Radiological factors related to pre-operative hearing levels in patients with vestibular schwannomas

The pathogenetic mechanism of hearing loss in patients with vestibular schwannomas (VS) remains unclear. Our aim was to determine the radiological and clinical parameters that might be related to hearing. The radiological images and charts of 99 patients were reviewed. Image processing software was used to analyse the maximal tumor diameter in three planes; its volume; its extension cranially, caudally, anteriorly and posteriorly; the width and length of the intrameatal tumor portion, its shape and consistency; and the tumor-fundus distance. These parameters were correlated with the patient's pre-operative hearing range. The degree of hearing correlated significantly with the tumor size, volume and coronal diameter, the degree of intrameatal tumor growth, and the distance between the lateral tumor end and the fundus (p < 0.05). No correlation was found regarding tumor extension, shape and consistency, the presence of hydrocephalus, or the extent of erosion of the internal auditory canal. Loss of hearing in the VS appears to be multifactorial. Determining the radiological parameters related to the hearing level can help to clarify the pathophysiological mechanisms involved.

Benefit of a Contralateral Routing of Signal Device for Unilateral Cochlear Implant Users.

Objective: To investigate objective and subjective effects of an adjunctive contralateral routing of signal (CROS) device at the untreated ear in patients with a unilateral cochlear implant (CI). Design: Prospective study of 10 adult experienced unilateral CI users with bilateral severe-to-profound hearing loss. Speech in noise reception (SNR) and sound localization were measured with and without the additional CROS device. SNR was measured by applying speech signals at the untreated/CROS side while noise signals came from the front (S90N0). For S0N90, signal sources were switched. Sound localization was measured in a 12-loudspeaker full circle setup. To evaluate the subjective benefit, patients tried the device for 2 weeks at home, then filled out the abbreviated Speech, Spatial and Qualities of Hearing Scale as well as the Bern benefit in single-sided deafness questionnaires. Results: In the setting S90N0, all patients showed a highly significant SNR improvement when wearing the additional CROS device (mean 6.4 dB, p < 0.001). In the unfavorable setting S0N90, only a minor deterioration of speech understanding was noted (mean -0.66 dB, p = 0.54). Sound localization did not improve substantially with CROS. In the two questionnaires, 12 of 14 items showed an improvement in mean values, but none of them was statistically significant. Conclusion: Patients with unilateral CI benefit from a contralateral CROS device, particularly in a noisy environment, when speech comes from the CROS ear side. © 2014 S. Karger AG, Basel.

