Major perioperative adverse events of peroral endoscopic myotomy: a systematic 5-year analysis.

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Major perioperative adverse events of peroral endoscopic myotomy: a systematic 5-year analysis.

Endoscopy. 2016 Jul 22;

Authors: Zhang XC, Li QL, Xu MD, Chen SY, Zhong YS, Zhang YQ, Chen WF, Ma LL, Qin WZ, Hu JW, Cai MY, Yao LQ, Zhou PH

Abstract
Background and study aims: Peroral endoscopic myotomy (POEM) is now a widely used treatment for esophageal achalasia, supported by several large cohort studies. Although major perioperative adverse events (mAE) are rare, in-depth investigations of related risks and preventive measures are lacking. The aim of this study was to systematically assess mAEs during POEM by analyzing their incidence, risks, prevention, and management. Patients and methods: This retrospective single-center analysis included all patients (n = 1680) undergoing POEM between August 2010 and July 2015 at Zhongshan Hospital. Major adverse events were defined as: vital-sign instability, intensive care unit (ICU) stay, hospital readmission, conversion to open surgery, invasive postoperative procedure, blood transfusion, or prolonged (> 5 days) hospitalization for functional impairment. Results: A total of 55 patients (3.3 %, 95 % confidence interval [CI] 2.5 % - 4.2 %) experienced mAEs: delayed mucosal barrier failure (n = 13, 0.8 %; 95 %CI 0.4 % - 1.3 %), delayed bleeding (n = 3, 0.2 %; 95 %CI 0.04 % - 0.5 %), hydrothorax (n = 8, 0.5 %; 95 %CI 0.2 % - 0.9 %), pneumothorax (n = 25, 1.5 %; 95 %CI 1.0 % - 2.2 %), and miscellaneous (n = 6, 0.4 %; 95 %CI 0.1 % - 0.8 %). Four patients (0.2 %) required ICU admission. No surgical conversion occurred, and 30-day mortality was zero. In stepwise multivariate regression, institution experience of < 1 year (odds ratio [OR] 3.85, 95 %CI 1.49 - 9.95), air insufflation (OR 3.41, 95 %CI 1.37 - 8.50), and mucosal edema (OR 2.01, 95 %CI 1.14 - 3.53) were identified as related risk factors. After introducing CO2 insufflation, the mAE rate declined to 1.9 % (95 %CI 1.2 % - 2.7 %) and seemed to plateau after 3.5 years at ~ 1 %. Conclusion: In general, POEM appears to be a safe procedure. Major adverse events were rare and could usually be prevented or anticipated, and were all managed effectively.

PMID: 27448052 [PubMed - as supplied by publisher]

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Overexpression of ErbB4 is an independent marker for lymph node metastasis in Japanese patients with oral squamous cell carcinoma.

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Overexpression of ErbB4 is an independent marker for lymph node metastasis in Japanese patients with oral squamous cell carcinoma.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 May 11;

Authors: Ohashi Y, Kumagai K, Miyata Y, Matsubara R, Kitaura K, Suzuki S, Hamada Y, Suzuki R

Abstract
OBJECTIVE: Overexpression of the epidermal growth factor receptor (EGFR) family is common in oral squamous cell carcinoma (OSCC). Therefore, we analyzed the expression profiles of the four EGFR family members (ErbB1, ErbB2, ErbB3, and ErbB4) in OSCC of Japanese patients.
STUDY DESIGN: Sixty-eight primary tumors and 18 normal oral mucosal tissue specimens were evaluated in this study. We analyzed EGFR family members using quantitative polymerase chain reaction and immunohistochemistry, as well as their relationships with clinical factors.
RESULTS: The expression level of ErbB1 messenger RNA (mRNA) was markedly increased in OSCC. By comparing the gene expression levels of EGFR family members in OSCC tissues that had lymph node metastasis with those in the absence of lymph node metastasis, we found that ErbB4 mRNA expression was increased significantly. There was also a significant correlation between the mRNA expression level of ErbB4 and those of ErbB2 and ErbB3 in cases with lymph node metastasis. Moreover, we confirmed protein expression of ErbB4 in the cytoplasm and membrane of tumor cells, which was stronger in cases with lymph node metastasis.
CONCLUSIONS: ErbB4 is an independent marker for lymph node metastasis in OSCC.

PMID: 27444519 [PubMed - as supplied by publisher]

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Impaired Vestibular Function and Low Bone Mineral Density: Data from the Baltimore Longitudinal Study of Aging.

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Impaired Vestibular Function and Low Bone Mineral Density: Data from the Baltimore Longitudinal Study of Aging.

J Assoc Res Otolaryngol. 2016 Jul 22;

Authors: Bigelow RT, Semenov YR, Anson E, du Lac S, Ferrucci L, Agrawal Y

Abstract
Animal studies have demonstrated that experimentally induced vestibular ablation leads to a decrease in bone mineral density, through mechanisms mediated by the sympathetic nervous system. Loss of bone mineral density is a common and potentially morbid condition that occurs with aging, and we sought to investigate whether vestibular loss is associated with low bone mineral density in older adults. We evaluated this question in a cross-sectional analysis of data from the Baltimore Longitudinal Study of Aging (BLSA), a large, prospective cohort study managed by the National Institute on Aging (N = 389). Vestibular function was assessed with cervical vestibular evoked myogenic potentials (cVEMPs), a measure of saccular function. Bone mineral density was assessed using dual-energy X-ray absorptiometry (DEXA). In two-way t test analysis, we observed that individuals with reduced vestibular physiologic function had significantly lower bone mineral density. In adjusted multivariate linear regression analyses, we observed that older individuals with reduced vestibular physiologic function had significantly lower bone mineral density, specifically in weight-bearing hip and lower extremity bones. These results suggest that the vestibular system may contribute to bone homeostasis in older adults, notably of the weight-bearing hip bones at greatest risk of osteoporotic fracture. Further longitudinal analysis of vestibular function and bone mineral density in humans is needed to characterize this relationship and investigate the potential confounding effect of physical activity.

PMID: 27447468 [PubMed - as supplied by publisher]

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[Therapy of fatigue in multiple sclerosis : A treatment algorithm].

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[Therapy of fatigue in multiple sclerosis : A treatment algorithm].

