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  • 机译 朝优化cVEMP迈进:2000 Hz的音调爆破改善了上运河开裂的检测
    摘要:BackgroundThe cervical vestibular evoked myogenic potential (cVEMP) test measures saccular and inferior vestibular nerve function. The cVEMP can be elicited with different frequency stimuli and interpreted using a variety of metrics. Patients with superior semicircular canal dehiscence (SCD) syndrome generally have lower cVEMP thresholds and larger amplitudes, although there is overlap with healthy subjects. The aim of this study was to evaluate which metric and frequency best differentiate healthy ears from SCD ears using cVEMP.
  • 机译 视觉模拟量表作为耳鸣严重性初步评估的工具:临床人群的心理计量学评估
    摘要:The aim of this study was to evaluate the psychometric properties of patient-reported visual analogue scale (VAS) ratings. All of the participants (100 Polish-speaking adults) completed a Tinnitus Functional Index (TFI) once and a 4-component VAS twice over a period of 3 days. Spearman's correlation coefficients between the VAS score and global TFI ranged from ρ = 0.52 for VAS-coping (VAS-C) to ρ = 0.81 for VAS-annoyance (VAS-A). Using the Bland-Altman method, the agreement ranged from 93% for VAS-A to 96% for VAS-distress (VAS-D). Interclass correlation coefficients ranged from 0.67 for VAS-C to 0.90 for VAS-A. The VAS cutoff points representing significant tinnitus severity ranged from 45 points for VAS-C to 66 points for VAS-D. VAS scales are a valid and reliable brief screening tool for obtaining quick information about tinnitus.
  • 机译 成年人工耳蜗使用者的声音变化复合体反映的频率变化的皮层处理
    摘要:The purpose of this study was to examine neural substrates of frequency change detection in cochlear implant (CI) recipients using the acoustic change complex (ACC), a type of cortical auditory evoked potential elicited by acoustic changes in an ongoing stimulus. A psychoacoustic test and electroencephalographic (EEG) recording were administered in 12 post-lingually deafened adult CI users. The stimuli were pure tones containing different magnitudes of upward frequency changes. Results showed that the frequency change detection threshold (FCDT) was 3.79% in the CI users, with a large variability. The ACC N1’ latency was significantly correlated to the FCDT and the clinically collected speech perception score. The results suggested that the ACC evoked by frequency changes can serve as a useful objective tool in assessing frequency change detection capability and predicting speech perception performance in CI users.
  • 机译 主动中耳听力植入物的最低报告标准
    摘要:There is currently no standardized method for reporting audiological, surgical and subjective outcome measures in clinical trials with active middle ear implants (AMEIs). It is often difficult to compare studies due to data incompatibility and to perform meta-analyses across different centres is almost impossible. A committee of ENT and audiological experts from Germany, Austria and Switzerland decided to address this issue by developing new minimal standards for reporting the outcomes of AMEI clinical trials. The consensus presented here aims to provide a recommendation to enable better inter-study comparability.
  • 机译 早期失聪成年人的晚期人工耳蜗植入:听觉和自我感觉到的好处的详细分析
    摘要:ObjectivesIt is known that early-deafened cochlear implant (CI) users are a very heterogeneously performing group. To gain more insight into this population, this study investigated (1) postoperative changes in auditory performance over time based on various outcome measures, focusing on poor performers, (2) self-perceived outcomes, (3) relations between auditory and self-perceived outcomes, and (4) preimplantation factors predicting postoperative outcomes.
  • 机译 致力于优化VEMP:归一化减少了强壮颈肌收缩的需要
    摘要:BackgroundThe cervical vestibular evoked myogenic potential (cVEMP) represents an inhibitory reflex of the saccule measured in the ipsilateral sternocleidomastoid muscle (SCM) in response to acoustic or vibrational stimulation. Since cVEMP is a modulation of SCM electromyographic (EMG) activity, cVEMP amplitude is proportional to muscle EMG amplitude. We sought to evaluate muscle contraction influences on cVEMP peak-to-peak amplitudes (VEMPpp), normalized cVEMP amplitudes (VEMPn) and inhibition depth (VEMPid).
