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ORIGINAL ARTICLES
The effects of the Lee Silverman Voice Treatment program and traditional dysarthria therapy in flaccid dysarthria
Gamal Y Selim Youssef, Amr Anter, Hatem E Hassen
January-June 2015, 2(1):5-13
DOI:10.4103/2314-8667.158726  
Objective The aim of this study was to investigate the short-term and long-term speech effects of the Lee Silverman Voice Treatment (LSVT) program in a group of individuals with flaccid dysarthria and compare its effectiveness with traditional dysarthria therapy (TDT) methods. Design This study was designed as a randomized controlled trial. Patients and methods The study included 22 patients with flaccid dysarthria who were randomized into two groups and received either the LSVT or the TDT. Both interventions were administered at the same frequency, for 1 h a day, 4 days a week, for 4 weeks. Participants underwent a three-phase assessment: (a) before treatment, (b) immediately after treatment, and (c) 6 months after treatment or follow-up. Outcome measures included auditory perceptual analysis, acoustic and spectral analysis, aerodynamic analysis, nasometry, and Communication Partner questionnaire. Results There was significant improvement in most auditory perceptual analysis and instrumental variables in both treatment groups but most of these improvements were not maintained during follow-up in either group. Comparative statistical analysis revealed no significant differences between the two groups in the three assessment phases in most studied variables. Conclusion The apparent equity between LSVT and TDT in flaccid dysarthria highlights the clinical value of teaching the LSVT method and the potential for this treatment to yield improvements comparable to traditional articulation therapy methods through a technique that is cognitively less demanding. Thus the advantage of LSVT is not the amount of improvement but the less-demanding nature, cognitive-wise, of the technique.
  2,524 385 -
REVIEW ARTICLES
Developmental outcomes of children with auditory neuropathy/dyssynchrony (auditory neuropathy spectrum disorder)
Christine Yoshinaga-Itano
July-December 2014, 1(2):57-63
DOI:10.4103/2314-8667.149010  
Background This paper reviews current knowledge about the developmental outcomes of children with auditory neuropathy/auditory dyssynchrony (ANAD). Aim The article discusses the diverse variables that can impact developmental outcomes of this population of children with hearing loss and what is currently known in the literature. Since two-thirds of the children with ANAD have additional disabilities, this population of children is very complex. Patients The article discusses three children with very diverse developmental profiles including the differential diagnostic evaluations that supported decisions about communication approaches. Methods Three case histories of children with ANAD representing different individual characteristics and developmental trajectories are discussed. These three cases were chosen to represent the diversity of the population of children with ANAD. Results Case A is a child who received bilateral cochlear implantation and successfully developed listening and spoken language skills. Case B is a child who received bilateral cochlear implantation which did not result in successful listening and spoken language because of a breakdown at the level of the auditory cortex but is using sign language as a primary approach to learn to communicate. Case C is a child with significant co-morbidities including cerebral palsy and global developmental delays who is communicating through both spoken and signed language without the use of amplification. Conclusion Children with ANAD have significant diversity in their ability to access spoken language without amplification, with hearing aids and with cochlear implants. However, despite this diversity, when children are provided access to language through individualization and appropriate matching of both auditory and visual communication approaches, they can become successful language learners.
  1,585 826 -
ORIGINAL ARTICLES
Clinical diagnosis of middle ear disorders using wideband energy reflectance in adults
Walied M Ibraheem
July-December 2014, 1(2):87-96
DOI:10.4103/2314-8667.149017  
Accurate diagnosis of middle ear disorders in adults is a challenging task because of the complexity of disorders. The wideband energy reflectance (WBER) technique provides simplicity and accuracy in diagnosing middle ear disorders across a wide frequency range. This research is expanding the studies of WBER to investigate the middle ear function in normal and pathological conditions of the middle ear in adults. Several specific WBER patterns were established in a variety of middle ear disorders among adults that should help in early diagnosis of such pathologies. The energy reflectance (ER) pattern included significantly higher ER in the control group of children than the control group of adults at 0.5 and 1 kHz, abnormally high or shallower ER in otosclerotic ears with a characteristic Carhart notch at 2 kHz, abnormally low ER in ears with tympanic membrane (TM) perforation, and abnormally low ER with a deep notch in ears with hypermobile TM. In the presence of negative middle ear pressure, elevated ER at ambient pressure was also observed. Results also showed that standard tympanometry was less sensitive in diagnosing middle ear disorders compared with WBER, especially in otosclerotic cases. Further studies are still required to validate the clinical use of ER in larger numbers of individuals with confirmed middle ear disorders.
