Inquiry into old age deafness

Comparatively little work has been done 6n this subject in this country but many investigations have been made on the Continent during the last thirty years and some, more recently, in America.For The purposes of the present investigation I took the records of cases classified in this group of deafness who attended t he Royal Infirmary, Edinburgh, over a period of twenty years, together with records made personally in the Craiglockhart Poor-house, and studied the clinical findings.It was difficult to place These cases in a hard and last category; various factors such as heredity, environment, disease - both aural and constitutional - seemed all to play an important part in many of them and these factors had to be carefully weighed before including each case as definitely one of senile dearness

Transitions in auditory rehabilitation with bone conductive implant (bci)

Background: The bone conductive implants (BCI) are nowadays a reliable alternative for rehabilitation of specific forms of hearing loss, i.e. conductive, mixed or single sided deafness (SSD). Aims/Objective: To analyse the various factors in play when considering an auditory rehabilitation with a bone-conductive device (BCI). Materials and Methods: The clinical charts of subjects who underwent BCI application at the same Implanting Center from 2005 to 2018 were retrieved analysing also the reason for eventual explantation and the alternative option (transition) for hearing rehabilitation. Results: Nine BAHA Compact, 4 BAHA Intenso, 21 BAHA Divino, 3 BAHA BP100, 4 Ponto, 2 Sophono, 5 Bonebridge, 5 BAHA5 Attract; 11 BAHA5 Connect were used in 12 unilateral COM; 16 bilateral COM; 3 unilateral cholesteatoma; 6 bilateral cholesteatoma; 2 unilateral otosclerosis; 5 bilateral otosclerosis; 9 congenital malformations; 6 major otoneurosurgical procedures; 5 sudden deafness. Explantation was necessary for five subjects. Conclusions: Middle ear pathology and sequels from surgery represent the most common reason for BCI implantation, both in unilateral and in bilateral cases. Transition from one implantable device to another one can be predictable, mostly when explantation is necessary. Significance: The role of BCI for rehabilitation in middle ear pathology may be extremely important

Bone conductive implants in single sided deafness

Conclusion: The Bone Conductive Implants (BCI) showed to partly restore some of the functions lost when the binaural hearing is missing, such as in the single-sided deafness (SSD) subjects. The adoption of the single BCI needs to be advised by the clinician on the ground of a thorough counselling with the SSD subject. Objectives: To perform an overview of the present possibilities of BCI in SSD and to evaluate the reliability of the audiological evaluation for assessing the speech recognition in noise and the sound localization cues, as major problems related to the loss of binaural hearing. Method: Nine SSD subjects who underwent BCI implantation underwent a pre-operative audiological evaluation, consisting in the soundfield speech audiometry, as word recognition score (WRS) and sound localization, in quiet and in noise. Moreover, they were also tested for the accuracy of directional word recognition in noise and with the subjective evaluation with APHAB questionnaire. Results: The mean maximum percentage of word discrimination was 65.5% in the unaided condition and 78.9% in the BCI condition. The sound localization in noise with the BCI was better than the unaided condition, especially when stimulus and noise were on the same side of the implanted ear. The accuracy of directional word recognition showed to improve with BCI in respect to the unaided condition, in the BCI side, with either the stimulus on the implanted ear and the noise in the contralateral ear, or when both stimulus and noise were deliver to implanted ear

Sentence recognition in noise and perceived benefit of noise reduction on the receiver and transmitter sides of a BICROS hearing aid

Background: In the past, bilateral contralateral routing of signals (BICROS) amplification incorporated omnidirectional microphones on the transmitter and receiver sides and some models utilized noise reduction (NR) on the receiver side. Little research has examined the performance of BICROS amplification in background noise. However, previous studies examining contralateral routing of signals (CROS) amplification have reported that the presence of background noise on the transmitter side negatively affected speech recognition. Recently, NR was introduced as a feature on the receiver and transmitter sides of BICROS amplification, which has the potential to decrease the impact of noise on the wanted speech signal by decreasing unwanted noise directed to the transmitter side. Purpose: The primary goal of this study was to examine differences in the reception threshold for sentences (RTS in dB) using the Hearing in Noise Test (HINT) in a diffuse listening environment between unaided and three aided BICROS conditions (no NR, mild NR, and maximum NR) in the Tandem 16 BICROS. A secondary goal was to examine real-world subjective impressions of the Tandem 16 BICROS compared to unaided. Research Design: A randomized block repeated measures single blind design was used to assess differences between no NR, mild NR, and maximum NR listening conditions. Study Sample: Twenty-one adult participants with asymmetric sensorineural hearing loss (ASNHL) and experience with BICROS amplification were recruited from Washington University in St. Louis School of Medicine. Data Collection and Analysis: Participants were fit with the National Acoustic Laboratories’ Nonlinear version 1 prescriptive target (NAL-NL1) with the Tandem 16 BICROS at the initial visit and then verified using real-ear insertion gain (REIG) measures. Participants acclimatized to the Tandem 16 BICROS for 4 wk before returning for final testing. Participants were tested utilizing HINT sentences examining differences in RTS between unaided and three aided listening conditions. Subjective benefit was determined via the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire between the Tandem 16 BICROS and unaided. A repeated measures analysis of variance (ANOVA) was utilized to analyze the results of the HINT and APHAB. Results: Results revealed no significant differences in the RTS between unaided, no NR, mild NR, and maximum NR. Subjective impressions using the APHAB revealed statistically and clinically significant benefit with the Tandem 16 BICROS compared to unaided for the Ease of Communication (EC), Background Noise (BN), and Reverberation (RV) subscales. Conclusions: The RTS was not significantly different between unaided, no NR, mild NR, and maximum NR. None of the three aided listening conditions were significantly different from unaided performance as has been reported for previous studies examining CROS hearing aids. Further, based on comments from participants and previous research studies with conventional hearing aids, manufacturers of BICROS amplification should consider incorporating directional microphones and independent volume controls on the receiver and transmitter sides to potentially provide further improvement in signal-to-noise ratio (SNR) for patients with ASNHL.</jats:p