  • 机译 成人人工耳蜗植入患者的相关益处:多元文化纵向观察研究
    摘要:ObjectivesTo assess subjectively perceived, real-world benefits longitudinally for unilateral cochlear implant (CI) recipients in a multinational population treated routinely. To identify possible predictors of self-reported benefits.
  • 机译 建立单侧耳聋研究的统一测试框架:共识文件
    摘要:BackgroundWhile hearing aids for a contralateral routing of signals (CROS-HA) and bone conduction devices have been the traditional treatment for single-sided deafness (SSD) and asymmetric hearing loss (AHL), in recent years, cochlear implants (CIs) have increasingly become a viable treatment choice, particularly in countries where regulatory approval and reimbursement schemes are in place. Part of the reason for this shift is that the CI is the only device capable of restoring bilateral input to the auditory system and hence of possibly reinstating binaural hearing. Although several studies have independently shown that the CI is a safe and effective treatment for SSD and AHL, clinical outcome measures in those studies and across CI centers vary greatly. Only with a consistent use of defined and agreed-upon outcome measures across centers can high-level evidence be generated to assess the safety and efficacy of CIs and alternative treatments in recipients with SSD and AHL.
  • 机译 回顾性多中心队列研究的患者特征和手术方面与完全可植入活动中耳植入物的接受者的长期结果
    摘要:ObjectiveTo summarise treatment outcomes compared to surgical and patient variables for a multicentre recipient cohort using a fully implantable active middle ear implant for hearing impairment. To describe the authors' preferred surgical technique to determine microphone placement.
  • 机译 Waardenburg综合征患者的小儿人工耳蜗植入
    摘要:ObjectiveTo analyse the benefit of cochlear implantation in young deaf children with Waardenburg syndrome (WS) compared to a reference group of young deaf children without additional disabilities.
  • 机译 p114L COCH突变(DFNA9)中人内耳的组织病理学
    摘要:The histopathology of the inner ear in a patient with hearing loss caused by the p.L114P COCH mutation and correlation with the clinical phenotype are presented. To date, 23 COCH mutations causative of DFNA9 autosomal dominant sensorineural hearing loss and vestibular disorder have been reported, and the histopathology of the human inner ear has been described in four of these. The p.L114P COCH mutation was first described by in a Korean family. We have identified the same mutation in a family of non-Asian ancestry in the United States, and the temporal bone histopathology and clinical findings are presented herein. The histopathology found in the inner ear was similar to that shown in the four other COCH mutations and included degeneration of the spiral ligament with deposition of an eosinophilic acellular material, which was also found in the distal osseous spiral lamina, at the base of the spiral limbus and in mesenchymal tissue at the base of the vestibular neuroepithelium. This is the first description of human otopathology of the COCH p.L114P mutation. In addition, it is the only case with otopathology characterization in an individual with any COCH mutation and with residual hearing, therefore allowing assessment of primary histopathological events in DFNA9, before progression to more profound hearing loss. A quantitative cytologic analysis of atrophy in this specimen and immunostaining using anti-neurofilament and anti-myelin protein zero antibodies confirmed that the principal histopathologic correlate of hearing loss was degeneration of the dendritic fibers of spiral ganglion cells in the osseous spiral lamina. The implications for cochlear implantation in this disorder are discussed.
