Tonsillotomy

Sleep-disordered breathing (SDB) constitutes the most common indication for tonsil surgery. For a long time, the only performed tonsil procedure was tonsillectomy (TE) which reserves relatively high morbidity, and many patients suffer from complications, most often postoperative haemorrhage. Hence, tonsillotomy (TT), the less invasive method of tonsil surgery, has gained popularity in recent years. However, Finnish studies on TT are still lacking. This thesis aimed to examine TT – its utility in children – and to discuss the potential benefits and disadvantages of TT compared to TE. The first study analysed the trends in tonsil surgery over a 10-year period and evaluated the effects of these changes on the incidence of tonsil surgery complications and specialist service costs. TTs were started at the Department of Otorhinolaryngology, Helsinki University Hospital, in 2009, and since 2011, TT has become a more common method in the treatment of SDB in children than TE. Consequently, the incidence of complications has decreased, thereby lowering hospital costs. In the second study, the postoperative recovery after TT and TE was evaluated and compared in a prospective cohort of children. All the recovery-related outcomes showed a tendency towards faster recovery after monopolar TT than TE; for children who had undergone TT, the need for analgesics was shorter, and they were able to return to normal activities earlier than children who had undergone TE. The third study examined the health-related quality of life (HRQoL) and the costs of use of health care in children operated with TT. The results of this study were compared to those of an earlier cohort of children operated on with TE. Both TT and TE improved HRQoL in children with SDB and reduced health care service needs and sick leave days. There was no difference in the mean total hospital costs between TT and TE in the one-year follow-up. The fourth study histologically evaluated the differences in tissue from children with re-hypertrophy of tonsils after TT and those with tonsillar hyperplasia without a history of earlier surgery. Also, the incidence of reoperations and potential predictive factors for tonsillar regrowth were assessed retrospectively. There was no evidence of severe chronic inflammation or scarring in the regrown tonsils. The incidence for resurgery was low (1.9%), and young age seemed to be a predictive factor for tonsillar regrowth. This study confirmed the superiority of TT over TE in several aspects: the recovery from surgery was faster and less painful after TT than after TE, and the rate of complication was lower. TT improved HRQoL and reduced visits of health care. The incidence of resurgery because of tonsillar regrowth was low.Nielurisojen liikakasvun aiheuttama kuorsaus ja hengityskatkokset ovat hyvin tyypillisiä oireita lapsilla. Aikaisemmin nielurisaleikkaukset tehtiin syystä riippumatta nielurisojen kokopoistoina, joka tarkoittaa nielurisojen poistamista kapseleineen lihaskerrokseen saakka. Kokopoistosta toipuminen on hidasta ja kivuliasta, lisäksi siihen liittyy riski jälkiverenvuodosta, joka voi olla vaarallinen erityisesti lapsille. Viime vuosina on otettu käyttöön nielurisojen osapoistoleikkaus, johon on kansainvälisissä tutkimuksissa osoitettu liittyvän pienempi jälkiverenvuotoriski sekä nopeampi toipuminen. Suomessa tehtyjä tutkimuksia aiheesta ei ole. Tutkimuksen tavoitteena oli tutkia nielurisan osapoistoleikkausta, sen tehokkuutta ja turvallisuutta lapsilla, ja verrata edellä mainittuja tekijöitä nielurisan kokopoistoon. Ensimmäisessä osatyössä kartoitettiin nielurisakirurgian muutoksia 10 vuoden aikana HYKS Korva-, nenä- ja kurkkutautien -klinikalla ja selvitettiin muutosten vaikutuksia komplikaatioiden esiintyvyyteen ja erikoissairaanhoidon kustannuksiin. Nielurisan osapoistoleikkaukset aloitettiin vuonna 2009, ja vuodesta 2011 osapoisto on ollut käytetympi menetelmä lasten suurentuneiden nielurisojen aiheuttamien oireiden hoidossa kuin kokopoisto. Muutoksen seurauksena todettiin lasten nielurisaleikkauksiin liittyvien komplikaatioiden vähentyneen merkittävästi. Myös osapoiston kustannusten todettiin olevan pienemmät verrattuna kokopoistoon. Toisessa osatyössä seurattiin lasten toipumista nielurisakirurgian jälkeen ja havaittiin, että diatermialaitteella tehdyn osapoiston jälkeen lapset toipuivat nopeammin, kärsivät vähemmän kivusta kuin lapset, joille oli tehty kokopoistoleikkaus. Kolmannessa osatyössä tutkittiin osapoiston vaikutusta lasten elämänlaatuun ja terveydenhuollon kustannuksiin sekä verrattiin tuloksia aikaisemmin kokopoistolla hoidettujen lapsien tuloksiin. Elämänlaatu parani yhtäläisesti molemmissa ryhmissä eikä vuoden seurannassa havaittu eroa kustannuksissa toimenpiteiden välillä. Neljännessä osatyössä selvitettiin, eroaako nielurisan osapoiston jälkeen uudelleen kasvaneen risan histologinen rakenne tavanomaisesta suurentuneesta nielurisasta. Lisäksi selvitettiin 11 vuoden aikana leikattujen lasten uusintaleikkausriskiä sekä siihen vaikuttavia tekijöitä. Histologiset tutkimukset osoittivat, että uudelleen kasvaneissa nielurisoissa ei ollut merkkejä lisääntyneestä kroonisesta tulehduksesta tai arpimuodostuksesta. Riski uusintaleikkaukseen oli matala (1.9 %), nuori ikä leikkaushetkellä vaikutti olevan yhteydessä suurempaan uusintaleikkausriskiin. Tutkimuksemme osoitti, että kokopoistoon verrattuna nielurisan osapoisto on lapsen eduksi, leikkauksesta toipuu nopeammin ja kivut ovat vähäisempiä ja komplikaatioita esiintyy vähän. Toimenpiteen seurauksena lasten elämänlaatu parani ja terveydenhuollon käynnit nieluoireiden vuoksi vähenivät. Uusintaleikkauksen tarve nielurisojen uudiskasvun vuoksi oli pieni