  1,753 452 -
REVIEW ARTICLES
Pharmacotherapy of vestibular disorders
Hesham Mahmoud Samy
July-December 2015, 2(2):39-42
DOI:10.4103/2314-8667.171512  
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.
  797 1,330 -
ORIGINAL ARTICLES
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
DOI:10.4103/2314-8667.149016  
Objective To standardize the rotatory chair sinusoidal harmonic acceleration and velocity step tests in an adult population. Study design Prospective study. Setting Clinical tertiary care vestibular function test center. Patients 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. Intervention 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. Results 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. Conclusion 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.
  1,697 210 1
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
DOI:10.4103/2314-8667.137559  
Introduction 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. Objective 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). Study design 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).
  1,600 140 -
REVIEW ARTICLES
New trends in the therapy of chronic tinnitus
Gerhard Hesse
July-December 2014, 1(2):64-70
DOI:10.4103/2314-8667.149012  
Although tinnitus is mostly primarily of peripheral origin and due to damage of hair cells, suffering and annoyance derives from central cortical reactions and functional networks of cerebral plasticity. New therapeutic approaches thus try to influence these structures directly through magnetic or direct or indirect electrical stimulation. Acoustic stimulations were also presented with tones or notched music, but they must integrate the existing hearing loss. Effective habituation therapies combine hearing therapy, rehabilitation of hearing loss by hearing aids, and psychosomatic stabilization. This review presents different therapeutic approaches.
  1,498 153 -
ORIGINAL ARTICLES
Chronic noise exposure: impact on the vestibular function
Afaf A Emara, Takwa A Gabr
July-December 2014, 1(2):71-79
DOI:10.4103/2314-8667.149015  
Background Noise exposure causes permanent or temporary hearing loss. High levels of noise may stimulate the vestibular system and thereby cause disturbances in the balancing mechanism. Objectives This work was designed to investigate the effect of chronic noise exposure on the vestibular system. Participants and methods Two groups were included in this study: control group: 20 healthy individuals with normal hearing and vestibular function and study group: 40 patients with a history of prolonged noise exposure at work. This group was further divided into two subgroups: 20 patients with noise-induced hearing loss and 20 individuals with normal hearing sensitivity. All participants in this study were subjected to combined vestibular evoked myogenic potentials (VEMPs) and videonystagmography (VNG). Results cVEMPs were absent in 5 and 20% of participants of subgroup IIa and IIb, respectively, with significantly delayed P13 and N23 latencies in the rest of participants in subgroup IIb. In terms of P13 and N23 amplitudes, there was no statistically significant difference between the control and the study subgroups. oVEMPs were absent in 40% of participants of subgroup IIb, with normal latencies and amplitudes in the rest of the participants. For VNG, only saccades latency was significantly delayed in subgroup IIb compared with subgroup IIa. A correlation was found between the participants' complaints and the results of the vestibular function tests. Conclusion Chronic noise exposure is hazardous to the inner ear structures and enhances vestibular damage, especially the sacculocollic reflex pathway. Vestibular insult is higher among patients with noise-induced hearing loss than in those with normal hearing.