  • 机译 通过圆窗膜进行耳蜗内药物注射:改善药物滞留的措施
    摘要:The goal of this study was to develop appropriate methodology to apply drugs quantitatively to perilymph of the ear. Intratympanic applications of drugs to the inner ear often result in variable drug levels in perilymph and can only be used for molecules that readily permeate the round window (RW) membrane. Direct intracochlear and intralabyrinthine application procedures for drugs, genes or cell-based therapies by-pass the tight boundaries at the round window, oval window, otic capsule and the blood-labyrinth barrier. However, perforations can release inner ear pressure, allowing cerebrospinal fluid to enter through the cochlear aqueduct, displacing the injected drug solution into the middle ear. Two markers, fluorescein or fluorescein isothiocyanate (FITC)-labeled dextran, were used to quantify how much of an injected substance was retained in cochlear perilymph following an intracochlear injection. We evaluated whether procedures to mitigate fluid leaks improved marker retention in perilymph. Almost all procedures to reduce volume efflux, including the use of gel for internal sealing and glue for external sealing of the injection site, resulted in improved retention of the marker in perilymph. Adhesive on the RW membrane effectively prevented leaks but also influenced fluid exchange between CSF and perilymph. We conclude that drugs can be delivered to the ear in a consistent, quantitative manner using intracochlear injections if care is taken to control the fluid leaks that result from cochlear perforation.
  • 机译 带有和不带有对称低频听觉的听力保护患者的声源定位
    摘要:The aim of this paper was to study sound source localization by cochlear implant (CI) listeners with low-frequency (LF) acoustic hearing in both the operated ear and in the contralateral ear. Eight CI listeners had symmetrical LF acoustic hearing (symm) and four had asymmetric LF acoustic hearing (asymm). The effects of two variables were assessed: (i) the symmetry of the LF thresholds in the two ears and (ii) the presence/absence of bilateral acoustic amplification. Stimuli consisted of low-pass, high pass, and wide-band noise bursts presented in the frontal horizontal plane. Localization accuracy was 23 degrees of error for the symm listeners and 76 degrees of error for the asymm listeners. The presence of a unilateral CI used in conjunction with bilateral LF acoustic hearing does not impair sound source localization accuracy, but amplification for acoustic hearing can be detrimental to sound source localization accuracy.
  • 机译 评估上管开裂位置和大小对耳蜗内声压的影响
    摘要:Superior canal dehiscence (SCD) is a defect in the bony covering of the superior semicircular canal. Patients with SCD present with a wide range of symptoms, including hearing loss, yet it is unknown whether hearing is affected by parameters such as the location of the SCD. Our previous human cadaveric temporal bone study, utilizing intracochlear pressure measurements, generally showed that an increase in dehiscence size caused a low-frequency monotonic decrease in the cochlear drive across the partition, consistent with increased hearing loss. This previous study was limited to SCD sizes including and smaller than 2 mm long and 0.7 mm wide. However, the effects of larger SCDs (>2 mm long) were not studied, although larger SCDs are seen in many patients. Therefore, to answer the effect of parameters that have not been studied, this present study assessed the effect of SCD location and the effect of large-sized SCD (>2 mm long) on intracochlear pressures. We used simultaneous measurements of sound pressures in scala vestibuli and scala tympani at the base of the cochlea to determine the sound-pressure difference across the cochlear partition – a measure of the cochlear drive in a temporal bone preparation – allowing for assessment of hearing loss. We measured the cochlear drive before and after SCDs were made at different locations (e.g., closer to the ampulla of the superior semicircular canal or closer to the common crus), and for different dehiscence sizes (including larger than 2 mm long and 0.7 mm wide). Our measurements suggest that: 1) Different SCD locations result in similar cochlear drive; 2) Larger SCDs produce larger decreases in cochlear drive at low frequencies. However, the effect of SCD size seems to saturate as the size increases above 2–3 mm long and 0.7 mm wide. Although the monotonic effect was generally consistent across ears, the quantitative amount of change in cochlear drive due to dehiscence size varied across ears. Additionally, the size of the dehiscence above which the effect on hearing saturated, varied across ears. These findings show that the location of the SCD does not generally influence the amount of hearing loss and that SCD size can help explain some of the variability of hearing loss in patients.
