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Standardization of rotatory chair velocity step and sinusoidal harmonic acceleration tests in an adult population
Mohamed FM Ahmed
July-December 2014, 1(2):80-86
To standardize the rotatory chair sinusoidal harmonic acceleration and velocity step tests in an adult population.
Clinical tertiary care vestibular function test center.
One hundred normal participants (66 men and 34 women without suspected vestibular disorder) were evaluated using bithermal binaural caloric and sinusoidal and step-velocity rotary chair tests.
Hearing, videonystagmography, and rotary chair tests.
Materials and methods
All participants were selected according to the following criteria: (a) no history of dizziness; (b) normal otological examination; (c) normal hearing evaluation; (d) normal videonystagmography testing; and (e) rotational chair testing. The patient was positioned and secured to the rotational chair with the patient's head restrained and adjusted so that both lateral semicircular canals were close to the plane of stimulus (30 forward tilt), the rotational chair testing paradigms used in this study were: (a): the rotational sinusoidal harmonic acceleration (SHA) test and (b): the rotational velocity step test.
The demographic criteria for the study group were as follows: the age range was 18-56 years, mean age 36.47 years, and 66% of the participants were men and 34% were women. The mean, SD, range, and 95% confidence limits of the SHA and rotational velocity step test were calculated and compared with the manufacturer's normal values. No statistically significant differences were found between our lab test results and the manufacturer-measured values of the rotational SHA test and the rotational step velocity test (SVT); this could be attributed to the strict selection criteria of the study group.
In summary, the information obtained from rotational chair testing may provide valuable information in the diagnosis and subsequent management of patients with vestibular disorders. It completes the spectrum of tests necessary for the diagnosis of vestibular abnormalities and aids the identification of peripheral vestibular deficits not detectable with existing procedures. The major clinical advantage of computerized rotational testing is the ability to produce angular accelerations that can be precisely controlled and repeated. Multiple stimuli of varying intensities can be applied to the vestibular system within a relatively short time.
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Pharmacotherapy of vestibular disorders
Hesham Mahmoud Samy
July-December 2015, 2(2):39-42
Dizziness and vertigo are symptoms directly related to dysfunction of the vestibular system. Imbalance is the most common complaint, especially in the elderly population, which results in falls and mobility restriction. There is no common drug for the management of balance disorders. Medications should be prescribed carefully, and according to clear diagnosis. The pharmacotherapy of vertigo can be optimized with detailed knowledge of the drugs effective in vertigo, as well as their side effects. A thorough review of the literature reveals that there is a significant lack of information concerning the real utility of different drugs used in clinical practice. This article discusses the pharmacological options that are available for the treatment of balance disorders, along with some recent advances.
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Results of the first universal newborn hearing screening in Algeria
Farid Boudjenah, Mokhtar Hasbellaoui, Omar Zemirli
July-December 2015, 2(2):54-58
Hearing loss is the most common congenital pathology at birth. Its prevalence increases during the infant period, especially in children at risk. The application of hearing screening in three stages with follow-up of children at risk of developing hearing loss allows to optimize the screening.
The aim of this study was to evaluate the prevalence of hearing loss in the neonatal population and identify newborns at risk and to investigate the best way to support infants with such disability from screening to rehabilitation.
Materials and methods
This prospective study was conducted over a period of 22 months from June 2011 to March 2013, using a systematic screening for deafness in a high-birth-level maternity unit.
Over a period of 22 months, 17 912 live newborn were born in the maternity ward. The application of screening for deafness at birth allowed us to screen 15 382 newborns, with a coverage rate of 85.9%. We chose a three-stage screening protocol. In the first stage, 15 382 newborns were screened by means of analysis of distortion product of otoacoustic emissions (DPOAE). The screening was negative (presence of DPOAE and absence of hearing loss) in 13 467 newborns, and it was positive (absence of DPOAE and a possibility of hearing loss) for 1915 newborns who were addressed to the second stage of the screening protocol for the analysis of DPOAE again after 1 month of birth. In this second stage of screening, 1516 infants were screened in the ENT Department and 399 infants were lost to follow-up. After the second stage of the screening, 76 infants were addressed to the third stage of the screening protocol, which is also called stage of diagnosis. In this last step, 14 children were lost to follow-up and 62 infants were tested for hearing threshold using analysis of auditory brainstem response. Finally, after verification of the results obtained in the third stage using behavioral audiometry and impedance, 49 children showed hearing loss with a hearing threshold greater than 30 dB. The prevalence of neonatal hearing loss in the maternity unit was 3.2%. There were 27 male and 22 female patients, of whom 29 had bilateral hearing loss and 20 children had unilateral hearing loss. In contrast, the study of the risk factors of hearing loss allowed us to identify those who are present among the detected newborns and to calculate the prevalence of hearing loss among newborns admitted in the neonatal ICU, which was 2.14%. The risk factors most associated with deafness are infections with cytomegalovirus and rubella, damage to the nervous system and craniofacial malformations. The rehabilitation of hearing is based on speech rehabilitation and the use a hearing aid, either conventional prosthesis or cochlear implant.
