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Digital Therapeutics in Hearing Healthcare: Evidence-Based Review. 听力保健中的数字疗法:基于证据的综述。
IF 1.1 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-07-01 Epub Date: 2024-07-09 DOI: 10.7874/jao.2023.00780
Noori Kim, Keisuke Alexander Nakamura

Digital therapeutics (DTx) in hearing research have emerged as a new category of therapies providing evidence-based intervention via digital means, such as software, smartphone apps, or websites. However, although relatively new, they are not well-established. In this article, we review DTx technologies in hearing research fields, focusing on three categories: prevention and diagnosis, aid (assistance), and cure (digital medicine). We observe that most DTx systems require interactions with users (or patients) without the direct support of clinical professionals to obtain or collect medical evidence; this makes training (or education) features crucial to the therapy's success. In this view, this article discusses the education or training functions of the current DTx and their contribution and purposes. The impact of emerging artificial intelligence (AI) on DTx in hearing research is being explored, and the future of DTx concerning AI integration is being discussed. We believe that this work will contribute to a better understanding of the current and future DTx technological advancements and, in particular, shed light on the field of hearing research.

听力研究中的数字疗法(DTx)是通过软件、智能手机应用程序或网站等数字手段提供循证干预的一类新疗法。然而,尽管这些疗法相对较新,但尚未得到广泛认可。本文回顾了听力研究领域的 DTx 技术,重点关注三个类别:预防和诊断、援助(辅助)和治疗(数字医学)。我们注意到,大多数 DTx 系统需要与用户(或患者)互动,而不需要临床专业人员的直接支持来获取或收集医学证据;这使得培训(或教育)功能对疗法的成功至关重要。有鉴于此,本文将讨论当前 DTx 的教育或培训功能及其贡献和目的。本文探讨了新兴人工智能(AI)在听力研究中对 DTx 的影响,并讨论了 DTx 与 AI 整合的未来。我们相信,这项工作将有助于更好地理解当前和未来的 DTx 技术进步,特别是为听力研究领域带来启示。
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引用次数: 0
Current Issues With Pediatric Cochlear Implantation 小儿人工耳蜗植入的当前问题
IF 1.1 Q2 Health Professions Pub Date : 2024-04-10 DOI: 10.7874/jao.2024.00073
Donald Tan, R. Fujiwara, Kenneth H. Lee
Cochlear implants (CIs) have demonstrated a clear functional benefit in children with severe-to-profound sensorineural hearing loss (SNHL) and thus have gained wide acceptance for treating deafness in the pediatric population. When evaluating young children for cochlear implantation, there are unique considerations beyond the standard issues addressed during surgery in adults. Because of advances in genetic testing, imaging resolution, CI technology, post-implant rehabilitation, and other factors, issues related to CI surgery in children continue to evolve. Such factors have led to changes in candidacy guidelines, vaccine requirements, and lowering of age requirement for surgery. In addition, differences in the anatomy and physiology of infants require special attention to ensure safety when operating on young children. This review summarizes these issues and provides guidance for surgeons treating children with SNHL.
人工耳蜗(CI)对重度至聋人感音神经性听力损失(SNHL)儿童的功能明显有益,因此在治疗儿童耳聋方面获得了广泛认可。在对幼儿进行人工耳蜗植入评估时,除了成人手术中的标准问题外,还有一些独特的考虑因素。由于基因检测、成像分辨率、CI 技术、植入后康复等方面的进步,与儿童 CI 手术相关的问题也在不断发展。这些因素已导致候选指南、疫苗要求和手术年龄要求的降低。此外,婴儿的解剖和生理差异也需要特别注意,以确保幼儿手术的安全性。本综述总结了这些问题,并为外科医生治疗 SNHL 儿童提供指导。
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引用次数: 0
Clinical Applications of Intracochlear Electrocochleography in Cochlear Implant Users With Residual Acoustic Hearing 人工耳蜗植入者残余听力的蜗内耳电图临床应用
IF 1.1 Q2 Health Professions Pub Date : 2024-04-10 DOI: 10.7874/jao.2024.00129
Jeong-Seo Kim
