Effectiveness of transmeatal low power laser irradiation for chronic tinnitus

from the Journal of Laryngology and Otology

Objective: To evaluate effectiveness of 5 mW laser irradiation in the treatment of chronic tinnitus.

Study design: Prospective, randomised, double-blind study.

Methods: This investigation included 66 ears in 45 patients with chronic unilateral or bilateral tinnitus. A 5 mW laser with a wavelength of 650 nm, or placebo laser, was applied transmeatally for 15 minutes, once daily for a week. A questionnaire was administered which asked patients to score their symptoms on a five-point scale, before and two weeks after laser irradiation. A decrease of one scale point, regarding the loudness, duration and degree of annoyance of tinnitus, was accepted to represent an improvement.

Results: The loudness, duration and degree of annoyance of tinnitus were improved, respectively, in up to 48.8, 57.7 and 55.5 per cent of the patients in the active laser group. No significant improvement was observed in the placebo laser group.

Conclusion: Transmeatal, low power (5 mW) laser irradiation was found to be useful for the treatment of chronic tinnitus.

Receptive (aural) vocabulary development in children with permanent bilateral sensorineural hearing impairment

from the Journal of Laryngology and Otology

Objective: The receptive (aural) vocabulary development of children with binaural-aided residual hearing was investigated in a prospective longitudinal analysis (repeated measures).

Patient and methods: Thirty-three children with sensorineural hearing loss, without major co-morbidities (mean age at the first testing point, 56.2 months, standard deviation 19.0 months) were recruited from the 1994 German Goettinger Hearing Language Register. Their receptive vocabulary was measured using standardised tests (with reference to normal hearing child performance) on three separate test points (mean follow up, 18.7 months, standard deviation 5.0 months).

Results: On average, the study group scored below the normal range at the first and second tests and made a significant improvement at the last test. The degree of hearing loss was found to be significantly correlated to vocabulary performance at all time points, with increasing correlation coefficients. At the third test, significant predictive variables for successful receptive vocabulary outcome were found to be: degree of hearing loss (t = 5.43; p < 0.0001); age at diagnosis (t = 2.29; p = 0.03); and nonverbal intelligence (t = 2.82; p = 0.009).

Conclusion: If permanent childhood hearing impairment is mild and/or is detected early, and if the child grows up in a monolingual environment, the development of receptive vocabulary within the normal range is possible.

Cochlear implantation in infants less than 12 months of age

from the International Journal of Pediatric Otorhinolaryngology

Objective
Infants are diagnosed with severe to profound hearing loss at an earlier age due to the advent of universal newborn hearing screening. This offers the opportunity to provide intervention in the form of cochlear implantation at an earlier age than was previously possible. The purpose of this investigation is to evaluate the risk of cochlear implant surgery in children less than 12 months of age.

Design
Retrospective review of children who underwent cochlear implantation before 12 months of age.

Setting
Patients were identified from a database of pediatric cochlear implant patients at a tertiary care center. All patients were diagnosed with severe to profound hearing loss by otoacoustic emission and auditory brainstem response. Follow-up ranged from 2 months to 5 years.

Results
Fourteen of 15 patients had full insertions of the electrode hardware. Less than full insertion and post-operative CSF otorrhea occurred in one patient with severe cochlear abnormalities. There were no other perioperative surgical complications. The average speech detection threshold was 27.6 dB (20–45 dB) at approximately 1–3 months post-stimulation and 25 dB (15–30 dB) at approximately 5–7 months.

Conclusion
In our experience, we feel cochlear implantation is safe for infants as young as 6 months of age. The current standard at our institution is to implant by 7 months of age for prelingual deafness as opposed to waiting additional time until 12 months of age before the brain is presented with speech.

Vertigo, dizziness and imbalance in the elderly

from the Journal of Laryngology and Otology

Objective: The aim of this retrospective analysis was to evaluate the diagnosis of vertigo, dizziness and imbalance in elderly patients in two tertiary neurotology clinics.

Design and setting: Six hundred and seventy-seven patients aged over 65 years were assessed by the same senior author, and 601 patients were enrolled in the study.

Results: The most frequent diagnoses were benign paroxysmal positional vertigo (42.43 per cent), idiopathic vestibulopathy (20.29 per cent), migraine vestibulopathy (13.15 per cent), Ménière’s disease (12.47 per cent) and acute vestibular attack (6.49 per cent).