  1,267 291 -
A comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in prolonged dysphagic stroke patients
Gamal Y Selim Youssef, Adeeba Alnajjar, Mona Elsherbiny
January-June 2015, 2(1):14-18
DOI:10.4103/2314-8667.158727  
Objective To evaluate the effectiveness and the safety of percutaneous endoscopic gastrostomy (PEG) as compared with a nasogastric (NG) tube for adults with prolonged neurological dysphagia after stroke. Design A prospective case-controlled study. Patients and methods This study included 90 patients with severe neurogenic dysphagia categorized into two groups: those on PEG feeding and those on NG feeding because they refused PEG. A comparison of both groups was assessed by several methods. The primary outcome measures were death and aspiration pneumonia during 3 months' observation and the 2ry outcome measures were changes in the nutritional state during this period and patient and family satisfaction. Results Weight gain was significantly higher among patients in the NG group. The incidence of aspiration pneumonia was significantly higher among patients in the NG group (14) compared with seven patients in PEG. There were four (8.3%) deaths in the PEG group compared with eight (18.2%) in the NG group. Conclusion This study has demonstrated that PEG feeding in long-term dysphagic patients with stroke is associated with a significant reduction in the incidence of aspiration pneumonia with reduced mortality at 3 months. PEG is more acceptable and less irritating to patients and is superior in the delivery of feed and maintaining the nutritional status and improves the long-term quality of life.
  1,317 156 -
CASE REPORT
Bilateral sudden sensorineural hearing loss in Kawasaki disease
Hossam Sanyelbhaa Talaat, Abdullah M Jamos, Ahmed Thabet Kamal Eldin, Mohamed Samer S Abdelaal
January-June 2014, 1(1):47-49
DOI:10.4103/2314-8667.137566  
Kawasaki disease is an acute self-limited vasculitis and is commonly seen in children. This case report is a rare complication of Kawasaki disease. A 5-year-old boy had persistent fever, associated with bilateral nonexudative conjunctivitis, cervical lymphadenopathy, and maculopapular erythema on his trunk. The patient was diagnosed as Kawasaki disease and was treated by intravenous immunoglobulins and aspirin. However, 3 days after recovery of the symptoms, he developed bilateral severe sensorineural hearing loss. Corticosteroid therapy of 40 mg/day was immediately administrated for 15 days; no improvement was noticed in the child's hearing as evidenced by serial audiometry follow-up.
  1,306 98 -
ORIGINAL ARTICLES
Effect of strabismus on vestibular functions: value of its correction
Mohamed A Abd Al-Rahman, Badawy S Badawy
January-June 2014, 1(1):18-25
DOI:10.4103/2314-8667.137560  
Objective Studies that evaluate the relationship between strabismus and vestibular functions are very scarce with no consensus between their results. Hence, this study was designed to evaluate vestibular functions in patients with strabismus and to find out the effect of surgical correction of strabismus on vestibular functions. Materials and methods Thirty patients with strabismus aged between 10 and 33 years constituted the study group. The following procedures were carried out: otological examinations, detailed vertigo history, neurological and ophthalmological examinations, basic audiological evaluation, office tests for vestibular evaluation, videonystagmography, and computerized dynamic posturography. These vestibular tests either office tests or laboratory tests were performed three times, before eye surgery and 1 month and 2 months after eye surgery. Results Before surgery, in office tests for vestibular function, 36.6% of patients had abnormal results in dynamic visual acuity, whereas 26.7 and 16.7% had abnormalities in head thrust and head shake tests. In addition, 43.3% had abnormal sharpened Fukuda stepping test, whereas 33.3 and 13.3% had abnormal CTSIB and Fukuda stepping test. Reduction in equilibrium scores as well as condition 3, 5, and 6 of sensory organization test in all patients showed abnormal videonystagmography test results. Improvement occured postoperatively in office as well as laboratory tests. Conclusion Vestibular functions in strabismus patients are globally better in postoperative than in preoperative conditions, and this improvement appeared to be stable.