We herein review the use of electrocochleography (ECoG) to assess peripheral auditory system responsiveness in a growing population of cochlear implant (CI) users with preserved hearing in ears with implants. Twenty-eight recently published intracochlear ECoG articles were thoroughly reviewed to investigate the prognostic utility of intraoperative ECoG monitoring to assess hearing preservation, and the clinical applicability of postoperative ECoG for estimating audiometric thresholds and monitoring longitudinal changes in residual acoustic hearing in patients with EAS. Intraoperative ECoG studies have focused on monitoring the changes in the cochlear microphonics (CM) amplitudes during and after electrode insertion. Mixed results have been reported regarding the relationship between changes in CM amplitude in the operating room and changes in hearing thresholds after surgery. Postoperative ECoG studies have shown that CM and auditory nerve neurophonics thresholds correlate significantly with behavioral thresholds. ECoG thresholds sensitively detect changes as residual acoustic hearing decreases over time in some CI users. This indicates its potential clinical value for monitoring the post-implantation status of the peripheral auditory system. Intracochlear ECoG can provide real-time intraoperative feedback and monitor postoperative hearing preservation in a growing population of CI users.
越来越多的人工耳蜗 (CI) 用户在植入人工耳蜗后听力得到了保留,我们在此回顾了使用耳蜗内电子耳电图 (ECoG) 评估外周听觉系统反应能力的情况。我们对最近发表的28篇耳蜗内ECoG文章进行了全面审查,以研究术中ECoG监测对评估听力保存的预后效用,以及术后ECoG对估算听阈和监测EAS患者残余听力纵向变化的临床适用性。术中心电图研究的重点是监测电极插入期间和之后耳蜗微音(CM)振幅的变化。关于手术室中 CM 振幅的变化与术后听阈变化之间的关系,研究结果不一。术后心电图研究表明,CM 和听神经神经音阈值与行为阈值有显著相关性。心电图阈值能灵敏地检测出一些人工耳蜗使用者的残余听力随时间推移而下降的变化。这表明它在监测外周听觉系统植入后的状态方面具有潜在的临床价值。耳蜗内心电图可提供实时术中反馈,并监测越来越多 CI 用户的术后听力保护情况。
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引用次数: 0
The Role of Measuring Preoperative Social Maturation Score in Children With Additional Needs Who Underwent Cochlear Implantation 测量术前社交成熟度评分对接受人工耳蜗植入术的有额外需求儿童的作用
IF 1.1 Q2 Health Professions Pub Date : 2024-04-10 DOI: 10.7874/jao.2024.00101
Ji Won Choi, Yun Ji Lee, W. Kang, J. Ahn, Hong Ju Park, Jong Woo Chung
Background and Objectives: Additional needs refer to specific requirements or support for individuals with disabilities or syndromes. Intellectual ability is a crucial outcome determinant of a cochlear implant. The social quotient (SQ) is an indirect predictor of intellectual capacity and social skills. This study aimed to investigate the clinical significance of the SQ on children with additional needs who received cochlear implants. Subjects andMethods: This study included 24 patients with diagnosed developmental delays and syndromes, who demonstrated SQ scores of <70. Preoperative social skills were evaluated using the SQ. All patients underwent cochlear implantation (CI) surgery before 7 years of age. Outcomes were evaluated using the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and Categories of Auditory Performance (CAP) scores. Data were collected through a retrospective chart review.Results: Children were categorized into three groups based on their SQ. There were no correlations between the preoperative SQ and IT-MAIS or CAP scores at 2 and 5 years of follow-up postoperatively. The CI outcomes of children with low SQ (<70) differed from those with normal development (SQ>70). In the low-SQ group, inner ear anomalies were observed in 10 (41.7%) patients. Although not statistically significant, these children exhibited a trend of lower average outcomes than children without inner ear anomalies.Conclusions: CI outcomes in children with additional needs positively affected auditory performance. Postoperative auditory and language skills tended to improve slowly in children with additional needs and a lower SQ. Over time, development gradually became more comparable to the other groups of children. However, this improvement was less than that observed in children without additional needs. Our findings support CI for children with additional needs as part of long-term auditory rehabilitation following surgery.
背景和目标:额外需求是指对残疾或综合症患者的特殊要求或支持。智力是决定人工耳蜗植入效果的关键因素。社交商数(SQ)是智力和社交能力的间接预测指标。本研究旨在调查社交商数对接受人工耳蜗植入的有额外需求儿童的临床意义。研究对象和方法:本研究包括 24 名确诊为发育迟缓和综合症的患者,他们的 SQ 评分均为 70 分。)在低 SQ 组中,有 10 名患者(41.7%)出现内耳异常。虽然没有统计学意义,但与没有内耳异常的儿童相比,这些儿童的平均治疗效果呈下降趋势:结论:有额外需求的儿童的 CI 结果对听觉表现有积极影响。有额外需求且 SQ 较低的儿童的术后听觉和语言技能往往改善缓慢。随着时间的推移,他们的发展逐渐与其他组别的儿童相当。但是,这种改善程度低于无额外需求儿童。我们的研究结果支持对有额外需求的儿童进行 CI,作为术后长期听觉康复的一部分。
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引用次数: 0
