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Hearing Disorders: HELP
Articles from Toronto
Based on 260 articles published since 2010

These are the 260 published articles about Hearing Disorders that originated from Toronto during 2010-2020.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11
201 Article Children with bilateral cochlear implants identify emotion in speech and music. 2013

Volkova, Anna / Trehub, Sandra E / Schellenberg, E Glenn / Papsin, Blake C / Gordon, Karen A. ·Department of Psychology, University of Toronto, Toronto, Canada. ·Cochlear Implants Int · Pubmed #23453221.

ABSTRACT: OBJECTIVES: This study examined the ability of prelingually deaf children with bilateral implants to identify emotion (i.e. happiness or sadness) in speech and music. METHODS: Participants in Experiment 1 were 14 prelingually deaf children from 5-7 years of age who had bilateral implants and 18 normally hearing children from 4-6 years of age. They judged whether linguistically neutral utterances produced by a man and woman sounded happy or sad. Participants in Experiment 2 were 14 bilateral implant users from 4-6 years of age and the same normally hearing children as in Experiment 1. They judged whether synthesized piano excerpts sounded happy or sad. RESULTS: Child implant users' accuracy of identifying happiness and sadness in speech was well above chance levels but significantly below the accuracy achieved by children with normal hearing. Similarly, their accuracy of identifying happiness and sadness in music was well above chance levels but significantly below that of children with normal hearing, who performed at ceiling. For the 12 implant users who participated in both experiments, performance on the speech task correlated significantly with performance on the music task and implant experience was correlated with performance on both tasks. DISCUSSION: Child implant users' accurate identification of emotion in speech exceeded performance in previous studies, which may be attributable to fewer response alternatives and the use of child-directed speech. Moreover, child implant users' successful identification of emotion in music indicates that the relevant cues are accessible at a relatively young age.

202 Article Postnatal maturation of contralateral DPOAE suppression in a precocious animal model (chinchilla) of the human neonate. 2013

Harrison, Robert V / Konomi, Ujimoto / Kanotra, Sohit / James, Adrian L. ·Auditory Science Laboratory, Hospital for Sick Children, Toronto, Canada. rvh@sickkids.ca ·Acta Otolaryngol · Pubmed #23373512.

ABSTRACT: CONCLUSION: In the neonatal chinchilla, the degree of contralateral distortion product otoacoustic emission (DPOAE) suppression and the latency and time constants of suppression are immature for 40-60 days. This suggests that olivocochlear efferent innervation of outer hair cells is not fully mature at birth in this animal model, and this may also be the case for human neonates. OBJECTIVES: To track postnatal changes in the dynamics of the olivocochlear efferent system in an animal model with cochlear development at birth similar to that in humans. METHODS: Real-time measurements of contralateral DPOAE suppression were made in 79 ears of anaesthetized chinchillas, ranging in age from 1 day to 70 days. An adult control group (13 ears) was also tested. DPOAE (2f1-f2; f2 = 4.4 kHz; f2/f1 = 1.22) input/output functions were measured. Dynamics of contralateral broadband noise suppression were measured, including latency and suppression time constants. RESULTS: DPOAE amplitude input/output functions are immature until 20-30 days postnatally. The maturation period for contralateral suppression amplitude is about 30 days. Latency of onset suppression was 40 ms at birth reducing to adult values (23 ms) at 40 days. The DPOAE suppression time constant was about 350 ms at birth and mature (230 ms) at 60 days.

203 Article From nucleus 24 to 513: changing cochlear implant design affects auditory response thresholds. 2013

Gordon, Karen A / Papsin, Blake C. ·Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada. karen.gordon@utoronto.ca ·Otol Neurotol · Pubmed #23370566.

ABSTRACT: OBJECTIVES: We asked how thresholds of auditory activity evoked by a recent research cochlear implant, the Nucleus 513, compared with those evoked by previous generations of devices from the same manufacturer. STUDY DESIGN: Prospective repeated measures. SETTING: Tertiary pediatric hospital. PATIENTS: A total of 182 children receiving unilateral or bilateral Nucleus cochlear implants. INTERVENTIONS: Of 182 children, 39 received the N24M straight array, the oldest device in this study, 20 received the N24RCS Contour, the next device released, 57 received the 24RE Freedom, released after the N24RCS, and 66 received the N513 Leap electrode array, the newest device. MAIN OUTCOME MEASURES: Behavioral thresholds and auditory nerve response thresholds were evoked by an apical, mid-array, and basal electrode and measured in 203 ears. RESULTS: In general, auditory nerve thresholds decreased with newer devices. Responses evoked by the mid-array electrode had higher thresholds than responses to the other electrodes in most devices and highest in the operating room for the N513. Apical electrodes evoked the lowest thresholds at the level of the auditory nerve. Auditory nerve response thresholds decreased from the operating room to initial device activation with the 2 newest devices (N24RE and N513) tending to show the largest changes. Behavioral thresholds were at lowest levels for the 2 newest devices studied and, unlike auditory nerve response thresholds, decreased with age for all devices. CONCLUSION: Evolving cochlear implant electrode design significantly affects auditory thresholds, but these changes do not occur uniformly along the array.

204 Article Vestibular end-organ dysfunction in children with sensorineural hearing loss and cochlear implants: an expanded cohort and etiologic assessment. 2013

Cushing, Sharon L / Gordon, Karen A / Rutka, John A / James, Adrian L / Papsin, Blake C. ·Department of Otolaryngology Head and Neck Surgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON Canada. s.cushing@utoronto.ca ·Otol Neurotol · Pubmed #23370550.

