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  Citation statistics : Table of Contents
   2014| July-December  | Volume 1 | Issue 2  
    Online since January 9, 2015

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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
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.
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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.
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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.
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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.
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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.
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