Speech Intelligibility in Noise With a Pinna Effect Imitating Cochlear Implant Processor.

OBJECTIVE To evaluate the speech intelligibility in noise with a new cochlear implant (CI) processor that uses a pinna effect imitating directional microphone system. STUDY DESIGN Prospective experimental study. SETTING Tertiary referral center. PATIENTS Ten experienced, unilateral CI recipients with bilateral severe-to-profound hearing loss. INTERVENTION All participants performed speech in noise tests with the Opus 2 processor (omnidirectional microphone mode only) and the newer Sonnet processor (omnidirectional and directional microphone mode). MAIN OUTCOME MEASURE The speech reception threshold (SRT) in noise was measured in four spatial settings. The test sentences were always presented from the front. The noise was arriving either from the front (S0N0), the ipsilateral side of the CI (S0NIL), the contralateral side of the CI (S0NCL), or the back (S0N180). RESULTS The directional mode improved the SRTs by 3.6 dB (p < 0.01), 2.2 dB (p < 0.01), and 1.3 dB (p < 0.05) in the S0N180, S0NIL, and S0NCL situations, when compared with the Sonnet in the omnidirectional mode. There was no statistically significant difference in the S0N0 situation. No differences between the Opus 2 and the Sonnet in the omnidirectional mode were observed. CONCLUSION Speech intelligibility with the Sonnet system was statistically different to speech recognition with the Opus 2 system suggesting that CI users might profit from the pinna effect imitating directionality mode in noisy environments.

Influence of unilateral maxillary first molar extraction treatment on second and third molar inclination in Class II subdivision patients.

OBJECTIVE To assess the maxillary second molar (M2) and third molar (M3) inclination following orthodontic treatment of Class II subdivision malocclusion with unilateral maxillary first molar (M1) extraction. MATERIALS AND METHODS Panoramic radiographs of 21 Class II subdivision adolescents (eight boys, 13 girls; mean age, 12.8 years; standard deviation, 1.7 years) before treatment, after treatment with extraction of one maxillary first molar and Begg appliances and after at least 1.8 years in retention were retrospectively collected from a private practice. M2 and M3 inclination angles (M2/ITP, M2/IOP, M3/ITP, M3/IOP), constructed by intertuberosity (ITP) and interorbital planes (IOP), were calculated for the extracted and nonextracted segments. Random effects regression analysis was performed to evaluate the effect on the molar angulation of extraction, time, and gender after adjusting for baseline measurements. RESULTS Time and extraction status were significant predictors for M2 angulation. M2/ITP and M2/IOP decreased by 4.04 (95% confidence interval [CI]: -6.93, 1.16; P  =  .001) and 3.67 (95% CI: -6.76, -0.58; P  =  .020) in the extraction group compared to the nonextraction group after adjusting for time and gender. The adjusted analysis showed that extraction was the only predictor for M3 angulation that reached statistical significance. M3 mesial inclination increased by 7.38° (95% CI: -11.2, -3.54; P < .001) and 7.33° (95% CI: -11.48, -3.19; P  =  .001). CONCLUSIONS M2 and M3 uprighting significantly improved in the extraction side after orthodontic treatment with unilateral maxillary M1 extraction. There was a significant increase in mesial tipping of maxillary second molar crowns over time.

Aberrant protective force generation during neural provocation testing and the effect of treatment in patients with neurogenic cervicobrachial pain