The effect of acoustic screens on orchestra musicians

La Directiva 2003/10/CE del Parlamento Europeo y del Consejo, del 6 de febrero de 2003, específica con arreglo al apartado 1 del artículo 16 de la Directiva 89/391/CEE las disposiciones mínimas de seguridad y de salud relativas a la exposición de los trabajadores a los riesgos derivados de los agentes físicos (ruido). En la industria musical, y en concreto en los músicos de orquesta, una exposición de más de ocho horas al día a un nivel de presión sonora de 80dB(A) o más es algo muy común. Esta situación puede causar a los trabajadores daños auditivos como la hiperacusia, hipoacusia, tinitus o ruptura de la membrana basilar entre otros. Esto significa que deben tomarse medidas para implementar las regulaciones de la forma más razonable posible para que la interpretación del músico, la dinámica y el concepto musical que se quiere transmitir al público se vea lo menos afectada posible. Para reducir la carga auditiva de los músicos de orquesta frente a fuertes impactos sonoros provenientes de los instrumentos vecinos, se está investigando sobre el uso de unos paneles acústicos que colocados en puntos estratégicos de la orquesta pueden llegar a reducir el impacto sonoro sobre el oído hasta 20dB. Los instrumentos de viento metal y de percusión son los responsables de la mayor emisión de presión sonora. Para proteger el oído de los músicos frente a estos impactos, se colocan los paneles en forma de barrera entre dichos instrumentos y los músicos colocados frente a ellos. De esta forma se protege el oído de los músicos más afectados. Para ver el efecto práctico que producen estos paneles en un conjunto orquestal, se realizan varias grabaciones en los ensayos y conciertos de varias orquestas. Los micrófonos se sitúan a la altura del oído y a una distancia de no más de 10cm de la oreja de varios de los músicos más afectados y de los músicos responsables de la fuerte emisión sonora. De este modo se puede hacer una comparación de los niveles de presión sonora que percibe cada músico y evaluar las diferencias de nivel existentes entre ambos. Así mismo se utilizan configuraciones variables de los paneles para comparar las diferencias de presión sonora que existen entre las distintas posibilidades de colocarlos y decidir así sobre la mejor ubicación y configuración de los mismos. A continuación, una vez obtenidos las muestras de audio y los diferentes archivos de datos medidos con un analizador de audio en distintas posiciones de la orquesta, todo ello se calibra y analiza utilizando un programa desarrollado en Matlab, para evaluar el efecto de los paneles sobre la percepción auditiva de los músicos, haciendo especial hincapié en el análisis de las diferencias de nivel de presión sonora (SPL). Mediante el cálculo de la envolvente de las diferencias de nivel, se evalúa de un modo estadístico el efecto de atenuación de los paneles acústicos en los músicos de orquesta. El método está basado en la probabilidad estadística de varias muestras musicales ya que al tratarse de música tocada en directo, la dinámica y la sincronización entre los músicos varía según el momento en que se toque. Estos factores junto con el hecho de que la partitura de cada músico es diferente dificulta la comparación entre dos señales grabadas en diferentes puntos de la orquesta. Se necesita por lo tanto de varias muestras musicales para evaluar el efecto de atenuación de los paneles en las distintas configuraciones mencionadas anteriormente. El estudio completo del efecto de los paneles como entorno que influye en los músicos de orquesta cuando están sobre el escenario, tiene como objetivo la mejora de sus condiciones de trabajo. Abstract For several years, the European Union has been adopting many laws and regulations to protect and give more security to people who are exposed to some risk in their job. Being exposed to a loud sound pressure level during many hours in the job runs the risk of hearing damage. Particularly in the field of music, the ear is the most important working tool. Not taking care of the ear can cause some damage such as hearing loss, tinnitus, hyperacusis, diplacusis, etc. This could have an impact on the efficiency and satisfaction of the musicians when they are playing, which could also cause stress problems. Orchestra musicians, as many other workers in this sector, are usually exposed to a sound level of 80dB(A) or more during more than eight hours per day. It means that they must satisfy the law and their legal obligations to avoid health problems proceeding from their job. Putting into practice the new regulations is a challenge for orchestras. They must make sure that the repertoire, with its dynamic, balance and feeling, is not affected by the reduction of sound levels imposed by the law. This study tries to investigate the benefits and disadvantages of using shields as a hearing protector during rehearsals and orchestral concerts.

Effects of salicylates and aminoglycosides on spontaneous otoacoustic emissions in the Tokay gecko

The high sensitivity and sharp frequency discrimination of hearing depend on mechanical amplification in the cochlea. To explore the basis of this active process, we examined the pharmacological sensitivity of spontaneous otoacoustic emissions (SOAEs) in a lizard, the Tokay gecko. In a quiet environment, each ear produced a complex but stable pattern of emissions. These SOAEs were reversibly modulated by drugs that affect mammalian otoacoustic emissions, the salicylates and the aminoglycoside antibiotics. The effect of a single i.p. injection of sodium salicylate depended on the initial power of the emissions: ears with strong control SOAEs displayed suppression at all frequencies, whereas those with weak control emissions showed enhancement. Repeated oral administration of acetylsalicylic acid reduced all emissions. Single i.p. doses of gentamicin or kanamycin suppressed SOAEs below 2.6 kHz, while modulating those above 2.6 kHz in either of two ways. For ears whose emission power at 2.6–5.2 kHz encompassed more than half of the total, individual emissions displayed facilitation as great as 35-fold. For the remaining ears, emissions dropped to as little as one-sixth of their initial values. The similarity of the responses of reptilian and mammalian cochleas to pharmacological intervention provides further evidence for a common mechanism of cochlear amplification.

Molecular genetics of pattern formation in the inner ear: Do compartment boundaries play a role?