  1,250 98 -
High-resolution computerized tomography and Magnetic Resonance Imaging (MRI) in preoperative evaluation of cochlear implant patients
Vyas D Pooja, Garge S Shaileshkumar, Vyas D Deepak, Rasool B Bushra, Thakker R Nirav, Jaggi T Sunila, Talwar A Inder
January-June 2015, 2(1):1-4
DOI:10.4103/2314-8667.158148  
Context Preoperative cross-sectional imaging evaluation of cochlear implant patients is critically important in deciding whether the patient is suitable for implantation and in choosing the side of implantation. Aims The aim of this prospective study was to determine the incidence of structural cochlear anomalies in patients with congenital profound bilateral sensorineural hearing loss, who were being evaluated for the feasibility of cochlear implantation. Settings and design This was a prospective observational nonrandomized study. Patients and methods A total of 26 patients with congenital profound bilateral sensorineural hearing loss, who were being evaluated for feasibility of cochlear implantation were included in this study. These patients were evaluated with high-resolution computerized tomography of the temporal bone and MRI for incidence of structural cochlear anomalies. Results The incidence of structural cochlear anomalies, excluding cochlear nerve aplasia, in patients with congenital profound bilateral sensorineural hearing loss, who were being evaluated for the feasibility of cochlear implantation was 50%. Conclusion This study highlights the importance of preoperative radiological scanning in the assessment of patients undergoing cochlear implantation. It provides vital information on cochlear status and in ruling out noncochlear causes where cochlear implantation is not feasible or contraindicated.
  1,092 181 -
Vestibular evoked myogenic potentials and video head impulse tests in different stages of Meniere's disease
Doaa M Elmoazen, Ossama A Sobhy, Fathy Abd Elbaky
July-December 2015, 2(2):45-53
DOI:10.4103/2314-8667.171518  
Introduction Meniere's disease (MD) is characterized by intermittent episodes of vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural pressure. Histopathologically, endolymphatic hydrops is seen initially in the cochlear duct and the saccule; with the progression of the disease, subsequent affection of the utricle and semicircular canals (SCC) occur. Objectives The aim of this study was to assess the function of the saccule, the utricle, and the three SCCs using cervical vestibular evoked myogenic potential (cVEMP), ocular vestibular evoked myogenic potential (oVEMP), and video head impulse test (vHIT), respectively, in Meniere's patients and to correlate the findings with the different stages of MD. Patients and methods Forty patients diagnosed with unilateral definite MD according to the American Academy of Otolaryngology and Head and Neck Surgery's 1995 criteria [AAO-HNS (1995) criteria] were tested. They were divided into four subgroups based on the stage of MD using the average of 500, 1000, 2000, and 3000 Hz pure-tone thresholds of the worst documented audiogram during the 6-month interval before examination. A control group of 40 healthy age-matched adults were equally divided into four corresponding subgroups based on their pure-tone average. In all, 500 and 1000 Hz tone burst air conduction cVEMP and oVEMP tests, bithermal caloric test, and vHIT for all SCCs were recorded for both groups. Results The results of this study showed that the highest prevalence of abnormalities in Meniere's patients were seen in the pure tone average (PTA) (85%), followed by cVEMP (72.5%) and oVEMP (67.5%). Caloric test abnormalities follow with a lower prevalence of 32.5%. The vHIT presented the lowest prevalence of abnormalities, with 20% in the lateral canal, 7.5% in the anterior, and 5% in the posterior canal. This pattern of abnormality is in agreement with the reported pattern of hydrops formation in the vestibular system. Conclusion The findings of the current study suggest that with the advancement in the stage of MD consequent abnormal cVEMP, oVEMP, caloric, and vHIT responses occur following the histopathological evidence of progression of the disease from the saccule up to the SCCs.
  1,048 200 -
Videonystagmography findings in epileptic children
Mohamad El-Gohary, Madeha Elmously, Naema Esmail, Elhady A Abdel Gawwad, Soha Mekki, Ebtessam Nada
January-June 2014, 1(1):26-31
DOI:10.4103/2314-8667.137561  
This study included 60 epileptic children (6-18 years) and 20 neurologically free age-matched children. It was conducted to identify vestibular system abnormalities associated with or caused by epilepsy in patients either complaining of dizziness or not. Otoneurological testing was performed including videonystagmographic testing. More than one type of epilepsy was encountered. Dizziness was reported as a complaint in most patients diagnosed with partial epilepsy. Variable videonystagmographic findings were found. Among patients with dizziness, the most prominent abnormality was abnormal oculomotor test results (23 of the 37 patients). Only two patients showed abnormal Dix-Hallpike testing. Positive vestibular findings were found among patients without dizziness, in only three of the 23 patients who had unilateral caloric weakness during caloric testing.