Background: Observation of the occurrence of protective muscle activity is advocated in assessment of the peripheral nervous system by means of neural provocation tests. However, no studies have yet demonstrated abnormal force generation in a patient population. Objectives: To analyze whether aberrations in shoulder girdle-elevation force during neural tissue provocation testing for the median nerve (NTPTI) can be demonstrated, and whether possible aberrations can be normalized following cervical mobilization. Study Design: A single-blind randomized comparative controlled study. Setting: Laboratory setting annex in a manual therapy teaching practice. Participants: Twenty patients with unilateral or bilateral neurogenic cervicobrachial pain. Methods: During the NTPTI, we used a load cell and electrogoniometer to record continuously the shoulder-girdle elevation force in relation to the available range of elbow extension. Following randomization, we analyzed the immediate treatment effects of a cervical contralateral lateral glide mobilization technique (experimental group) and therapeutic ultrasound (control group). Results: On the involved side, the shoulder-girdle elevation force occur-red earlier, and the amount of force at the end of the test was substantially, though not significantly, greater than that on the uninvolved side at the corresponding range of motion. Together with a significant reduction in pain perception after cervical mobilization, a clear tendency toward normalization of the force curve could be observed, namely, a significant decrease in force generation and a delayed onset. The control group demonstrated no differences. Conclusions: Aberrations in force generation during neural, provocation testing are present in patients with neurogenic pain and can be normalized with appropriate treatment modalities.

Neck flexor muscle fatigue is side specific in patients with unilateral neck pain

Despite the evidence of greater fatigability of the cervical flexor muscles in neck pain patients, the effect of unilaterality of neck pain on muscle fatigue has not been investigated. This study compared myoelectric manifestations of sternocleidomastoid (SCM) and anterior scalene (AS) muscle fatigue between the painful and non-painful sides in patients with chronic unilateral neck pain. Myoelectric signals were recorded from the sternal head of SCM and the AS muscles bilaterally during sub-maximal isometric cervical flexion contractions at 25% and 50% of the maximum voluntary contraction (MVC). The time course of the mean power frequency, average rectified value and conduction velocity of the electromyographic signals were calculated to quantify myoelectric manifestations of muscle fatigue. Results revealed greater estimates of the initial value and slope of the mean frequency for both the SCM and AS muscles on the side of the patient's neck pain at 25% and 50% of MVC. These results indicate greater myoelectric manifestations of muscle fatigue of the superficial cervical flexor muscles ipsilateral to the side of pain. This suggests a specificity of the effect of pain on muscle function and hence the need for specificity of therapeutic exercise in the management of neck pain patients. (C) 2003 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All rights reserved.

"mind the gap": The size-distance dissociation in visual neglect is a cueing effect

There is a growing body of evidence that the processes mediating the allocation of spatial attention within objects may be separable from those governing attentional distribution between objects. In the neglect literature, a related proposal has been made regarding the perception of (within-object) sizes and (between-object) distances. This proposal follows observations that, in size-matching and bisection tasks, neglect is more strongly expressed when patients are required to attend to the sizes of discrete objects than to the (unfilled) distances between objects. These findings are consistent with a partial dissociation between size and distance processing, but a simpler alternative must also be considered. Whilst a neglect patient may fail to explore the full extent of a solid stimulus, the estimation of an unfilled distance requires that both endpoints be inspected before the task can be attempted at all. The attentional cueing implicit in distance estimation tasks might thus account for their superior performance by neglect patients. We report two bisection studies that address this issue. The first confirmed, amongst patients with left visual neglect, a reliable reduction of rightward error for unfilled gap stimuli as compared with solid lines. The second study assessed the cause of this reduction, deconfounding the effects of stimulus type (lines vs. gaps) and attentional cueing, by applying an explicit cueing manipulation to line and gap bisection tasks. Under these matched cueing conditions, all patients performed similarly on line and gap bisection tasks, suggesting that the reduction of neglect typically observed for gap stimuli may be attributable entirely to cueing effects. We found no evidence that a spatial extent, once fully attended, is judged any differently according to whether it is filled or unfilled.

The effect of depression on balance decline in mature women

Depression has been identified as a risk factor for falls, and a change in balance ability over time has yet to be investigated. This study aimed to identify if, over a 3-year period, balance ability changed in 26 women who were on medication for depression, compared to 26 non-depressed women. The two groups were matched for age, number of co-morbidities, activity level, medications, and height. All participants were simultaneously enrolled in a larger, longitudinal study of ageing. Balance measures included the Functional Reach (FR) test, Lateral Reach (LR) test, Step Test (ST), Timed Up and Go, and the Modified Clinical Test of Sensory Integration and Balance, Unilateral Stance (ULS) and Limit of Stability (LOS) laboratory tests. Results showed a significant difference between the groups on ST, right ULS (eyes closed) and forward end point excursion of the LOS. There was no difference in the number of falls between groups. Analysis of the depressed group alone showed that right FR declined significantly and left and right LR tended towards decline, but not differently between groups. There was no between-group differences for these measures. There was no significant decline in non-depressed women for any measurement. Depressed women have less ability to maintain their balance than non-depressed women, and should be encouraged to participate in appropriate activities known to improve or maintain balance.