ABSTRACT: INTRODUCTION: Similarities between the peripheral auditory and vestibular systems suggest that children with sensorineural hearing loss (SNHL) may demonstrate associated vestibular impairments. The current study examines vestibular function in a previously reported cohort (n = 40) augmented by 113 children with profound SNHL. METHODS: The current study is prospective and cross-sectional with repeated measures. Horizontal canal function was assessed in response to caloric and rotational stimuli. Saccular function was examined using vestibular evoked myogenic potentials (VEMP). One hundred fifty-three children were tested; 119 had unilateral cochlear implants (CIs) at time of testing, and 34 were evaluated before CI. RESULTS: Horizontal semicircular canal function was abnormal in response to caloric stimuli in 50% (69/139), with a proportion (18/69, 26%) reflecting mild to moderate unilateral abnormalities. Severe hypofunction or areflexia occurred in 37% (51/139). Horizontal semicircular canal function in response to rotation was abnormal in 47% (64/139). Bilateral reduction in VOR gain was seen across frequencies in 29% (40/139) and 13% (18/139) demonstrated isolated high-frequency (≥ 2 Hz) loss. Saccular function was absent bilaterally in 21% (32/135) and unilaterally in 30% (40/135). All children with meningitis (n = 11) and 46% with radiologic cochleovestibular anomalies (n = 31) had horizontal canal dysfunction, whereas 45% and 46%, respectively, displayed saccular dysfunction. Unilateral dysfunction of the horizontal canal or the saccule was equally distributed between the implanted and nonimplanted ear (14:9 and 22:18, respectively), and the differences in proportions were not statistically significant. CONCLUSION: Vestibular end organ dysfunction occurred in half of all children with profound SNHL. Approximately one-third of the subjects displayed severe abnormalities(bilateral and/or severe loss). The likelihood of vestibular end-organ dysfunction is highly dependent on etiology, with meningitis and cochleovestibular anomalies having the highest rates of severe dysfunction.

205 Article Aggregate health burden and the risk of hospitalization in older persons post hip replacement surgery. 2013

Perruccio, Anthony V / Losina, Elena / Wright, Elizabeth A / Katz, Jeffrey N. ·Department of Orthopedic Surgery, Toronto Western Hospital, 399 Bathurst St, EW 1-427, Toronto, ON, Canada M5T 2S8. perrucci@uhnres.utoronto.ca ·J Gerontol A Biol Sci Med Sci · Pubmed #22879451.

ABSTRACT: BACKGROUND: We sought to understand the association between aggregate health burden-chronic conditions, functionally limiting health problems and mental well-being-and the likelihood of hospitalization among older persons post hip replacement surgery. METHODS: Eight hundred and twenty-eight Medicare recipients from three U.S. states completed a questionnaire 3 years postsurgery. Using administrative data (Medicare Provider Analysis and Review), participants were prospectively followed for 12 months postquestionnaire to capture hospitalizations. Using logistic regression, demographic, socioeconomic, and behavioral characteristics and medical comorbidities were considered as predictors. Subsequently, musculoskeletal (MSK) functional and geriatric problems were added as predictors, then mental well-being and activity limitations. Path analysis was employed to elucidate interrelationships between these predictors, investigating whether mediated effects through mental well-being and activity limitations were operational. RESULTS: Mean age was 76 years (range: 67-96); 63% were women; 23% had ≥1 hospitalization(s). When medical comorbidity, MSK limitations, and geriatric problems were considered, each was independently associated with hospitalization (odds ratios: 1.3, 1.1, 1.2, respectively). When mental well-being and activity limitations were added, these variables were predictive of hospitalization (odds ratios: 1.2, 1.1, respectively), while MSK limitations and geriatric problems were no longer predictive. Path analysis results suggested that the influence of medical comorbidity and MSK and geriatric problems were mediated through mental well-being and activity limitations. CONCLUSIONS: Several health domains predict hospitalization, beyond and including medical comorbidity. Efforts aimed at delaying/minimizing hospitalizations in this population should consider an array of domains for potentially targeted intervention. These findings can serve as a baseline against which future research can assess the impact of changes to the health care system.

206 Article Identification of homozygous WFS1 mutations (p.Asp211Asn, p.Gln486*) causing severe Wolfram syndrome and first report of male fertility. 2013

Haghighi, Amirreza / Haghighi, Alireza / Setoodeh, Aria / Saleh-Gohari, Nasrollah / Astuti, Dewi / Barrett, Timothy G. ·The Hospital for Sick Children, University of Toronto, Toronto, Canada. haghighi@well.ox.ac.uk ·Eur J Hum Genet · Pubmed #22781099.

ABSTRACT: Wolfram syndrome (WFS) is a neurodegenerative genetic condition characterized by juvenile-onset of diabetes mellitus and optic atrophy. We studied clinical features and the molecular basis of severe WFS (neurodegenerative complications) in two consanguineous families from Iran. A clinical and molecular genetic investigation was performed in the affected and healthy members of two families. The clinical diagnosis of WFS was confirmed by the existence of diabetes mellitus and optic atrophy in the affected patients, who in addition had severe neurodegenerative complications. Sequencing of WFS1 was undertaken in one affected member from each family. Targeted mutations were tested in all members of relevant families. Patients had most of the reported features of WFS. Two affected males in the first family had fathered unaffected children. We identified two homozygous mutations previously reported with apparently milder phenotypes: family 1: c.631G>A (p.Asp211Asn) in exon 5, and family 2: c.1456C>T (p.Gln486*) in exon 8. Heterozygous carriers were unaffected. This is the first report of male Wolfram patients who have successfully fathered children. Surprisingly, they also had almost all the complications associated with WFS. Our report has implications for genetic counseling and family planning advice for other affected families.