Conclusion and significance: This retrospective study showed that 93.5 per cent of the elderly patients studied had been diagnosed with peripheral vertigo. The majority of patients had been classified as having benign paroxysmal positional vertigo, idiopathic vestibulopathy or migraine vestibulopathy.

A voice-detecting sensor and a scanning keyboard emulator to support word writing by two boys with extensive motor disabilities

from Research in Developmental Disabilities

The present study assessed the use of a voice-detecting sensor interfaced with a scanning keyboard emulator to allow two boys with extensive motor disabilities to write. Specifically, the study (a) compared the effects of the voice-detecting sensor with those of a familiar pressure sensor on the boys’ writing time, (b) checked which of the sensors the boys preferred, and (c) conducted a social validation assessment of the boys’ performance with the two sensors, employing psychology students as raters. The difference in the boys’ overall mean writing time per letter across sensors was, by the end of the study, about 1.5 s. This difference favored the pressure sensor for one of the boys and the voice-detecting sensor for the other boy. Both boys showed preference for the voice-detecting sensor. Moreover, the psychology students involved in the social validation assessment indicated that such sensor was more satisfactory, suitable, and educationally relevant than the pressure sensor, and represented the solution that they as raters supported more.

Motor programming in apraxia of speech

from Brain and Language

Apraxia of Speech (AOS) is an impairment of motor programming. However, the exact nature of this deficit remains unclear. The present study examined motor programming in AOS in the context of a recent two-stage model [Klapp, S. T. (1995). Motor response programming during simple and choice reaction time: The role of practice. Journal of Experimental Psychology: Human Perception and Performance, 21, 1015–1027; Klapp, S. T. (2003). Reaction time analysis of two types of motor preparation for speech articulation: Action as a sequence of chunks. Journal of Motor Behavior, 35, 135–150] that proposes a preprogramming stage (INT) and a process that assigns serial order to multiple programs in a sequence (SEQ). The main hypothesis was that AOS involves a process-specific deficit in the INT (preprogramming) stage of processing, rather than in the on-line serial ordering (SEQ) and initiation of movement. In addition, we tested the hypothesis that AOS involves a central (i.e., modality-general) motor programming deficit. We used a reaction time paradigm that provides two dependent measures: study time (the amount of time for participants to ready a motor response; INT), and reaction time (time to initiate movement; SEQ). Two experiments were conducted to examine INT and SEQ in AOS: Experiment 1 involved finger movements, Experiment 2 involved speech movements analogous to the finger movements. Results showed longer preprogramming time for patients with AOS but normal sequencing and initiation times, relative to controls. Together, the findings are consistent with the hypothesis of a process-specific, but central (modality-independent) deficit in AOS; alternative explanations are also discussed.

Behavioural NeurologyVery few studies have investigated the development of visual search of aligned stimuli in relation to normal reading acquisition and in developmental dyslexia">Visual scanning and reading ability in normal and dyslexic children from Behavioural NeurologyVery few studies have investigated the development of visual search of aligned stimuli in relation to normal reading acquisition and in developmental dyslexia

from Behavioural Neurology

Very few studies have investigated the development of visual search of aligned stimuli in relation to normal reading acquisition and in developmental dyslexia.

In this study we used a new computerised experimental task which requires a visuo-motor response (RT) to a target appearing unpredictably in one out of seven different spatial positions on a horizontally aligned array of 18 geometrical figures.

The aims of the study were to investigate: 1) the visual scanning development in normal children from pre-school to school age; 2) whether visual scanning performance in kindergarten children could predict reading acquisition; 3) the visual scanning abilities in a group of developmental dyslexic children.

The main results were: 1) a significant decrement of RTs with age and a progressive increase of the left-to-right gradient with reading experience; 2) visual scanning abilities in kindergarten proved to be a good predictor of reading acquisition; 3) dyslexics were slow scanners and did not present the left-to-right strategy typical of normal readers.

The results support the hypothesis of a relationship between visual scanning and reading abilities.

Characterization of age-related changes in vestibular evoked myogenic potentials

from the Journal of Vestibular Research

A tone-burst stimulation of 500 Hz seems to be clinically most appropriate to elicit vestibular evoked myogenic potentials (VEMPs) because those VEMPs can be recorded at the lowest stimulus intensity possible. However, little is known about gender and age-related changes of the amplitude in tone-burst (500 Hz) evoked VEMPs. The aim of the present paper was therefore to investigate the influence of gender and age on VEMP amplitude in relation to the tonic muscle activity.

