The neural response telemetry (NRT) is a standard procedure in cochlear implantation mostly used to determine the functionality of implanted device and to check auditory nerve responds to the ...stimulus. Correlation between NRT measurements and subjective threshold (T) and maximum comfort (C) levels has been reported but results are inconsistent, and it is still not clear which of the NRT measurements could be the most useful in predicting fitting levels.
In our study we aimed to investigate which NRT measurement corresponds better to fitting levels. Impedance (IMP), Evoked Action Potential (ECAP) threshold and amplitude growth function (AGF) slope values were included in the study. Also, we tried to identify cochlear area at which the connection between NRT measurements and fitting levels would be the most pronounced.
Thirty-one children implanted with Cochlear device were included in this retrospective study.
IMP, ECAP thresholds and AGF were obtained intra-operatively and 12 months after surgery at electrodes 5, 11 and 19 as representative for each part of cochlea. Subjective T and C levels were obtained 12 months after the surgery during cochlear fitting.
ECAP thresholds obtained 12 months after surgery showed statistically significant correlation to both T and C levels at all 3 selected electrodes. IMP correlated with C levels while AGF showed tendency to correlate with T levels. However, these correlations were not statistically significant for all electrodes.
ECAP threshold measurements correlated to T and C values better than AGF slope and IMP. Measurements obtained twelve months after surgery seems to be more predictive of T and C values compared to intra-operative measurements.
The best correlation between ECAP threshold and T and C values was found at electrode 11 suggesting NRT measurements at mid-portion cochlear region to be the most useful in predicting fitting levels.
Systemic steroids are the most common first-line therapy in sudden sensorineural hearing loss (SSNHL), with significant improvement in hearing outcomes in over 60% of patients. It is unknown why 40% ...of patients do not respond to systemic steroid therapy. Salvage treatment includes intratympanic steroids (ITS) and hyperbaric oxygenation (HBO) therapy, with inconsistent results reported. This study aimed to compare the results of ITS and HBO therapy in patients with SSNHL that previously failed systemic steroid therapy.
This is a comparative retrospective nonrandomized interventional cohort study, enrolling 126 patients with SSNHL. Out of these, 35 patients received HBO therapy, 43 patients received ITS, and 48 patients did not receive any second-line therapy (control group). Pure-tone audiograms were performed before and after the salvage therapy in the IT and HBO groups and at the same time interval in the control group. Study variables included age, time until therapy initiation, tinnitus status, and hearing outcomes, with a cutoff criteria of cumulative >30 dB improvement on all frequencies indicating recovery.
ITS and HBO therapy were associated with statistically significant hearing recovery at all frequencies compared to systemic steroids. The results show an average hearing improvement of 13.6 dB overall frequencies (250 to 8000 Hz) after ITS therapy and 7.4 dB in HBO therapy in comparison to the control group. Presence of significant hearing improvement positively correlated with age, ITS therapy, and HBO therapy. Presence of tinnitus before therapy was negatively correlated with hearing improvement. Patients with tinnitus present at the start of therapy improve 4.67 dB less on average compared to those without tinnitus. ITS therapy significantly reduced tinnitus compared to the other two treatment options. Patients with tinnitus present before therapy significantly improve hearing at low frequencies, compared to the control group.
ITS and HBO therapy show superior hearing results compared to observation alone after failed oral steroid therapy for SSNHL. ITS shows an additional positive impact on tinnitus reduction and shows superior hearing outcomes after salvage therapy.