207 Article Congenital cholesteatoma and cochlear implantation: Implications for management. 2013

Chung, Janet / Cushing, Sharon L / James, Adrian L / Gordon, Karen A / Papsin, Blake C. ·Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada. janchung@gmail.com ·Cochlear Implants Int · Pubmed #22450542.

ABSTRACT: INTRODUCTION: Cholesteatoma is an uncommon condition that has occasionally been associated with cochlear implantation (CI). Cases of secondary acquired cholesteatoma have been described, in which intra-operative breech of the posterior canal wall is thought to be a contributing factor. Primary acquired cholesteatoma is not typically associated with congenital sensorineural hearing loss (SNHL) or CI in children. Congenital cholesteatoma is a rarer entity yet with an incidence in the literature of 2‐4% of all cholesteatomas. We present lessons learned from our experience of congenital cholesteatoma in CI candidates. METHODS: Retrospective reviews of departmental CI and cholesteatoma databases in a tertiary/quaternary pediatric center were conducted. Cases of congenital cholesteatoma were identified. The proportion of congenital cholesteatoma cases in CI candidates was compared with number of acquired cholesteatoma. Optimum management of congenital cholesteatoma in CI candidates was reviewed. RESULTS: In our pediatric CI population, 2/794 patients (0.25%) were recognized as having a congenital cholesteatoma during their evaluation for CI. No cases of primary acquired cholesteatoma were identified in this population at presentation or at follow up to 18 years. DISCUSSION: The 0.25% incidence of congenital cholesteatoma in our population of CI patients is higher than expected of this rare condition. It is surprisingly common given the absence of any cases of primary acquired cholesteatoma, which is considerably more common even in the pediatric population. Both patients likely had an inherited form of hearing loss and a genetic contribution to the presence of congenital cholesteatoma cannot be excluded. The presence of congenital cholesteatoma has implications for the algorithm currently employed for the assessment of CI. We consider that surgery should be staged to ensure complete removal of the cholesteatoma before implantation. Thus bilateral CI should be provided sequentially rather than simultaneously in the presence of unilateral cholesteatoma.

208 Article Providing auditory cues to improve stability in children who are deaf. 2012

Cushing, Sharon L / Pothier, David / Hughes, Cian / Hubbard, Bradley J / Gordon, Karen A / Papsin, Blake C. ·Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada. s.cushing@utoronto.ca ·Laryngoscope · Pubmed #23254598.

ABSTRACT: -- No abstract --

209 Article Ten top considerations in pediatric tympanoplasty. 2012

James, Adrian L / Papsin, Blake C. ·Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. adr.james@utoronto.ca ·Otolaryngol Head Neck Surg · Pubmed #22988036.

ABSTRACT: Tympanoplasty in children poses some different challenges from the same procedure in adults. The aim of the current article is to review 10 important considerations in pediatric tympanoplasty that focus on these differences and help to optimize the chance of successful outcome.

210 Article Middle ear ventilation in children with primary ciliary dyskinesia. 2012

Wolter, Nikolaus E / Dell, Sharon D / James, Adrian L / Campisi, Paolo. ·University of Toronto, Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada. nikolaus.wolter@utoronto.ca ·Int J Pediatr Otorhinolaryngol · Pubmed #22883987.

ABSTRACT: OBJECTIVE: Otitis media with effusion (OME) in children with primary ciliary dyskinesia (PCD) is recurrent and persistent and presents a complex clinical problem for otolaryngologists. We sought to review the otological presentation of children with PCD treated medically and surgically and to compare audiological outcomes and complications of surgical and medical management in children with PCD and correlate these findings with known PCD ultrastructural ciliary phenotype. METHODS: A retrospective review was performed of all patients with PCD and OME presenting from 1991 to 2009. Patients were grouped into "medical management" and "ventilation tube (VT) insertion" groups to observe changes in hearing and post-operative complications. RESULTS: Of 31 patients with PCD and OME, 20 received VTs and 11 were treated by medical management strategies. A median of one set of VTs (range 1-5) were inserted per patient. Hearing thresholds improved to normal (<25 dB HL) in 80% ears with VTs (mean improvement from 27.1 dB to 22.1 dB (p=0.034)), whereas patients managed medically had stable thresholds (22.7-23.6 dB (p=0.397) over the study period. At least one episode of post-operative otorrhea occurred in eight (42.1%) VT insertion patients during the study period, and four had multiple episodes. We could not demonstrate any differences in post-surgical outcomes between patient groups based on ultrastructural ciliary phenotype. Otorrhea was well controlled with medical therapy with only one requiring tube removal. Bilateral cholesteatoma was found in two patients. CONCLUSIONS: Our data support the use of VT insertion as an option for patients with PCD and OME with mild to moderate hearing loss. Patients should be counseled on the possibility of multiple insertions and the likelihood of post-operative otorrhea, although this was not very troublesome in our group. Ultrastructural ciliary phenotype did not appear to alter the likelihood of post-operative otorrhea in our series. Cholesteatoma should be considered as a potential cause of otorrhea in PCD.