Nervenarzt. 2016 Jul 21;

Authors: Veauthier C, Paul F

Abstract
BACKGROUND: Fatigue is one of the most frequent symptoms of multiple sclerosis (MS) and one of the main reasons for underemployment and early retirement. The mechanisms of MS-related fatigue are unknown but comorbid disorders play a major role. Anemia, diabetes, side effects of medication and depression should be ruled out. Moreover, excessive daytime sleepiness (EDS) should be differentiated from fatigue. No approved medicinal therapy of MS fatigue is currently available.
OBJECTIVE: Presentation of current treatment strategies with a particular focus on secondary fatigue due to sleep disorders.
MATERIAL AND METHODS: A review of the literature was carried out.
RESULTS AND CONCLUSION: All MS patients suffering from fatigue should be questioned with respect to EDS and if necessary sleep medical investigations should be carried out; however, pure fatigue without accompanying EDS can also be caused by a sleep disorder. Medications, particularly freely available antihistamines, can also increase fatigue. Furthermore, anemia, iron deficits, diabetes and hypothyroidism should be excluded. Self-assessment questionnaires show an overlap between depression and fatigue. Several studies have shown that cognitive behavioral therapy and various psychotherapeutic measures, such as vertigo training, progressive exercise training and individualized physiotherapy as well as fatigue management interventions can lead to a significant improvement of MS-related fatigue. There is currently no medication which is suitable for treatment of fatigue, with the exception of fampridine for the treatment of motor functions and motor fatigue.

PMID: 27443156 [PubMed - as supplied by publisher]

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Authors' reply.

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Authors' reply.

J Laryngol Otol. 2016 Apr;130(4):413-4

Authors: Shankar R, Virk RS, Gupta K, Gupta AK, Bal A, Bansal S

PMID: 27447015 [PubMed - indexed for MEDLINE]

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Authors' reply.

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Authors' reply.

J Laryngol Otol. 2016 Apr;130(4):412-3

Authors: Shankar R, Virk RS, Gupta K, Gupta AK, Bal A, Bansal S

PMID: 27447014 [PubMed - indexed for MEDLINE]

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Contemporary occurrence of hydrocephalus and Chiari I malformation in sagittal craniosynostosis. Case report and review of the literature.

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Contemporary occurrence of hydrocephalus and Chiari I malformation in sagittal craniosynostosis. Case report and review of the literature.

Childs Nerv Syst. 2016 Jul 22;

Authors: Sgulò FG, Spennato P, Aliberti F, Di Martino G, Cascone D, Cinalli G

Abstract
Chiari malformation type I (CM-I) and hydrocephalus are often associated with complex craniosynostosis. On the contrary, their simultaneous occurrence in monosutural synostosis is extremely rare. The pathophysiological hypothesis is that they may alter posterior fossa growth and lead to cerebellar tonsil herniation also without skull base primary involvement. Hydrocephalus is multifactorial and may be secondary to fourth ventricle outlet obstruction. The management of these cases is quite complex and not well defined. Cranial vault remodeling should be the only treatment when CM-I is asymptomatic and not related to syringomyelia. Suboccipital decompression should be reserved only in complicated CM-I, usually as a second surgical step following the correction of the supratentorial deformity. In our opinion, the associated hydrocephalus should be treated first in order to normalize intracranial hypertension before opening the cranial sutures. We report the case of a 26-month-old child that presented with sagittal craniosynostosis, hydrocephalus, and CM-I. He was managed by performing endoscopic third ventriculostomy (ETV) first and cranial vault remodeling thereafter. Clinico-radiological outcome was very satisfying. Concerning literature is reviewed; physiopathology and surgical management are discussed.

PMID: 27447182 [PubMed - as supplied by publisher]

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Experience with 7.0 T MRI in Patients with Supratentorial Meningiomas.

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Experience with 7.0 T MRI in Patients with Supratentorial Meningiomas.

J Korean Neurosurg Soc. 2016 Jul;59(4):405-9

Authors: Song SW, Son YD, Cho ZH, Paek SH

Abstract
Meningiomas are typically diagnosed by their characteristic appearance on conventional magnetic resonance imaging (MRI). However, detailed image findings regarding peri- and intra-tumoral anatomical structures, tumor consistency and vascularity are very important in pre-surgical planning and surgical outcomes. At the 7.0 T MRI achieving ultra-high resolution, it could be possible to obtain more useful information in surgical strategy. Four patients who were radiologically diagnosed with intracranial meningioma in 1.5 T MRI underwent a 7.0 T MRI. Three of them underwent surgery afterwards, and one received gamma knife radiosurgery. In our study, the advantages of 7.0 T MRI over 1.5 T MRI were a more detailed depiction of the peri- and intra-tumoral vasculature and a clear delineation of tumor-brain interface. In the safety issues, all patients received 7.0 T MRI without any adverse event. One disadvantage of 7.0 T MRI was the reduced image quality of skull base lesions. 7.0 T MRI in patients with meningiomas could provide useful information in surgical strategy, such as the peri-tumoral vasculature and the tumor-brain interface.

PMID: 27446524 [PubMed]

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Sinonasal Inflammatory Myofibroblastic Tumor with Anaplastic Lymphoma Kinase 1 Rearrangement: Case Study and Literature Review.

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Sinonasal Inflammatory Myofibroblastic Tumor with Anaplastic Lymphoma Kinase 1 Rearrangement: Case Study and Literature Review.

Head Neck Pathol. 2016 Jul 21;

Authors: Lahlou G, Classe M, Wassef M, Just PA, Le Clerc N, Herman P, Verillaud B

Abstract
Inflammatory myofibroblastic tumors (IMTs) are rare mesenchymal tumors initially described in the lung. About half of them exhibit expression of the ALK1 protein, generally resulting from a gene rearrangement. Paranasal sinus IMTs are extremely uncommon, and gene rearrangement of ALK1 is very rare in this localization. A 47-year-old woman presented with rapidly progressive vision loss in her left eye. Clinical and imaging work-up revealed a tumor invading the left ethmoidal and sphenoidal sinuses and extending into the nasal cavity, the orbit and the skull base. Complete tumor resection was performed using an endonasal approach. Pathological examination revealed a paranasal localization of IMT, positive for ALK1 immunostaining. FISH analysis showed an ALK1 gene rearrangement. This case illustrates the local aggressive potential for IMTs. Treatment is primarily surgical, but targeted therapies (crizotinib) might be a solution for ALK1 rearranged cases with a poor prognosis.