There is an increased number of people with hearing impairment and decreased cognitive abilities among the elderly population. Due to the fact that the auditory system and central nervous system are ...connected, pathological changes associated with aging occur on both levels. With the development of hearing aid technology, the quality of life of these patients can be improved. The aim of this study was to determine whether wearing a hearing aid has an impact on cognitive abilities and tinnitus. Current research does not show a clear connection between these factors. This study involved 44 subjects with sensorineural hearing loss. They were divided into two groups of 22 people, depending on whether they had previously used a hearing aid or not. Assessment of cognitive abilities was performed via the MoCA questionnaire, and assessment of the impact of tinnitus on daily activities was evaluated using the Tinnitus Handicap Inventory (THI) and the Iowa Tinnitus Handicap Questionnaire (ITHQ). Hearing aid status was classified as a primary outcome, while cognitive assessment and tinnitus intensity were associated variables. Our study showed an association between longer hearing aid use and poorer naming ability (p = 0.030, OR 4.734), poorer delayed recall (p = 0.033, OR 4.537), and spatial orientation (p = 0.016, OR 5.773) when compared with patients who had not used hearing aids, while tinnitus did not correlate with cognitive impairment. Based on the results, we can emphasize the importance of the auditory system as an input source for the central nervous system. The data direct us to improve the rehabilitation strategies for hearing and cognitive abilities in patients. Such an approach results higher quality of life in patients and prevents further cognitive decline. Key words: Cognition; Hearing aid; Sensorineural hearing loss; Tinnitus; Quality of life Medu starijom populacijom nalazimo povecan broj osoba s o?tecenim sluhom i smanjenim kognitivnim sposobnostima. Zbog povezanosti slu?nog sustava sa sredi?njim ?ivcanim sustavom, dolazi do patolo?kih promjena na obje razine. Razvoj tehnologije u podrucju slu?nih pomagala pobolj?ao je kvalitetu ?ivota takvih bolesnika. Cilj istra?ivanja je utvrditi postoji li utjecaj no?enja slu?nog pomagala na kognitivne sposobnosti i ?um u uhu. Trenutna istra?ivanja ne pokazuju striktno povezanost ta dva entiteta. U provedenoj studiji sudjelovalo je 44 ispitanika sa zamjedbenim o?tecenjem sluha. Podijeljeni su u dvije skupine po 22 osobe, ovisno o tome koriste li slu?no pomagalo. Procjena kognitivnih sposobnosti vr?ila se putem Montrealske ljestvice kognitivne procjene (MoCA), a procjena utjecaja ?uma u uhu na svakodnevne aktivnosti putem upitnika Tinnitus Handicap Inventory (THI) i Iowa Tinnitus Handicap Questionnaire (ITHQ). Analizirana je povezanost no?enja slu?nog pomagala s rezultatima navedenih upitnika. U na?em istra?ivanju pokazana je povezanost duljeg no?enja slu?nog pomagala i lo?ije sposobnosti imenovanja (p=0,030, OR 4,734), slabijeg odgodenog prisjecanja (p=0,033, OR 4,537) i prostorne orijentacije (p=0,016, OR 5,773). Tinitus nije pokazao povezanost s kognitivnim o?tecenjem. Rezultati govore o specificnim vezama izmedu slu?nog sustava i funkcije sredi?njeg ?ivcanog sustava. Ovi nas podaci usmjeravaju na pobolj?anje strategije rehabilitacije sluha i kognitivnih sposobnosti u bolesnika. Takvim se pristupom omogucava veca kvaliteta ?ivota i prevencija daljeg kognitivnog o?tecenja. Kljucne rijeci: Slu?no pomagalo; Kvaliteta ?ivota; Tinnitus; Kognicija; Zamjedbena nagluhost