211 Article Vibrotactile discrimination of musical timbre. 2012

Russo, Frank A / Ammirante, Paolo / Fels, Deborah I. ·Department of Psychology, Ryerson University, Toronto, ON, Canada. russo@ryerson.ca ·J Exp Psychol Hum Percept Perform · Pubmed #22708743.

ABSTRACT: Five experiments investigated the ability to discriminate between musical timbres based on vibrotactile stimulation alone. Participants made same/different judgments on pairs of complex waveforms presented sequentially to the back through voice coils embedded in a conforming chair. Discrimination between cello, piano, and trombone tones matched for F0, duration, and magnitude was above chance with white noise masking the sound output of the voice coils (Experiment 1), with additional masking to control for bone-conducted sound (Experiment 2), and among a group of deaf individuals (Experiment 4a). Hearing (Experiment 3) and deaf individuals (Experiment 4b) also successfully discriminated between dull and bright timbres varying only with regard to spectral centroid. We propose that, as with auditory discrimination of musical timbre, vibrotactile discrimination may involve the cortical integration of filtered output from frequency-tuned mechanoreceptors functioning as critical bands.

212 Article Cochlear implantation: a personal and societal economic perspective examining the effects of cochlear implantation on personal income. 2012

Monteiro, Eric / Shipp, David / Chen, Joseph / Nedzelski, Julian / Lin, Vincent. ·Department of Otolaryngology/Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, ON. ·J Otolaryngol Head Neck Surg · Pubmed #22569049.

ABSTRACT: OBJECTIVE: Although cochlear implantation has been shown to improve quality of life, the socioeconomic benefit to the individual and society has not been thoroughly investigated. Our objective was to determine the economic impact of profound deafness and subsequent effects of unilateral cochlear implantation. DESIGN: Retrospective analysis of a prospectively collected cochlear implantation database. SETTING: An academic, tertiary care hospital. METHODS: A prospectively collected cochlear implantation database of 702 patients was reviewed. Known Canadian economic surrogates were used to estimate the personal economic impact of both deafness and unilateral cochlear implantation. MAIN OUTCOME MEASURES: The main outcome measures included employment rates and personal income prior to and following cochlear implantation. RESULTS: A total of 637 patients had sufficient occupational data for inclusion in the study; 36.7% suffered a negative economic impact as a result of their deafness. Cochlear implantation was associated with a significant increase in median yearly income compared to preimplantation ($42 672 vs $30 432; p = .007). CONCLUSIONS: Cochlear implantation not only improves quality of life but also translates into significant economic benefits for patients and the Canadian economy. These benefits appear to exceed the overall costs of cochlear implantation.

213 Article Binaural interactions develop in the auditory brainstem of children who are deaf: effects of place and level of bilateral electrical stimulation. 2012

Gordon, Karen A / Salloum, Claire / Toor, Gurvinder S / van Hoesel, Richard / Papsin, Blake C. ·Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada. karen.gordon@utoronto.ca ·J Neurosci · Pubmed #22442083.

ABSTRACT: Bilateral cochlear implants (CIs) might promote development of binaural hearing required to localize sound sources and hear speech in noise for children who are deaf. These hearing skills improve in children implanted bilaterally but remain poorer than normal. We thus questioned whether the deaf and immature human auditory system is able to integrate input delivered from bilateral CIs. Using electrophysiological measures of brainstem activity that include the Binaural Difference (BD), a measure of binaural processing, we showed that a period of unilateral deprivation before bilateral CI use prolonged response latencies but that amplitudes were not significantly affected. Tonotopic organization was retained to some extent as evidenced by an elimination of the BD with large mismatches in place of stimulation between the two CIs. Smaller place mismatches did not affect BD latency or amplitude, indicating that the tonotopic organization of the auditory brainstem is underdeveloped and/or not well used by CI stimulation. Finally, BD amplitudes decreased when the intensity of bilateral stimulation became weighted to one side and this corresponded to a perceptual shift of sound away from midline toward the side of increased intensity. In summary, bilateral CI stimulation is processed by the developing human auditory brainstem leading to perceptual changes in sound location and potentially improving hearing for children who are deaf.

214 Article Seizure activity following cochlear implantation: is it the implant? 2012

Shinghal, Tulika / Cushing, Sharon / Gordon, Karen A / Huber, Joelene F / Lee, John / Papsin, Blake. ·Department of Otolaryngology, Head and Neck Surgery, University of Toronto, 2409, 1001 Bay Street, Toronto, ON M5S 3A6, Canada. tulika.sh@gmail.com ·Int J Pediatr Otorhinolaryngol · Pubmed #22386273.

ABSTRACT: OBJECTIVE: Cochlear implantation is a successful method of auditory rehabilitation. This procedure has been associated with facial nerve and vestibular end-organ stimulation suggesting potential for extra-cochlear stimulation. The objectives of this study were to investigate the potential relationship between cochlear implantation and seizure activity in the pediatric implant population. METHODS: Local Research Ethics Board approval was obtained. The Hospital for Sick Children's Cochlear Implant Database from 1998 to 2011 was retrospectively reviewed. Based on a multidisciplinary team, patients who received a diagnosis of seizure disorder or had been investigated for seizure-like activity were identified and reviewed. RESULTS: Fifteen children from a group of 816 pediatric cochlear implant users were identified as having suspected seizure-like activity. Eventually 10 children were found to have seizures based on an evaluation by a pediatric neurologist and an electroencephalogram. Of these 10, only 3 children had new onset of seizures after cochlear implantation and 2 of these 3 suffered from global developmental delay and other medical comorbidities. No definite temporal connection was found between cochlear implant use and seizure activity. CONCLUSIONS: Cochlear implantation in the pediatric population continues to be a reliable and safe intervention for children. Overall the prevalence of post implantation seizure disorders in our population (0.37%) is lower than that of the overall population (0.5-1%). The presence of new-onset seizure activity following cochlear implantation is unusual and while there are theoretic possibilities of how a cochlear implant could be implicated in initiating seizures we were unable to find evidence to support this association.