  1,138 96 -
Central auditory plasticity indexed by mismatch negativity
Abdel-Hamid Elshintinawy, Enaas Kolkaila, Takwa A Gabr
January-June 2014, 1(1):3-11
DOI:10.4103/2314-8667.137558  
Introduction Unilateral hearing loss (UHL) represents a particular model for investigating the functional auditory plasticity in humans. Normally, monaural stimulation produces a normal pattern of a contralateral dominance. With UHL, this pattern changes. Objective The aim of the study was to investigate the effects of UHL side and age at onset on auditory processing. Design Mismatch negativity (MMN) was recorded in response to speech and tone stimuli. Study sample This study included two groups: the control (50 bilateral normal hearing) and study (206 UHL patients) groups. This group was further classified according to UHL side and age at UHL onset. Results In controls, higher speech-evoked MMN amplitude was recorded in the right ear. The study group showed impaired speech-evoked MMN in either left or right UHL patients, especially in early onset UHL patients. Tone-evoked MMN was not affected in controls or UHL patients. Conclusion Cortical reorganization induced by UHL occurs mainly in patients with left-side affection. Speech processing is affected in UHL irrespective of the affected side, especially in early onset patients.
  1,108 113 -
Auditory steady-state response audiometry in children with severe to profound sensorineural hearing loss
Dalia M Hassan, Nagwa Hazzaa, Elham El Saiid, Mohamed Moneer
January-June 2014, 1(1):38-46
DOI:10.4103/2314-8667.137565  
Objective The aim of the study was to find out the predictive value of single monotic auditory steady-state response (ASSR) for hearing threshold estimation in children with severe to profound sensorineural hearing loss (SNHL). Methodology Forty-eight children (96 ears) with severe to profound SNHL were included in the present study, with age range 1-10 years. They were subjected to age-based audiological evaluation to estimate the behavioral thresholds. Single monotic ASSR was performed for all children using test signals of 250, 500, 1000, 2000, and 4000 Hz, modulated in both ears at high rates of 67, 74, 81, 88, and 95 Hz, respectively, using GSI Audera-evoked potential system. ASSR thresholds were obtained and analyzed according to the equipment default criteria. Results The number and percentage of ASSR detected were highest at 1000 Hz then 500 Hz followed by 2000 Hz and were the least at 4000 and 250 Hz in all children. The ASSR thresholds obtained were statistically correlated with the behavioral pure tone audiometry thresholds at 500, 100, and 2000 Hz. A considerable number of ears with no sound field thresholds or click auditory brainstem response responses showed ASSR. Conclusion Single monotic ASSR, with high modulation frequencies, has proven to be a reasonable method for estimating hearing sensitivity in the mid-conventional audiometric frequencies in children with severe to profound SNHL. Recommendations All children with no behavioral hearing threshold and/or absent click-evoked auditory brainstem response should be tested by ASSR at 500, 1000, and 2000 Hz to give information about the presence of useful residual hearing. ASSR can provide important information for use in the cochlear implant selection process
  1,098 107 -
Evaluation of speech perception in patients with ski slope hearing loss using Arabic consonant speech discrimination lists
Mai M El Ghazaly, Mohamed A Talaat, Mona I Mourad
January-June 2014, 1(1):32-37
DOI:10.4103/2314-8667.137563  
Introduction Cochlear dead regions are regions of the basilar membrane where the inner hair cells and/or associated neurons function so poorly, such that they may be considered dead. Diagnosing patients suffering from ski slope hearing loss should put in consideration the possibility of cochlear dead regions. These patients often miss out high-frequency components of speech, which are consonant sounds (especially fricatives). Objectives The current study was designed to evaluate speech perception of patients with ski slope high-frequency hearing loss on a modified Arabic consonant speech discrimination lists developed at the University of Alexandria and to evaluate the possible effect of high-frequency dead regions of the cochlear partition on such performance. Materials and methods Twenty patients with ski slope hearing loss were subjected to the Threshold Equalizing Noise (HL) test to bracket cochlear dead regions. The performance of each on the modified Arabic consonant speech discrimination lists was assessed and correlated with the presence or absence of cochlear dead regions and also with their extent if present across a number of spectral frequencies. Results The results of this study showed that the average correct score of ears with no dead regions on the modified Arabic consonant discrimination lists was 75.32%, whereas the score of ears with dead region(s) was 61.19%. According to the extent of dead regions, the average score of ears with dead region at 4000 Hz only was 62.5%, that of ears with dead regions at 2000-4000 Hz was 61.8%, and that of ears with dead regions at 1000-4000 Hz was 56.5%. The highest probability of error in all ears was for the fricatives. Conclusion Speech tests that emphasize high-frequency speech elements are crucial in determining cochlear functional reserves in a practical manner. Psychophysical tests that investigate dead regions of the cochlea are synergistic to the high-frequency emphasis speech tests.
