposes of fitting behind-the-ear hearing aids.

PMID: 26967366 [PubMed - as supplied by publisher]

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Stability of Audiometric Thresholds for Children with Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Implications for Safety.

Stability of Audiometric Thresholds for Children with Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Implications for Safety.

J Am Acad Audiol. 2016 Mar;27(3):252-263

Authors: McCreery R, Walker E, Spratford M, Kirby B, Oleson J, Brennan M

Abstract
BACKGROUND: Children who wear hearing aids may be at risk for further damage to their hearing from overamplification. Previous research on amplification-induced hearing loss has included children using linear amplification or simulations of predicted threshold shifts based on nonlinear amplification formulae. A relationship between threshold shifts and the use of nonlinear hearing aids in children has not been empirically verified.
PURPOSE: The purpose of the study was to compare predicted threshold shifts from amplification to longitudinal behavioral thresholds in a large group of children who wear hearing aids to determine the likelihood of amplification-induced hearing loss.
RESEARCH DESIGN: An accelerated longitudinal design was used to collect behavioral threshold and amplification data prospectively.
STUDY SAMPLE: Two-hundred and thirteen children with mild-to-profound hearing loss who wore hearing aids were included in the analysis.
DATA COLLECTION AND ANALYSIS: Behavioral audiometric thresholds, hearing aid outputs, and hearing aid use data were collected for each participant across four study visits. Individual ear- and frequency-specific safety limits were derived based on the Modified Power Law to determine the level at which increased amplification could result in permanent threshold shifts. Behavioral thresholds were used to estimate which children would be above the safety limit at 500, 1000, 2000, and 4000 Hz using thresholds in dB HL and then in dB SPL in the ear canal. Changes in thresholds across visits were compared for children who were above and below the safety limits.
RESULTS: Behavioral thresholds decreased across study visits for all children, regardless of whether their amplification was above the safety limits. The magnitude of threshold change across time corresponded with changes in ear canal acoustics as measured by the real-ear-to-coupler difference.
CONCLUSIONS: Predictions of threshold changes due to amplification for children with hearing loss did not correspond with observed changes in threshold over across 2-4 yr of monitoring amplification. Use of dB HL thresholds and predictions of hearing aid output to set the safety limit resulted in a larger number of children being classified as above the safety limit than when safety limits were based on dB SPL thresholds and measured hearing aid output. Children above the safety limit for the dB SPL criteria tended to be fit above prescriptive targets. Additional research should seek to explain how the Modified Power Law predictions of threshold shift overestimated risk for children who wear hearing aids.

PMID: 26967365 [PubMed - as supplied by publisher]

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Fitting Noise Management Signal Processing Applying the American Academy of Audiology Pediatric Amplification Guideline: Verification Protocols.

Fitting Noise Management Signal Processing Applying the American Academy of Audiology Pediatric Amplification Guideline: Verification Protocols.

J Am Acad Audiol. 2016 Mar;27(3):237-251

Authors: Scollie S, Levy C, Pourmand N, Abbasalipour P, Bagatto M, Richert F, Moodie S, Crukley J, Parsa V

Abstract
BACKGROUND: Although guidelines for fitting hearing aids for children are well developed and have strong basis in evidence, specific protocols for fitting and verifying some technologies are not always available. One such technology is noise management in children's hearing aids. Children are frequently in high-level and/or noisy environments, and many options for noise management exist in modern hearing aids. Verification protocols are needed to define specific test signals and levels for use in clinical practice.
PURPOSE: This work aims to (1) describe the variation in different brands of noise reduction processors in hearing aids and the verification of these processors and (2) determine whether these differences are perceived by 13 children who have hearing loss. Finally, we aimed to develop a verification protocol for use in pediatric clinical practice.
STUDY SAMPLE: A set of hearing aids was tested using both clinically available test systems and a reference system, so that the impacts of noise reduction signal processing in hearing aids could be characterized for speech in a variety of background noises. A second set of hearing aids was tested across a range of audiograms and across two clinical verification systems to characterize the variance in clinical verification measurements. Finally, a set of hearing aid recordings that varied by type of noise reduction was rated for sound quality by children with hearing loss.
RESULTS: Significant variation across makes and models of hearing aids was observed in both the speed of noise reduction activation and the magnitude of noise reduction. Reference measures indicate that noise-only testing may overestimate noise reduction magnitude compared to speech-in-noise testing. Variation across clinical test signals was also observed, indicating that some test signals may be more successful than others for characterization of hearing aid noise reduction. Children provided different sound quality ratings across hearing aids, and for one hearing aid rated the sound quality as higher with the noise reduction system activated.
CONCLUSIONS: Implications for clinical verification systems may be that greater standardization and the use of speech-in-noise test signals may improve the quality and consistency of noise reduction verification cross clinics. A suggested clinical protocol for verification of noise management in children's hearing aids is suggested.