Stapes surgery is generally performed to treat otosclerosis, and there are numerous surgical techniques and prosthesis materials available. Critical evaluation of postoperative hearing outcomes is ...crucial for identification and further improvement of treatment options. This study is a non-randomized retrospective analysis of hearing threshold levels before and after stapedectomy or stapedotomy in 365 patients during a twenty-year period. The patients were classified into three groups depending on the prosthesis and surgery type: stapedectomy with Schuknecht prosthesis placement and stapedotomy with either Causse or Richard prosthesis. The postoperative air-bone gap (ABG) was calculated by subtracting the bone conduction pure tone-audiogram (PTA) from the air conduction PTA. Hearing threshold levels were evaluated preoperatively and postoperatively from 250 Hz to 12 kHz. The results showed air-bone gap reduction <10 dB in 72% patients, 70% of patients, and 76% of patients using Schucknecht's prosthesis, Richard prosthesis, and Causse prosthesis, respectively. The results did not differ significantly between three prothesis types. Choice of prosthesis should be made individually for each patient, but surgeon competency is still the most important outcome variable, regardless of prosthesis type. Key words: Surgery; Stapedectomy; Stapedotomy; Prosthesis; Outcome; Hearing Stapedotomija ili stapedektomija su metode izbora za lijecenje otoskleroze, a postoji velik broj proteza koje se koriste u obje kirur?ke tehnike. Konstantna evaluacija postoperativnih ishoda sluha kljucna je za vrednovanje najboljeg tipa i materijala za kori?tenih u kirur?kom lijecenju otoskleroze. Ovo je istra?ivanje nerandomizirana retrospektivna analiza pragova sluha prije i nakon stapedektomije ili stapedotomije u 365 pacijenata tijekom desetogodi?njeg razdoblja. Pacijenti su na temelju tipa operacije i proteze svrstani u tri grupe; stapedektomija s postavljanjem Schuknechtove proteze, stapedetomija s Causse ili Richardovom protezom. Postoperativni ABG izracunat je oduzimanjem BC PTA od AC PTA. Tonskim audiogramom su evaluirani pragovi sluha prijeoperativno i postoperativno u rasponu od 250 Hz do 12 kHz. Rezultati pokazuju smanjenje zracno-ko?tanog prozora na <10 dB u 72% pacijenata s Schucknecht protezama, dok je u grupi pacijenata s Richardovim protezama takvih pacijenata bilo 70%, a u grupi pacijenata s Causse protezama 76%. Rezultati su bili slicni za sve tri promatrane opcije. Odluka o tipu operacije i proteze trebala bi biti individualna za svakog pacijenta, a ishod operacije ne ovisi o tipu proteze. Kljucne rijeci: Kirurgija; Stapedektomija; Stapedotomija; Proteza; Ishod; Sluh
The aim of the study was to describe singing voice handicap in the Croatian professional and amateur classical singers. This cross-sectional study included 69 professionals (median age 47.5 ...interquartile range 42.0-55.8 years) and 41 amateurs (median age 30.0, interquartile range 25.0-41.0 years). Participants completed the Croatian version of the Singing Voice Handicap Index (SVHI-36), self-rated the severity of singing voice problem on another scale and answered questions about their age, gender, voice type and self-perceived average number of singing hours per week in the past three months. Cronbach’s alpha of the Croatian version of the SVHI was 0.97 in amateurs, and 0.98 in professionals. SVHI scores significantly differed across the categories of self-perceived singing voice problem in amateurs (P=0.001) and professionals (P<0.001). Median SVHI score was 16.7 (interquartile range 7.6-29.2) in amateurs and 13.8 (interquartile range 5.9-30.2) in professionals. Higher SVHI score was associated with more severe self-perceived singing voice problem in amateurs (ρ=0.63, P<0.001) and professionals (ρ=0.68, P<0.001). Amateurs and professionals did not significantly differ in the self-perceived singing voice problem (P=0.698), nor the SVHI score (P=0.538). Compared to the professionals, amateurs more often reported voice breaks (P=0.009) and the trouble with loud singing (P=0.020), and were less concerned about losing money because of their singing problems (P=0.022). Croatian classical singers mostly had mild singing voice problems. Voice difficulties in amateurs indicate the importance of learning vocal technique. It is necessary to balance work commitments with vocal rest to preserve workability in professional classical singers.
