Audiology and Neuro-Otology最新文献

Introduction: Slim perimodiolar electrodes (PSEs) are designed for close modiolar proximity, but deviations from ideal placement may affect speech perception. This study investigates the prevalence, radiologic characteristics, and audiologic outcomes of abnormally positioned PSE arrays and proposes intraoperative management strategies.

Methods: We retrospectively reviewed 239 adults implanted with Cochlear® PSE arrays (2015-2023). Postoperative CT scan identified arrays positioned laterally to mid-scala without tip fold-over. Objective metrics such as angular insertion depth (AID), intracochlear position index (ICPI), wrapping factor (WF), and maximum insertion angle were compared to a control group with normal positioning (n = 52). Speech perception outcomes at 3 and 12 months were assessed using monosyllabic word tests and compared to a reference cohort (n = 1,414).

Results: Abnormal positioning occurred in 3% (n = 7). All arrays remained within scala tympani but had shallower insertions (AID 296° vs. 392°), greater lateralization (ICPI 0.52 vs. 0.33), and higher WF (0.62 vs. 0.36). Compared to controls, speech scores were lower at 3 months (33% vs. 65%) and 12 months (45% vs. 74%). Intraoperative X-rays did not detect these deviations.

Conclusion: Abnormal PSE placement is uncommon but associated with poorer speech outcomes. Surgeons should assess electrode shape intraoperatively and consider reinsertion if the classic curl is absent. Postoperative CT remains critical for quality assurance. Tailored intraoperative strategies are needed to prevent lateralization and optimize outcomes.

Introduction: Age-related hearing loss (ARHL) is a multifactorial disorder due to impairment in the peripheral or central auditory pathway (CAP). CAP impairment refers to difficulties in speech understanding, particularly in the presence of background noise, problems in discrimination, and integrating and separating binaural auditory information. Changes in CAP mechanisms, such as neurotransmitters or ion movement, may correlate with this impairment. The regulation of calcium (Ca2+) concentrations by Ca2+-binding proteins (CaBPs) is critical for synaptic function and plasticity, and changes are directly related to ARHL. Thus, changes in the neuronal expression of CaBPs in aging could be related to CAP disorders. Considering that supplementation with antioxidant and/or neuroprotective substances can delay neuronal loss in aging, antioxidant-based therapies can prevent and/or reduce the progression of ARHL in animal models and humans. The hormone melatonin has important antioxidant and neuroprotective actions, which can sometimes depend on melatonin receptors. This work aimed to investigate changes in the expression of CaBPs and melatonin receptors in the CAP stations and whether this expression could vary with aging.

Methods: Brain sections of Wistar rats young and elderly were processed using immunohistochemistry technique, and for analysis and quantification, the stereology and optical density technique were used.

Results: The analysis revealed a lower density of CaBP-immunoreactive cells in most CAP nuclei. In contrast, elderly rats showed increased expression of MT1 and MT2 in CAP stations.

Conclusion: These findings suggest that changes in neuronal number and transmission in these nuclei in aging are concomitant with increased melatonin's potential sites of action in the CAP.

Introduction: This study aimed to investigate differences between two precurved cochlear implant electrode arrays - Contour Advance (CA) and Slim Modiolar Electrode (SME) - in adult users, with a focus on electrically evoked compound action potential (ECAP) thresholds, 1-year postoperative C-levels, and battery consumption.

Methods: Data from 70 adult cochlear implant recipients (35 CA, 35 SME) were analyzed. Intra- and postoperative ECAP thresholds were obtained using Cochlear Custom Sound software. One-year C-levels were measured through psychophysical loudness scaling. Estimated battery runtimes were examined in relation to median C-levels. A linear mixed-effects model was used to assess differences across electrode positions and between arrays. Model validation was performed through examination of standardized residuals versus fitted values, QQ-plots analysis, and comparison of observed versus expected serial correlations.

Results: The CA array showed a more linear and more directly proportional relationship between ECAPs and C-levels. The SME array demonstrated significantly higher ECAPs and C-levels for the basal electrodes, larger pre- to postoperative changes in thresholds, and larger differences between ECAPs and C-levels, compared to the CA array. Battery runtime was significantly correlated with C-levels in the CA group, whereas impedance appeared more closely related to battery consumption in the SME group.

Conclusion: Electrode array design affects electrophysiological and behavioral responses as well as battery consumption. We found significant differences between two precurved electrode arrays from the same manufacturer. These findings highlight the importance of array-specific programming strategies and suggest that electrode characteristics should be considered in clinical decision-making and device optimization.