Updates on Genetic Hearing Loss: From Diagnosis to Targeted Therapies 遗传性听力损失的最新进展:从诊断到靶向治疗
IF 1.1 Q2 Health Professions Pub Date : 2024-04-10 DOI: 10.7874/jao.2024.00157
Y. Yun, Sang-Yeon Lee
Sensorineural hearing loss (SNHL) is the most common sensory disorder, with a high Mendelian genetic contribution. Considering the genotypic and phenotypic heterogeneity of SNHL, the advent of next-generation sequencing technologies has revolutionized knowledge on its genomic architecture. Nonetheless, the conventional application of panel and exome sequencing in real-world practice is being challenged by the emerging need to explore the diagnostic capability of whole-genome sequencing, which enables the detection of both noncoding and structural variations. Small molecules and gene therapies represent good examples of how breakthroughs in genetic understanding can be translated into targeted therapies for SNHL. For example, targeted small molecules have been used to ameliorate autoinflammatory hearing loss caused by gain-of-function variants of NLRP3 and inner ear proteinopathy with OSBPL2 variants underlying dysfunctional autophagy. Strikingly, the successful outcomes of the first-in-human trial of OTOF gene therapy highlighted its potential in the treatment of various forms of genetic hearing loss. clustered regularly interspaced short palindromic repeats (CRISPR)-based technologies are currently being developed for site-specific genome editing to treat human genetic disorders. These advancements have led to an era of genotype- and mechanism-based precision medicine in SNHL practice.
感音神经性听力损失(SNHL)是最常见的感官疾病,具有很高的孟德尔遗传率。考虑到感音神经性听力损失的基因型和表型异质性,新一代测序技术的出现彻底改变了人们对其基因组结构的认识。然而,在现实世界中,传统的面板测序和外显子组测序正受到挑战,因为人们需要探索全基因组测序的诊断能力,因为全基因组测序可以检测非编码变异和结构变异。小分子药物和基因疗法是遗传学方面的突破性进展如何转化为 SNHL 靶向疗法的良好范例。例如,靶向小分子药物已被用于改善由 NLRP3 功能增益变异引起的自身炎症性听力损失,以及由 OSBPL2 变异引起的内耳蛋白病,其根本原因是自噬功能障碍。引人注目的是,OTOF 基因疗法首次人体试验的成功结果突显了它在治疗各种形式的遗传性听力损失方面的潜力。目前正在开发基于聚类规则间隔短回文重复序列(CRISPR)的技术,用于治疗人类遗传疾病的特定位点基因组编辑。这些技术的进步使基于基因型和机理的精准医疗时代在遗传性听力损失的实践中到来。
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引用次数: 0
In Memory of Professor Seung Ha Oh and Highlights From the 14th Asia Pacific Symposium on Cochlear Implant and Related Sciences (APSCI), Seoul, Korea 纪念 Seung Ha Oh 教授和第 14 届亚太人工耳蜗及相关科学研讨会(APSCI)花絮,韩国首尔
IF 1.1 Q2 Health Professions Pub Date : 2024-04-10 DOI: 10.7874/jao.2024.00283
Jun Ho Lee
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引用次数: 0
Application of Genetic Information to Cochlear Implantation in Clinical Practice 遗传信息在人工耳蜗植入临床实践中的应用
IF 1.1 Q2 Health Professions Pub Date : 2024-04-10 DOI: 10.7874/jao.2024.00080
Chen-Chi Wu
Cochlear implantation is currently the treatment of choice for children with severe-to-profound sensorineural hearing impairment (SNHI). However, the outcomes with cochlear implant (CI) vary significantly among recipients. Genetic diagnosis offers direct clues regarding the pathogenesis of SNHI, which facilitates the development of personalized medicine for potential candidates for CI. In this article, I present a comprehensive overview of the usefulness of genetic information in clinical decision-making for CI. Genetically confirmed diagnosis enables clinicians to: 1) monitor the evolution of SNHI and determine the optimal surgical timing, 2) predict the potential benefits of CI in patients with identified genetic etiology, and 3) select CI devices/electrodes tailored to patients with specific genetic mutations.
人工耳蜗植入术是目前治疗重度至永久性感音神经性听力损伤(SNHI)儿童的首选方法。然而,人工耳蜗植入术(CI)的效果在不同受术者之间存在很大差异。基因诊断为感音神经性听力障碍(SNHI)的发病机制提供了直接线索,有助于为潜在的 CI 候选者开发个性化药物。在本文中,我将全面概述基因信息在 CI 临床决策中的作用。通过基因确诊,临床医生可以1)监测 SNHI 的演变并确定最佳手术时机;2)预测 CI 对已确定遗传病因的患者的潜在益处;3)为具有特定基因突变的患者选择量身定制的 CI 设备/电极。
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引用次数: 0
Comparison of Two Clinical Devices for the Measurement of Distortion Product Otoacoustic Emissions in Normal-Hearing Adults. 两种用于测量正常听力成年人失真产物耳声发射的临床设备的比较。
IF 1.1 Q2 Health Professions Pub Date : 2024-04-01 Epub Date: 2024-02-22 DOI: 10.7874/jao.2023.00269
Oscar M Cañete, Mouhamad El-Haj-Ali, Michal Fereczkowski