215 Article Tympanic membrane retraction: An endoscopic evaluation of staging systems. 2012

James, Adrian L / Papsin, Blake C / Trimble, Keith / Ramsden, James / Sanjeevan, Nadarajah / Bailie, Neil / Chadha, Neil K. ·Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada. adr.james@utoronto.ca ·Laryngoscope · Pubmed #22374833.

ABSTRACT: OBJECTIVES/HYPOTHESIS: The objectives of this work were to assess inter- and intraobserver variability of different staging systems for tympanic membrane (TM) retraction using otoendoscopy in children at risk of retraction from cleft palate, to compare hearing level with stage of retraction, and to propose optimum characteristics for monitoring TM retraction with endoscopy. STUDY DESIGN: Cross-sectional study. METHODS: Endoscopic images of 245 TMs of children with cleft palate (mean age, 13.0 years) were assessed on two separate occasions by six observers using the Sade and Erasmus staging systems for pars tensa retraction and Tos system for pars flaccida retraction. Intra- and interobserver agreements were calculated. Extent of TM retraction was compared with hearing threshold. TMs with middle ear effusion, tympanostomy tubes, or perforation were excluded. RESULTS: A total of 108 ear drums (44%) were rated as having pars tensa and/or flaccida retraction. Intraobserver agreement was fair to moderate (kappa = 0.3-0.37, P < .001) for the different staging systems and interobserver agreement slight to moderate (0.18-0.41 P < .001). Conductive hearing loss (four-tone average air-bone gap >25 dB HL) was present in 11 ears (15%). No correlation between hearing threshold and retraction stage was found. Isolated tensa retraction onto the promontory increased hearing threshold more than retraction involving the incus (P = .02; analysis of variance). CONCLUSIONS: Endoscopic image capture may provide a clear objective record of TM retraction, but current staging systems have unsatisfactory reliability when applied to such images, and retraction stage correlates poorly with hearing threshold. Modification of retraction assessment to improve validity and clinical relevance is proposed.

216 Article Age affects responses on the Speech, Spatial, and Qualities of Hearing Scale (SSQ) by adults with minimal audiometric loss. 2012

Banh, Jessica / Singh, Gurjit / Pichora-Fuller, M Kathleen. ·Department of Psychology, University of Toronto, Toronto, Canada. ·J Am Acad Audiol · Pubmed #22353676.

ABSTRACT: BACKGROUND: Age-related declines in auditory and cognitive processing may contribute to the difficulties with listening in noise that are often reported by older adults. Such difficulties are reported even by those who have relatively good audiograms that could be considered "normal" for their age (ISO 7029-2000 [ISO, 2000]). The Speech, Spatial, and Qualities of Hearing Scale (SSQ; Gatehouse and Noble, 2004) is a questionnaire developed to measure a listener's self-reported ability to hear in a variety of everyday situations, such as those that are challenging for older adults, and it can provide insights into the possible contributions of auditory and cognitive factors to their listening difficulties. The SSQ has been shown to be a sensitive and reliable questionnaire to detect benefits associated with the use of different hearing technologies and potentially other forms of intervention. Establishing how age-matched listeners with audiograms "normal" for their age rate the items on the SSQ could enable an extension of its use in audiological assessment and in setting rehabilitative goals. PURPOSE: The main purpose of this study was to investigate how younger and older adults who passed audiometric screening and who had thresholds considered to be "normal" for their age responded on the SSQ. It was also of interest to compare these results to those reported previously for older listeners with hearing loss in an attempt to tease out the relative effects of age and hearing loss. STUDY SAMPLE: The SSQ was administered to 48 younger (mean age = 19 yr; SD = 1.0) and 48 older (mean age = 70 yr, SD = 4.1) adults with clinically normal audiometric thresholds below 4 kHz. The younger adults were recruited through an introductory psychology course, and the older adults were volunteers from the local community. DATA COLLECTION AND ANALYSIS: Both age groups completed the SSQ. The differences between the groups were analyzed. Correlations were used to compare the pattern of results across items for the two age groups in the present study and to assess the relationship between SSQ scores and objective measures of hearing. Comparisons were also made to published results for older adults with hearing loss. RESULTS: The pattern of reported difficulty across items was similar for both age groups, but younger adults had significantly higher scores than older adults on 42 of the 46 items. On average, younger adults scored 8.8 (SD = 0.6) out of 10 and older adults scored 7.7 (SD = 1.2) out of 10. By comparison, scores of 5.5 (SD = 1.9) have been reported for older adults (mean age = 71 yr, SD = 8.1) with moderate hearing loss (Gatehouse and Noble, 2004). CONCLUSIONS: By establishing the best scores that could reasonably be expected from younger and older adults with "normal" hearing thresholds, these results provide clinicians with information that should assist them in setting realistic targets for interventions for adults of different ages.

