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   2015| July-December  | Volume 2 | Issue 2  
    Online since December 10, 2015

 
 
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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.
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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.
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ORIGINAL ARTICLES
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.
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Results of the first universal newborn hearing screening in Algeria
Farid Boudjenah, Mokhtar Hasbellaoui, Omar Zemirli
July-December 2015, 2(2):54-58
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.
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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.
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