Background and objectives: Otoacoustic emissions (OAEs) are low-intensity sounds generated by the cochlea and associated with the function of the outer hair cells. Since OAE measurements do not require active participation of a listener, OAEs are considered an objective measure of cochlear function. While distortion-product OAEs (DPOAEs) are commonly used in clinical practice, limited information is available on the performance of various clinical devices. This study compared two commercial clinical devices, Titan and Eclipse from Interacoustics, and collected normative data for DPOAEs in people with normal hearing. The data collection and analysis were focused on signal and noise amplitudes as well as signal-to-noise ratios (SNRs).

Subjects and methods: Sixty-three participants with normal hearing (age 23.2±2.0 years) were included in the study. DPOAEs were measured at 31 frequencies ranging from 500 to 10,000 Hz.

Results: DPOAE amplitude differed across frequencies. Additionally, a high number of unreliable responses were observed at the edge frequencies (<828 Hz and >6,072 Hz). There were no significant differences between the two devices in terms of DPOAE amplitudes, but the recorded-noise levels (amplitude) differed significantly. SNRs of the recorded OAEs were frequency dependent (higher frequencies showed larger SNRs), and significant differences in terms of SNR were found between the two devices.

Conclusions: Despite the above-mentioned differences, the OAEs recorded with both devices met the pass criteria for the SNR (≥6 dB) consistently across frequencies, and thus the differences do not compromise the test outcomes. The frequency dependence of the OAE amplitudes and the corresponding SNRs may be relevant for clinical practice.

背景和目的:耳声发射(OAE)是耳蜗产生的低强度声音,与外毛细胞的功能有关。由于 OAE 测量不需要听者的积极参与,因此 OAE 被认为是衡量耳蜗功能的客观指标。虽然畸变产物 OAE(DPOAE)在临床实践中得到了普遍应用,但有关各种临床设备性能的信息却很有限。本研究比较了 Interacoustics 的 Titan 和 Eclipse 两款商用临床设备,并收集了听力正常者的 DPOAEs 标准数据。数据收集和分析的重点是信号和噪声幅度以及信噪比(SNR):研究对象和方法:63 名听力正常的参与者(年龄为 23.2±2.0 岁)。在 500 至 10,000 Hz 的 31 个频率范围内测量了 DPOAE:结果:不同频率的 DPOAE 振幅不同。此外,在边缘频率(6,072 Hz)处观察到大量不可靠的反应。两种设备在 DPOAE 振幅方面没有明显差异,但记录的噪声水平(振幅)却有很大不同。记录的 OAE 的信噪比与频率有关(频率越高,信噪比越大),两种设备在信噪比方面存在显著差异:结论:尽管存在上述差异,但使用两种设备记录的 OAEs 在不同频率下均符合信噪比合格标准(≥6 dB),因此这些差异不会影响测试结果。OAE 振幅和相应信噪比的频率依赖性可能与临床实践有关。
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引用次数: 0
Effect of Vestibular Rehabilitation on Sleep Quality and Depression in the Elderly With Chronic Dizziness: A Prospective Study. 前庭康复对慢性头晕老年人睡眠质量和抑郁的影响:前瞻性研究。
IF 1.1 Q2 Health Professions Pub Date : 2024-04-01 Epub Date: 2023-12-07 DOI: 10.7874/jao.2023.00171
Zahra Hosseini Dastgerdi, Nasrin Gohari, Mobina Mehrabifard, Hasti Seifi, Bahare Khavarghazalani

Background and objectives: Dizziness and the accompanying complaints, including sleep disorders and depression, are common among the elderly. This study investigated the effect of vestibular rehabilitation on complaints of dizziness, sleep problems, and the severity of depression in older people with chronic dizziness.