PMID: 27443585 [PubMed - as supplied by publisher]

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Fungal skull base osteomyelitis: Emerging microbial identification techniques.

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Fungal skull base osteomyelitis: Emerging microbial identification techniques.

Laryngoscope. 2016 Jul 22;

Authors: Volsky PG, Hillman TA

Abstract
Culture-based pathogen identification in skull base osteomyelitis, particularly for fungi, is often inaccurate. We report the case of patient with fungal skull base osteomyelitis cured by sustained antifungal therapy after 16 months of debilitating illness. Due to medical complications, a strong clinical rationale was needed to justify long-term antifungal therapy. The offending fungus was identified by experimental molecular technology (Ibis T5000 universal biosensor); invasive fungal disease was corroborated by biochemical assays. Our discussion will help familiarize the otolaryngologist with existing biochemical and molecular diagnostics for invasive fungal disease. We encourage future investigators to study their application in cases of skull base osteomyelitis. Laryngoscope, 2016.

PMID: 27443284 [PubMed - as supplied by publisher]

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The Relief of Unilateral Painful Thoracic Radiculopathy without Headache from Remote Spontaneous Spinal Cerebrospinal Fluid Leak.

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The Relief of Unilateral Painful Thoracic Radiculopathy without Headache from Remote Spontaneous Spinal Cerebrospinal Fluid Leak.

Pain Res Manag. 2016;2016:4798465

Authors: Son BC, Ha SW, Lee SH, Choi JG

Abstract
Spontaneous intracranial hypotension (SIH) caused by spontaneous spinal cerebrospinal fluid (CSF) leaks produces orthostatic headaches. Although upper arm pain or paresthesia is reportedly associated with SIH from spontaneous spinal CSF leak in the presence of orthostatic headache, low thoracic radicular pain due to spontaneous spinal CSF leak unassociated with postural headache is extremely rare. We report a 67-year-old female who presented with chronic, positional radicular right T11 pain. Computed tomography myelography showed a spontaneous lumbar spinal CSF leak at L2-3 and repeated lumbar epidural blood patches significantly alleviated chronic, positional, and lower thoracic radiculopathic pain. The authors speculate that a chronic spontaneous spinal CSF leak not severe enough to cause typical orthostatic headache or epidural CSF collection may cause local symptoms such as irritation of a remote nerve root. There might be considerable variabilities in the clinical features of SIH which can present a diagnostic challenge.

PMID: 27445613 [PubMed - in process]

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[Idiopathic intracranial hypertension and spontaneous cerebrospinal fluid fistula. Usefulness of intracranial pressure monitoring].

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[Idiopathic intracranial hypertension and spontaneous cerebrospinal fluid fistula. Usefulness of intracranial pressure monitoring].

Neurocirugia (Astur). 2016 Jul 18;

Authors: Horcajadas Almansa A, Román Cutillas A, Jorques Infante A, Ruiz Gómez J, Busquier H

Abstract
Spontaneous cerebrospinal fluid (CSF) fistulas are rather common in daily practice. The aim of the surgical treatment is closure of the leak, but recurrences are quite frequent. The association between spontaneous CSF fistulas and idiopathic intracranial hypertension (IIH) is not uncommon, and this is probably the cause of the low rate of success of the surgical treatment. Symptoms of IIH associated with spontaneous CSF fistula are atypical, and diagnosis is often missed. Continuous intracranial pressure monitoring is very useful in the diagnosis of chronic IIH and in patients with spontaneous CSF fistula, as it helps in making decisions on the treatment of these patients.

PMID: 27445081 [PubMed - as supplied by publisher]

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A Systematic Review of Perioperative Versus Prophylactic Antibiotics for Cochlear Implantation.

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A Systematic Review of Perioperative Versus Prophylactic Antibiotics for Cochlear Implantation.

Ann Otol Rhinol Laryngol. 2016 Jul 21;

Authors: Anne S, Ishman SL, Schwartz S

Abstract
BACKGROUND: Previous Cochrane review of prophylactic antibiotic use in clean and clean-contaminated ear surgery showed no benefit; however, these studies did not address cochlear implant (CI) surgery specifically.
OBJECTIVE: Systematically review effects of perioperative antibiotics on risk of infections and related complications in CI surgery SEARCH METHODS: PubMed, EMBASE, Medline, CINAHL, and Cochrane library were searched from inception to March 2015. Manual searches of bibliographies were also completed.
SELECTION CRITERIA: We included all studies that describe perioperative antibiotic use in CI surgery. Outcome measures included infection, meningitis, implant extrusion, and adverse antibiotics effects. Two independent evaluators reviewed each abstract and article.
RESULTS: One hundred and seventy-three studies were identified in search. Three met inclusion criteria and were reviewed. Articles were low quality; no randomized trials were identified. For included studies, numerous antibiotic types and dosing regimens were used. Recorded outcome measures were heterogeneous, and detailed information was frequently unavailable. Overall infection rate was low (3%-4.5%); single dose antibiotic prophylaxis showed low rate of complications (1%) in 2 studies.
CONCLUSIONS: There is insufficient evidence to make definitive conclusions about the role of perioperative antibiotics in CI surgery. Reported infection rates are low; however, decision to use antibiotics should be based on assessment of risks and benefits to each patient.

PMID: 27443344 [PubMed - as supplied by publisher]

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Depth of Cochlear Implant Array Within the Cochlea and Performance Outcome.

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Depth of Cochlear Implant Array Within the Cochlea and Performance Outcome.

Ann Otol Rhinol Laryngol. 2016 Jul 21;

Authors: Hilly O, Smith L, Hwang E, Shipp D, Symons S, Nedzelski JM, Chen JM, Lin VY

Abstract
OBJECTIVE: To evaluate whether the depth of cochlear implant array within the cochlea affects performance outcomes 1 year following cochlear implantation.
METHODS: A retrospective case review of 120 patients who were implanted with the Advanced Bionics HiFocus 1J. Post-implantation plain-radiographs were retrospectively reviewed, and the depth of insertion was measured in degrees from the round window to the electrode tip. Correlation between the depth of insertion and 1-year post-activation Hearing in Noise Test (HINT) scores was analyzed. Intrascala position was not assessed.
RESULTS: Depth of electrode insertion ranged from 180° to 720°, and HINT scores ranged from 0% to 100%. A Mann-Whitney U test demonstrated significantly improved 1-year post-activation HINT scores in patients with an insertion depth of 360° or more in comparison with patients with insertion depth of less than 360° (81% vs 61%, P = .048). Patients with 13 to 15 contacts within cochlear turns performed as well as patients with full insertion of all 16 contacts, while patients with only 12 contacts performed poorly.
CONCLUSIONS: Insertion depth of the AB HiFocus 1J electrode of less than 360° is associated with reduced 1-year post-activation HINT scores when compared with deeper insertions. Partial insertion of 13 active contacts or more led to similar results as full insertion.