How robust is the United Kingdom justice system against the advance of deepfake audio and video?

A recent development is the application of AI to either alter or create video and audio files - called Deepfakes. The paper examines the issues arising from deepfakes, to determine how robust the UK justice system is against deepfakes. The work analyses deepfake technology, with respect to an evaluation of professional knowledge, evidential standards, and current legislation. The paper discusses difficulties presented by deepfakes, highlighting the need for methods to authenticate digital evidence, and considers what UK legal remedies can protect the justice system and public from digitally falsified evidence. The paper concludes with potential recommendations for the justice system

Bilateral age-related atrophy in the planum temporale is associated with vowel discrimination difficulty in healthy older adults

In this study we investigated the association between age-related brain atrophy and behavioural as well as electrophysiological markers of vowel perception in a sample of healthy younger and older adults with normal pure-tone hearing. Twenty-three older adults and 27 younger controls discriminated a set of vowels with altered second formants embedded in consonant-vowel syllables. Additionally, mismatch negativity (MMN) responses were recorded in a separate oddball paradigm with the same set of stimuli. A structural magnet resonance scan was obtained for each participant to determine cortical architecture of the left and right planum temporale (PT). The PT was chosen for its function as a major processor of auditory cues and speech. Results suggested that older adults performed worse in vowel discrimination despite normal-for-age pure-tone hearing. In the older group, we found evidence that those with greater age-related cortical atrophy (i.e., lower cortical surface area and cortical volume) in the left and right PT also showed weaker vowel discrimination. In comparison, we found a lateralized correlation in the younger group suggesting that those with greater cortical thickness in only the left PT performed weaker in the vowel discrimination task. We did not find any associations between macroanatomical traits of the PT and MMN responses. We conclude that deficient vowel processing is not only caused by pure-tone hearing loss but is also influenced by atrophy-related changes in the ageing auditory-related cortices. Furthermore, our results suggest that auditory processing might become more bilateral across the lifespan

