The aim of this work was to establish hearing aid (HA) functional gain measurements using free field (FF) auditory steady-state response (ASSR) and to compare and correlate sound field (SF) versus ASSR functional gain and unaided and aided hearing thresholds in order to assess the reliability of FF ASSR as an objective tool for the verification of HA fitting.
This study was conducted on 20 HA user adults with a mean age of 57.09±14.79 years. For each patient, the following were administered: history taking, basic audiological evaluation including pure tone audiometry and immittancemetry, unaided and aided SF audiometry thresholds, and unaided and aided FF ASSR thresholds. The results obtained were then compared. In addition, correlation studies between all the obtained results were carried out.
A highly significant difference was found at 500 Hz only between the SF hearing thresholds and the FF ASSR thresholds among the unaided patients at the four test frequencies (500–4000 Hz). Similarly, aided SF and FF ASSR hearing thresholds showed a statistically significant difference only at 500 Hz. The results of correlation coefficient showed that unaided SF and FF ASSR thresholds were positively significantly correlated at 2 and 4 kHz. In addition, aided SF and FF ASSR thresholds were positively significantly correlated at 1 and 2 kHz. Comparison between the functional gain obtained using both SF and FF ASSR tests showed that there was a highly significant difference only at 4000 Hz.
SF audiometry and FF ASSR unaided and aided thresholds showed very similar results and this indicates that ASSR may be a good alternative method for the measurement of hearing level in infants and children, for whom pure tone audiometry is not possible. FF ASSR appears to be a reliable procedure for the verification of HA fitting and can be used to assess functional gain in difficult-to-test populations and children. Future research on the effect of the electroacoustic characteristics of HAs on aided FF ASSR thresholds is recommended.
To be effective, all professional practices, including speech and language pathology, should be built on a foundation of basic and applied research. Clinicians working in these fields, similar to clinicians in other fields, need to be aware of the validity and reliability of the methods they select while dealing with their patients. Moreover, the current emphasis on evidence-based practice in medicine across all scientific fields emphasizes the importance of understanding the philosophy of science, research strategies, and evidence-based practice. This would aid in bridging the gap between the research and clinical work, thereby, maximizing the therapeutic benefit that the patients gain.
The aim of this article is to review some of the facts related to research methodology, research evaluation, and evidence-based practice as well as to highlight the importance of integrating individual clinical expertise with the best available external evidence obtained from systematic research.
(a) Research should be considered as an integral part of clinical practice. (b) Keeping the concept of validity, reliability, and evidence-based practice in mind at all times while designing scientific studies. (c) Discussing the project design with an advisor or a group of colleagues to help ensure that validity is maintained at every stage of the process. (d) Correctly forming a research problem, sticking to research ethics while carrying out research work, and closely reviewing the selected literature before as well as during the study. (e) Randomly selecting a representative sample population of adequate size to represent the target population. (f) Identifying variables before starting research, choosing appropriate study designs, and appropriately dealing with missing data and confounding (extraneous) variables.
Falls and unstable balance are multifactorial problems and rank high among serious clinical problems faced by the elderly. They are a cause of substantial rates of mortality and morbidity as unintentional injuries.
The aim of the study was to explore the most common risk factors for falls in the elderly and to construct the most specific test battery including clinical and laboratory tests capable of determining risk for falls in the elderly.
A 6-month prospective study was carried out on a sample of 30 elderly persons of age at least 60 years, reporting more than one fall within last 6 months. Detailed history on neuro-otological symptoms, previous falls, dizziness episodes, and symptoms of systemic disease or osteoarthritis was taken. Visual acuity, musculoskeletal examination, complete neurological examination, and a complete vestibular test battery in the form of the videonystagmography (VNG) test battery, vestibular-evoked myogenic potentials, and computerized dynamic posturography was performed. All participants underwent radiological diagnosis and grading of the osteoarthritic knee and hip. The mobility and gait screening protocol was used, which includes the timed up and go test (TUG), fall risk assessment screening tool (FRAST), and Dynamic Gait Index (DGI).