PMID: 27443343 [PubMed - as supplied by publisher]

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Efficacy and safety of ultrasound guided radiofrequency ablation for treating low risk papillary thyroid microcarcinoma: a prospective study.

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Efficacy and safety of ultrasound guided radiofrequency ablation for treating low risk papillary thyroid microcarcinoma: a prospective study.

Thyroid. 2016 Jul 22;

Authors: Zhang M, Luo Y, Zhang Y, Tang J

Abstract
BACKGROUND: Papillary thyroid microcarcinoma (PTMC) has a high incidence and a good prognosis. Surgical operation for all PTMC might be an overtreatment. The objective of our study was to evaluate the efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) for treating low risk PTMC.
METHODS: 98 PTMC in 92 patients were included in our study. US and contrast-enhanced ultrasound (CEUS) examinations were performed before ablation. RFA was performed using the moving shot technique. The ablation area exceeded the tumor edge to prevent marginal residue and recurrence. Patients were followed at one, three, six, and twelve months and every six months thereafter. US and CEUS examinations were used to evaluate the ablation area. At 3 months after ablation, US-guided core needle biopsy (CNB) was performed in the center, at the edge of the ablation area, and in the surrounding thyroid parenchyma, respectively, to exclude recurrence.
RESULTS: The mean tumor volume was 118.8±106.9 mm3. The mean volume reduction ratio was 0.47±0.27, 0.19±0.16, 0.08±0.11, 0.04±0.10 and 0 at one month, 3 months, 6 months, 12 months and 18 month after RFA respectively. Significant differences of the volume reduction ratio were found between every two follow-up times before 6 months (P<0.01), and no significant differences of the volume reduction ratio were found between 6 months and after 12 months (P=0.42). Of all the nodules, 10 (41.7%) resolved in 6 months and 23 (95.8%) resolved in 12 months. No residual or recurrent tumor tissue was detected in RFA area or in residual thyroid tissue during follow up. No suspicious metastatic lymph nodes were detected. The histological pathology results of US-guided CNB confirmed no recurrent tumor. No major complications were encountered.
CONCLUSIONS: RFA can effectively eliminate low risk PTMC with a very small complication rate. RFA may be an alternative strategy for the therapy of PTMC.

PMID: 27445090 [PubMed - as supplied by publisher]

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Clinicopathological characteristics of head and neck Merkel cell carcinomas.

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Clinicopathological characteristics of head and neck Merkel cell carcinomas.

Head Neck. 2016 Jul 22;

Authors: Knopf A, Bas M, Hofauer B, Mansour N, Stark T

Abstract
BACKGROUND: There are still controversies about the therapeutic strategies and subsequent outcome in head and neck Merkel cell carcinoma.
METHODS: Clinicopathological data of 23 Merkel cell carcinomas, 93 cutaneous head and neck squamous cell carcinomas (HNSCCs), 126 malignant melanomas, and 91 primary parotid gland carcinomas were comprehensively analyzed. Merkel cell carcinomas were cytokeratin 20 (CK20)/neuron-specific enolase (NSE)/chromogranin A (CgA)/synaptophysin (Syn)/thyroid transcription factor-1 (TTF-1)/MIB1 immunostained.
RESULTS: All Merkel cell carcinomas underwent wide local excision. Parotidectomy/neck dissection was performed in 40%/33% cutaneous Merkel cell carcinoma and 100%/100% in parotid gland Merkel cell carcinoma. Five-year recurrence-free interval (RFI)/overall survival (OS) was significantly higher in malignant melanoma (81/80%) than in cutaneous Merkel cell carcinoma/HNSCC. Interestingly, 5-year RFI/OS was significantly higher in Merkel cell carcinoma (61%/79%) than in HNSCC (33%/65%; p < .0001) despite comparable TNM classifications and treatment regimens. There were neither differences of RFI/OS between parotid gland Merkel cell carcinoma and parotid gland carcinomas, nor in the immunohistochemical profile.
CONCLUSION: Five-year RFI/OS was significantly better in cutaneous Merkel cell carcinoma when compared with TNM classification matched HNSCC. Five-year RFI/OS was comparable in parotid gland Merkel cell carcinoma and other primary parotid gland malignancies. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27447124 [PubMed - as supplied by publisher]

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EMG Activity of Masseter Muscles in the Elderly According to Rheological Properties of Solid Food.

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EMG Activity of Masseter Muscles in the Elderly According to Rheological Properties of Solid Food.

Ann Rehabil Med. 2016 Jun;40(3):447-56

Authors: Kang AJ, Kim DK, Kang SH, Seo KM, Park HS, Park KH

Abstract
OBJECTIVE: To assess the impact of aging on masticatory muscle function according to changes in hardness of solid food.
METHODS: Each of fifteen healthy elderly and young people were selected. Subjects were asked to consume cooked rice, which was processed using the guidelines of the Universal Design Foods concept for elderly people (Japan Care Food Conference 2012). The properties of each cooked rice were categorized as grade 1, 2, 3 and 4 (5×10(3), 2×10(4), 5×10(4), and 5×10(5) N/m(2)) respectively. Surface electromyography (sEMG) was used to measure masseter activity from food ingestion to swallowing of test foods. The raw data was normalized by the ratio of sEMG activity to maximal voluntary contraction and compared among subjects. The data was divided according to each sequence of mastication and then calculated within the parameters of EMG activities.
RESULTS: Intraoral tongue pressure was significantly higher in the young than in the elderly (p<0.05). Maximal value of average amplitude of the sequence in whole mastication showed significant positive correlation with hardness of food in both young and elderly groups (p<0.05). In a comparisons between groups, the maximal value of average amplitude of the sequence in whole mastication and peak amplitude in whole mastication showed that mastication in the elderly requires a higher percentage of maximal muscle activity than in the young, even with soft foods (p<0.05).
CONCLUSION: sEMG data of the masseter can provide valuable information to aid in the selection of foods according to hardness for the elderly. The results also support the necessity of specialized food preparation or products for the elderly.