Cilj istraživanja bio je opisati poteškoće pjevačkog glasa u hrvatskih profesionalnih i amaterskih klasičnih pjevača. U ovo presječno istraživanje uključeno je 69 profesionalnih pjevača (medijan dobi 47,5, interkvartilni raspon 42,0-55,8 godina) i 41 amaterski pjevač (medijan dobi 30,0, interkvartilni raspon 25,0-41,0 godina). Sudionici su ispunili hrvatsku verziju Indeksa vokalnih poteškoća pjevača (engl. Singing Voice Handicap Index, SVHI-36), samostalno su ocijenili ozbiljnost poteškoća s pjevačkim glasom na drugoj skali, odgovorili su na pitanja o svojoj dobi, spolu, vrsti glasa te procijenili prosječan tjedni broj sati pjevanja u prethodna tri mjeseca. Cronbachov koeficijent pouzdanosti hrvatskog verzije indeksa SVHI bio je 0,97 u amatera i 0,98 u profesionalaca. Rezultati indeksa značajno su se razlikovali među stupnjevima samoprocijenjenih poteškoća s pjevačkim glasom u amatera (P=0,001) i u profesionalaca (P<0,001). Medijan rezultata indeksa SVHI bio je 16,7 (interkvartilni raspon 7,6-29,2) u amatera i 13,8 (interkvartilni raspon 5,9-30,2) u profesionalaca. Veći rezultat indeksa SVHI bio je povezan s težim samoprocijenjenim poteškoćama s pjevačkim glasom u amatera (ρ=0,63, P<0,001) i profesionalaca (ρ=0,68, P<0,001). Amateri i profesionalci nisu se značajno razlikovali u samoprocijenjenim poteškoćama s pjevačkim glasom (P=0,698) niti u rezultatu indeksa SVHI (P=0,538). U odnosu na profesionalce, amateri su češće prijavili pucanje glasa (P=0,009) i poteškoće s glasnim pjevanjem (P=0,020) te su se manje brinuli za gubitak novca zbog poteškoća s pjevanjem (P=0,022). Hrvatski klasični pjevači većinom su imali blage poteškoće s pjevačkim glasom. Vokalne poteškoće u amatera ukazuju na važnost učenja vokalne tehnike. Potrebno je balansirati radne obveze i vokalni odmor radi očuvanja radne sposobnosti u profesionalnih klasičnih pjevača.
Aim of our study was to provide insight into the temporal and spatial expression of FGFR1, FGFR2 and CTGF during normal human lung development which may have an important impact on understanding ...occurrence of developmental lung anomalies. Morphological parameters were analysed using double immunofluorescence on human embryonal (6th and 7th developmental week-dw) and foetal (8th, 9th and 16th developmental week) human lung samples.
FGFR1 and FGFR2 was positive during all the dw in both the epithelium and mesenchyme. The highest number of FGFR1 positive cells was observed during the 6th dw (112/mm2) and 9th dw (87/mm2) in the epithelium compared to the 7th, 8th and 16th dw (Kruskal-Wallis test, p < 0.001, p < 0.0001). The highest number of FGFR1 positive cells in the mesenchyme was observed during the 8th dw (19/mm2) and 16th dw (13/mm2) compared to the 6th, 7th, and 9th dw (Kruskal-Wallis test, p < 0.001, p < 0.0001). The number of FGFR1 positive cells in the epithelium was higher for FGFR2 compared to number of positive cells (Mann-Whitney test, p < 0.0001). FGFR2 showed the highest number in the epithelium during the 7th dw (111/mm2) and 9th dw (87/mm2) compared to 6th, 8th and 16th dw (Kruskal-Wallis test, p < 0.001, p < 0.0001, p < 0.01 respectively). The highest number of FGFR2 positive cells in the mesenchyme was observed during the 9th dw (26/mm2), compared to the 6th, 7th,8th and 16th dw (Kruskal-Wallis test, p < 0.0001), while the number of FGFR2 positive cells in the epithelium was significantly higher than in the mesenchyme (Mann-Whitney test, p < 0.0001). CTGF was negative in both epithelium and mesenchyme during all except the 16th dw in the mesenchyme where it co-localized with FGFR2.