217 Article Resting neural activity patterns in auditory brainstem and midbrain in conductive hearing loss. 2012

Harrison, Robert V / Negandhi, Jaina. ·Auditory Science Laboratory, Department of Otolaryngology-HNS, Hospital for Sick Children, ON, Canada. rvh@sickkids.ca ·Acta Otolaryngol · Pubmed #22339503.

ABSTRACT: CONCLUSIONS: Conductive hearing loss (CHL) lowers resting neural activity patterns in the auditory periphery. Such reductions of peripheral auditory activity may influence the developing central brain during early postnatal years when the system is still highly plastic. OBJECTIVES: A common cause of CHL in young children is otitis media; if chronic and/or episodic there may be a risk to speech and language development. In this clinical context we have investigated changes in neural activity patterns in the brainstem and midbrain in an animal model of CHL. METHODS: In a mouse model, a 50-60 dB CHL was produced by blocking the ear canals. We quantified resting neural activity patterns in the cochlear nucleus and inferior colliculus using c-fos immuno-labelling. This experimental group was compared with normal-hearing controls and with animals with bilateral cochlear ablation. RESULTS: Subjects with CHL had a statistically significant reduction in c-fos-labelled cells in the cochlear nucleus and central nucleus of the inferior colliculus compared with normal controls. This decreased c-fos expression suggests a change in resting neural activity generated at the inner hair cell synapse, leading to a reduction in activity levels in the ascending auditory pathways.

218 Article Toward a method for programming balanced bilateral cochlear implant stimulation levels in children. 2012

Gordon, Karen Ann / Chaikof, Michael Harry / Salloum, Claire / Goulding, Gina / Papsin, Blake. ·The Hospital for Sick Children, Toronto, Ontario, Canada. karen.gordon@utoronto.ca ·Cochlear Implants Int · Pubmed #22325057.

ABSTRACT: OBJECTIVES: In the present study, we investigated differences in stimulation levels between bilateral cochlear implants (CIs) in children and compared these to previously recorded measures of balanced input. We hypothesized that differences in stimulation levels between two CI: (1) will be observed both in behavioral and objective measures, and (2) can help to provide bilateral stimulation levels that are perceived as balanced. METHOD: Participants were 19 children who received bilateral CIs sequentially. Behaviorally determined minimum and maximum stimulation levels from the first (CI-1) and second (CI-2) CIs at an apical electrode (#20) were compared with thresholds of the electrically evoked compound action potential (ECAP) of the auditory nerve and electrically evoked stapedius reflex (ESR). RESULTS: All four measures were found to be greater when evoked from CI-1 than CI-2 and the dynamic range between behavioral measures was reduced in CI-2 relative to CI-1. Significant correlations were found between differences in behavioral and objective measures; as differences in T-levels between CI-1 and CI-2 increased, so did the differences in ECAP thresholds and a similarly positive relationship was found between C-level differences and ESR threshold differences. Differences in ECAP thresholds between CI-1 and CI-2 were significantly correlated with balanced bilateral levels. DISCUSSION: Children using two different Nucleus CIs often require different stimulation levels on either side. Although lower levels were needed on the side more recently implanted with newer technology, the dynamic range of input provided on the second side was reduced relative to the more experienced side. Differences in behavioral measures between CI-1 and CI-2 can be partially predicted by objective measures. ECAP thresholds show the best promise for helping to provide balanced bilateral CI input in children.

219 Article Results with cochlear implantation in adults with speech recognition scores exceeding current criteria. 2012

Amoodi, Hosam A / Mick, Paul T / Shipp, David B / Friesen, Lendra M / Nedzelski, Julian M / Chen, Joseph M / Lin, Vincent Y W. ·Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. hosamamodi@hotmail.com ·Otol Neurotol · Pubmed #22090001.

ABSTRACT: OBJECTIVES: The primary purpose of this study was to evaluate a group of postlingually deafened adults, whose aided speech recognition exceeded commonly accepted candidacy criteria for implantation. The study aimed to define performance and qualitative outcomes of cochlear implants in these individuals compared with their optimally fitted hearing aid(s). STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center. PATIENTS: All postlingually deafened subjects (N = 27), who were unsuccessful hearing aid users implanted between 2000 and 2010 with a preimplantation Hearing in Noise Test (HINT) score of 60% or more were included. INTERVENTION: We compared patients' preoperative performance (HINT score) with hearing aids to postoperative performance with the cochlear implant after 12 months of device use. In addition, the Hearing Handicap Inventory questionnaire was used to quantify the hearing-related handicap change perceived after the implantation. RESULTS: The study group demonstrated significant postoperative improvement on all outcome measures; most notably, the mean HINT score improved from 68.4% (standard deviation, 8.3) to 91.9% (standard deviation, 9.7). Additionally, there was a significant improvement in hearing-related handicap perceived by all patients. CONCLUSION: The envelope of implantation candidacy criteria continues to expand as shown by this study's cohort. Patient satisfaction and speech recognition results are very encouraging in support of treating those who currently perform at a level above the conventional candidacy threshold but struggle with optimally fitted hearing aids.

220 Article Non-accidental caustic ear injury: two cases of profound cochleo-vestibular loss and facial nerve injury. 2012

Wolter, Nikolaus E / Cushing, Sharon L / Das-Purkayastha, Prodip K / Papsin, Blake C. ·University of Toronto, Otolaryngology - Head and Neck Surgery, Canada. nikolaus.wolter@utoronto.ca ·Int J Pediatr Otorhinolaryngol · Pubmed #22018928.