PMID: 27446781 [PubMed]

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The Functional Dysphagia Scale Is a Useful Tool for Predicting Aspiration Pneumonia in Patients With Parkinson Disease.

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The Functional Dysphagia Scale Is a Useful Tool for Predicting Aspiration Pneumonia in Patients With Parkinson Disease.

Ann Rehabil Med. 2016 Jun;40(3):440-6

Authors: Lee JH, Lee KW, Kim SB, Lee SJ, Chun SM, Jung SM

Abstract
OBJECTIVE: To describe the correlation between the functional dysphagia scale and aspiration pneumonia and which characteristics influence the occurrence of aspiration pneumonia in patients with idiopathic Parkinson disease.
METHODS: Fifty-three patients with idiopathic Parkinson disease were prospectively evaluated in this study. Disease severity and functional status were measured by modified Hoehn and Yahr (H&Y) staging, Schwab and England activities of daily living (S-E ADL) scale and Korean version of Mini-Mental State Examination (K-MMSE). Swallowing function was evaluated by the functional dysphagia scale (FDS) and the penetration-aspiration scale (PAS) based on a videofluoroscopic swallowing study. The patients were followed up for 3 months and divided into two groups according to the occurrence of aspiration pneumonia. The correlation between the variables and aspiration pneumonia was analyzed.
RESULTS: Eight patients of the 53 patients were allocated to the aspiration pneumonia group and 45 patients to the non-aspiration pneumonia group. The patients in the aspiration pneumonia group had significantly higher H&Y staging, and scored lower on S-E ADL scale and K-MMSE. The patients in the aspiration pneumonia group had significantly higher scores on FDS and PAS. A multiple logistic regression analysis showed that the S-E ADL scale and the FDS were associated with the occurrence of aspiration pneumonia in the patients with Parkinson disease.
CONCLUSION: Given that the FDS can quantitatively assess the functional problems associated with dysphagia, it can be clinically effective in predicting the occurrence of aspiration pneumonia, and the FDS and the S-E ADL scale could be predictive variables for aspiration pneumonia in patients with Parkinson disease.

PMID: 27446780 [PubMed]

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Characteristics of Dysphagia in Severe Traumatic Brain Injury Patients: A Comparison With Stroke Patients.

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Characteristics of Dysphagia in Severe Traumatic Brain Injury Patients: A Comparison With Stroke Patients.

Ann Rehabil Med. 2016 Jun;40(3):432-9

Authors: Lee WK, Yeom J, Lee WH, Seo HG, Oh BM, Han TR

Abstract
OBJECTIVE: To compare the swallowing characteristics of dysphagic patients with traumatic brain injury (TBI) with those of dysphagic stroke patients.
METHODS: Forty-one patients with TBI were selected from medical records (between December 2004 to March 2013) and matched to patients with stroke (n=41) based on age, sex, and disease duration. Patients' swallowing characteristics were analyzed retrospectively using a videofluoroscopic swallowing study (VFSS) and compared between both groups. Following thorough review of medical records, patients who had a history of diseases that could affect swallowing function at the time of the study were excluded. Dysphagia characteristics and severity were evaluated using the American Speech-Language-Hearing Association National Outcome Measurement System swallowing scale, clinical dysphagia scale, and the videofluoroscopic dysphagia scale.
RESULTS: There was a significant difference in radiological lesion location (p=0.024) between the two groups. The most common VFSS finding was aspiration or penetration, followed by decreased laryngeal elevation and reduced epiglottis inversion. Swallowing function, VFSS findings, or quantified dysphagia severity showed no significant differences between the groups. In a subgroup analysis of TBI patients, the incidence of tube feeding was higher in patients with surgical intervention than in those without (p=0.011).
CONCLUSION: The swallowing characteristics of dysphagic patients after TBI were comparable to those of dysphagic stroke patients. Common VFSS findings comprised aspiration or penetration, decreased laryngeal elevation, and reduced epiglottis inversion. Patients who underwent surgical intervention after TBI were at high risk of tube feeding requirement.

PMID: 27446779 [PubMed]

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Cross-Cultural Adaptation and Validation of the Italian Version of SWAL-QOL.

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Cross-Cultural Adaptation and Validation of the Italian Version of SWAL-QOL.

Dysphagia. 2016 Jul 21;

Authors: Ginocchio D, Alfonsi E, Mozzanica F, Accornero AR, Bergonzoni A, Chiarello G, De Luca N, Farneti D, Marilia S, Calcagno P, Turroni V, Schindler A

Abstract
The aim of the study was to evaluate the reliability and validity of the Italian SWAL-QOL (I-SWAL-QOL). The study consisted of five phases: item generation, reliability analysis, normative data generation, validity analysis, and responsiveness analysis. The item generation phase followed the five-step, cross-cultural, adaptation process of translation and back-translation. A group of 92 dysphagic patients was enrolled for the internal consistency analysis. Seventy-eight patients completed the I-SWAL-QOL twice, 2 weeks apart, for test-retest reliability analysis. A group of 200 asymptomatic subjects completed the I-SWAL-QOL for normative data generation. I-SWAL-QOL scores obtained by both the group of dysphagic subjects and asymptomatic ones were compared for validity analysis. I-SWAL-QOL scores were correlated with SF-36 scores in 67 patients with dysphagia for concurrent validity analysis. Finally, I-SWAL-QOL scores obtained in a group of 30 dysphagic patients before and after successful rehabilitation treatment were compared for responsiveness analysis. All the enrolled patients managed to complete the I-SWAL-QOL without needing any assistance, within 20 min. Internal consistency was acceptable for all I-SWAL-QOL subscales (α > 0.70). Test-retest reliability was also satisfactory for all subscales (ICC > 0.7). A significant difference between the dysphagic group and the control group was found in all I-SWAL-QOL subscales (p < 0.05). Mild to moderate correlations between I-SWAL-QOL and SF-36 subscales were observed. I-SWAL-QOL scores obtained in the pre-treatment condition were significantly lower than those obtained after swallowing rehabilitation. I-SWAL-QOL is reliable, valid, responsive to changes in QOL, and recommended for clinical practice and outcome research.

PMID: 27444734 [PubMed - as supplied by publisher]

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Impact of Multiple Factors on the Degree of Tinnitus Distress.

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Impact of Multiple Factors on the Degree of Tinnitus Distress.