Subjects and methods: The study included 25 participants with chronic dizziness accompanied by comorbid sleep disturbance (Pittsburgh Sleep Quality Index [PSQI] global score >5). Participants completed the Dizziness Handicap Inventory (three sub-scales: physical, emotional, and functional), the PSQI, and the Persian version of the shortened Beck Depression Inventory (BDI-13) before and after the vestibular rehabilitation.

Results: The findings showed that the handicap caused by dizziness, the severity of depression, and the quality of sleep in the study participants improved significantly after the intervention (p<0.05).

Conclusions: Vestibular rehabilitation is an effective intervention to reduce dizziness handicap, comorbid sleep disturbance, and depression.

背景和目的: :头晕及其伴随的主诉,包括睡眠障碍和抑郁,在老年人中很常见。本研究调查了前庭康复对患有慢性头晕的老年人的头晕主诉、睡眠问题和抑郁严重程度的影响:研究包括25名患有慢性头晕并伴有睡眠障碍(匹兹堡睡眠质量指数[PSQI]总分大于5分)的参与者。参与者在前庭康复治疗前后填写了头晕障碍量表(三个分量表:身体、情绪和功能)、匹兹堡睡眠质量指数和波斯语版贝克抑郁简易量表(BDI-13):结果:研究结果表明,干预后,研究对象因头晕造成的障碍、抑郁的严重程度和睡眠质量都有了明显改善(p 结论:前庭康复治疗是一种有效的治疗方法:前庭康复是减少头晕障碍、合并睡眠障碍和抑郁的有效干预措施。
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引用次数: 0
Comparison of Speech Perception Performance According to Prosody Change Between People With Normal Hearing and Cochlear Implant Users. 根据前奏变化比较正常听力者与人工耳蜗使用者的语音感知能力
IF 1.1 Q2 Health Professions Pub Date : 2024-04-01 Epub Date: 2023-12-07 DOI: 10.7874/jao.2023.00234
Eun Yeon Kim, Hye Yoon Seol

Background and objectives: Cochlear implants (CIs) are well known to improve audibility and speech recognition in individuals with hearing loss, but some individuals still struggle with many aspects in communication, such as prosody. This study explores how prosodic elements are perceived by those with normal hearing (NH) and CIs.

Subjects and methods: Thirteen individuals with NH and thirteen CI users participated in this study and completed speech perception, speech prosody perception, speech prosody production, pitch difference discrimination, and melodic contour perception testing.

Results: NH listeners performed significantly better than CI users on speech perception, speech prosody perception (except for words with neutral meaning and a negative prosody change and when words were repeated twice), pitch difference discrimination, and melodic contour perception testing. No statistical significance was observed for speech prosody production for both groups.

Conclusions: Compared to NH listeners, CI users had limited ability to recognize prosodic elements. The study findings highlight the necessity of an assessment tool and signal processing algorithm for CIs, specifically targeting prosodic elements in clinical settings.

背景和目的:众所周知,人工耳蜗(CI)可提高听力损失患者的听力和语音识别能力,但有些患者在交流中仍有许多困难,如模仿发音:众所周知,人工耳蜗(CI)可提高听力损失者的听力和语音识别能力,但有些人在交流的许多方面仍有困难,例如前音。本研究探讨了听力正常(NH)和 CI 患者如何感知前音元素:13名听力正常者和13名CI使用者参与了本研究,并完成了言语感知、言语前奏感知、言语前奏制作、音高差异辨别和旋律轮廓感知测试:在言语感知、言语前音感知(中性含义和负面前音变化的词语以及重复两次的词语除外)、音高差异辨别和旋律轮廓感知测试中,NH 听者的表现明显优于 CI 使用者。两组听者在语音拟声方面均无统计学意义:与正常听者相比,CI 使用者识别前奏元素的能力有限。研究结果突出表明,有必要为 CI 设计一种评估工具和信号处理算法,特别是针对临床环境中的前音元素。
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引用次数: 0
期刊
Journal of Audiology and Otology
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