Three-dimensional models of cochlear implants : a review of their development and how they could support management and maintenance of cochlear implant performance

Three-dimensional (3D) computational modelling of the auditory periphery forms an integral part of modern-day research in cochlear implants (CIs). These models consist of a volume conduction description of implanted stimulation electrodes and the current distribution around these, coupled to auditory nerve fibre models. Cochlear neural activation patterns can then be predicted for a given input stimulus. The objective of this article is to present the context of 3D modelling within the field of CIs, the different models and approaches to models that have been developed over the years, as well as the applications and potential applications of these models. The process of development of 3D models is discussed, and the article places specific emphasis on the complementary roles of generic models and user-specific models, as the latter is important for translation of these models into clinical application.http://tandfonline.com/toc/inet202017-05-31hb2016Electrical, Electronic and Computer Engineerin

Human movements and mandibular stability

Intensive studies of the positioning and movements of the human jaw in both healthy and diseased subjects have been undertaken because of the importance of the mouth in daily human activities, such as verbal and nonverbal communication, breathing, chewing and swallowing. The observation that our teeth do not crash together in a potentially harmful way during locomotion and other whole body activities is common, although the reason for this is not clear. The aim of the present study was to investigate the mechanisms controlling the rest position of the human jaw and the influence of whole body movements such as running and hopping on these mechanisms. While there have been numerous studies relating jaw elevator muscle activity with jaw movement and position in seated subjects, there are no reports of this in fully ambulatory humans. I developed specific equipment, built around miniature accelerometers and magnetic sensors, to enable a rapid and accurate measurement of small excursions of the mandible in response to take-off and landing during multi-dimensional movements. Accurate detection and recording of short-latency reflex activation in muscles attached to the jaw was required during unconstrained movements of the subject. I developed a recording system that was robust yet non-invasive for this purpose. In the present study short-latency excitation was found in the masseter after an abrupt landing (heel land) from a hop. No reflex activation was seen in either a soft landing (toe land) or a hard landing with the teeth fully occluded in which there was minimal displacement of the mandible with respect to the maxilla. This provides strong evidence that the excitation is a stretch reflex and not of vestibular origin. This is the first report of short-latency stretch reflex in the human masseter resulting from a natural movement. Landing on the heel or on the toe in different forms of locomotion on a treadmill was followed by rapid deceleration of the downward movement of the head and slightly less rapid deceleration of the downward movement of the mandible, i.e., the mandible moved downwards relative to the maxilla, then upwards again to near its normal posture, within 200 ms. No tooth contact occurred in any forms of gait or at any inclination of the treadmill. The movement of the mandible relative to the maxilla was found to depend on the nature and velocity of the locomotion and the effects on head deceleration. The least deceleration, and hence the minimal mandibular displacement, occurred during toe-landing, such as occurs during "uphill" running. The maximum displacement of the mandible relative to the head was less than 1 mm, even at the fastest running speed. The mechanisms that limit the vertical movements of the jaw within such a narrow range are not known, but are likely to include passive soft-tissue visco-elasticity and stretch reflexes in the jaw-closing muscles. The techniques developed in the present study will allow the investigation of the role of stretch reflexes under these conditions in a future study.Thesis (MSc) -- University of Adelaide, School of Molecular and Biomedical Sciences, 200

Comparisons of unilateral and bilateral cochlear implantation for children: spatial listening skills and quality of life