PMID: 26967364 [PubMed - as supplied by publisher]

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Fitting Frequency-Lowering Signal Processing Applying the American Academy of Audiology Pediatric Amplification Guideline: Updates and Protocols.

Fitting Frequency-Lowering Signal Processing Applying the American Academy of Audiology Pediatric Amplification Guideline: Updates and Protocols.

J Am Acad Audiol. 2016 Mar;27(3):219-236

Authors: Scollie S, Glista D, Seto J, Dunn A, Schuett B, Hawkins M, Pourmand N, Parsa V

Abstract
BACKGROUND: Although guidelines for fitting hearing aids for children are well developed and have strong basis in evidence, specific protocols for fitting and verifying technologies can supplement such guidelines. One such technology is frequency-lowering signal processing. Children require access to a broad bandwidth of speech to detect and use all phonemes including female /s/. When access through conventional amplification is not possible, the use of frequency-lowering signal processing may be considered as a means to overcome limitations. Fitting and verification protocols are needed to better define candidacy determination and options for assessing and fine tuning frequency-lowering signal processing for individuals.
PURPOSE: This work aims to (1) describe a set of calibrated phonemes that can be used to characterize the variation in different brands of frequency-lowering processors in hearing aids and the verification with these signals and (2) determine whether verification with these signal are predictive of perceptual changes associated with changes in the strength of frequency-lowering signal processing. Finally, we aimed to develop a fitting protocol for use in pediatric clinical practice.
STUDY SAMPLE: Study 1 used a sample of six hearing aids spanning four types of frequency lowering algorithms for an electroacoustic evaluation. Study 2 included 21 adults who had hearing loss (mean age 66 yr).
DATA COLLECTION AND ANALYSIS: Simulated fricatives were designed to mimic the level and frequency shape of female fricatives extracted from two sources of speech. These signals were used to verify the frequency-lowering effects of four distinct types of frequency-lowering signal processors available in commercial hearing aids, and verification measures were compared to extracted fricatives made in a reference system. In a second study, the simulated fricatives were used within a probe microphone measurement system to verify a wide range of frequency compression settings in a commercial hearing aid, and 27 adult listeners were tested at each setting. The relation between the hearing aid verification measures and the listener's ability to detect and discriminate between fricatives was examined.
RESULTS: Verification measures made with the simulated fricatives agreed to within 4 dB, on average, and tended to mimic the frequency response shape of fricatives presented in a running speech context. Some processors showed a greater aided response level for fricatives in running speech than fricatives presented in isolation. Results with listeners indicated that verified settings that provided a positive sensation level of /s/ and that maximized the frequency difference between /s/ and /∫/ tended to have the best performance.
CONCLUSIONS: Frequency-lowering signal processors have measureable effects on the high-frequency fricative content of speech, particularly female /s/. It is possible to measure these effects either with a simple strategy that presents an isolated simulated fricative and measures the aided frequency response or with a more complex system that extracts fricatives from running speech. For some processors, a more accurate result may be achieved with a running speech system. In listeners, the aided frequency location and sensation level of fricatives may be helpful in predicting whether a specific hearing aid fitting, with or without frequency-lowering, will support access to the fricatives of speech.

