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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
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.
  9,520 1,114 1
Sound therapy for tinnitus patients
Mohamed I Shabana, Abeir O Dabbous, Ayman M.M. Abdelkarim
January-June 2017, 4(1):1-5
Sound therapy, or use of any sound for the purposes of tinnitus management, is widely accepted as a management tool for tinnitus. Sound therapy have varying goals. Reducing the attention drawn to tinnitus, reducing the loudness of tinnitus, substituting a less disruptive noise. Sound therapy can be achieved with many modalities: Environmental Enrichment, tinnitus maskers, hearing aids and combination instruments such as: Danalogic iFIT Tinnitus, ReSound Live TS, Oticon’s Tinnitus “SoundSupport”, Phonak’s Tinnitus Balance and Widex Zen Fractal Tones. There are other sound devices e.g.: Acoustic Co-ordinated Reset, Neuromodulation, Serenade, Neuromonics, Phase-Out, Phase-shift and tinnitus inhibitory pathway activation. The advantages of sound therapy are: being non-invasive, reduce patient frustration and anxiety, some patients experience residual inhibition and it can facilitate patient’s habituation to tinnitus.
  7,331 1,812 -
Developmental outcomes of children with auditory neuropathy/dyssynchrony (auditory neuropathy spectrum disorder)
Christine Yoshinaga-Itano
July-December 2014, 1(2):57-63
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.
  3,650 4,238 -
Clinical diagnosis of middle ear disorders using wideband energy reflectance in adults
Walied M Ibraheem
July-December 2014, 1(2):87-96
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.
  6,639 863 -
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.
  2,745 4,334 2
Templates for speech-evoked auditory brainstem response performance in cochlear implantees
Mona I Mourad, Mohamed Eid, Hicham G Elmongui, Mohamed M Talaat, Mirhan K Eldeeb
July-December 2016, 3(2):25-34
Introduction Speech-evoked auditory brainstem response (ABR) has been used to assess the fidelity of encoding speech stimuli at the subcortical level in normal individuals in noise and in special populations such as learning-impaired children and musicians. The neural code generated by cochlear implants (CIs) in the auditory brainstem pathway and its similarity to stimulus may account for variable speech development in cochlear implantees. Objective The aim of this study was to describe speech ABR recorded in CI individuals and establish measurement parameters for the neural response and its reproducibility. Participants and methods Children between 5 and 10 years of age implanted in the right ear with fully inserted 12-electrode CIs were selected. All participants had normal morphology of the cochlea and auditory nerve in preoperative computed tomographic scan and MRI. Speech syllable 40 ms /da/ was used to elicit speech ABR. Response traces for intensity input/output functions were harvested. Grand averages were constructed for peak picking. Individual patient responses were analyzed for reproducibility, latency of wave V, root mean square amplitude of the response, and correlation to the stimulus. Results Grand averages showed wave V, followed by the frequency following response. Wave V is a vertex-positive peak, equivalent to that elicited by a click, which reflects the stimulation by the transient /d/. The mean latency of wave V was 2.59±0.7 ms at 70 dBHL. The frequency following response showed multiple sequenced troughs corresponding to the sustained vowel /a/. Individual responses collected for similar stimulus parameters showed high reproducibility, being 99.65% at 60 dBHL and 52.8% at 30 dBHL. Participants showed variable latency and root mean square amplitude-intensity input–output functions slopes. The mean stimulus-to-response correlation was 18.1±3.1%. Conclusion Speech ABR in CI participants shows similar morphology to that recorded in norms. CIs thus transcribe the speech signal with high fidelity to the brainstem pathways.
  2,345 3,676 -
Tympanometric assessment of Eustachian tube function as a prognostic indicator in myringoplasty
Suresh Babu Undavalli, Narayan Hanumanth Rao Kulkarni, Sukrit Bose, Anuradha Ananthaneni
January-June 2017, 4(1):14-18
Aim To determine eustachian tube function in tubo-tympanic type of chronic ear disease and correlate it with pathological changes in middle ear. Objective To ascertain whether eustachian tube function had any demeanor upon the outcome of myringoplasty. Backgound The prevailing interest in the patho-physiology of the eustachian tube has been stimulated by the persistent incidence of middle ear effusion and chronic otitis media. The ongoing sophistication in current middle ear reconstructive surgery has added more dimensions to the study of eustachian tube and its effects in the course of reconstructive middle ear surgery. One of the prime elements accountable for failure of reconstructive middle ear surgery has been tubal dysfunction. Method In the present study eustachian tube function was evaluated in in 30 patients who were undergoing myringoplasty for tubo-tympanic type of chronic suppurative otitis media having central perforation by tuning fork tests, microscopic evaluation of the middle ear mucosa and Impedance audiometry. Results 70% of the myringoplasty cases had good surgical outcome and of the 24 cases that had good eustation tube function 87.5% had successful surgical outcome remaining cases had recurrence of otorrhea. Conclusion The results were validating good eustachain tube function as a criterion for electing cases under middle ear reconstructive surgery and Impedance audiometer assures a superlative means of appraising Eustachain tube function.