VEMPs of 64 healthy subjects were recorded ipsilaterally during air- or bone-conducted tone burst stimulation. The EMG of the tonically activated sternocleidomastoid muscle was recorded ipsilaterally with surface electrodes. Averages were taken for P1/N1 amplitudes of male and female volunteers within 3 different age groups.

Although the amplitude decreased with increasing age the tonic activity was not significant different between the age groups. Consequently the relation between VEMP amplitude and tonic muscle activity decreased with increasing age. The normative values of the age-dependent relation between VEMP amplitude and tonic muscle activity were described by the 90% confidence interval of the individual values. Normative thresholds were calculated. Normal saccular receptor function could be diagnosed if the VEMP amplitude is above (or equal to) the normative value at a given tonic muscle activity and age.

Normative data as described above are required to diagnose isolated saccular defects, which are indicative of a vestibular disorder.

Effect of age and height on trunk sway during stance and gait

from the Journal of Vestibular Research

The aim of the studies reported here was to quantify changes in balance control for stance and gait tasks with age and to pinpoint possible advantages and difficulties in using these tasks and measures derived from them to identify pathological balance control in patients. Some 470 normal subjects in the age range 6 to 82 were examined for a battery of 14 stance and gait tasks. During the tasks, angular velocity transducers mounted at lumbar 1–3 measured pitch and roll angular velocities of the body. A combination of outcome measures from several tasks was used to create an overall balance control index. Three types of sensory analyses on pitch angle and velocity amplitudes for stance trials were used to quantify possible changes in the contributions of visual, somatosensory and vestibular inputs to balance control with age for 2-legged stance tasks. Correlation analysis on task variables was used to determine the relationship of subjects’ age and height on outcome measures.

Outcome measures showed a characteristic “L” or “U” shaped profile with a rapid decrease in values between 7 and 25 years of age, a plateau until 55 then a gradual increase with age after 55 years of age for most stance and gait tasks. The sensory analysis technique using differences between stance tests indicated that visual contributions to balance control continuously increased with age between the ages of 15 and 80, and vestibular and lower leg somatosensory contributions remain relatively constant with age. Sensory analysis calculated as commonly-used quotients of outcome measures revealed large variance across all ages, asymmetric distributions, and no clear trends in sensory contributions to stance with age. A third technique based on a discriminant function analysis using measures from model patient populations indicated that proprioceptive but not vestibular contributions first increased with age and then decreased after 55 years of age. Correlations of outcome measures with age and height indicated that both contributed equally to changes in outcome measures between the ages of 7 and 25, otherwise height had no effect. We conclude that both stance and gait tasks should be selected for identifying changes in balance control from that of healthy persons with a preference for gait tasks as these show less variation with age. Because of the large increases in variance in the elderly and those younger than 20 years, appropriate age-matched reference values should be employed to ascertain if trunk sway is out of normal ranges.

Efficacy of electrotactile vestibular substitution in patients with peripheral and central vestibular loss

from the Journal of Vestibular Research

Vestibular dysfunction of either central or peripheral origin can significantly affect balance, posture, and gait. We conducted a pilot study to test the effectiveness of training with the BrainPort® balance device in subjects with a balance dysfunction due to peripheral or central vestibular loss. The BrainPort® balance device transmits information about the patient’s head position via electrotactile stimulation of the tongue. Head position data is sensed by an accelerometer and displayed on the tongue as a pattern of stimulation. This pattern of stimulation moves forward, backward, and laterally on the tongue in direct response to head movements. Users of the device were trained to use this stimulation to adjust their position in order to maintain their balance.

Twenty-eight subjects with peripheral or central vestibular loss were trained with the BrainPort balance device and tested using the following standardized quantitative measurements of the treatment effects: Computerized Dynamic Posturography (CDP) using the Sensory Organization Test (SOT), Dynamic Gait Index (DGI), Activities-specific Balance Confidence Scale (ABC), and Dizziness Handicap Inventory (DHI). All subjects had chronic balance problems and all but one had previously participated in vestibular rehabilitation therapy. The scores on the clinical tests upon entry into the study were compared to their scores following training with the BrainPort balance device. Our results exhibit consistent positive and statistically significant improvements in balance, posture and gait. These results exceed what could normally be achieved in three to five days of traditional balance training alone. Since this was not a controlled study, we are unable to distinguish the degree to which these improvements are attributable to training with the BrainPort balance device versus the balance exercises performed by all subjects as a part of the BrainPort training sessions. Nonetheless, after training with the BrainPort balance device, all subjects demonstrated significant improvements in performance beyond what might be expected from conventional vestibular rehabilitation therapy.