Introduction: The international outcome inventory for hearing aids (IOI-HA) is a questionnaire widely used to assess the subjective benefits of hearing aids. This study aimed to evaluate the relationship between IOI-HA outcomes and target mismatch in real-ear measurement (REM).

Methods: Thirty-four ears of 25 patients who had worn hearing aids were evaluated using the Korean version of the IOI-HA and REM after fitting for 2 months. Real-ear insertion gain (REIG) was measured at three different levels of input intensity - 50, 65, and 80 dB sound pressure level (SPL) - and a frequency range of 0.25-6 kHz. Factors 1 and 2 and total IOI-HA scores were compared with the mismatches of REIGs and target gains of REM.

Results: Factor 1, factor 2, and total IOI-HA scores were 14.6 ± 3.5, 11.4 ± 2.2, and 25.9 ± 5.1, respectively. The averages of the difference of REIGs and target gains in REM at 50, 65, and 80 dB SPL input levels were -3.1 ± 6.7, -2.3 ± 7.2, and -3.0 ± 8.2, respectively. Factors 1 and 2 scores of the IOI-HA showed significant correlations with target mismatch in REM at 1 kHz and 0.75 kHz frequencies, respectively. Total IOI-HA scores had significant correlations with target mismatches in REM at 0.75 and 1 kHz frequencies.

Conclusion: IOI-HA scores correlated with target mismatch in REM at mid frequencies. The IOI-HA can be a useful screening measure for evaluating the necessity of further adjustments in hearing aids through REM at mid frequencies.

Introduction: Anatomy-based fitting (ABF), a relatively new technique for cochlear implant (CI) programming, attempts to lessen the impact of the electrode insertion location-related frequency-to-place mismatch (FPM). This study aimed to compare vowels and consonant perception in quiet and in noise among experienced adult CI users using the ABF and the regular, conventional-based fitting (CBF) map (pre-ABF) over 6 months.

Methods: Nine ears from eight experienced adult CI users were included in the experimental and longitudinal research. Using surgical planning software called Otoplan, postoperative computed computed tomography scans were used to determine the locations of intracochlear electrodes and their angle of insertion. The anatomy-based frequency bands were produced by Maestro 9.0 CI fitting software using the Otoplan data. Nonsense syllables with consonant-vowel-consonant (CVC) recognition scores in quiet and noise (+5 dB SNR) were compared at baseline, 3, and 6 months after ABF. The vowels involved were /a, i, u/, while the consonants were voiced /b, d, g/ and voiceless /p, t, k/ plosives. Speech pieces were presented at 30 dB SL in a sound-treated room through a loudspeaker positioned at 0° azimuth.

Results: On average, the ABF maps shifted center frequency ranging from 0.46 semitones (0.04 octave) at (E12) to 23.94 semitones (1.99 octave) at (E1) as compared to the CBF maps. The mean vowel and consonant identification scores in quiet and in noise were significantly higher in ABF than in CBF (p < 0.05) with a large effect size and the trend of improvement was seen with time. Voiced consonants had better scores than the voiceless consonants.

Conclusion: The results demonstrated improved perception of vowels and consonants, particularly for sounds containing voicing cues after using the ABF maps. The results also suggested that ABF could be more effective for voice detection in noise. Overall, the findings indicate that correcting place mismatch with an ABF map may improve speech perception, at least among experienced adult CI users.

Introduction: We were conducting this study to evaluate the effects of different hearing aid adaptation formulas on middle latency responses (MLR) in adult hearing aid users.

Methods: The study included 72 participants: those with moderate hearing loss using hearing aids with two different formulas for the last year, those with moderate hearing loss not using hearing aids, and those without hearing loss. Sixteen participants using NAL-NL1 and NAL-RP formulas were group 1; twenty using NAL-NL2 and DSL formulas were group 2; fifteen with hearing loss not using devices were group 3; and twenty-one without hearing loss were group 4. We obtained and compared MLR responses, including Na latency, Pa latency, and Na-Pa amplitude.