  5,035 661 -
Comparison of two hearing aid fitting formulae in improving the patients’ satisfaction with amplification for experienced hearing aid users
Mohamed Shabana, Mona H Selim, Salwa M Abd El-Latif, Mona M Hamdy, Mai M El-Gohary
January-June 2017, 4(1):19-25
Introduction The effectiveness of real word satisfaction is very important for optimal hearing aid (HA) fitting, which can be assessed using self-report questionnaires. The Client Oriented Scale of Improvement (COSI) and Abbreviated Profile of Hearing Aid Benefit (APHAB) are useful tools for assessing the effectiveness of HA in achieving patient satisfaction. Patients and methods This study included 20 hearing-impaired adults. Their hearing thresholds ranged from moderate to moderately severe sensorineural hearing loss and had previous experience with HAs. Their ages ranged from 18 to 60 years, and the mean duration of HA experience was 3.85±5.02 years. Participants were examined in three scheduled sessions: unaided, aided National Acoustics Laboratories-Nonlinear 2 (NAL-NL2), and aided desired sensation level (DSL) v5. Each session was scheduled 2 months after the previous session. Patient satisfaction was assessed using the COSI and APHAB questionnaires for each HA fitting formulae. Results Both formulae have improved patient’s five client needs of the COSI; however, NAL-NL2 had better final ability score compared with DSL v5. Using the APHAB questionnaire, both formulae have decreased the listening difficulty score significantly. Using APHAB questionnaire, NAL-NL2 showed significantly less listening difficulty compared with DSL v5 as regards difficulties in ease of communication, broadband noise, and reverberation. However, both formulae did not improve ‘aversiveness’ conditions. Conclusion Questionnaires are equally important to audiometric tests and should not be underestimated and hence should be relied upon it in HA-fitting verification.
  4,873 638 1
Hearing profile in children with allergic rhinitis
Adekunle Adeyemo, Josephine Eziyi, Yemisi Amusa, Sanyaolu Ameye
January-June 2017, 4(1):10-13
Objective We carried out this study to determine the profile of hearing of children with allergic rhinitis compared with normal controls. Patients and methods Children with allergic rhinitis between the ages of 4 and 16 years attending the Otorhinolaryngology Clinics as well as age-matched and sex-matched controls were recruited into this study. We obtained the participants’ bio data, symptoms and duration using a structured interviewer questionnaire. We then carried out a pure tone audiometry on the participants. The degree of hearing loss was determined on the basis of the WHO standard classification. Results We recruited 99 children with clinical evidence of allergic rhinitis and an equal number of healthy controls completed the study. The mean age was 9.19±3.98 years in the test participants and 9.35±4.05 years in the controls, respectively. Mild hearing loss on the right side was more than twice as common among patients, 24 (24.2%), compared with the controls, 11(11.1%). Left-sided mild hearing loss was more than four times more prevalent among patients with allergic rhinitis, 26 (26.3%), compared with the controls, six (6.1%). Hearing threshold worse than 25 dB hearing level in the better-hearing ear was found to be significantly more prevalent among patients compared with the controls. Conclusion We could conclude that hearing is significantly worse in allergic children compared with controls, with disabling hearing loss being more significantly associated with allergic rhinitis.
  4,620 644 1
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
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.
  4,811 446 2
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
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.
  4,667 522 3
New trends in the therapy of chronic tinnitus
Gerhard Hesse
July-December 2014, 1(2):64-70
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.