The effect of disfiguring features on covert and overt attention to faces

It is well documented that facial disfigurements can generate avoidance responses in observers towards the afflicted person, yet less is known about the effect of a facial disfigurement on attention to and perception of faces. In two experiments we studied overt and covert attention to laterally presented face stimuli when these contained a unilateral disfiguring feature (a simulated portwine stain), an occluding feature, or no salient feature. In Experiment 1, observers’ eye movements were tracked while they explored laterally presented faces which they had to rate for attractiveness. Overt attention, as measured by the patterns of fixations on the face, was found to be significantly affected by the presence of a facial disfigurement or an occluder. In Experiment2, we used a covert orienting task with bilaterally presented target and distractor to measure the interference effect induced by a distractor face (disfigured, occluded, or normal) on a non facetarget discrimination task. The presence of a face increased response times to the target stimulus,but this interference was not modulated by the presence of a salient feature (disfigurement or occluder). Together, these results suggest that the presence of salient features affect overt but not the covert processing of faces.

Effects of unilateral visual deprivation on the developing avian brain

The effect of varying states of visual deprivation on the development of the optic lobes and cerebral hemispheres has been studied in the chick where the visual pathways are totally crossed over. Unilateral eye extirpation of the new hatched chick resulted in arrested development of the contralateral but not ipsilateral lobe, as measured by weight, protein content and acetylcholinesterase activity. Similar effects but of smaller magnitude were observed in the cerebral hemispheres. Histologic and enzymic evidence revealed the absence of significant degeneration in the optic lobe contralateral to an eye removed 17 days previously. These results were observed in the optic lobes of operated animals maintained either in light of in darkness between 3 and 17 days after hatch. However, in the inpaired cerebral hemispheres, differences could only be detected in birds kept the light. The effects of unilateral eyelid suturing on the development of chick brain regions were also examined. In this group, all asymmetrical differences observed within paired brain regions were totally light dependent and confined to the cerebral hemispheres. The hemisphere contralateral to the sutured eye weighed less and had less acetylcholinesterase activity than its paired hemisphere. The cerebral hemispheres of monocularly treated birds manifested effects of similar magnitude whether the treatment was enucleation or suturing. This suggests that the complete development of the associative centers in avian cerebral hemispheres is dependent on both intact innervation and on the information content of the visual input. © 1969.

Stapedotomy and its effect on hearing – our experience with 54 cases.

Introduction: This study reviews the cases of stapedotomy and evaluates its effectiveness at improving hearing loss in patients with otosclerosis. Materials and methods: Retrospective review of patients’ records who had clinical and audiometric diagnosis of otosclerosis from January to December 2012. Results: A total of 54 stapedotomy surgeries (52 unilateral and 1 bilateral surgeries) were received. Average post-operative ABG for 0.5, 1, 2 and 4 KHz showed that 61.1% had complete closure of ABG (ABG < 10 dB) compared with 1.6% preoperatively and 85.2% had closure of ABG to within 20dB compared with 4.7% preoperatively (t – 13.89, p = 0.000). More than 94% had hearing improvement and 81.5% had ABG closure greater than 10 dB postoperatively (mean gain 23.38 ± 12.37, t = 13.89, p = 0.000). A total of 13% complications were recorded with TM perforation (5.6%) being the commonest complication. Conclusion: Stapedotomy is an effective surgical procedure for the treatment of otosclerosis which leads to improvement in patients’ quality of life. A favorable hearing outcome can be obtained by the combination of experienced hands with minimal surgical trauma and appropriate surgical technique.