  • 机译 听觉脑干植入后儿童听觉知觉的发展
    摘要:Auditory brainstem implants (ABI) can provide useful auditory perception and language development in deaf children who are not able to use a cochlear implant (CI). We prospectively followed-up a consecutive group of 64 deaf children up to 12 years following ABI implantation. The etiology of deafness in these children was: cochlear nerve aplasia in 49, auditory neuropathy in 1, cochlear malformations in 8, bilateral cochlear post-meningitic ossification in 3, NF2 in 2, and bilateral cochlear fractures due to a head injury in 1. Thirty five children had other congenital non-auditory disabilities. Twenty two children had previous CIs with no benefit. Fifty eight children were fitted with the Cochlear 24 ABI device and six with the MedEl ABI device and all children followed the same rehabilitation program. Auditory perceptual abilities were evaluated on the Categories of Auditory Performance (CAP) scale. No child was lost to follow-up and there were no exclusions from the study. All children showed significant improvement in auditory perception with implant experience. Seven children (11%) were able to achieve the highest score on the CAP test; they were able to converse on the telephone within 3 years of implantation. Twenty children (31.3%) achieved open set speech recognition (CAP score of 5 or greater) and 30 (46.9%) achieved a CAP level of 4 or greater. Of the 29 children without non-auditory disabilities, 18 (62%) achieved a CAP score of 5 or greater with the ABI. All children showed continued improvements in auditory skills over time. The long-term results of ABI implantation reveal significant auditory benefit in most children, and open set auditory recognition in many.
  • 机译 鼓膜内应用的水凝胶为高糖皮质激素剂量的输送而持续释放曲安西龙乙酰丙酮。
    摘要:The pharmacokinetic properties and tolerability of a triamcinolone acetonide poloxamer 407 hydrogel for intratympanic application were investigated in a guinea pig model. Evaluation of in vivo release kinetics showed very high initial perilymph drug levels, with clinically relevant levels present for a minimum of 10 days. Assessment of auditory brainstem response thresholds showed a minimal, delayed and transient threshold shift, which was apparent on day 3 and resolved by day 10. No relevant histological changes of the middle and inner ear structures were noted, and hair cell counts showed no significant differences between treated and untreated ears. Thus, the triamcinolone-acetonide-loaded poloxamer 407 hydrogel is an effective vehicle for sustained high-dose inner ear glucocorticoid delivery.
  • 机译 双峰听觉的好处:频率区域和声带宽的影响
    摘要:We examined the effects of acoustic bandwidth on bimodal benefit for speech recognition in adults with a cochlear implant (CI) in one ear and low-frequency acoustic hearing in the contralateral ear. The primary aims were to (1) replicate with a steeper filter roll-off to examine the low-pass bandwidth required to obtain bimodal benefit for speech recognition and expand results to include different signal-to-noise ratios (SNRs) and talker genders, (2) determine whether the bimodal benefit increased with acoustic low-pass bandwidth and (3) determine whether an equivalent bimodal benefit was obtained with acoustic signals of similar low-pass and pass band bandwidth, but different center frequencies. Speech recognition was assessed using words presented in quiet and sentences in noise (+10, +5 and 0 dB SNRs). Acoustic stimuli presented to the nonimplanted ear were filtered into the following bands: <125, 125–250, <250, 250–500, <500, 250–750, <750 Hz and wide-band (full, nonfiltered bandwidth). The primary findings were: (1) the minimum acoustic low-pass bandwidth that produced a significant bimodal benefit was <250 Hz for male talkers in quiet and for female talkers in multitalker babble, but <125 Hz for male talkers in background noise, and the observed bimodal benefit did not vary significantly with SNR; (2) the bimodal benefit increased systematically with acoustic low-pass bandwidth up to <750 Hz for a male talker in quiet and female talkers in noise and up to <500 Hz for male talkers in noise, and (3) a similar bimodal benefit was obtained with low-pass and band-pass-filtered stimuli with different center frequencies (e.g. <250 vs. 250–500 Hz), meaning multiple frequency regions contain useful cues for bimodal benefit. Clinical implications are that (1) all aidable frequencies should be amplified in individuals with bimodal hearing, and (2) verification of audibility at 125Hz is unnecessary unless it is the only aidable frequency.