ABSTRACT: Non-accidental caustic injury is a rare form of child abuse usually secondary to forced ingestion. Caustic injury to the ear most commonly arises from battery lodgement in the external canal. This case series represents the first report of non-accidental caustic injury to previously normal ears resulting in profound sensorineural hearing loss, vertigo with horizontal canal hypofunction and in one patient a severe facial nerve paralysis. Both patients required blind-end sac closure of the injured ear and one required sural nerve interposition combined with transfer of the masseteric branch of the trigeminal nerve to the ipsilateral facial nerve.

221 Article Electrophysiologic and behavioral outcomes of cochlear implantation in children with auditory nerve hypoplasia. 2012

Valero, Jerome / Blaser, Susan / Papsin, Blake C / James, Adrian L / Gordon, Karen A. ·Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. ·Ear Hear · Pubmed #21750462.

ABSTRACT: OBJECTIVES: Hypoplasia of the auditory nerve (AN) refers to significant narrowing of the VIIIth cranial nerve which could compromise stimulation of the nerve by electrical pulses delivered from a cochlear implant (CI), thereby hindering activity in other parts of the auditory pathways. To compensate, high current levels or increased charge may be required to elicit auditory perception causing current to spread to other cranial nerves and potentially resulting in unwanted myogenic responses. Deficits in central auditory activity could reduce perception of speech and language. In the present study, we measured auditory brainstem responses in children with and without hypoplasia of the AN to answer the following questions. In children with hypoplastic ANs, (a) can CI stimulation evoke typical patterns of activity from the AN and brainstem?, (b) do brainstem responses change with CI experience?, (c) are evoked responses dependent on the size of the AN pathway?, and (d) does auditory development measured by behavioral tests of speech perception develop more slowly than in peers with normal AN diameter? DESIGN: Of 807 children using CIs in our program, 20 (2.5%) were identified as having AN hypoplasia using high-resolution computed tomographic scan and/or magnetic resonance imaging. An age-matched control group of children using CIs with normal AN diameter were recruited to compare electrophysiological and behavioral measures. Radiologic imaging was used to measure the diameter of the internal auditory canal (IAC), auditory nerve canal (ANC), and AN. Electrophysiological testing of the evoked compound action potential and auditory brainstem response was performed at CI activation and every 3 mo after initial testing up to 2 yr. Peak latency and waveform morphology were compared between study and control groups. Tests of speech perception and discrimination were attempted every 12 mo after device activation up to 10 yr. RESULTS: : Hypoplastic AN was identified as moderate to critical stenosis of the IAC, ANC, and AN. Initial electrically evoked compound action potential responses were mostly absent in children with AN hypoplasia. In the time window when electrically evoked auditory brainstem responses would be expected, some responses included single amplitude peaks at normal wave eV latencies, but the majority were abnormal, with peaks at atypical latencies or with no observable wave peaks. All evoked responses were inconsistent over time and did not reflect a typical pattern of auditory brainstem development. Speech perception scores were significantly poorer in the study group compared with controls and did not improve with CI experience. The type of abnormal evoked waveform response was independent of IAC, ANC, or AN diameter and also independent of behavioral outcome measures. CONCLUSIONS: : Evoked responses recorded in CI children with AN hypoplasia indicate a high incidence of nonauditory activity with CI use. The range of abnormal responses was not predicted by the severity of the hypoplastic AN or associated structures. This, along with poorer auditory development compared with peers with normal AN diameters, suggests that children with hypoplasia of the AN are poor candidates for cochlear implantation.

222 Article Chlorhexidine ototoxicity in ear surgery part II: survey of preparation solution used by otolaryngologists in Canada: is there a cause for concern? 2011

Lai, Philip / Coulson, Chris / Pothier, David / Rutka, John. ·Department of Otolaryngology-Head and Neck Surgery, University of Toronto. ·J Otolaryngol Head Neck Surg · Pubmed #22420429.

ABSTRACT: OBJECTIVE: To conduct a survey of the antiseptic preparations used for ear surgeries among otolaryngologists in Canada. METHODS: An electronic survey was sent to active members of the Canadian Society of Otolaryngology-Head and Neck Surgery via e-mail. Questions included the use of antiseptic, choice of preparation solution, duration of preparation, use of a barrier method, and compliance with hospital protocol changes. RESULTS: The e-mail was received by 253 otolaryngologists, and 85 completed the survey. Four of 85 respondents did not perform tympanoplasty surgery and were not included in the analysis. Of those who performed tympanoplasty (n  =  81), 78 of the 81 respondents (96%) used an antiseptic preparation solution at surgery, whereas 3 respondents (4%) did not. Sixty-six of the 77 respondents (86%) used aqueous povidone-iodine, 4 (5%) used a chlorhexidine-based preparation, 3 (4%) used an alcohol-based solution, 3 (4%) used others, and 1 answered "I don't know." Thirty-eight of 75 (29%) respondents used a barrier method, 23 (31%) answered "always," 18 (24%) answered "sometimes," and 5 (7%) answered "I don't know." When asked if they would comply with a hypothetical hospital policy to use chlorhexidine in ear surgery, 15 of 79 (19%) respondents agreed, whereas 64 (81%) disagreed. Among the aqueous povidone-iodine users (n  =  66), 7 (11%) agreed to change to chlorhexidine. CONCLUSIONS: There is a wide variation in practice in the use of surgical preparation solution among otolaryngologists performing ear surgery. Surgeons must be vigilant to avoid ototoxicity. A national society consensus on appropriate preparation solutions for ear surgery would minimize patients' risk and minimize future medicolegal actions.