Newborn hearing screening using a three-stage protocol is possible. It allows to detect hearing loss earlier to initiate early hearing and language rehabilitation, the only way to guarantee alignment of children born with hearing impairment or with contracted hearing loss during the neonatal period with their peers with normal hearing.
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Fast psychophysical tuning curves of the cochlea in normal hearing individuals
Mohamed Shabana, Brian CJ Moore, Mostafa el-Khosht, Mona H Selim, Mona Dokla
January-June 2014, 1(1):12-17
Fast psychophysical tuning curve (fPTC) test is a fast computer-based method that aims to assess the frequency selectivity of the cochlea and to detect the dead regions. It can quickly identify tip frequency and Q10 of psychophysical tuning curves (PTCs) derived by using a band of noise that changes in center frequency and a Bιkιsy method to adjust the masker level required for threshold of the noise. We applied this method in normal hearing individuals in the presence of threshold equalizing noises at three signal levels. The sharpness of the PTCs (Q10) and the typical shift of tips of the PTCs for 16 normal hearing individuals, when the tip frequency is estimated for the average of a forward and reverse sweep, were obtained. The results were used to determine the mean, SD, and 95% confidence interval of the shifts in normal hearing individuals.
The purpose of this experiment was to estimate the typical shift of tips of the PTCs for normal hearing individuals. The results were used to determine the mean, SD, and 95% confidence interval of the shifts. The sharpness of the PTCs change with signal level under conditions where off-frequency listening is restricted, using a background noise, was also assessed. This was performed to allow a comparison with the results of hearing-impaired patients tested at the same level (but without background noise).
Sixteen adults of both sexes (eight male individuals and eight female individuals) were randomly selected to establish normative data for the fPTC test. They were selected with age ranging from 18 to 45 years. All individuals had normal middle ear function as indicated by tympanometry and acoustic reflex measurement and by hearing threshold equal to or better than 20 dB at octave frequencies in the frequency range (250-8000 Hz) (as defined by ANSI S3.6-2004).
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Evaluation of factors that influence cochlear implant performance
Vergena S Ahmed Elkayal, Mona I Mourad, Manal M Elbanna, Mohamed A Mohamed Talaat
January-June 2016, 3(1):1-8
One of the primary goals of cochlear implantation is open-set auditory-only speech understanding in everyday listening environments. An understanding of the etiology and neurocognitive factors that contribute to a favorable outcome after cochlear implantation would potentially allow clinicians to predict the results for a cochlear implant patient. The ability to discriminate small acoustic differences is very important for the perception and processing of speech signals. The mismatch negativity (MMN) method is an objective tool that provides a measure of automatic stimuli discrimination.
Objective of the study
The aim of this study was to classify the communicative performance of children with cochlear implants and verify this outcome by means of electrophysiological biomarkers.
The study was carried out in three phases: phase I included completing an audiological data information sheet for all patients, with data taken from their records, which included demographic data, preoperative and postoperative audiological evaluation, operative detailed information, cochlear implant mapping data, and preoperative auditory verbal therapy details as regards regularity and benefit. Phase II involved classifying the patients’ communicative performance according to a phoniatric evaluation protocol into poor, fair, and good response, determining behavioral pure tone aided thresholds with their cochlear implants, and conducting electrophysiological studies ‘P1 and MMN’ for those with aided thresholds in the long-term average speech spectrum with their cochlear implant. Phase III entailed verification of factors that affect the outcome of all cochlear implant users.
Age of cochlear implantation, cause of hearing loss, comorbidity, preoperative electrophysiological test results, and radiological findings are variables affecting cochlear implant performance and affecting the patient's communicative performance, whereas sex of the patient and number of stimulated electrodes are variables not affecting the cochlear implant performance.
Early cochlear implantation and good auditory verbal therapy have better outcomes as regards listening and communication skills. Cortical auditory evoked potential (P1) and MMN might provide a clinical tool to monitor aural rehabilitation outcome. These objective electrophysiological parameters may also be used as prognostic indicators for speech and language outcome.
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