Audiology and Neuro-Otology最新文献

Background: Since first introduced in the mid-1980s, cochlear implant (CI) technology has significantly evolved to reach the current state of the art. Commencing with straight, lateral wall electrode arrays, advances in the last decade led to the development of slim perimodiolar arrays that lie closer to the electrically targeted spiral ganglion. Over the years, as a consequence of improving hearing benefits, CI indications have been steadily expanded. Today, individuals with moderately severe-to-profound sensorineural hearing loss, many with residual hearing in the low-frequency range, may receive a CI in one or both ears.

Summary: Before implantation, individual recipient characteristics, such as years of auditory deprivation, hearing thresholds, and speech understanding ability with conventional amplification, can have an effect on CI hearing outcomes. Also individuals with normal hearing/mild hearing loss in the low frequencies can also qualify for CI. Surgical procedures such as careful, soft surgery techniques are imperative to reduce cochlear trauma and optimize outcomes and can be supported by surgical guidance tools and drug therapies to help preserve the delicate intracochlear structures and also for patients with single-side deafness. Histopathological investigations provide evidence that support the design concept of slim perimodiolar electrode arrays. Modiolar proximity and scalar tympani location permit energy-efficient, focused electrical stimulation of the targeted neural interface, while minimizing injury to the fine structures of the intracochlear lateral wall and its blood supply.

Key messages: Modiolar electrode arrays may provide highly consistent scala tympani placement and modiolar proximity which may improve functional hearing outcomes, compared to lateral wall electrode array results. Modiolar proximity can result in narrower spread of excitation, reduced channel interaction, lower electrical stimulation thresholds and may improve speech understanding. Reservation of functional residual low-frequency hearing is possible with both straight and perimodiolar electrode arrays.

Introduction: The clinical saccadometry test is an ocular motor test that provides a functional assessment of the brain regions and circuits involved in the generation of saccadic eye movements. Clinical saccadometry is thought to be more sensitive to concussions and neurodegenerative disorders. The aim of our study was to compare healthy individuals with individuals diagnosed with relapsing-remitting multiple sclerosis (RRMS) using a saccadometry test, and to evaluate pro-saccade and anti-saccade performances.

Methods: The study included 32 patients (mean age: 41 ± 11.88 years) between the ages of 18-60 years with relapsing remitting multiple sclerosis (RRMS), and a healthy control group of 28 individuals (mean age: 37.3 ± 12.2 years). Spontaneous nystagmus, gaze, random saccade, pursuit, and optokinetic and saccadometry tests included in the videonystagmography (VNG) test battery were performed for all participants.

Results: There were no significant differences in random saccade (RS) latencies between the groups (p > 0.05). However, the pro-saccade and anti-saccade latencies were significantly prolonged in the multiple sclerosis (MS) group (p < 0.05). There were no statistically significant differences between the groups in peak velocity and accuracy for random saccades, pro-saccades, and anti-saccades (p > 0.05). Directional error rates in the pro-saccade and anti-saccade tests were significantly different between the MS and control groups (p < 0.05).

Conclusion: The findings of our study show that there are significant differences in saccadometry test results between MS patients and healthy participants. Therefore, the clinical saccadometry test, which is newly added to the VNG test battery and offers short and noninvasive evaluation, could be included in the vestibular test battery for neurodegenerative diseases such as MS.

Background: Cochlear implantation (CI) has emerged as a promising intervention for children with auditory neuropathy spectrum disorder (ANSD). Several studies have investigated the efficacy of CIs in children with ANSD, demonstrating improvements in auditory performance and language skills following implantation. Whether the benefits and outcomes of CIs in children with ANSD are comparable to children with sensorineural hearing loss (SNHL) is still debatable. The present updated systematic review and meta-analysis evaluated the outcomes of CI for children with ANSD compared to children with SNHL.

Methods: A meta-analysis was conducted on studies that included pediatric patients and the outcomes of CI in patients with ANSD versus SNHL were compared. A comprehensive search was performed using the following electronic databases: PubMed, Scopus, Web of Science, EBSCOhost, and Cochrane Central Register of Controlled Trials (CENTRAL).

Results: Fourteen studies (number of patients = 722 patients) were included. The total number of patients in the ANSD and SNHL groups in the present systematic review was 212 and 520, respectively. The most utilized assessment tests were the Speech Intelligibility Rating (SIR) and Categories of Auditory Performance (CAP) scores. The pooled estimate showed that patients with ANSD had comparable CAP scores compared to patients with SNHL (MD: -0.52, 95% CI [-1.34, 0.29], p = 0.21). Likewise, three studies reported the SIR after CI and showed comparable findings between ANSD and SNHL patients. The pooled estimate showed that patients with ANSD had comparable SIR scores compared to patients with SNHL (MD: -0.26, 95% CI [-0.65, 0.13], p = 0.19).