PMID: 26967363 [PubMed - as supplied by publisher]

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Children with Auditory Neuropathy Spectrum Disorder Fitted with Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Current Practice and Outcomes.

Children with Auditory Neuropathy Spectrum Disorder Fitted with Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Current Practice and Outcomes.

J Am Acad Audiol. 2016 Mar;27(3):204-218

Authors: Walker E, McCreery R, Spratford M, Roush P

Abstract
BACKGROUND: Up to 15% of children with permanent hearing loss (HL) have auditory neuropathy spectrum disorder (ANSD), which involves normal outer hair cell function and disordered afferent neural activity in the auditory nerve or brainstem. Given the varying presentations of ANSD in children, there is a need for more evidence-based research on appropriate clinical interventions for this population.
PURPOSE: This study compared the speech production, speech perception, and language outcomes of children with ANSD, who are hard of hearing, to children with similar degrees of mild-to-moderately severe sensorineural hearing loss (SNHL), all of whom were fitted with bilateral hearing aids (HAs) based on the American Academy of Audiology pediatric amplification guidelines.
RESEARCH DESIGN: Speech perception and communication outcomes data were gathered in a prospective accelerated longitudinal design, with entry into the study between six mo and seven yr of age. Three sites were involved in participant recruitment: Boys Town National Research Hospital, the University of North Carolina at Chapel Hill, and the University of Iowa.
STUDY SAMPLE: The sample consisted of 12 children with ANSD and 22 children with SNHL. The groups were matched based on better-ear pure-tone average, better-ear aided speech intelligibility index, gender, maternal education level, and newborn hearing screening result (i.e., pass or refer).
DATA COLLECTION AND ANALYSIS: Children and their families participated in an initial baseline visit, followed by visits twice a year for children <2 yr of age and once a yr for children >2 yr of age. Paired-sample t-tests were used to compare children with ANSD to children with SNHL.
RESULTS: Paired t-tests indicated no significant differences between the ANSD and SNHL groups on language and articulation measures. Children with ANSD displayed functional speech perception skills in quiet. Although the number of participants was too small to conduct statistical analyses for speech perception testing, there appeared to be a trend in which the ANSD group performed more poorly in background noise with HAs, compared to the SNHL group.
CONCLUSIONS: The American Academy of Audiology Pediatric Amplification Guidelines recommend that children with ANSD receive an HA trial if their behavioral thresholds are sufficiently high enough to impede speech perception at conversational levels. For children with ANSD in the mild-to-severe HL range, the current results support this recommendation, as children with ANSD can achieve functional outcomes similar to peers with SNHL.

PMID: 26967362 [PubMed - as supplied by publisher]

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Prescribing and Verifying Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Protocols and Outcomes from the Ontario Infant Hearing Program.

Prescribing and Verifying Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Protocols and Outcomes from the Ontario Infant Hearing Program.

J Am Acad Audiol. 2016 Mar;27(3):188-203

Authors: Bagatto M, Moodie S, Brown C, Malandrino A, Richert F, Clench D, Scollie S