Hearing instruments for unilateral severe-to-profound sensorineural hearing loss in adults

Objectives: A systematic review of the literature and meta-analysis was conducted to assess the nature and quality of the evidence for the use of hearing instruments in adults with a unilateral severe-to-profound sensorineural hearing loss. Design: The PubMed, EMBASE, MEDLINE, Cochrane, CINAHL and DARE databases were searched with no restrictions on language. The search included articles from the start of each database until 11th February 2015. Studies were included that: (a) assessed the impact of any form of hearing instrument, including devices that re-route signals between the ears or restore aspects of hearing to a deaf ear, in adults with a sensorineural severe-to-profound loss in one ear and normal or near-normal hearing in the other ear; (b) compared different devices or compared a device to placebo or the unaided condition; (c) measured outcomes in terms of speech perception, spatial listening, or quality of life; (d) were prospective controlled or observational studies. Studies that met prospectively-defined criteria were subjected to random-effects meta-analyses. Results: Twenty-seven studies reported in thirty articles were included. The evidence was graded as low-to-moderate quality having been obtained primarily from observational before-after comparisons. The meta-analysis identified statistically-significant benefits to speech perception in noise for devices that re-routed the speech signals of interest from the worse ear to the better ear using either air or bone conduction (mean benefit 2.5 dB). However, these devices also degraded speech understanding significantly and to a similar extent (mean deficit 3.1 dB) when noise was re-routed to the better ear. Data on the effects of cochlear implantation on speech perception could not be pooled as the prospectively-defined criteria for meta-analysis were not met. Inconsistency in the assessment of outcomes relating to sound localisation also precluded the synthesis of evidence across studies. Evidence for the relative efficacy of different devices was sparse but a statistically significant advantage was observed for re-routing speech signals using abutment-mounted bone conduction devices when compared to outcomes after pre-operative trials of air-conduction devices when speech and noise were co-located (mean benefit 1.5 dB). Patients reported significant improvements in hearing-related quality of life with both re-routing devices and following cochlear implantation. Only two studies measured health-related quality of life and findings were inconclusive. Conclusions: Devices that re-route sounds from an ear with a severe-to-profound hearing loss to an ear with minimal hearing loss may improve speech perception in noise when signals of interest are located towards the impaired ear. However, the same device may also degrade speech perception as all signals are re-routed indiscriminately, including noise. While the restoration of functional hearing in both ears through cochlear implantation could be expected to provide benefits to speech perception, the inability to synthesise evidence across existing studies means that such a conclusion cannot yet be made. For the same reason, it remains unclear whether cochlear implantation can improve the ability to localise sounds despite restoring bilateral input. Prospective controlled studies that measure outcomes consistently and control for selection and observation biases are required to improve the quality of the evidence for the provision of hearing instruments to patients with unilateral deafness and to support any future recommendations for the clinical management of these patients

An autopsy study of a familial oculopharyngeal muscular dystrophy (OPMD) with distal spread and neurogenic involvement

An 81-year-old man from a family with a history of oculopharyngeal muscular dystrophy (OPMD) involving 6 members over 4 generations is described. The patient first noted drooping of his eyelids at the age of 65. Dysphagia and dysarthria occurred soon thereafter. At age 78, impairment of gait developed and progressive wasting occurred in the limbs with an initial distal distribution. Electromyography of several limb muscles displayed a mixed myopathic and neurogenic pattern with giant potentials. Examination at autopsy revealed slight loss of neurons in the anterior horns of the spinal cord, with scanty ghost cells, neuronophagia, and central chromatolysis. By light microscopy the limb muscles showed moderate small-group atrophy with severe myopathy and target fibers. The viscerocranial muscles, including the ocular, vocal, and tongue muscles, demonstrated only myopathic change with the typical features of progressive muscular dystrophy. Advanced replacement by fibrous connective tissue and fat had occurred in both the viscerocranial and the lower limb muscles. The significance of neurogenic involvement in OPMD is discussed