The membranous labyrinth of the inner ear establishes a precise geometrical topology so that it may subserve the functions of hearing and balance. How this geometry arises from a simple ectodermal placode is under active investigation. The placode invaginates to form the otic cup, which deepens before pinching off to form the otic vesicle. By the vesicle stage many genes expressed in the developing ear have assumed broad, asymmetrical expression domains. We have been exploring the possibility that these domains may reflect developmental compartments that are instrumental in specifying the location and identity of different parts of the ear. The boundaries between compartments are proposed to be the site of inductive interactions required for this specification. Our work has shown that sensory organs and the endolymphatic duct each arise near the boundaries of broader gene expression domains, lending support to this idea. A further prediction of the model, that the compartment boundaries will also represent lineage-restriction compartments, is supported in part by fate mapping the otic cup. Our data suggest that two lineage-restriction boundaries intersect at the dorsal pole of the otocyst, a convergence that may be critical for the specification of endolymphatic duct outgrowth. We speculate that the patterning information necessary to establish these two orthogonal boundaries may emanate, in part, from the hindbrain. The compartment boundary model of ear development now needs to be tested through a variety of experimental perturbations, such as the removal of boundaries, the generation of ectopic boundaries, and/or changes in compartment identity.

Surgical anatomy; a treatise on human anatomy in its application to the practice of medicine and surgery,

v.1. Upper extremity; back of neck; shoulder; trunk; cranium; scalp; face.--v.2 Neck; mouth; pharynx; larynx; nose; orbit; eyeball; organ of hearing; brain; male perineum; female perineum.--v.3 Abdomen; pelvic cavity; lymphatics of the abdomen and pelvis; thorax; lower extremity.

Hearing sensitivity and bone mineral density in older adults: the Health, Aging and Body Composition Study

Bone mineral density (BMD) may be associated with hearing loss in older adults. Demineralization of the cochlear capsule has been associated with hearing loss in those with Paget's disease of the bone and otosclerosis. Osteoporosis may also result in cochlear capsule demineralization. We hypothesized that lower hip BMD and lower heel ultrasound measurements would be associated with hearing loss in a population-based sample of 2,089 older black and white men and women. Bone parameters and hearing function were measured at the fourth clinical follow-up visit. Audiometric threshold testing was used to measure air- and bone-conduction hearing sensitivity. BMD of the hip and its subregions was measured using dual-energy X-ray absorptiometry. Calcaneal bone measurements [broadband ultrasound attenuation (BUA), speed of sound (SOS) and the quantitative ultrasound index (QUI)] were obtained using heel ultrasound. After adjusting for known hearing loss risk factors, no association was found between hearing and any of the bone measurements in whites and black women. In black men, however, lower hip BMD was associated with higher odds of hearing loss; for each standard deviation decrease in total hip BMD, the odds of hearing loss were 1.41 (95% confidence interval 1.08, 1.83), 1.39 (95% CI 1.07, 1.82) for femoral neck BMD and 1.65 (95% CI 1.26, 2.16) for trochanter BMD. Conductive hearing loss was associated with lower heel ultrasound measurements, though only among white men. The results of this study are mixed and inconclusive. Lower BMD of the hip and its subregions was associated with hearing loss among black men, but not among whites or black women. Lower measurements on heel ultrasound were associated with conductive hearing loss, though only among white men. These results suggest that axial and appendicular bone parameters may be modestly associated with hearing loss in older men, but not in women.

Postnatal developmental expression of the PDZ scaffolds Na+-H+ exchanger regulatory factors 1 and 2 in the rat cochlea