223 Article Improved hearing with cochlear implantation in Fabry's disease. 2011

Clinkard, David J / Amoodi, Hosam / Lin, Vincent Y W / Chen, Joseph M / Nedzelski, Julian M. ·Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. David.Clinkard@sunnybrook.ca ·Cochlear Implants Int · Pubmed #22251813.

ABSTRACT: OBJECTIVE: To describe our center's experience with cochlear implantation in patients suffering from Fabry's disease, an inherited mutation resulting in an alpha-galactosidase A enzyme deficiency. CLINICAL PRESENTATION: Case report of two patients aged 49 and 59 at implant, with genetically confirmed Fabry's disease and progressive hearing loss. INTERVENTION: Surgical implantation of Clarion (Advanced Bionics) and Nucleus Freedom (Cochlear) cochlear implants. CONCLUSION: Cochlear implantation improves hearing discrimination by 60 points on the HINT scale. This suggests that cochlear implantation is a safe and effective intervention that improves hearing discrimination in patients suffering from Fabry's disease.

224 Article When do we choose the 'better balance' ear for cochlear implants? 2011

Hugh, Sarah C / Shipp, David B / Chen, Joseph M / Nedzelski, Julian M / Lin, Vincent Y W. ·University of Toronto, Toronto, Ontario, Canada. ·Cochlear Implants Int · Pubmed #22251805.

ABSTRACT: OBJECTIVES: In cochlear implant planning, the ear with poorer vestibular function, as determined through electronystagmography (ENG), is often selected as the site for implantation since surgery carries a low risk of iatrogenic labyrinthine injury. We sought to determine reasons for placing a cochlear implant in the 'better balance' ear. METHODS: A retrospective cohort study of patients implanted with a cochlear implant at a tertiary care center from 1984 to June 2009 was performed. Based on ENG results, patients with asymmetric caloric reduction were identified. Of these patients, those who were implanted in the 'better balance' ear were selected for chart review. The charts were reviewed to determine rationale for ear selection. RESULTS: Of the 724 cochlear implant patients implanted from 1984 to June 2009, ENG tests demonstrated that 130 (18%) had asymmetric abnormal responses. Thirty five (27%) of the patients with asymmetric abnormal responses were implanted in the 'better balance' ear. Review of these 35 patient charts revealed that reasons for selection of the 'better balance' ear fell into four categories: anatomical contraindications, attempting to attain binaural hearing, avoiding implantation of an ear with marked auditory deprivation, and patient preference. DISCUSSION: Based on our current practice, we have identified four situations in which patients were implanted in the 'better balance' ear, and subsequently developed an algorithm to aid surgeons in side selection for cochlear implantation. Further study and validation of this algorithm is recommended.

225 Article Postlingually deaf adults of all ages derive equal benefits from unilateral multichannel cochlear implant. 2011

Park, Edward / Shipp, David B / Chen, Joseph M / Nedzelski, Julian M / Lin, Vincent Y W. ·Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada. ·J Am Acad Audiol · Pubmed #22212763.

ABSTRACT: BACKGROUND: Controversy still exists regarding the impact of age on speech recognition following cochlear implant in postlingually deaf adults. In some studies elderly recipients did not perform as well as younger patients on standard speech recognition tests. Furthermore, previous studies have shown that cochlear implantation improves quality of life, as measured by self-administered questionnaires, but the sample sizes of these studies have been relatively small, thus making age stratification a challenge. PURPOSE: The primary objective was to assess whether the age at which a patient receives a unilateral cochlear implant affects improvements in speech recognition scores and perceived quality of life. A secondary objective was to determine whether preoperative use of hearing aids correlates with improvement in speech recognition and perceived quality of life after cochlear implantation. RESEARCH DESIGN: A retrospective study in a tertiary referral center. PATIENTS: A total of 161 postlingually deaf adults, who were divided based on age (<50, 50-65, >65) and on prior hearing aid(s) use. INTERVENTION: All patients received a unilateral multichannel cochlear implant. DATA COLLECTION AND ANALYSIS: Speech recognition was quantified by percent correct scores on the Hearing in Noise Test sentences delivered in a quiet setting only (HINT%), and quality of life was quantified by the Hearing Handicap Inventory (HHI) before and 1 yr after cochlear implantation. RESULTS: Speech recognition, as measured by HINT%, improved significantly and to similar extents in all three age groups following cochlear implantation. Similarly, quality of life as quantified by HHI improved markedly and to similar extents in all age groups. Whether hearing aids were used pre-implant, or whether the cochlear implant (CI) was implanted on the same side or contralateral to the hearing aid side, had no substantial effect on the patients' performances on either speech recognition or quality of life. Moreover, there were no statistically significant correlations between pre-implant speech recognition scores and pre-implant quality of life scores or between postimplant speech recognition scores and postimplant quality of life scores. CONCLUSION: The findings of the present study demonstrate that cochlear implantation improves HINT% and HHI scores to similar extents across all age groups. This finding suggests that elderly patients may derive speech recognition and quality of life benefits similar to those of younger patients and that age should not be an essential factor in the determination of CI candidacy. Furthermore, prior use of a hearing aid, and its location in relation to the cochlear implant, does not influence the extent of improvement in speech recognition or quality of life measurements following cochlear implantation.

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