Front Hum Neurosci. 2016;10:341

Authors: Brüggemann P, Szczepek AJ, Rose M, McKenna L, Olze H, Mazurek B

Abstract
OBJECTIVE: The primary cause of subjective tinnitus is a dysfunction of the auditory system; however, the degree of distress tinnitus causes depends largely on the psychological status of the patient. Our goal was to attempt to associate the grade of tinnitus-related distress with the psychological distress, physical, or psychological discomfort patients experienced, as well as potentially relevant social parameters, through a simultaneous analysis of these factors.
METHODS: We determined the level of tinnitus-related distress in 531 tinnitus patients using the German version of the tinnitus questionnaire (TQ). In addition, we used the Perceived Stress Questionnaire (PSQ); General Depression Scale Allgemeine Depression Skala (ADS), Berlin Mood Questionnaire (BSF); somatic symptoms inventory (BI), and SF-8 health survey as well as general information collected through a medical history.
RESULTS: The TQ score significantly correlated with a score obtained using PSQ, ADS, BSF, BI, and SF-8 alongside psychosocial factors such as age, gender, and marital status. The level of hearing loss and the auditory properties of the specific tinnitus combined with perceived stress and the degree of depressive mood and somatic discomfort of a patient were identified as medium-strong predictors of chronic tinnitus. Social factors such as gender, age, or marital status also had an impact on the degree of tinnitus distress. The results that were obtained were implemented in a specific cortical distress network model.
CONCLUSIONS: Using a large representative sample of patients with chronic tinnitus permitted a simultaneous statistical measurement of psychometric and audiological parameters in predicting tinnitus distress. We demonstrate that single factors can be distinguished in a manner that explains their causative association and influence on the induction of tinnitus-related distress.

PMID: 27445776 [PubMed]

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Dependence of the Startle Response on Temporal and Spectral Characteristics of Acoustic Modulatory Influences in Rats and Gerbils.

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Dependence of the Startle Response on Temporal and Spectral Characteristics of Acoustic Modulatory Influences in Rats and Gerbils.

Front Behav Neurosci. 2016;10:133

Authors: Steube N, Nowotny M, Pilz PK, Gaese BH

Abstract
The acoustic startle response (ASR) and its modulation by non-startling prepulses, presented shortly before the startle-eliciting stimulus, is a broadly applied test paradigm to determine changes in neural processing related to auditory or psychiatric disorders. Modulation by a gap in background noise as a prepulse is especially used for tinnitus assessment. However, the timing and frequency-related aspects of prepulses are not fully understood. The present study aims to investigate temporal and spectral characteristics of acoustic stimuli that modulate the ASR in rats and gerbils. For noise-burst prepulses, inhibition was frequency-independent in gerbils in the test range between 4 and 18 kHz. Prepulse inhibition (PPI) by noise-bursts in rats was constant in a comparable range (8-22 kHz), but lower outside this range. Purely temporal aspects of prepulse-startle-interactions were investigated for gap-prepulses focusing mainly on gap duration. While very short gaps had no (rats) or slightly facilitatory (gerbils) influence on the ASR, longer gaps always had a strong inhibitory effect. Inhibition increased with durations up to 75 ms and remained at a high level of inhibition for durations up to 1000 ms for both, rats and gerbils. Determining spectral influences on gap-prepulse inhibition (gap-PPI) revealed that gerbils were unaffected in the limited frequency range tested (4-18 kHz). The more detailed analysis in rats revealed a variety of frequency-dependent effects. Gaps in pure-tone background elicited constant and high inhibition (around 75%) over a broad frequency range (4-32 kHz). For gaps in noise-bands, on the other hand, a clear frequency-dependency was found: inhibition was around 50% at lower frequencies (6-14 kHz) and around 70% at high frequencies (16-20 kHz). This pattern of frequency-dependency in rats was specifically resulting from the inhibitory effect by the gaps, as revealed by detailed analysis of the underlying startle amplitudes. An interaction of temporal and spectral influences, finally, resulted in higher inhibition for 500 ms gaps than for 75 ms gaps at all frequencies tested. Improved prepulse paradigms based on these results are well suited to quantify the consequences of central processing disorders.

PMID: 27445728 [PubMed]

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Decreased Speech-In-Noise Understanding in Young Adults with Tinnitus.

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Decreased Speech-In-Noise Understanding in Young Adults with Tinnitus.

Front Neurosci. 2016;10:288

Authors: Gilles A, Schlee W, Rabau S, Wouters K, Fransen E, Van de Heyning P

Abstract
OBJECTIVES: Young people are often exposed to high music levels which make them more at risk to develop noise-induced symptoms such as hearing loss, hyperacusis, and tinnitus of which the latter is the symptom perceived the most by young adults. Although, subclinical neural damage was demonstrated in animal experiments, the human correlate remains under debate. Controversy exists on the underlying condition of young adults with normal hearing thresholds and noise-induced tinnitus (NIT) due to leisure noise. The present study aimed to assess differences in audiological characteristics between noise-exposed adolescents with and without NIT.
METHODS: A group of 87 young adults with a history of recreational noise exposure was investigated by use of the following tests: otoscopy, impedance measurements, pure-tone audiometry including high-frequencies, transient and distortion product otoacoustic emissions, speech-in-noise testing with continuous and modulated noise (amplitude-modulated by 15 Hz), auditory brainstem responses (ABR) and questionnaires.Nineteen students reported NIT due to recreational noise exposure, and their measures were compared to the non-tinnitus subjects.
RESULTS: No significant differences between tinnitus and non-tinnitus subjects could be found for hearing thresholds, otoacoustic emissions, and ABR results.Tinnitus subjects had significantly worse speech reception in noise compared to non-tinnitus subjects for sentences embedded in steady-state noise (mean speech reception threshold (SRT) scores, respectively -5.77 and -6.90 dB SNR; p = 0.025) as well as for sentences embedded in 15 Hz AM-noise (mean SRT scores, respectively -13.04 and -15.17 dB SNR; p = 0.013). In both groups speech reception was significantly improved during AM-15 Hz noise compared to the steady-state noise condition (p < 0.001). However, the modulation masking release was not affected by the presence of NIT.
CONCLUSIONS: Young adults with and without NIT did not differ regarding audiometry, OAE, and ABR.However, tinnitus patients showed decreased speech-in-noise reception. The results are discussed in the light of previous findings suggestion NIT may occur in the absence of measurable peripheral damage as reflected in speech-in-noise deficits in tinnitus subjects.