Abstract
BACKGROUND: Guidelines and protocols for pediatric hearing aid fitting are necessary to meet the goals of Early Hearing Detection and Intervention (EHDI) programs. The American Academy of Audiology published an update to their Pediatric Amplification Guideline in 2013. Ontario's Infant Hearing Program (IHP) offers specific protocols that aim to fulfill recommended guidelines. It has recently been updated to align with the American Academy of Audiology Guideline and other evidence.
PURPOSE: A summary of the updates to the Ontario IHP's Amplification Protocol is described. In addition, data illustrating hearing-related outcomes of the program are offered.
RESEARCH DESIGN: The updated Ontario protocol is based on evidence, wherever possible. Where research is not yet available, clinical decision support has been described in a systematic way. Outcomes of the Ontario IHP were obtained through a longitudinal clinical observation study.
STUDY SAMPLE: One hundred and fifteen children with hearing loss, who wore hearing aids, were included in the outcome analyses (mean = 28.6 mo; range = 1.3-115.3 mo). Hearing losses ranged from mild to profound, unilateral or bilateral sensorineural (pure-tone average = 52.3 dB HL). They were recruited from four IHP clinics within Ontario. Children with complexities in addition to hearing loss were included.
INTERVENTION: The children were fitted with hearing aids following Ontario's Amplification Protocol.
DATA COLLECTION AND ANALYSES: During routine clinical appointments, IHP Audiologists administered questionnaires to the parents of their pediatric patients using a systematic outcome measurement protocol (University of Western Ontario Pediatric Audiological Monitoring Protocol). Hearing aid fitting details (e.g., speech intelligibility index) were also gathered to describe the quality of the hearing aid fittings in relation to the functional outcomes. Regression analyses were conducted to characterize scores on the questionnaires and the impact of important variables. Children with complexities were analyzed separately from those who were typically developing.
RESULTS: Important updates to Ontario's Amplification Protocol offer new details about candidacy considerations as well as technical updates. Outcomes from the IHP reveal protocol elements can be executed clinically and when they are, typically developing children who wear hearing aids are meeting auditory development and performance milestones.
CONCLUSIONS: Updates to Ontario's Amplification Protocol are necessary to support the evolution of EHDI programs and the evidence which sustains them. With advances in technology and additional research, pediatric hearing aid fitting will continue to progress and support systematic measurement of outcomes for children who wear hearing aids. The application of state-of-the-art hearing aid fitting practices to the pediatric population within EHDI programs supports good outcomes for infants and children with hearing loss.

PMID: 26967361 [PubMed - as supplied by publisher]

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Pediatric Audiology in North America: Current Clinical Practice and How It Relates to the American Academy of Audiology Pediatric Amplification Guideline.

Pediatric Audiology in North America: Current Clinical Practice and How It Relates to the American Academy of Audiology Pediatric Amplification Guideline.

J Am Acad Audiol. 2016 Mar;27(3):166-187

Authors: Moodie S, Rall E, Eiten L, Lindley G, Gordey D, Davidson L, Bagatto M, Scollie S

Abstract
BACKGROUND: There is broad consensus that screening and diagnosis of permanent hearing loss in children must be embedded within a comprehensive, evidence-based, family-centered intervention program. Clinical practice guidelines (CPGs) for pediatric hearing assessment and hearing aid verification aim to reduce variability in practice and increase the use of effective evidence-based diagnostic and treatment options so that optimal outcomes may be achieved. To be of value, guidelines must be translated and implemented into practice and ongoing monitoring of their use in practice should occur.
PURPOSE: This paper provides the results of two studies that aim to examine current pediatric audiology and amplification practice in North America.
RESEARCH DESIGN: A concurrent embedded mixed methods design was used.
STUDY SAMPLE: An electronic survey was distributed to North American audiologists who delivered pediatric audiology services with 350 audiologists participating in study 1 and 63 audiologists participating in study 2.
DATA COLLECTION AND ANALYSIS: A quantitative approach was the predominant method of data collection. Respondents were prompted to provide additional qualitative text and detail regarding their quantitative response choice. This qualitative text was used during the analysis phase and combined with quantitative results to assist understanding of respondents' knowledge, skills, and barriers/facilitators to implement best practice in pediatric amplification.
RESULTS: Approximately 70% of audiologists reported using best-practice protocols for pediatric hearing aid fitting. Despite widespread knowledge and increased use of CPGs over the last 18 yrs, results of these studies show that variation in practice patterns continue to exist. Several examples of implementation challenges are discussed with recommendations provided.
CONCLUSIONS: In order for audiologists working with children who are deaf or hard of hearing and their families to achieve the principles of family-centered early intervention, practice guidelines must continue to be developed, disseminated, and translated as they have a positive impact on the services provided. Researchers and clinical audiologists who deliver services must continue to collaborate to understand the "how" and "why" of implementing guidelines into practice and to identify the barriers/facilitators encountered in trying to do so.

PMID: 26967360 [PubMed - as supplied by publisher]

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Providing Hearing Aids to Infants and Young Children.