  3,586 1,448 1
The role of antibiotics in treating secretory otitis media in children aged 2–12 years in an accredited teaching hospital in southeast Asia
Sarmishtha De, Kamal Kachhawa, Arun Gambhir, Rajesh K Jain, Rasmirekha Behera, Sanjay K Diwan, Sanjay Kumar
January-June 2017, 4(1):6-9
Introduction Secretory otitis media (SOM) is the most common clinical condition that can cause conductive deafness, especially among school-going children. The outcomes of hearing loss in children include speech problems, behavioral problems, and poor academic performance. Management of SOM therefore remains crucial. We carried out a comparative study of antibiotics versus surgical therapy for the treatment of SOM. Patients and methods The present study included 50 patients. Detailed history taking with ENT examinations was performed and documented in a validated pro forma. Routine investigations such as complete blood count, urine examination, audiological investigation such as impedance audiometry, etc, were carried out. Observation and results About 70% of the patients presented with symptoms of ear block with mouth breathing. Increased incidence was found in the 2–6 years age group. The present showed that surgery can increase the rate of recovery, shorten the duration of therapy, and prevent the recurrence of SOM compared with treatment with antibiotics. Conclusion Both the treatments have complications associated with them. Large, well-controlled studies can help resolve the risk–benefit ratio by measuring SOM recurrence, functional outcome, quality of life, and long-term outcomes.
  4,297 651 -
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
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.
  4,443 354 -
Chronic noise exposure: impact on the vestibular function
Afaf A Emara, Takwa A Gabr
July-December 2014, 1(2):71-79
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.
  3,788 580 -
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
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).
  3,893 378 3
School-based hearing screening program in children, four to seven years old, Quesnay City, Minufia, Egypt
Radwa Mahmoud, Mohammed Ibrahim Shabana, Ahmed Mohsen Seleit, Ahmed Ashraf Salah El-hamshary, Noha Ali Hosni
July-December 2016, 3(2):35-42
Background Hearing is the most essential perceptive sense for individual development, especially during childhood, contributing to a child’s ability to interact with other people. Its deprivation can have serious consequences on various aspects, such as speech and language acquisition and prereading skills. This study aimed to perform hearing screening of school children aged 4 and 7 years to detect the prevalence, incidence, and degree of hearing loss (HL) in this age group. Participants and methods This study was a cross-sectional investigation that included all children aged 4–7 years from all primary schools in Quesnay City, Minufiyah governorate, Egypt, from November 2014 to March 2016 (number of children=4500). A total number of 9000 ears were studied. All children included in the study underwent otoscopic examination, followed by two stages of school-based hearing screening. All children who failed the second stage of school-based hearing rescreening were referred for full audiological evaluation. Results Otoscopic examinations revealed the following: 54.2% of ears had normal ears 21.3% had impacted wax, 13.6% had congested tm, and 10.8% had perforated tm. Twenty percent (1800 ears) failed the first stage of school-based hearing screening. Six percent (540 ears) failed the second stage of school-based hearing rescreening. A total of 529 ears were diagnosed as having HL as follows: 427 (80.7%) had conductive hearing loss, 81 (15.3%) had sensorineural hearing loss, and 21 (4%) had mixed HL of different degrees − 265 (50.1%) had mild, 132 (24.9%) had moderate, 85 (16.1%) had moderately severe, 40 (7.6%) had severe, and seven (1.3%) had profound degree of HL. Conclusion A systematic screening program with correct equipment, trained personnel, and adequate follow-up services will allow children with educationally significant HL to be accurately diagnosed and managed to provide them with equal hearing opportunities.
  2,101 1,722 -
Neuroplastic changes in musician's brain: A review
Himanshu Kumar Sanju
July-December 2015, 2(2):43-44
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.
  2,391 1,376 -
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
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.
  3,364 278 -
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
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.
  2,899 681 -
Assessment of hearing loss in tympanic membrane perforation
Haider W Alsarhan, Mohammed R Dawood, Abd Alhussen Kareem Jwery, Ammar H Khammas, Abbas K Hamad
January-June 2016, 3(1):16-19
Background Tympanic membrane perforation is a common problem and causes hearing disability, and many factors can affect the degree of hearing loss. Objective The aim of this study was to assess the degree of hearing loss in relation with the size and site of tympanic membrane perforation. Patients and methods This prospective study was conducted at Al-Yarmouk Teaching Hospital during the period from February 2015 to February 2016 on 75 patients (93 ears) with tympanic membrane perforations. The size and site of perforations were evaluated under the microscope and classified according to the size (small, moderate, and large), and the site (anteroinferior, anterosuperior, posteroinferior, and posterosuperior quadrants). Hearing loss was measured in each case with pure-tone audiometry and its relation with these parameters was analyzed. Results There was an increase in hearing loss with the increase in the size of perforation. Perforation locations had an impact on hearing loss; this was statistically significant, especially in the posteroinferior quadrant if compared with other quadrants, as P value was 0.037. Conclusion The size and site of tympanic membrane perforation had a significant effect on the magnitude of hearing loss.
  3,145 289 -
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
Background 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. Methods 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. Results 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. Conclusion 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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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
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.
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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
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.
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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
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
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