PMID: 27445661 [PubMed]

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Endoscopic Transoral Resection of Parapharyngeal Osteoma: A Case Report.

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Endoscopic Transoral Resection of Parapharyngeal Osteoma: A Case Report.

J Oral Maxillofac Surg. 2016 Jun 25;

Authors: Yaslikaya S, Koca CF, Toplu Y, Kizilay A, Akpolat N

Abstract
Osteoma is a benign, mesenchymal, slow-growing, osteogenic tumor commonly occurring in the craniofacial bones and is characterized by the proliferation of compact or cancellous bone. Solitary osteomas can be classified as peripheral (parosteal, periosteal, or exophytic) when arising from the periosteum or central (endosteal) when arising from soft tissue. Peripheral osteoma occurs most frequently in the paranasal sinuses. Other locations include the orbital wall, temporal bone, pterygoid processes, external ear canal, and, rarely, the mandible. Osteomas in the oromandibular region often appear in the jaw in the canine fossa, hard palate, and maxillary sinus and in the lower jaw in the inner mandible and outer circumference and lingual side of the molar region. At radiologic imaging, a peripheral osteoma of the mandible appears as a well-circumscribed, round to oval, mushroom-like radiopaque mass with distinct borders. Computed tomography is the best imaging modality for determining the location and actual extension of the lesion. Parapharyngeal space tumors are rare tumors of the head and neck region. Benign tumors of the parapharyngeal space are more common than malignant tumors. A foreign body sensation in the pharynx, difficulty with deglutition, and hoarseness are symptoms generally related to the position of the tumor. Upper airway obstruction, painful throat, unilateral tinnitus, trismus, dysarthria, glossopharyngeal neuralgia, and cranial nerve palsies are other reported symptoms. This report presents the case of a huge osteoma of the left mandibular condyle extending to the parapharyngeal space.

PMID: 27444102 [PubMed - as supplied by publisher]

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Imaging Manifestations of Neurologic Complications in Anemia.

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Imaging Manifestations of Neurologic Complications in Anemia.

Hematol Oncol Clin North Am. 2016 Aug;30(4):733-56

Authors: Patel R, Sabat S, Kanekar S

Abstract
The hallmark signs and symptoms of anemia are directly related to a decrease in oxygen delivery to vital tissues and organs and include pallor, fatigue, lightheadedness, and shortness of breath. Neurologic complications are often nonspecific and can include poor concentration, irritability, faintness, tinnitus, and headache. If undiagnosed or untreated, anemia can progress to cognitive dysfunction, psychosis, encephalopathy, myelopathy, peripheral neuropathy, and more focal syndromes, such as stroke, seizures, chorea, and transverse myelitis. Imaging can play an important role in the early diagnosis and treatment of these neurologic and systemic complications associated with anemia, and hence, better outcome.

PMID: 27443995 [PubMed - in process]

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CD151 expression is frequent but unrelated to clinical outcome in head and neck cancer.

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CD151 expression is frequent but unrelated to clinical outcome in head and neck cancer.

Clin Oral Investig. 2016 Jul 21;

Authors: Nienstedt JC, Gröbe A, Lebok P, Büscheck F, Clauditz T, Simon R, Heumann A, Sauter G, Moebius C, Münscher A, Knecht R, Blessmann M, Heiland M, Pflug C

Abstract
OBJECTIVES: CD151 is a plasma membrane protein belonging to the tetraspanin family. CD151 represents a putative therapeutic target and has been suggested as a prognostic marker in several cancer types. The present study aims to investigate the prognostic relevance of immunohistochemical CD151 expression in head and neck squamous cell carcinoma (HNSCC).
MATERIALS AND METHODS: Tissue microarray (TMA) sections containing samples from 667 cancers of oral cavity, oro- and hypopharynx and larynx, for which follow-up data were available, were analyzed for CD151 expression by immunohistochemistry.
RESULTS: Membranous CD151 immunostaining was recorded in 269 (60.3 %) of 446 analyzable cases. Staining was considered weak in 129 (28.9 %), moderate in 98 (22.0 %), and strong in 42 (9.4 %) of cancers. CD151 expression was unrelated to histological grade, tumor stage, nodal status, or surgical margin. There was a tendency towards a somewhat lower prevalence of CD151 expression in tumors of the oral cavity (52.9 % positive) as compared to cancers of the oro-hypopharynx (62.1 %) and larynx (63.3 %; p = 0.0100). CD151 expression had no impact on patient survival.
CLINICAL RELEVANCE: In summary, immunohistochemical analysis of CD151 lacks prognostic utility in HNSCC. The high prevalence of CD151 expression in HNSCC emphasizes its putative relevance as a therapeutic target for further development of anti-CD151 drugs.

PMID: 27444451 [PubMed - as supplied by publisher]

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[Primary laryngeal aspergillosis with laryngeal obstruction:a case report].

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[Primary laryngeal aspergillosis with laryngeal obstruction:a case report].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Apr;50(4):328

Authors: Chen Z, Zhuo M, Yang F

PMID: 26081089 [PubMed - indexed for MEDLINE]

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[Transoral CO2 laser surgery for early glottic carcinoma with anterior commissure involvement].

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[Transoral CO2 laser surgery for early glottic carcinoma with anterior commissure involvement].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Apr;50(4):286-9

Authors: Zhang Q, Li P, Hu H, Yu Z

Abstract
OBJECTIVE: To explore the feasibility and effect of CO2 laser surgery for early glottic carcinoma with anterior commissure involvement.
METHODS: Twenty-seven patients with T1b glottic squamous cell carcinoma who underwent transoral CO2 laser surgery as the primary modality of treatment from January 2008 to August 2013 were reviewed. All patients were males and the age ranged from 46 to 81 years old. The patients did not receive any other treatments. Preoperative enhanced CT scan was performed to assess the status of the tumors and the lamina of thyroid cartilage. All the patients without the lamina of thyroid cartilage involved underwent transoral CO2 laser surgery.
RESULTS: Among 27 cases, aside from 1 patient converted to open operation due to inadequate exposure, 26 patients were successfully implemented operation. All the patients were followed-up for 12 to 60 months (median 26 months) and no recurrence. Granulation occurred four to six weeks after operation in all patients. Among them, granulation disappeared automatically three to six months in 22 patients and was resected with local anesthesia in other 4 patients, which the pathological results were inflammatory lesion. All patients did not undergo tracheotomy and nasogastric feeding, with an average stay of three days in hospital after surgery, and had different degree of vocal cord adhesion 6 months later.
CONCLUSIONS: Transoral CO2 laser surgery is an ideal procedure for early glottic carcinoma with anterior commissure involvement. Better preoperative evaluation, endoscopic technique and satisfied exposure are keys to the success of operation.