Recently, controversy in the care of severely-profoundly deaf children has centred on whether they should be provided with bilateral cochlear implants (two implants, one in each ear) rather than a unilateral cochlear implant (one implant in one ear). Potentially, implanting both ears rather than one could improve children’s spatial listening skills, meaning the ability to localise sources of sound (by comparing the intensity and timing of sounds arriving at the two ears) and to perceive speech in noise (by attending to whichever ear gives the better signal-to-noise ratio). The overall aim of the studies reported in this thesis was to assess whether bilateral implantation for children is more effective than unilateral implantation in improving spatial listening skills and quality of life. The first study measured the relationship between spatial listening skills and age in normally-hearing children. The second study compared the spatial listening skills of unilaterally- and bilaterally-implanted children. Whilst controlling for confounds, the bilateral group performed significantly better than the unilateral group on tests of sound-source localisation. Moreover, the bilateral group, but not the unilateral group, displayed improved speech perception when the source of a masking noise was moved from the front to either side of the head. Neither group of implanted children performed as well as normally-hearing children on tests of the ability to localise sources of sound and to perceive speech in noise. The third study measured the spatial listening skills of normally-hearing adults when listening to simulations of unilateral or bilateral implants. The differences in performance between simulations were similar to the differences in performance between groups of implanted children, which provides further evidence that the children's performance was primarily influenced by the number of implants they used rather than by confounds. The fourth study found that there was no significant difference between bilaterally- and unilaterally-implanted children in parental estimates of quality of life. The fifth study presented informants, who were not the parents of hearing-impaired children, with descriptions of a hypothetical child with unilateral or bilateral implants. The informants judged that the bilaterally-implanted child had a higher quality of life than the unilaterally-implanted child. These studies indicate that bilateral implantation for children is more effective than unilateral implantation in enabling spatial listening skills, but the extent of any gain in quality of life remains uncertain

The Development and Evaluation of the Hearing Intervention Battery in Arabic (HIBA) for Auditory Perception in Children with Cochlear Implants

The Hearing Intervention Battery in Arabic (HIBA), is a multi-modal auditory training intervention, that was developed based on the recommendations from our published systematic review of the literature on the effectiveness of auditory training (AT) for children with cochlear implants (CIs). HIBA was primarily intended to help improve speech and pitch perception in Arabic-speaking children with CIs. Due to the lack of auditory and speech assessment tools for the Arabic language, the A-CAPT, an Arabic version of the English Chear Auditory Perception Test (CAPT) was developed. The A-CAPT was validated prior its use in this project with 26 children with typical hearing. There was a strong agreement between the test and retest measures and normative data and the critical difference values were calculated which were similar to the British English CAPT. A randomized control trial (RCT) to evaluate the HIBA training programme was conducted with 14, 5- to 13-year-old Arabic-speaking children with CIs. The control group received art training following step-by-step drawing and face-paint exercises while the HIBA multi-modal training group received games involving communication interactions (DiaPix), speech cue discrimination (Alefbata.com), and pitch discrimination (musical discrimination using a keyboard). All tasks were interactive and designed to be completed by the children together with their parents or caregivers. There was a double baseline measurement, followed by a 4-week intervention period before a post intervention assessment. There was a significant improvement in consonant perception for children who received the HIBA multi-modal training intervention but this was not observed in the active control group. There was some evidence of generalization of learning, as observed by improvements in the non-trained task (phoneme discrimination) for the intervention group but not for controls. It was unclear if one particular element of the HIBA led to these improvements. Parents were actively involved in the multi-modal training group and their feedback indicated that the most preferred part of multi-modal training was the communication interaction tasks using the Diapix. To understand which element of the HIBA led to improvements in speech perception and whether the duration of training and sample size masked any gains, a trial forward in a larger scale should be conducted. In addition, to improve the quality of evidence of the study, collaboration is need to achieve a double blinded study and minimize bias. Findings of this project may suggest that children with CIs and their parents can benefit from regular and sustained access to age-appropriate auditory training materials and activities. In addition, findings would extend the current understanding of the impact of auditory training on CI outcomes in children and provide inspiration for a more comprehensive rehabilitation scheme for CI users

Ultrastructure and function of respiratory cilia in critical illness

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