Sensory transduction in the mammalian cochlea requires the maintenance of specialized fluid compartments with distinct ionic compositions. This is achieved by the concerted action of diverse ion channels and transporters, some of which can interact with the PDZ scaffolds, Na+-H+ exchanger regulatory factors 1 and 2 (NHERF-1, NHERF-2). Here, we report that NHERF-1 and NHERF-2 are widely expressed in the rat cochlea, and that their expression is developmentally regulated. Reverse transcription/polymerase chain reaction (RT-PCR) and Western blotting initially confirmed the RNA and protein expression of NHERFs. We then performed immunohistochemistry on cochlea during various stages of postnatal development. Prior to the onset of hearing (P8), NHERF-1 immunolabeling was prominently polarized to the apical membrane of cells lining the endolymphatic compartment, including the stereocilia and cuticular plates of the inner and outer hair cells, marginal cells of the stria vascularis, Reissner's epithelia, and tectorial membrane. With maturation (P21, P70), NHERF-1 immunolabeling was reduced in the above structures, whereas labeling increased in the apical membrane of the interdental cells of the spiral limbus and the inner and outer sulcus cells, Hensen's cells, the inner and outer pillar cells, Deiters cells, the inner border cells, spiral ligament fibrocytes, and spiral ganglion neurons (particularly type II). NHERF-1 expression in strial basal and intermediate cells was persistent. NHERF-2 immunolabeling was similar to that for NHERF-1 during postnatal development, with the exception of expression in the synaptic regions beneath the outer hair cells. NHERF-1 and NHERF-2 co-localized with glial fibrillary acidic protein and vimentin in glia. The cochlear localization of NHERF scaffolds suggests that they play important roles in the developmental regulation of ion transport, homeostasis, and auditory neurotransmission.

Comparison of cognitive screening tasks in an elderly veteran population

Screening measures of cognitive status are traditionally administered face to face. In survey research such screening mcasurcs, while desirable, must he administered by other means. As part of pilot survey research on a New Zealand war veteran population with some degree of hearing impairment, a face-to-face administration of the Mini-Mental State Examination (MMSE; Folstein, Folstein and McHugh, 1975) and a telephoneadministration of the Telephonc Interview for Cognitive Status (TICS; Brandt, Spencer and Folstein. 1988) were compared. Brandt ('/ u/. (1988) reported a very strong linear relationship between scores on the MMSE and the TICS (r=0.94, p < .0001) in an Alzheimer patient population with a mcan MMSE score of 12.06 (6.78). For a sample of 44 mildly to moderately hearing impaired veterans, with a mean MMSE score of 25.52 (2.16) and a mean TICS score of 32.52(5.43), the correlation between the instruments was .39. When veterans who wore hearing aids during the telephone interview ( N = 2 2 ) wcrc separated out from those who did not, the correlation rose to .54. Age was ncgatively correlated with the MMSE ( r = -0.41, / I < .01) and not significantly correlated with the TICS. Education level was unrelated to either measure. The data suggest that the wearing or non-wearing of hearing aids may contribute significantly to the reliability of the TICS. Furthermore, on non-demented populations with a less restricted range of scores. the correlation of the MMSE and TICS may he lower than previously reported.

Hearing and vision:the age old problem

Opticians and audiologists tend to see the same people. Many factors that are associated with poorer vision, whether hereditary, pre-natal, or post-natal, are also associated with poorer hearing. The most common factor is simply old age. According to the Royal National Institute for Deaf People (RNID), more than half of all people aged over 60 have some degree of hearing loss and are gradually losing their hearing as part of the ageing process – a process known as presbycusis.

Hearing protectors: a dilemma involving acoustics and personal safety

This thesis is concerned with the optimising of hearing protector selection. A computer model was used to estimate the reduction in noise exposure and risk of occupational deafness provided by the wearing of hearing protectors in industrial noise spectra. The model was used to show that low attenuation hearing protectors con provide greater protection than high attenuation protectors if the high attenuation protectors ore not worn for the total duration of noise exposure; or not used by a small proportion of the population. The model was also used to show that high attenuation protectors will not necessarily provide significantly greater reduction in risk than low attenuation protectors if the population has been exposed to the noise for many years prior to the provision of hearing protectors. The effects of earplugs and earmuffs on the localisation of sounds were studied to determine whether high attenuation earmuffs are likely to have greater potential than the lower attenuation earplugs for affecting personal safety. Laboratory studies and experiments at a foundry with normal-hearing office employees and noise-exposed foundrymen who had some experience of wearing hearing protectors showed that although earplugs reduced the ability of the wearer to determine the direction of warning sounds, earmuffs produced more total angular error and more confusions between left and right. !t is concluded from the research findings that the key to the selection of hearing protectors is to be found in the provision of hearing protectors that can be worn for a very high percentage of the exposure time by a high percentage of the exposed population with the minimum effect on the personal safety of the wearers - the attenuation provided by the protection should be adequate but not a maximum value.