Otolith-ocular responses in Meniere’s patients before and after endolymphatic shunt operation

from the Journal of Vestibular Research

Caloric testing in prone/supine position and constant velocity off-vertical axis rotation (OVAR) in yaw axis (rotate-then-tilt paradigm) can evaluate labyrinth function and vestibular-ocular reflex (VOR) behaviour before and after endolymphatic shunt surgery (ESS). Preoperative and postoperative otolith dysfunction can be documented by constant velocity OVAR, before the VOR is modulated by the vestibular compensation. Vestibulo-ocular responses in prone/supine position and linear VOR (lVOR) OVAR responses were observed in 10 patients before and after ESS. Ipsilateral caloric reaction in prone/supine position was reduced after ESS. Otolith-ocular function and canal-otolith-interaction were improved postoperatively. Meniere’s patients with bias component opposite to normal when rotating towards the lesioned ear showed relief of symptoms postoperatively. The bias component returning to normal can help to identify the relief of Meniere’s attacks after ESS. The canal-otolith interaction can be observed pre- and postoperatively by means of caloric reaction in prone/supine position as part of the clinical routine.

Presbyvertigo-aging of otoconia and vestibular sensory cells

from the Journal of Vestibular Research

Imbalance is a common clinical problem in elderly persons. Subsequently falls and fractures may occur. Age-related balance problems constitute an underestimated but prominent public health problem and a socioeconomic burden. At the histological level the peripheral vestibular system in animals and humans exhibits a variety of age-related changes. The number of otoconia in the utricule and the saccule is reduced with increasing age. Degenerated otoconia caused by aging showed distinct changes of the shape. Moreover age-related decreasing hair cell counts, lipofuscin inclusions and deformation of cilia are observed in human vestibular sensory and supporting cells. Results of vestibular function testing of age-related balance disorders still remain controversially. Regular balance training and vestibular rehabilitation results in less more falls and imbalance.

Short-term rehabilitation of patients with posttraumatic otolith disorders by auditory feedback training: A pilot study

from the Journal of Vestibular Research

In a prospective, non-randomized pilot study, two groups of patients with dizziness for more than one year due to posttraumatic otolith disorders had been investigated. They were treated by a one-day vestibular rehabilitation training with/without auditory feedback. It could be shown that auditory feedback training for a limited period of time can reduce significantly trunk sway compared to those patients who did vestibular exercises alone without auditory feedback. This audiofeedback-based therapy seems to be a promising tool in the vestibular rehabilitation and in treating patients with otolith disorders in particular. Long-term effects cannot yet be assessed with the present data of our series.

Word retrieval failure episodes after traumatic brain injury

from Aphasiology

No abstract available.

Infant hearing screening: effects of timeline

from Clinical Otolaryngology

Objectives: Universal infant hearing screening using otoacoustic emission and auditory brain-stem response audiometry is widely administered to attain the goals of early identification of, and intervention for hearing impairment. Concerns regarding screening specificity have, however, been raised. False positives may result from vernix occlusion in the ear canal or transient middle ear effusion, and can result in substantial costs to health care systems. The current study investigates the effects of age and time interval between tests on hearing assessment results.

Setting & participants: Three hundred and seventeen positive screens from a 2-stage distortion product otoacoustic emission (DPOAE) screening programme in Hong Kong, who subsequently received diagnostic auditory brainstem response (ABR) assessment and monitoring, were investigated.

Main outcome measures: Differences in diagnostic ABR results were compared among infants of different ages at tests, and with different time lapses after DPOAE screening. The proportion of those having persistent hearing impairment, conductive loss and impairment of moderate degree or above, were also compared.

Results: A significantly higher rate of normal ABR thresholds (60% versus 24%) was noted in infants assessed after age 50 days, and in infants diagnostically assessed with a time lapse of over 20 days post-DPOAE screening (65% versus 42%).

Conclusions: Delaying diagnostic ABR assessment may reveal a higher percentage of normal thresholds, and hence probably higher specificity. Time delay may allow for spontaneous resolution of transient outer and middle ear conditions. However, the goals of early identification and intervention, as well as possible parental anxiety with delayed assessment, should also be considered when reviewing infant hearing screening schedules.