Most patients suffered from peripheral vestibular dysfunction and the most frequent VNG abnormality was unilateral vestibular lesion. Radiological assessment of knee and hip osteoarthritis revealed 36.76% with grades II and III. Significant impairment of vision was found in 40% of the elderly. TUG test revealed high risk of falls in those elderly. In total, 20 participants revealed moderate or high risk for falls by FRAST. There was significant correlation between the number of falls and SOT tests (C5 and C6) together with adaptation tests reflecting vestibular pattern of dysfunction. Functional test of dynamic posturography revealed a highly significant correlation between limits of stability reaction time, movement velocity, and tandem of gait step and the number of falls. TUG showed a highly significant correlation in elderly people who experienced falls, whereas DGI showed only significant correlation and FRAST showed nonsignificant correlation. A highly significant correlation was found between SOT C5 and C6 scores and TUG and DGI with a weak correlation with FRAST. Vestibular-evoked myogenic potential asymmetry and unilateral canal paresis revealed nonsignificant results with all functional tests except DGI, which revealed a weak correlation with them. Analysis of variance test revealed that the vestibular dysfunction group is more vulnerable to falls than other groups.
The VNG test battery and computerized dynamic posturography in conjunction with stance tests in the elderly who complain of dizziness can identify those with high risk of a fall.
The aim of this work is to compare the effectiveness of intratympanic therapy of gentamicin versus steroids in the treatment of Meniere’s disease in terms of symptomatic control and audiovestibular changes.
Thirty patients with intractable unilateral Meniere’s disease were included in our study. They were divided into two groups. The first group was administered intratympanic (IT) gentamicin and the second group was administered IT dexamethasone. We followed our patients with respect to three main symptoms including vertigo, which was determined by the number and duration of attacks, and the class according to AA-HNS 1995 guidelines. We also assessed tinnitus and aural fullness in addition to the Dizziness Handicap Inventory. These parameters were followed up after 6 months and 1 year. Audiological assessment included pure tone audiometry, the speech reception threshold, and the speech discrimination score. Vestibular assessment included the caloric test, rotatory chair stimulation, and vestibular evoked myogenic potential. These parameters were checked at 1 week, 6 months, and 1 year after injection.
Our results showed complete control of vertigo in 76.9% of patients in group I and 30.8% in group II, which was found to be statistically significant. Both groups showed 80–86% satisfactory control of vertigo by 6 months of follow-up, which increased to 100% by 1 year. We found an improvement in tinnitus in 30.8% of the patients in group I and in 38.4% of the patients in group II; the difference between the two groups was nonsignificant. In terms of aural fullness, both groups showed a significant improvement in aural fullness (76.9% in group I and 61.5% in group II). Patients in group I had a 15.4% rate of significant hearing loss and those in group II had 7.7%. Also, we found a significant difference in the rate of hearing loss between both the groups in the high frequencies as gentamicin produced more deterioration in the hearing threshold than dexamethasone. However, the dexamethasone group showed a significant improvement in hearing at low frequencies much more than the gentamicin group. In terms of vestibular testing, we found that gentamicin significantly affected the phase parameter in the rotatory chair test and it also increased the canal paresis in caloric testing. Both effects were absent in the dexamethasone group. We did not find any significant correlation between control of vertigo and any of the vestibular tests.
IT therapy, whether gentamicin or dexamethasone, is an effective way to treat intractable Meniere’s disease, with very little side effects. When considering complete control of vertigo, IT gentamicin produces better results than dexamethasone. IT dexamethasone leads to greater improvement in tinnitus than gentamicin, but not significantly. Both drugs significantly improve aural fullness. IT gentamicin produces more hearing loss than dexamethasone at high frequencies. No benefit can be gained from vestibular testing in the follow-up of therapy.
Vogt–Koyanagi–Harada (VKH) disease, also known as uveomeningitic syndrome, is a multisystem autoimmune disorder directed against any melanocyte-containing organ, including the eye, central nervous system, auditory, and integumentary system. We present a case of an African woman with total deafness and blindness of VKH, and discuss the histological characteristics, and review the classification and the management of VKH. The most important factor for prognosis is the immediate treatment. The rarity of this syndrome makes its diagnosis a challenge and the presence of deafness, tinnitus, and vertigo must be considered in its diagnosis.
Sickle cell disease (SCD) is a blood disorder; however, the central nervous system is one of the organs frequently affected by the disease. Brain insult can begin early in life and often leads to neurocognitive dysfunction. The progression of central nervous system abnormalities in SCD and its effect on language development have not been fully delineated.
To determine the effect of SCD on language development in Egyptian children with SCD in order to delineate this group as a possible high-risk group for language disorders. In this way, further proper assessment of these children will aid the initiation of an early intervention and prevention of these problems.
A total of 24 children with SCD were subjected to the language assessment protocol of Ain Shams University Hospitals. These patients underwent language testing using the Standardized Arabic Language Test and hearing assessment including a basic audiological assessment and transient evoked otoacoustic emissions (TEOAEs) testing. The results obtained from this group were compared with the results of 17 normal children who were subjected to the same assessment protocol.