Conclusion: While the results show mixed findings across various outcome measures, the overall impact of CI on speech recognition and language development appears to be positive and comparable between ANSD and SNHL.

Objective: The aim of this study was to evaluate the utility of auditory steady-state responses (ASSRs) to narrow-band chirps (NB-chirps) for estimating hearing levels in children.

Design: Thresholds from the NB-chirp ASSR were evaluated in 30 sedated children with normal hearing or hearing loss. The correlation between the NB-chirp ASSR and pure-tone audiometry (PTA) thresholds was analyzed, and the difference score (DS) between these thresholds was calculated. Data from the NB-chirp ASSR were compared to retrospective data from conventional ASSR to exponentially amplitude-modulated tones in 25 sedated children.

Results: Positive correlations between the NB-chirp ASSR and PTA thresholds were found at 500, 1,000, 2,000, and 4,000 Hz. Multiple comparisons of the DSs for the NB-chirp ASSR and PTA revealed significant differences at 500-2,000 Hz and 4,000 Hz, as well as 1,000-2,000 Hz, and 4,000 Hz. Comparisons of the DSs demonstrated that the DS of the NB-chirp ASSR was significantly smaller than that of the conventional ASSR at 2,000 Hz. Furthermore, the testing times for the NB-chirp ASSR were significantly shorter than those for the conventional ASSR.

Conclusion: The NB-chirp ASSR closely reflected the PTA thresholds, and the testing time was shorter than that of the conventional ASSR. Thus, this study demonstrated that the NB-chirp ASSR is useful for hearing threshold estimation in children.

Introduction: Research suggests deaf children who receive cochlear implants (CIs) at an early age can achieve age-appropriate language. Recent studies suggest age at full-time CI use is a better predictor of language outcomes than age at implant. The aim of this study was to investigate whether there are correlations between age at implantation, establishing consistent device use, and language outcomes in a cohort of young children in Aotearoa New Zealand.

Methods: A retrospective analysis was conducted. The study included 46 participants, implanted by the Southern Cochlear Implant Programme by age 18 months. The median age at implant was 8 months. Device use was measured via data logging. Consistent device use was defined as ≥8 h per day. Language outcomes were measured at 2- and 3-year post-implantation using PLS-5.

Results: Consistent use was established by 78.3% by 3 years. Language results were at least one SD higher for children who achieved consistent use within 2 years of implant. Language scores for Maori children were more than one SD lower than non-Maori, a finding not entirely explained by less usage. There was no correlation between age of implantation and length of time to consistent device use. The presence of additional disabilities affected consistent device use.

Conclusion: Simply offering CIs earlier is not sufficient to improve language outcomes in the congenitally deaf population. Earlier consistent use was associated with better language outcomes for those implanted before 18 months of age, and language scores were higher for children who achieved consistent use within 2 years of implantation. There is a need to understand why children with pre-lingual deafness may not be achieving consistent device use, and by doing so, we would be a step closer to being able to tailor culturally appropriate supports and services that could help more children achieve better outcomes.

Introduction: To date, no study has reported the various otologic conditions associated with coronavirus disease 2019 (COVID-19) using population-based design. The aim of this study was to investigate the incidence and risk of audio-vestibular disorders (benign paroxysmal positional vertigo, sudden sensorineural hearing loss, Meniere's disease, vestibular neuritis, and tinnitus) increasing after COVID-19 infection.

Methods: This retrospective population-based study was conducted using the National Health Insurance Service (NHIS)-COVID-19 cohort database of South Korea. We identified participants in the COVID-19 group using real-time reverse transcription-polymerase chain reaction tests. A matched cohort without COVID-19 was randomly selected in a 1:1 ratio. Benign paroxysmal positional vertigo, sudden sensorineural hearing loss, Meniere's disease, vestibular neuritis, and tinnitus were defined using diagnostic, medication, and procedure codes. The incidence and risk of these disorders were assessed in both groups using univariate and multivariate Cox proportional hazard analyses.

Results: In total, 4,976,589 COVID-19 patients and an equivalent number of matched non-infected controls were analyzed. COVID-19 patients faced an increased risk of developing benign paroxysmal positional vertigo, sudden sensorineural hearing loss, vestibular neuritis, and tinnitus compared to controls in univariate and multivariate Cox hazard analyses. COVID patients were at an increased risk of Meniere's disease in the univariate analysis; however, the risk of Meniere's disease after COVID-19 did not reach statistical significance in the multivariate analysis.