FGFR1 and FGFR2 might be essential for epithelial-mesenchymal interactions that determine epithelial branching and mesenchymal growth during early lung development. Sudden increase in FGF1 in the epithelium and FGF2 in the mesenchyme in the foetus at 9th dw could be associated with the onset of foetal breathing movements. CTGF first appear during the foetal lung development.
Objective: To compare wideband absorbance (WBA) patterns between ears with otosclerosis and normal hearing ears and to investigate if WBA findings could be useful in the diagnosis of otosclerosis.
...Design: WBA was obtained at 107 frequency samples ranging from 0.226 to 8 kHz (24 per octave). A T-test was performed to compare between WBA in ears with otosclerosis and in normal hearing ears. The ability of WBA to discriminate between the patients with otosclerosis from the normal hearing participants was tested with a receiver operating characteristics (ROC) curve analysis.
Study sample: Thirty-five patients with otosclerosis (age 31-64) and thirty-five normal hearing volunteers (age 32-64).
Results: In frequency range 0.432-1.059 kHz, mean WBA in otosclerosis was significantly lower than mean WBA in normal hearing ears and in frequency range 4.238-8 kHz mean WBA in otosclerosis was significantly higher than mean WBA in normal hearing ears. The ROC analysis revealed that ears with otosclerosis and normal hearing ears could be distinguished based on mean WBA in frequency range >0.5 ≤ 1 kHz (AUC = 0.673) and based on mean WBA in frequency range >4 ≤ 8 kHz (AUC = 0.769).
Conclusion: Our results suggest that WBA findings in ears with otosclerosis differ from WBA findings in normal hearing ears.
Purpose This article investigates the possible connections between the level of chronic stress and success of steroid therapy in patients with sudden sensorineural hearing loss (SSNHL). Method A ...single-center, retrospective, longitudinal cohort study on 55 patients in a tertiary referral otology center was examined. Patients diagnosed with SSNHL between 2014 and 2017 were asked to complete a Measure of Perceived Stress (Brajac, Tkalcic, Dragojević, & Gruber, 2003 ) questionnaire. Inclusion criteria were patients > 18 years of age, SSNHL diagnosed within 4 previous weeks, completed steroid treatment, and complete documentation. Results There were 30 patients (55%) that showed significant improvement in their pure-tone audiogram (PTA) hearing threshold average (≥ 15 dB) after steroid treatment. Two-step cluster analysis identified 3 clusters based on average PTA hearing threshold recovery and average Measure of Perceived Stress scores. The difference between pretreatment and posttreatment hearing levels was significantly higher in the cluster with moderate stress compared to clusters with mild and high stress levels (Kruskal-Wallis test, Friedman test, p < .001). There were no significant differences in average PTA hearing threshold recovery after steroid therapy between groups of patients with mild and severe stress. Conclusion Patients with moderate stress levels show significantly better results after steroid treatment for SSNHL than patients with low or high stress levels.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
To measure the effect of hyperbaric oxygen (HBO) therapy as salvage therapy after the failure of steroid therapy for sudden sensorineural hearing loss (SSNHL).
Ninety-three patients with SSNHL were ...unsuccessfully treated with systemic steroid therapy. Following steroid therapy, 43 patients received additional HBO therapy while 50 did not. Hearing levels at 0.25, 0.5, 1, 2, 4, and 8 kHz before and after therapy were measured.
A significant difference in hearing thresholds after HBO therapy was found at all frequencies in patients with a hearing loss of >61 dB. The group of patients with a hearing threshold of ≤60 dB had a significant improvement only at 250 and 500 Hz, while group of patients without additional therapy control group showed no hearing improvement.
Hyperbaric oxygen therapy therapy as salvage therapy for SSNHL showed some benefits in hearing improvement. Better results could be expected in patients with severe hearing loss, while in patients with mild-or-moderate hearing loss, recovery should be expected only at low frequencies.
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