Providing Hearing Aids to Infants and Young Children.

J Am Acad Audiol. 2016 Mar;27(3):164-165

Authors: Bagatto M

PMID: 26967359 [PubMed - as supplied by publisher]

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Assessment of Vibratory Characteristics in Children Following Airway Reconstruction Using Flexible and Rigid Endoscopy and Stroboscopy.

Related Articles

Assessment of Vibratory Characteristics in Children Following Airway Reconstruction Using Flexible and Rigid Endoscopy and Stroboscopy.

JAMA Otolaryngol Head Neck Surg. 2015 Oct;141(10):882-7

Authors: Zacharias SR, Weinrich B, Brehm SB, Kelchner L, Deliyski D, Tabangin M, de Alarcon A

Abstract
IMPORTANCE: Up to half of children have substantial dysphonia after airway reconstruction. Visual assessment of vocal function is valuable. Feasibility of flexible and rigid endoscopy has been reported; however, the clinical utility of stroboscopy has not been examined. Rating of vibratory characteristics, such as mucosal wave and amplitude of vibration, is essential for the development of interventions to improve voice outcomes.
OBJECTIVE: To examine (1) clinicians' ratings of anatomical and physiological features in children following airway reconstruction on initial voice evaluation using videolaryngostroboscopy and (2) the relationship of age to the type of endoscopy used.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective medical record review of 32 patients aged 3 to 21 years evaluated for post–airway reconstruction dysphonia between July 2011 and July 2012 at a quaternary care children's hospital.
INTERVENTIONS: Clinical voice evaluation protocol including rigid and/or flexible endoscopy with stroboscopy.
MAIN OUTCOMES AND MEASURES: Demographic and voice quality characteristics were collected. The ability to complete endoscopy and ratings of anatomical and/or physiological features were assessed by a consensus of 4 clinicians. A t test was used to determine whether age was a significant factor in successful completion of videolaryngostroboscopy.
RESULTS: Of 31 children who underwent flexible videolaryngostroboscopy, 22 (71%) examinations were completed with a distal chip endoscope and 9 (29%) with a fiberoptic. Significant differences were found in age between children who completed the distal chip vs. fiberoptic examination (mean [SD], 7.3 [2.7] vs. 5.5 [6.2] years; P = .05). Rigid endoscopy was attempted for 14 (44%) of 32 patients; 9 examinations (64%) were successful. Significant differences were found in age between patients for whom a rigid endoscopy could be successfully completed vs. those for whom it was not (mean [SD], 12.9 [3.4] vs. 6.2 [2.1] years; P < .001). Eighteen (56%) were glottic phonators, 8 (25%) supraglottic, and 6 (19%) aphonic. Vibratory characteristics were visible in 10 of 37 examinations (27%); 6 (16%) had ratable characteristics.
CONCLUSIONS AND RELEVANCE: Endoscopy can be successfully completed in most children who have undergone airway reconstruction, most often using a distal chip endoscope.We found that vibratory characteristics were often not assessed adequately using videolaryngostroboscopy. Further work identifying imaging modalities that better display vibratory characteristics, such as high-speed videoendoscopy, may provide new insight into vocal function and lead to a more thorough evaluation.

PMID: 26402578 [PubMed - indexed for MEDLINE]

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MULTIFOCAL CHOROIDITIS IN DISSEMINATED SPOROTRICHOSIS IN PATIENTS WITH HIV/AIDS.

MULTIFOCAL CHOROIDITIS IN DISSEMINATED SPOROTRICHOSIS IN PATIENTS WITH HIV/AIDS.