PMID: 26081081 [PubMed - indexed for MEDLINE]

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Is social inequality related to different patient concerns in routine oral cancer follow-up clinics?

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Is social inequality related to different patient concerns in routine oral cancer follow-up clinics?

Eur Arch Otorhinolaryngol. 2016 Jul 22;

Authors: Allen S, Lowe D, Harris RV, Brown S, Rogers SN

Abstract
Oral cancer has a higher incidence in the lower social strata, and these patients are less likely to engage in supportive interventions and report a poorer quality of life (QoL). The aim of this paper is to compare the Patient Concerns Inventory (PCI) responses across social groups attending routine oral cancer follow-up clinics with particular focus on the deprivation lower quartile. The PCI package is completed by patients as part of their routine review consultation with SNR. Patients were those diagnosed between 2008 and 2012. Deprivation was stratified using the IMD 2010 from postcode. Of the 106 eligible patients, 85 % used the PCI. Just over half (54 %) were living in the most deprived quartile, with two-thirds (68 %) of males in the most deprived quartile, compared with 35 % of females (p = 0.004). In regard to number and type of PCI items selected by patients at their first PCI clinic, there were no notable differences in respect of IMD classification. The two commonest concerns were fear of recurrence (43 %) and sore mouth (43 %). The most deprived quartile reported significant problems in regard to mood (p = 0.004) and recreation (p = 0.02), and a non-significant trend (36 vs 18 %, p = 0.09) in stating their overall QoL as being less than good. It is possible to identify the concerns of patients from lower socioeconomic strata as part of routine follow-up clinics. This allows for targeted multi-professional intervention and supports to improve the outcome in this hard to reach group.

PMID: 27447962 [PubMed - as supplied by publisher]

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High Frequency Sensorineural Hearing Loss Associated With Vestibular Episodic Syndrome.

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High Frequency Sensorineural Hearing Loss Associated With Vestibular Episodic Syndrome.

Clin Otolaryngol. 2016 Jul 22;

Authors: Martin-Sanz E, Esteban J, Vaduva C, Sanz R, Lopez-Escamez JA

Abstract
Current diagnostic criteria of Meniere's disease (MD) have been formulated by the Classification Committee of the Bárány Society, the Equilibrium Committee of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), the Japan Society for Equilibrium Research, the European Academy of Otology and Neurotology (EAONO), and the Korean Balance Society(1) . This article is protected by copyright. All rights reserved.

PMID: 27443791 [PubMed - as supplied by publisher]

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A patient assessed morbidity to evaluate outcome in surgically treated vestibular schwannomas.

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A patient assessed morbidity to evaluate outcome in surgically treated vestibular schwannomas.

World Neurosurg. 2016 Jul 18;

Authors: Al-Shudifat AR, Kahlon B, Höglund P, Lindberg S, Magnusson M, Siesjo P

Abstract
OBJECTIVE: Outcome after treatment of vestibular schwannomas can be evaluated by health providers as mortality, recurrence, performance and morbidity. As mortality and recurrence are rare events evaluation has to focus on performance and morbidity. The latters have mostly been reported by health providers. In the present study we validate two new scales for patient assessed performance and morbidity in comparison with different outcome tools as QOL (EQ5D), facial nerve score and work capacity.
METHODS: 167 patients in a retrospective (n=90) and a prospective (n=50) cohort of surgically treated vestibular schwannomas were studied. A new patient assessed morbidity score (paMS), a patient assessed Karnofsky score (paKPS), the patient assessed QOL (EQ-5D) score, work capacity and House Brackmann facial nerve score were used as outcome measures. Analysis of paMS components and their relation to other outcomes were done in uni- and multivariate analysis.
RESULTS: All outcome instruments except EQ5D and paKPS showed a significant decrease postoperatively. Only the facial nerve score (HB) differed significantly between the retrospective and prospective cohorts. Out of the 16 components of the patient assessed morbidity score hearing dysfunction, tear dysfunction, balance dysfunction and eye irritation were most often reported. Both paMS and EQ-5D correlated significantly to work capacity.
CONCLUSIONS: Standard QOL and performance instruments may not be sufficiently sensitive or specific to measure outcome at the cohort level after surgical treatment of vestibular schwannomas. A morbidity score may yield more detailed information on symptoms that can be relevant for rehabilitation and occupational training after surgery.

PMID: 27443231 [PubMed - as supplied by publisher]

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Adjustments of the amplitude mapping function: Sensitivity of cochlear implant users and effects on subjective preference and speech recognition.

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Adjustments of the amplitude mapping function: Sensitivity of cochlear implant users and effects on subjective preference and speech recognition.

Int J Audiol. 2016 Jul 22;:1-14

Authors: Theelen-van den Hoek FL, Boymans M, van Dijk B, Dreschler WA

Abstract
OBJECTIVE: In sound processors of cochlear implant (CI) users, input sound signals are analysed in multiple frequency channels. The amplitude mapping function (AMF) is the output compression function dictating the conversion from (acoustical) channel output levels to (electrical) current levels used for electrode stimulation. This study focused on the detectability of AMF adjustments by CI users and the effects of detectable AMF adjustments on subjective preference and performance.
DESIGN: Just noticeable differences (JNDs) for AMF settings were measured for pre-processed sentences at 60 dB SPL in quiet and noise. Three AMF settings, ranging twice the JND, were used during a take-home trial period of 12 days. Subjective ratings were collected and speech recognition in quiet and noise was measured.
STUDY SAMPLE: JND measurements: 17 CI users. Field experiment: 15 CI users.
RESULTS: JNDs for AMF settings varied among subjects and were similar in quiet and noise. A steeper AMF in the lower part was advantageous for speech recognition in quiet at soft levels. Subjective ratings showed limited agreement with speech recognition, both in quiet and noise.
CONCLUSIONS: CI users may benefit from different AMF settings in different listening situations regarding subjective preference and speech perception, especially for speech in quiet.

PMID: 27447758 [PubMed - as supplied by publisher]

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