  1,027 93 -
BOOK REVIEW
Textbook on vertigo: Diagnosis and management

January-June 2014, 1(1):50-51
  933 128 -
ORIGINAL ARTICLES
Evaluation of dizzy adult patients using the Arabic dizziness questionnaire and its correlation with different vestibular test results
Mohamed T Ghannoum, Mona H Selim, Mohamed S Elminawi, Mariam M Medhat
January-June 2015, 2(1):28-38
DOI:10.4103/2314-8667.158730  
Objectives The aim of this study was to develop an Arabic dizziness questionnaire for adults and compare the questionnaire conclusion with the results of vestibular evaluation. Participants and methods Twenty dizzy adults, age 21-60 years, were subjected to an interview with patients using the Arabic dizziness questionnaire, otological examination, bedside examination for dizzy patients, basic audiological evaluation, and vestibular assessment, which included the following: videonystagmography, cervical vestibular-evoked myogenic potentials, and sensory organization testing through dynamic posturography. Parameters under study were questionnaire scores and conclusion, videonystagmography results including canal paresis, and cervical vestibular-evoked myogenic potentials latency, amplitude, and threshold. Sensory organization testing result analysis in the form of equilibrium scores and sensory analysis. Results Comparisons and correlations between the vestibular score of the questionnaire and results of the vestibular assessment were nonstatistically significant. The most common diagnoses for dizziness in the adult group were vestibular neuritis (four cases), Mιniθre's disease (four cases), benign paroxysmal positional vertigo (three cases), and migraine-associated dizziness (three cases). Conclusion Adult patients sharing the same diagnosis consistently answered certain questions positively in the questionnaire. We recommend the use of the dizziness questionnaire as a first step of the test battery for the evaluation of dizzy patients.
  864 149 -
Results of the first universal newborn hearing screening in Algeria
Farid Boudjenah, Mokhtar Hasbellaoui, Omar Zemirli
July-December 2015, 2(2):54-58
DOI:10.4103/2314-8667.171521  
Introduction 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. Goals 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. Results 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. Conclusion 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.
  757 213 -
REVIEW ARTICLES
Neuroplastic changes in musician's brain: A review
Himanshu Kumar Sanju
July-December 2015, 2(2):43-44
DOI:10.4103/2314-8667.171513  
Neuroplasticity refers to any change or modification in the central nervous system because of any adaptation or experience to environmental demands. Musical training and experience can lead to neuroplasticity because music requires cognitive and neural challenges that need accurate and precise timing of many actions, exact interval control of pitch not involved in language, and various different way of producing sound. It was also reported that a musician's brain is best to study neuroplastic changes. Therefore, the current review explored studies related to neuroplasticity in musicians' brains. Various database such as Medline, PubMed, Google, and Google Scholar were searched for the reference to neuroplasticity in musicians.