Retin Cases Brief Rep. 2016 Mar 10;

Authors: Biancardi AL, Freitas DF, Valviesse VR, Andrade HB, de Oliveira MM, do Valle AC, Zancope-Oliveira RM, Galhardo MC, Curi AL

Abstract
PURPOSE: In this article, the authors describe multifocal choroiditis related to disseminated sporotrichosis in patients with HIV/AIDS.
METHODS: We conducted a retrospective observational study of three patients infected with HIV who presented with disseminated sporotrichosis characterized by cutaneous lesions, multifocal choroiditis, and other manifestations, including osteomyelitis and involvement of the bone marrow, larynx, pharynx, and nasal and oral mucosa.
RESULTS: Five eyes of three patients with HIV/AIDS showed multifocal choroiditis related to disseminated sporotrichosis. The CD4 counts ranged from 25 to 53 mm. All patients were asymptomatic visually. The ocular disease was bilateral in two patients. The lesion size ranged from 1/3 to 2 disc diameters. None of the patients had vitritis. Of the 12 lesions, 9 were localized in the posterior pole (Zone 1) and 3 were localized in the mild periphery (Zone 2).
CONCLUSION: Multifocal choroiditis due to disseminated sporotrichosis can occur in profoundly immunosuppressed patients with HIV/AIDS.

PMID: 26967963 [PubMed - as supplied by publisher]

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Patterns of lymphatic spread and the management of eyelid carcinomas.

Patterns of lymphatic spread and the management of eyelid carcinomas.

Auris Nasus Larynx. 2016 Mar 7;

Authors: Hashimoto K, Yasumatsu R, Toh S, Shiratsuchi H, Yoshida T, Nishiyama K, Yoshikawa H, Nakashima T, Nakagawa T

Abstract
OBJECTIVE: Eyelid carcinomas are rare, and the management strategy of regional lymph node metastasis linked to eyelid carcinomas has not been standardized to date. The aim of the present study was to analyze the patterns of regional metastasis and to assess the optimal extent of surgical treatment for lymph node metastasis of eyelid carcinoma.
METHODS: This study was a retrospective review of patient data from a single institution. From a series of 268 eyelid carcinomas, we selected the 21 patients with lymph node metastasis, and we analyzed the patterns of lymphatic spread, approach to treatment and outcomes.
RESULTS: The most common histological type of eyelid carcinoma with regional metastasis was sebaceous carcinoma (17/21, 81.0%). Submandibular area metastases were seen only in the patients with the primary tumor originating in the medial half of the eyelid, but parotid area metastases were seen in both the patients whose tumors had a medial-half origin and those with a lateral-half origin. Although 11 of the 16 patients with parotid-area metastases underwent a tumorectomy or superficial parotidectomy (which resulted in four cases of recurrence in the parotid area), none of the five patients who underwent a total parotidectomy developed parotid-area recurrence. The incidence of regional recurrence of the patients who received adjuvant radiotherapy (14.3%) was lower than that of the patients without adjuvant radiotherapy (57.1%).
CONCLUSION: Continued surveillance and optimal management of regional lymph node metastases are important for the control and survival of eyelid carcinomas.

PMID: 26965587 [PubMed - as supplied by publisher]

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Bilateral haemorrhagic vocal cords with supraglottic bruising following blunt laryngeal trauma.

Related Articles

Bilateral haemorrhagic vocal cords with supraglottic bruising following blunt laryngeal trauma.

J Coll Physicians Surg Pak. 2014 Nov;24 Suppl 3:S235-7

Authors: Sheikh E, Keh S, Vallamkondu V, Khan I, Shakeel M

Abstract
Isolated vocal cord haemorrhage secondary to blunt neck trauma is rare. It can lead to compromised airway in a patient with otherwise minimal clinical findings. The authors report a patient with traumatic haemorrhage in the supraglottis and vocal cords. A 24 years old Caucasian male presented with acute hoarseness, dysphagia, and a tender anterior neck swelling 3 hours after he was punched in his neck. There was no stridor or surgical emphysema. Flexible pharyngolaryngoscopy revealed no endolaryngeal mucosal tear but evidence of bleeding into his true vocal cords. The patient was successfully treated with dexamethasone, analgesia and voice rest. The patient refused to stay in hospital for overnight airway monitoring. The authors believe that all patients presenting with a blunt neck trauma should undergo laryngoscopy for assessment and monitoring of the airway.

PMID: 25518786 [PubMed - indexed for MEDLINE]

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