Results: Group 1 mean Na-Pa amplitude value was found to be higher than group 2 (p = 0.001). No significant difference was observed between group 1 and group 2 in terms of Na latency and Pa latency values (p = 0.001; p = 0.035). It was observed that the mean Na-Pa amplitude values in group 1 and group 2 were higher than group 3 (p = 0.001), but this elevation reached the level of statistical significance only in group 1. No difference was observed between group 1, group 2, and group 3 in terms of Na latency and Pa latency values (p = 0.001; p = 0.035). Compared with those without hearing loss (group 4), participants with hearing loss (group 1, group 2, and group 3) had longer Na latency and Pa latency values (p = 0.001; p = 0.035), and Na-Pa amplitudes were lower (p = 0.001). The effect of current (tested) hearing aid usage time on Na latency, Pa latency, and Na-Pa amplitude values of group 1 and group 2 was not observed. In all groups, there was a positive correlation between audiometric airway/bone conduction pure tone averages and speech acquisition threshold values, Na latency and Pa latency values, and a negative correlation between Na-Pa amplitude values. In all groups, there was a negative correlation between speech discrimination scores and Na and Pa latency values, as well as a positive correlation between Na and Pa amplitude values. There was a positive correlation between age and Pa latency values in all groups, as well as a negative correlation between Na and Pa amplitude values.

Conclusion: MLRs are affected by the presence of hearing loss, the use of hearing aids, and different hearing aid adaptation formulas. MLR measurements with a hearing aid can be used as an objective test to evaluate the benefit of hearing aid use.

Introduction: Despite improved hearing, children who receive cochlear implants (CIs) at a later age encounter difficulties in adapting to society, exposing them to psychological and social risks. This study contributes to the conceptualisation of preventive interventions in schools to address potential issues so that these children can play a more active role in society.

Methods: A total of 52 children (aged 3-12 years) who received CIs at 30 months of age were assessed using the Asahide-Shiki Social Adaptive skills test, which evaluates children's social skills on four domains: (A) language, (B) everyday life, (C) social life, (D) communication.

Results: Overall, the average score of children who receive CIs at a later age was lower than that of their hearing peers. Pre-school children obtained statistically lower scores in all skills. While this general lag in skill development was no longer observed in the lower grades of elementary school, the upper-grade school children presented lower scores than their hearing peers, although only those pertaining to everyday and social life skills were statistically significant. Accordingly, the average scores were distributed in an inverted V shape among age groups.

Conclusion: These results suggest that children who receive CIs at a later age develop their social skills later than their peers with normal hearing in preschool, catch up to their peers in the 1st to 3rd grades, and then lag in the 4th to 6th grades. Accordingly, acquiring age-appropriate social skills in the upper grades remains a challenge for children who obtained CIs at the age of approximately 3, suggesting the need for intervention programs for school-age children even when they do not show significant language acquisition delays.

Background and Aim: The primary concern among adults with regard to their hearing is the difficulty in comprehending speech, particularly in noisy environments. The constant need to listen attentively leads to heightened frustration, fatigue, and decreased concentration. According to research, high-frequency hearing loss could have negative implications on speech perception and make it even harder to communicate. In this study, the focus is on patients with DFNA9 as it is one of the most common forms of non-syndromic high-frequency hearing loss. These patients carry the p.Pro51Ser variant in the COCH gene, which leads to progressive decline of hearing and vestibular function. Despite various cross-sectional studies on the natural progression of hearing levels, speech perception in silence and noisy surroundings is largely unexplored in this group of patients.

Method: For the longitudinal analysis of speech perception, 101 heterozygous carriers of the p.Pro51Ser variant in the COCH gene were enrolled. In addition, a control group composed of individuals with normal hearing, who matched the patients with DFNA9 in the study in terms of age and sex, was recruited. All patients underwent pure-tone audiometry, speech perception in quiet (SPIQ), and speech perception in noise (SPIN).

Results: The SPIQ outcomes reveal a mean speech reception threshold (SRT) of 28.18 dB SPL for male carriers and 29.29 dB SPL for female carriers in the youngest age-group (18-29 years). With increasing age, a steep decrease was noticed, and no speech discrimination ability in quiet remained for carriers in their seventh decade. Differences between carriers and control participants seem evident in the third decade of life and become more pronounced in the decades that follow. The SPIN displayed a similar trend, varying from -5 dB SNR in the youngest age-group, to no speech-in-noise thresholds in patients above the age of 60 years. In contrast, the matched group exhibited a SRT range from -5.5 to -3.25 dB SNR for males, and from -6.23 to -4.58 dB SNR for females from the second/third to the seventh decade. This stands in contrast to the DFNA9 population, where male carriers reach values of -5.18 dB SNR and female carriers reach -3.12 dB SNR as early as in the fourth decade.

Conclusion: This study indicates poor performance on speech understanding in quiet and noise in DFNA9 patients in comparison with the group with normal hearing, even at a young age. Therefore, future research should not only investigate pure-tone audiometry, but also speech perception. Moreover, reimbursing hearing aids based on speech-in-noise testing could prove to be more advantageous than based on pure-tone audiometry.