  762 149 -
ORIGINAL ARTICLES
Sensitivity of CHIRP auditory brainstem response and auditory steady state response for detecting normal hearing in children
Haider W Alsarhan
July-December 2015, 2(2):59-63
DOI:10.4103/2314-8667.171527  
Background In recent years, great development of electrophysiological procedures for detection of hearing level in infants and children has been achieved - click auditory brainstem response (ABR), tone burst ABR, and notched noise ABR. The two most recent methods are CHIRP signal ABR and auditory steady state response (ASSR). Aim of the study The aim of this study was to identify the best electrophysiological method for detecting normal hearing thresholds. Patients and methods A prospective study was conducted on 80 ears from 58 children aged from 1 to 2 years that showed normal hearing thresholds in all frequencies in visual reinforcement audiometry (VRA) cooperatively, for which CHIRP ABR and ASSR were evaluated and the results were analyzed. Results Both CHIRP ABR and ASSR showed moderate correlation with VRA at 0.5 and 1 kHz and a strong correlation at 2 and 4 kHz. CHIRP ABR thresholds were closer to VRA thresholds and showed a sensitivity of 100%, detecting normal hearing thresholds at all frequencies, whereas the sensitivity of ASSR in detecting normal hearing was decreased with decreasing testing frequency, reaching a low percentage of 57.5% at 0.5 kHz. Conclusion CHIRP ABR is the best electrophysiological method for assessing hearing thresholds in children whose hearing average is expected to be close to normal threshold.
  716 130 -
Ocular motor tests in relapsing remitting multiple sclerosis
Hesham Mohamed Negm, Mohamed Ibrahim Shabana, Hatem Samir Mohamed Shehata
January-June 2015, 2(1):19-27
DOI:10.4103/2314-8667.158728  
Background Multiple sclerosis (MS) is the quintessential neurologic disorder from which one can gain insights into the principles of afferent and efferent neuro-ophthalmology. The popularity of eye movements as an experimental tool can be partly attributed to the fact that they can be conveniently and accurately measured and analyzed, and also because much is known about their neural substrate. It is therefore no surprise that eye movements have been commonly applied to better understand the visual and motor disorders in patients with MS. Objectives The aim of this study was to demonstrate the vast ocular motor abnormalities that occur in this disease using videonystagmography as our tool of description and determine the relationship with Expanded Disability Status Scale (EDSS) and MRI findings. Materials and methods The current study included 76 patients who were divided into two groups. Group I comprised 54 patients with relapsing-remitting multiple sclerosis who fulfilled the Revised Mcdonald's criteria for diagnosis of MS. The age of the patients in group I ranged from 20 to 68 years, with a mean of 35.13 ± 9.42 SD (23 men and 31 women). Group II comprised 22 healthy age-matched and sex-matched individuals who were recruited from the general population and were not relatives of the patients. Their ages ranged from 19 to 54 years, with a mean of 33.81 years ± 10.07 SD (11 men and 11 women). Video-nystagmography, saccadic tracking, random horizontal saccades, optokinetic tracking (at 20, 40, and 60΀/s), smooth pursuit (0.2, 0.3, 0.4, 0.5, 0.6, and 0.7 Hz), and gaze-evoked nystagmus were examined in both groups. Group I, in addition, was subjected to a thorough neurological history and neurological examination, EDSS assessment, ophthalmologic examination (visual acuity and ocular motility), and radiological assessment by MRI with and without contrast. Results The eye movement disorders most commonly noted are saccadic dysmetria, followed by gaze-evoked nystagmus and pendular nystagmus. They are caused by disease affecting the brain stem and cerebellar circuits. Reduced pursuit gain and saccadic pursuit were also noted. A strong correlation between brainstem and cerebellar MRI lesions and the affection of the ocular motor system was well noted. A high EDSS score was well correlated with abnormal ocular motor test findings. Conclusion Ocular motor system tests are more sensitive than conventional clinical examinations in identifying abnormalities in MS.
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WELCOME MESSAGE
Welcome message
Khaled Abdul-Hady
January-June 2014, 1(1):1-1
DOI:10.4103/2314-8667.137556  
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EDITORIAL
Message from the Editor-in-Chief
Mohamed Shabana
January-June 2014, 1(1):2-2
DOI:10.4103/2314-8667.137557  
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