The clinical utility of the middle latency and 40Hz auditory evoked potentials in audiological electrodiagnosis

The two elcctrophysiological tests currently favoured in the clinical measurement of hearing threshold arc the brainstorm evoked potential (BAEP) and the slow vertex response (SVR). However, both tests possess disadvantages. The BAEP is the test of choice in younger patients as it is stable at all levels of arousal, but little information has been obtained to date at a range of frequencies. The SVR is frequency specific but is unreliable in certain adult subjects and is unstable during sleep or in young children. These deficiencies have prompted research into a third group of potentials, the middle latency response (MLR) and the 40HZ responses. This research has compared the SVR and 40HZ response in waking adults and reports that the 40HZ test can provide a viable alternative to the SVR provided that a high degree of subject relaxation is ensured. A second study examined the morphology of the MLR and 40HZ during sleep. This work suggested that these potentials arc markedly different during sleep and that methodological factors have been responsible for masking these changes in previous studies. The clinical possibilities of tone pip BAEPs were then examined as these components were proved to be the only stable responses present in sleep. It was found that threshold estimates to 5OOHz, lOOOHz and 4000Hz stimuli could be made to within 15dBSL in most cases. A final study looked more closely at methods of obtaining frequency specific information in sleeping subjects. Threshold estimates were made using established BAEP parameters and this was compared to a 40HZ procedure which recorded a series of BAEPs over a 100msec. time sweep. Results indicated that the 40mHz procedure was superior to existing techniques in estimating threshold to low frequency stimuli. This research has confirmed a role for the MLR and 40Hz response as alternative measures of hearing capability in waking subjects and proposes that the 40Hz technique is useful in measuring frequency specific thresholds although the responses recorded derive primarily from the brainstem.

Foundations of an intervention package to improve communication in residential care settings:a mixed methods study

Background: The prevalence of hearing loss is considerably higher in individuals in residential care than in people within the community-dwelling population, and yet hearing aids and hearing services are relatively underused. Care staff have a key role in supporting access to services. Objectives: This study identifies staff perspectives on hearing loss and their views about potential hearing service improvements. Study design: A four-stage mixed methods study was used, made up of qualitative interviews, observation, a survey and a stakeholder involvement meeting. Results: The qualitative stages indicated that staff were concerned about their levels of interaction with residents. Staff considered maximizing communication as part of their professional role. The quantitative survey indicated that these views were widely held by staff, and the stakeholder stage identified the need for social support and dedicated staff training opportunities. Conclusion: Care home staff regard communication as a shared issue. Future interventions could enhance access to hearing services and provide care home staff with training in hearing loss and hearing aid management. © 2013 Informa Healthcare.

Illness perceptions and hearing difficulties in King-Kopetzky syndrome:what determines help seeking?

The present study explored illness perceptions of hearing difficulties amongst one hundred participants who reported experiencing hearing difficulties despite normal audiometric thresholds. This experience is referred to as King-Kopetzky syndrome (KKS), obscure auditory dysfunction (OAD), or auditory processing disorder (APD). Logistic regression was used to consider the associations between help-seeking and a range of audiological and illness perception measures. Results indicate that help-seekers present with poorer speech in noise thresholds than non help-seekers, and that coherent illness perceptions and a negative belief in the consequences of hearing difficulties are associated with help-seeking status, regardless of hearing sensitivity.

The process of coping in King-Kopetzky Syndrome

Our object was to describe the process of coping in King-Kopetzky syndrome and hypothesise how the process is mediated. We used a qualitative study using open-ended interviews. The data were gathered purposefully from 19 cases in the first phase of the study. Accounts were then compared deductively with six accounts from a previous interview-based study. Maximum contrast was sought in cases and in experience of clinical interventions. Participants were recruited from Hearing Therapy services in Bath and North East Somerset Primary Care Trust and The Welsh Hearing Institute. Interviews were conducted in participants’ homes or clinic setting. Coping was determined by the concept that the individual developed about their hearing difficulties. The process of conceptualizing involves reconciling the symptoms experienced with the information obtained from clinicians. The process is mediated by the context in which hearing difficulties occur and the interventions that are received. Forming a coherent concept of hearing difficulties facilitates coping. Clinicians can assist this process by giving patients with King-Kopetzky Syndrome an explanation of the condition.