The results of this study showed that the age of acquisition of both the first word and sentence was significantly delayed in children with SCD than their control group. The scores of intelligence quotient and language parameters were significantly lower in the group of children with SCD. The language age deficit was significantly higher in the SCD group than the control group. The expressive language abilities and pragmatics were significantly lower than semantics and receptive abilities in children with SCD. The age of onset of the disease and number of vaso-occlusive crisis showed a significant correlation with the intelligence quotient score and all the language parameters. In terms of audiological assessment, all children of both groups had normal audiograms and tympanograms, but the group of children with SCD showed reduced TEOAEs echo levels in comparison with their control. Moreover, there was a significant correlation between TEOAEs echo levels and language parameters in children with SCD.
SCD is considered as one of the important risk factor that can affect proper language development. Therefore, long-term follow-up of these children is necessary to detect deficits early in life to prevent delayed language development and poor academic achievement.
The frequent use of inhaled corticosteroids (ICS), especially at higher doses, has been accompanied by concern about both systemic and local side effects. The systemic complications of ICS have been extensively studied and are well documented in the literature. There are comparatively few studies reporting on the local complications of ICS. Compared with systemic side effects, the local side effects of ICS are considered to constitute infrequent and minor problems. However, although not usually serious, these local side effects are of clinical importance.
The aim of this study was to demonstrate the effect of ICS on the larynx using videostroboscopy in patients suffering from bronchial asthma in order to avoid these effects on the patients in further protocols of treatment.
This study was carried out on 50 patients suffering from bronchial asthma. They were divided into two groups. Group A included 25 patients suffering from bronchial asthma treated using ICS (budesonide) for 1 year at a dose of 1600 μg/day. Group B included 25 patients having bronchial asthma and not receiving ICS. Each patient was subjected to the following protocols of assessment: (i) elementary diagnostic procedures such as (a) patient interviews, (b) auditory perceptual assessment, and (c) laryngeal visualization. (ii) Clinical diagnostic aids: laryngovideostroboscopy was carried out using a digitalized stroboscopy system to examine the vocal fold mobility, congestion, hypertrophy, ventricular folds hypertrophy, glottic gap, and glottic closure. The following acoustic parameters were measured: fundamental frequency, jitter (cycle-to-cycle variation in frequency), shimmer (cycle-to-cycle variation in amplitude), and noise-to-harmonic ratio (N/H). (iii) Additional instrumental diagnostic measures: the acoustic signals were recorded from each patient. The results of this study revealed more laryngeal abnormalities in group A than in group B. Dysphonia was found in 76% of the patients in group A, in which voice was perceived as either strained, leaky, or of rough qualities. The following changes in the glottis were observed in some patients: either localized or diffuse congestion of the vocal folds, hypertrophy in the ventricular bands, incomplete glottic closure, and glottic gap. In addition, there were also decreases in glottic wave and amplitude. Acoustic analysis showed significant increase in the jitter and shimmer values.
Transient voice change associated with endotracheal intubation has generally been attributed to vocal fold trauma.
The aim of this study was to examine the effects of short-term endotracheal intubation on the vocal fold vibratory pattern using videokymography in order to aid the early detection and prevention of these changes.
This study was carried out on 40 patients who were scheduled for a variety of elective surgical procedures under general anesthesia. They were 26 males, ranging in age from 17 to 61 years, mean age of 36.4±4.2 years, and 14 females ranging in age from 16 to 54 years, mean age of 34.6±5.3 years. Evaluation of vocal functions was carried out at three intervals, 1 day before intubation, 1 day after extubation, and 1 week later. All patients were subjected to analysis of their complaints, auditory perceptual assessment of their voice, and assessment of vocal fold vibration using videokymography.
Sixteen patients complained of postoperative voice change, ranging in severity from good in 11, moderate in four, and bad in one patient. After 1 week, five patients were still complaining of voice change, ranging from good in four to moderate in one. There was a positive significant correlation between the degree of voice change and both the duration of anesthesia and tube size. There was postextubation mild to moderate voice change in 12 patients. The pitch was decreased in nine patients, increased in two patients, and there was diplophonia in one patient. The loudness was fluctuating in eight patients and was decreased in four patients; after 1 week, there was an improvement in all the perceived parameters; however, persistent dysphonia was perceived in three patients. There was a positive significant correlation between the degree of dysphonia and both the duration of anesthesia and the tube size. The normal video mode of videokymography, performed 1 day after extubation, indicated evidence of traumatic laryngeal lesions in 15 patients. In the high-speed mode of videokymography performed before intubation, 1 day after extubation, and 1 week after extubation, a significant difference was found in most of the parameters when comparing before intubation and 1 day after extubation; also, a significant difference in all the parameters was found 1 day after extubation and 1 week after extubation, whereas a nonsignificant difference was found when comparing before intubation and 1 week after extubation. There was a significant positive correlation between both the duration of intubation and the tube size with the severity of voice complaint and grade of dysphonia. Also, there was a significant positive correlation between the aperiodicity in both the amplitude of mucosal wave and the glottal cycle time, and both the duration of intubation and the tube size in the dysphonic group.