  • 机译 全身应用后鳞片鼓膜周围淋巴液中庆大霉素的浓度梯度
    摘要:In prior studies it was shown that round window membrane (RWM) application of gentamicin produced a robust baso-apical concentration gradient in the perilymph of scala tympani (ST) with peak concentrations in the basal turn of ST. These gradients potentially contribute to the clinical efficacy and safety of intratympanic gentamicin applications for the treatment of Meniere’s disease. The present study aimed to establish the distribution of gentamicin along ST perilymph after systemic applications.Gentamicin sulfate was applied intravenously in the amounts of 100, 300 and 600 mg/kg/bw over a period of three hours or as a 300 mg/kg/bw subcutaneous bolus injection. Three and five hours after the start of the application perilymph of ST was aspirated from the cochlea apex of the right and left cochlea, respectively. Ten sequential 1 μL-perilymph samples from the apex of each cochlea were quantitatively analyzed using a fluorescence polarization immunoassay.In contrast to local RWM delivery, systemic application of gentamicin resulted in highest perilymph levels in the apex of the cochlea with decreasing concentrations towards the basal regions of ST. The absolute gentamicin concentrations increased with amount of drug applied and time before sampling.While the basal-apical gradient measured after local drug applications to the RW niche is likely the result of the direct uptake of drugs into the perilymph of the ST, distribution by diffusion and a very low perilymph flow towards the cochlear apex, computer simulations suggested that the apical-basal gradient observed with these systemic applications can be explained by higher entry rates of gentamicin in the apex compared to the basal turns of the cochlea. It is also possible that gentamicin enters perilymph indirectly from blood via the endolymph. In this case the faster kinetics in apical turns could be due to the smaller cross-sectional area of scala tympani relative to endolymph in the apical turns.
  • 机译 在童年时期接受耳蜗植入的聋哑儿童青少年和年轻人的长期语音和语言结局
    摘要:This study investigated long-term speech and language outcomes in 51 prelingually deaf children, adolescents, and young adults who received cochlear implants (CIs) prior to 7 years of age and used their implants for at least 7 years. Average speech perception scores were similar to those found in prior research with other samples of experienced CI users. Mean language test scores were lower than norm-referenced scores from nationally representative normal-hearing, typically-developing samples, although a majority of the CI users scored within one standard deviation of the normative mean or higher on the Peabody Picture Vocabulary Test, Fourth Edition (63%) and Clinical Evaluation of Language Fundamentals, Fourth Edition (69%). Speech perception scores were negatively associated with a meningitic etiology of hearing loss, older age at implantation, poorer pre-implant unaided pure tone average thresholds, lower family income, and the use of Total Communication. Users of CIs for 15 years or more were more likely to have these characteristics and were more likely to score lower on measures of speech perception compared to users of CIs for 14 years or less. The aggregation of these risk factors in the > 15 years of CI use subgroup accounts for their lower speech perception scores and may stem from more conservative CI candidacy criteria in use at the beginning of pediatric cochlear implantation.
  • 机译 人工耳蜗植入者螺距轮廓变化的皮质编码:失配负性研究。
    摘要:A better understanding of melodic pitch perception in cochlear implants (CIs) may guide signal processing and/or rehabilitation techniques to improve CI patients' music perception and appreciation. In this study, the mismatch negativity (MMN) in response to infrequent changes in five-tone pitch contours was obtained in CI users and normal hearing (NH) listeners. Melodic contour identification (MCI) was also measured. Results showed that MCI performance was poorer in CI subjects than in NH subjects; The MMNs were missing in all CI subjects for the 1-semitone contours. The MMNs with the 5-semitone contours were observed in a smaller proportion of CI subjects than in NH subjects. Results suggest that encoding of pitch contour changes in CI users appears to be degraded, most likely due to the limited pitch cues provided by the CI and deafness-related compromise of brain substrates.

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