Conclusion: COVID-19 infection may increase the risk of benign paroxysmal positional vertigo, sudden sensorineural hearing loss, vestibular neuritis, and tinnitus.

Introduction: Performing two tasks simultaneously may present various challenges for the human cognitive system. This study investigates how concurrent cognitive tasks impact the performance of the functional head impulse test (fHIT) in healthy adults. It was hypothesized that adding a cognitive load during fHIT would reduce the test's scores due to shared attentional resources.

Method: Twenty-seven participants completed the functional head impulse test (fHIT) and verbal fluency tests simultaneously. The study was designed in three stages: (1) recording fHIT results without any cognitive task, (2) completing the categorical fluency test and fHIT concurrently, and (3) administering the phonemic fluency test and fHIT simultaneously, with results recorded.

Results: Significant differences were observed in fHIT performance with and without additional cognitive tasks. Categorical tasks (e.g., animal and furniture categories) and phonemic tasks (e.g., words starting with "K," "A," or "S") impacted fHIT results, with notable performance reductions.

Conclusion: This study demonstrates that dual-task scenarios involving cognitive and vestibular demands adversely affect fHIT performance. The findings underscore the importance of attentional capacity in tasks requiring simultaneous cognitive and visual-oculomotor processing. These insights could guide future clinical applications in assessing and rehabilitating vestibular and cognitive deficits.

Introduction: Bilateral cochlear implantation can be performed simultaneously or sequentially based on hearing loss and patient age, though global consensus on sequential implantation remains unresolved.

Methods: Data of 27 individuals from this patient group were included in this study. The mean chronological age of the 27 individuals included in the study was 140.93 ± 41.51 months. The mean chronological age of the participants was 25.44 ± 9.25 months at the time of early unilateral cochlear implantation (CI 1). The implantation delay of late sequential cochlear implantation (CI 2) was 115.48 ± 41.45 months. Cortical auditory evoked potential P1 latency measurements were performed at 3, 6, 9, and 12 months. The change in performance over time was analyzed based on measurements at five different time points for CI 2.

Results: There were substantial improvements in auditory perception and performance 3 months after CI 2 activation. CAEP analyses were indicative of improvements in cortical responses and positive effects of CI 2 on central auditory system plasticity. These results suggested that late second implantation might be associated with improved auditory outcomes. These improved from CAEP test P1 latency were statistically significant (p < 0.001).

Conclusion: Late CI 2 can significantly improve auditory perception and promote adaptive plasticity in individuals with prior unilateral cochlear implants. These results suggest that even late consecutive cochlear implantations may provide clinical benefit.

Introduction: Mal de debarquement syndrome (MdDS) is a rare and poorly understood clinical entity defined as a persistent sensation of rocking and swaying that can severely affect the quality of life. To date, the treatment options are very limited. Even though vestibular rehabilitation (VR) efficacy following peripheral vestibular lesion is well-documented, little is known about its influence on MdDS. The objective of the study was to explore the influence of traditional VR program on postural control in a patient diagnosed with MdDS.

Methods: We assessed 3 different participants: 1 healthy control; 1 participant with identified peripheral vestibular impairment (VI); 1 participant diagnosed with MdDS. Postural control was assessed using a force plate (AMTI, Accusway). Participants were assessed following the modified Clinical Test Sensory Integration Balance protocol (mCTSIB, eyes open on firm surface/eyes closed on firm surface/eyes open on foam/eyes closed on foam). The raw data were exported and analyzed in a custom-made Matlab script (Matlab R2020a). We retrieved the center of pressure velocity in both anterior-posterior and mediolateral directions and performed an analysis of the frequency content using Daubechies wavelet of order 4 with 6 levels of decomposition. Protocol VI and MdDS patients performed a 4-week VR program. Postural control, using a force plate, and Dizziness Handicap Inventory (DHI) were assessed before and after the VR program. Healthy control was assessed twice separated by 1 week without any specific intervention.

Results: VI participant showed clear improvement on DHI and sway velocity on condition eyes closed with foam. Accordingly, a reduction of energy content within frequency bands (0.39-0.78 Hz and 0.78-1.56 Hz) was observed post-rehabilitation for VI participant in both conditions with foam. Interestingly, MdDS participant demonstrated a reduction in sway velocity in most of the conditions but the frequency content was not modified by VR and was comparable to healthy control. Accordingly, the DHI of the MdDS participant failed to demonstrate any difference following VR.

Conclusion: The results of the present study question the use of VR as an efficient treatment option for MdDS. Future studies must recruit a larger sample size and focus on the relationship between illusion of movement and postural characteristics such as sway velocity.