Traumatic lesions of the laryngeal structures that occur during intubation, in addition to possible subepithelial changes, are the most common causes of postoperative dysphonia, with a tendency toward a regressive course of the resulting dysphonia. As such, it is important to establish an early diagnosis and adopt preventive measures.
Malignant peripheral nerve sheath tumour represents 10% of all soft tissue sarcomas, only 10% of which occur in the head and neck, which makes it a rare entity.
The etiology of sudden sensorineural hearing loss is diverse; viral, vascular, immunologic, and abnormal cell stress responses have been proposed, the presentation of the disorder is abrupt, and hearing loss is progressive over a very short period. Steroids remain the treatment of choice irrespective of the etiology of hearing loss. Intratympanic corticosteroid injections have been widely used to deliver corticosteroids directly into the inner ear for those whom systemic steroids have not been successful. Complications such as perforations of the tympanic membrane, myringitis, and otitis media have been reported rarely.
To compare the hearing recovery results in patients with sudden sensorineural hearing loss receiving systemic versus intratympanic methylprednisolone acetate.
A randomized clinical trial was carried out over 4 years that included 46 patients randomly assigned to two groups of 23 patients each. Pretreatment hearing levels were compared with post-treatment audiograms up to 5 weeks following initial therapy. A 20-dB gain in pure-tone audiometry or a 20% improvement in speech discrimination score was considered a significant improvement. The results of both groups were compared and tested for statistical significance.
The recovery rate in the systemic group was 65%, whereas the recovery rate in the intratympanic group was 56%; the overall results were comparable over different frequencies. Failure to improve was observed equally in both groups in 21% of patients.
No statistically significant difference was observed between both the groups. Intratympanic steroid injection as a primary treatment of idiopathic sensorineural hearing loss is an effective alternative to systemic therapy.
Central auditory processing dysfunction is a general term that is applied to individuals whose hearing in quiet settings is normal or almost normal, and yet who have substantial hearing difficulty in the presence of auditory stressors such as competing noise and other difficult hearing situations. It is noticed that the prevalence of central auditory processing dysfunction increases with age.
Evaluation of the effects of aging on central auditory processing in elderly individuals who report good hearing sensitivity.
Thirty elderly individuals ranging in age from 60 to 75 years, right-handed, and who reported good hearing sensitivity participated in this study. The results of the synthetic sentence identification with an ipsilateral competitive message (SSI–ICM) and staggered spondee words (SSW) tests were compared with those of 15 young adults ranging in age from 20 to 40 years with normal hearing sensitivity as a control group.
The findings of the study showed a statistically significant difference between the control group and the elderly group in terms of SSI, with a lower percentage in the elderly group. The results of the SSW test showed that there was a significant difference in scoring between competing and noncompeting conditions, with more affection in the competing condition in both the control and the elderly groups. When we compared the control group and the elderly group in terms of the SSW error score in the competing condition in both ears, it was found that there was a statistically significant difference between the two groups, with more error scores in the elderly group.
Central auditory processing is affected by aging as shown by the lower percentage of results of the SSI–ICM test and more errors in the SSW test mainly in the competing conditions relative to the control group.
The aim of this work was to examine saccular function using cervical vestibular-evoked myogenic potentials (cVEMPs) in children with congenital or acquired sensorineural hearing loss (SNHL).
Descriptive cross-sectional study.
This study was carried out on 30 children with different degrees of SNHL with normal middle ear function and 25 age-matched and sex-matched typically developing children. All the participants’ age ranged from 5 to 18 years. For each child, the following were administered: history taking, an otologic examination, a basic audiological evaluation in the form of pure tone audiometry and immittancemetry, air-conducted cVEMPs, and computed tomography scan of the temporal bone. The results obtained from the two groups were then compared. In addition, correlation studies between all the results obtained were carried out.
There was a statistically nonsignificant difference between the patients and the controls in cVEMP P13 and N23 latencies, whereas the cVEMP P13–N23 amplitude and threshold results showed a highly significant difference. cVEMP measurements in relation to sex within the patient group showed that the cVEMP threshold was the only positive outcome that showed a significant difference, and was higher in females. There was a highly significant positive correlation between hearing loss and the cVEMP threshold among the patient groups with different degrees of hearing losses. In addition, there was a significant positive correlation between age and cVEMP P13 and N23 latencies among the patient group.