Preliminary speech recognition results after cochlear implantation in patients with unilateral hearing loss: a case series

<p>Abstract</p> <p>Introduction</p> <p>Cochlear implants known to provide support in individuals with bilateral hearing loss may also be of great benefit for individuals with unilateral hearing loss. This case report demonstrates the positive effects of cochlear implantation on speech understanding in noise conditions in patients with unilateral hearing loss and normal hearing on the contralateral side. To the best of our knowledge, the data presented here are from the first few cases to receive a cochlear implant for unilateral hearing loss.</p> <p>Case presentation</p> <p>Four Caucasian German men, two aged 48 and the others aged 51 and 57 years old, with post-lingual unilateral hearing loss and normal hearing on the contralateral side were implanted with a cochlear implant. All our patients were members of the German army. Before and after implantation, they were given a battery of speech tests in different hearing conditions to assess the effect of unilateral cochlear implantation on speech understanding in noise conditions. Test results showed that all patients benefited from unilateral cochlear implantation, particularly in terms of speech understanding in noise conditions.</p> <p>Conclusions</p> <p>Unilateral cochlear implantation might be a successful treatment method for patients with unilateral hearing loss not benefiting from alternative treatment options. The results of this case report open up the field of cochlear implantation for expanded criteria and new areas of research.</p

The effectiveness of the directional microphone in the Oticon Medical Ponto Pro in participants with unilateral sensorineural hearing loss

Background: Current bone anchored hearing solutions (BAHSs) have incorporated automatic adaptive multichannel directional microphones (DMs). Previous fixed single-channel hypercardioid DMs in BAHSs have provided benefit in a diffuse listening environment, but little data are available on the performance of adaptive multichannel DMs in BAHSs for persons with unilateral sensorineural hearing loss (USNHL). Purpose: The primary goal was to determine if statistically significant differences existed in the mean Reception Threshold for Sentences (RTS in dB) in diffuse uncorrelated restaurant noise between unaided, an omnidirectional microphone (OM), split DM (SDM), and full DM (FDM) in the Oticon Medical Ponto Pro. A second goal was to assess subjective benefit using the Abbreviated Profile of Hearing Aid Benefit (APHAB) comparing the Ponto Pro to the participant's current BAHS, and the Ponto Pro and participant's own BAHS to unaided. The third goal was to compare RTS data of the Ponto Pro to data from an identical study examining Cochlear Americas' Divino. Research Design: A randomized repeated measures, single blind design was used to measure an RTS for each participant for unaided, OM, SDM, and FDM. Study Sample: Fifteen BAHS users with USNHL were recruited from Washington University in St. Louis and the surrounding area. Data Collection and Analysis: The Ponto Pro was fit by measuring in-situ bone conduction thresholds and was worn for 4 wk. An RTS was obtained utilizing Hearing in Noise Test (HINT) sentences in uncorrelated restaurant noise from an eight loudspeaker array, and subjective benefit was determined utilizing the APHAB. Analysis of variance (ANOVA) was used to analyze the results of the Ponto Pro HINT and APHAB data, and comparisons between the Ponto Pro and previous Divino data. Results: No statistically significant differences existed in mean RTS between unaided, the Ponto Pro's OM, SDM, or FDM (p = 0.10). The Ponto Pro provided statistically significant benefit for the Background Noise (BN) (p &lt; 0.01) and Reverberation (RV) (p &lt; 0.05) subscales compared to the participant's own BAHS. The Ponto Pro (Ease of Communication [EC] [p &lt; 0.01], BN [p &lt; 0.001], and RV [p &lt; 0.01] subscales) and participant's own BAHS (BN [p &lt; 0.01] and RV [p &lt; 0.01] subscales) overall provided statistically significant benefit compared to unaided. Clinically significant benefit of 5% was present for the Ponto Pro compared to the participant's own BAHS and 10% for the Ponto Pro and the participant's own BAHS compared to unaided. The Ponto Pro's OM (p = 0.05), SDM (p = 0.05), and FDM (p &lt; 0.01) were statistically significantly better than the Divino's OM. No significant differences existed between the Ponto Pro's OM, SDM, and FDM compared to the Divino's DM. Conclusions: No statistically significant differences existed between unaided, OM, SDM, or FDM. Participants preferred the Ponto Pro compared to the participant's own BAHS and the Ponto Pro and participant's own BAHS compared to unaided. The RTS of the Ponto Pro's adaptive multichannel DM was similar to the Divino's fixed hypercardioid DM, but the Ponto Pro's OM was statistically significantly better than the Divino's OM.</jats:p