SNHL is associated with saccular dysfunction in the pediatric population in the form of decreased cVEMP P13–N23 amplitudes and elevated cVEMP thresholds. Females presented with higher cVEMP threshold values than men, and cVEMP latencies appear to increase with age. An increase in hearing loss is associated with an increase in the cVEMP threshold and cVEMP amplitude appears to decrease with hearing loss irrespective of its degree. We recommend the inclusion of cVEMPs in the battery of evaluation of children with SNHL to detect early subtle changes in saccular function. Future research focusing on the genes causing SNHL and its relation to VEMP findings should be carried out.
Many patients with obstructive sleep apnea (OSA) have coexisting nasal and sinus problems. In the absence of major anatomical abnormalities, these problems may be overlooked, hence jeopardizing the success rate of palatal surgery. Our objective was to identify the effect of medical management of nasal and sinus diseases on the success rate of palatal surgery in mild to moderate cases of OSA.
This prospective study included 28 patients divided in two groups; group A was treated medically with antibiotics and local steroids before palatal surgeries, whereas group B was not treated medically before palatal surgeries. Assessment was made preoperatively and postoperatively using polysomnography.
Group A showed more improvement in the apnea hypopnea index than group B.
Management of nasal and sinus problems improves the results of palatal surgery in cases of mild to moderate OSA.
This study included 20 dizzy children, who were compared with 10 healthy children, aged 6–12 years. Assessment of history taking was carried out using an Arabic dizziness questionnaire, for which a scoring system was designed to include a thorough evaluation of the different systems involved in balance control; a comparison with the results of referral was carried out.
To categorize the causes of dizziness into diagnostic categories and to determine the ability of the scoring system to direct to a certain referral for diagnosing the cause of dizziness.
The questionnaire’s diagnostic categories matched the diagnosis on referral in 75% of cases. Its sensitivity in diagnosing vestibular category was 88.89%. The scoring was applied to the present history, but relevant data in the past medical and family histories were taken into consideration.
The questionnaire seems to be a reasonable anamnesis for use in training, with a scoring system that can categorize dizzy children by the system/systems affected. It provides questions that a trainee needs to be considering when managing balance disorders in the clinic.
Factor XIII deficiency is a very rare disorder, which represents a significant threat to life and can result in significant morbidity. Factor XIII is the final enzyme in the coagulation cascade and is essential for normal homeostasis. There is a very high rate of bleeding in patients who do not receive appropriate prophylaxis. We report a case of patient who presented with profuse secondary post-tonsillectomy hemorrhage few days after the operation.
Despite the large number of native Arabic speakers, Arabic prosodic skills have not been studied thoroughly.
This study aimed to examine the perceptual judgment and acoustic characteristics of some elicited verbal prosodic patterns in a group of typically developing Egyptian children aged 2 years 2 months through 5 years 11 months in order to aid in the early identification of prosodic impairment in this age group.
The sample included 40 healthy typically developing Egyptian children aged 2 years 2 months through 5 years 11 months old. Participants were divided into two groups: group I included 20 children aged 2 years 2 months to 3 years 11 months old. Group II included 20 children aged 4 years 2 months to 5 years 11 months old. The prosodic patterns studied included socioaffective as well as grammatical patterns. The prosody of each elicited response was perceptually studied and acoustically analyzed. The results obtained were analyzed statistically using comparative and correlation studies.
(a) Significant differences were found between the two groups with respect to the perceptual scores of all the prosodic patterns studied, except resentment and interrogative patterns. (b) Significant differences were found between the two groups with respect to acoustic values. (c) For all the studied parameters, no significant differences were found between males and females. (d) The highest mean perceptual score obtained by the studied group was that obtained for the interrogative pattern, whereas the lowest ones obtained were for exception and warning patterns. (e) A significant positive correlation was found between age and the Total Perceptual Prosodic Scores (TPPS). (f) A significant negative correlation was found between duration and most of the perceptual scores. (g) A significant positive correlation was found between frequency and most of the perceptual scores. (h) A significant positive correlation was found between energy and most of the perceptual scores.
(a) The production of different Arabic prosodic patterns is associated with changes in frequency, duration, and energy. (b) The easiest prosodic patterns to be imitated by children are the interrogative and resentment patterns, whereas the most difficult ones were the exception, disapproval, and warning patterns. (c) Elicited prosodic patterns do not differ with sex in children.