Evaluation of the descriptive values and occlusion effects of air and bone conducted cervical vestibular evoked myogenic potentials in normal individuals

Objective:This study was aimed to establish the descriptive statistical values of cVEMPs's responses which are evoked by air and bone conducted stimuli and to examine the effects of occlusion on bone conducted (BC) cVEMPs test. Methods:The study was carried out on 20 individuals (n = 40 ears), 11 women and 9 men, at the Medipol Mega University Hospital. cVEMPs tests were applied in five stages to the individuals who are volunteer to participate in this study. Firstly, the air conducted (AC) cVEMPs test was applied. Then, BC cVEMPs tests were applied in four different conditions with the aim of examining the occlusion effect. Results:Latency values of the AC cVEMPs response were 15.17 +/- 0.77 ms for P1 and 24.12 +/- 1.38 ms for N1 and 8.95 +/- 1.12 ms for interpeak latencies. P1N1 amplitude value was 149.73 +/- 75.00 mu V. VEMPs asymmetry ratio (VAR) was 0.16 +/- 0.16. Latency measurements of the BC cVEMPs response were 14.38 +/- 0.85 ms for P1 and 23.40 +/- 1.50 ms for N1 and 9.05 +/- 1.57 ms for interpeak latencies. P1N1 amplitude value was 107.58 +/- 54.08 mu V. VAR was 0.15 +/- 0.12. Both AC cVEMPs and BC cVEMPs parameters were demonstrated that there are not any significant differences between female-male and left ear-right ear. When AC and BC cVEMPs responses were compared, the mean P1 and N1 latencies of BC cVEMPs were significantly shorter than those of AC cVEMPs (p < 0.01). The mean amplitudes of AC cVEMPs were significantly larger than those of BC cVEMPs (p < 0.01). When the impact of the occlusion effect on cVEMPs parameters was examined, no statistical significance was found. Conclusion:As a result, it was thought that the BC cVEMPs, which is not widely used in clinics, might be used in the vestibular assessment of conductive hearing losses (CHL) in clinics, by obtaining descriptive values with this study. In addition, it was thought that it might be used as an auxiliary test to diagnose patients with hyperacusis who are disturbed by loud noises

Can auditory and vestibular findings differentiate vestibular migraine and meniere’s disease?

Background and Objectives: Besides evaluating the auditory and vestibular systems of patients with vestibular migraine (VM) and Meniere's disease (MD), this study aimed to examine the clinical overlaps between these two conditions by detailed evaluation of the patient's symptoms. Subjects and Methods: The ears of the patients with VM and MD were evaluated and patients' vestibular and auditory complaints were questioned particularly. Pure tone audiometry, vestibular evoked myogenic potential (VEMP) responses, and caloric test results were evaluated for objective measurements. Results: The VM group had better air-conduction and bone conduction threshold and speech reception threshold and speech discrimination score test values (p<0.05). Regarding the interaural N1-P1 asymmetry ratio, the cervical VEMP between the groups had significant differences (p=0.019). The MD group had more unilateral tinnitus and ear fullness complaints and canal paresis results (p<0.01). The VM group had more motion sickness complaints (p<0.01). Conclusions: If only ears with hearing loss are evaluated; there was no significant difference between VM and MD, but regardless of hearing level or only the patients with normal hearing were evaluated, the VM group had better hearing levels. It should be considered that patients with VM may have VM-independent hearing loss, and patient complaints should be sufficiently detailed to make an accurate distinction from MD.J Audiol Otol

Effectiveness of virtual reality-based vestibular rehabilitation in patients with peripheral vestibular hypofunction

Indexed keywords Metrics Abstract Background/aim: The rehabilitation of classical peripheral vestibular disorders is long and costly. Recently, interactive systems based on virtual reality (VR) technology have reduced the cost of vestibular rehabilitation therapy (VRT) and made the process more enjoyable. This study aims to investigate the effects of VR-based VRT in patients diagnosed with peripheral vestibular hypofunction (PVH). Materials and methods: In this study, a VR-based VRT program that utilized Sony Playstation®4 VR Head Mounted Display was applied to 25 patients (between 18–60) diagnosed with PVH. PVH was diagnosed by evaluating the patients’ clinical histories, the findings in the “Micromedical Technologies VisualEyes Spectrum” videonystagmography (VNG) and the “Micromedical Aqua Stim” model bithermal water caloric tests. VR-based VRT program was applied to the patients for 4 weeks, 2 sessions per week, 8 sessions in total. Each session lasted around 30 to 40 min. All patients underwent the Dizziness Handicap Inventory (DHI), Sensory Organization Test (SOT), Adaptation Test (ADT), Limits of Stability (LOS), and Rhythmic Weight Shift (RWS) before, after, and 8-week follow-up of the VRT program. In addition, the Cybersickness Survey was applied to the patients at the end of the VR-based VRT session every week. Results: The DHI mean scores of the patients were 54.60, 19.20, and 16.84, respectively, before, just after, and at the 8-week follow-up VRT (p < 0.001). The mean SOT composite score of the patients was obtained as 58.08 before VRT; 77.16 after VRT and 76.40 at 8-week after VRT (p < 0.000). On the other hand, the values in the ‘movement velocity’ and “direction control” parameters of the patients in LOS and RWS showed a significant improvement after VRT compared to before VRT (p < 0.000). From before VRT to 8 weeks after VRT, the patient’s oscillation averages in the ‘toes up’ and ‘toes down’ positions in ADT reduced progressively (p < 0.000). Conclusion: This study demonstrates that implementing a VR-based VRT protocol may be an efficient option to improve posture stability and the quality of life in patients with PVH. In addition, VR-based vestibular rehabilitation therapy has shown to be effective for PVH patients in the mid-term

Genel anestezinin işitsel beyinsapı cevap testine etkisi

Objective: The auditory brainstem response (ABR) test is usually applied during natural sleep, but it can also be conducted under anesthesia. This retrospective study aimed to compare the ABR findings of a general anesthesia group and a control group that underwent ABR test during natural sleep. Methods: The anesthesia group consisted of 42 (mean age 44.5±20.3 months) children, and the control group included 58 children (36.1±16.1 months). The results of the click ABR test of the two groups were compared in terms of amplitude, latency, interpeak latencies, and hearing thresholds. Results: The amplitudes of waves III and V were significantly decreased in the general anesthesia group compared with that in the control group. The ABR latencies of waves I and V and the interpeak latencies for I-V and III-V were prolonged in the anesthesia group compared with that in the control group. Moreover, the click threshold obtained in the anesthesia group was significantly higher than those of the control group. Conclusions: Clinicians and audiologists should advise families to know the effects of general anesthesia on ABR and be cautious in interpreting the results obtained in ABR test performed under anesthesia.Amaç: İşitsel beyinsapı cevap (ABR) testi genellikle doğal uyku sırasında uygulansa da anestezi altında da yapılabilir. Bu retrospektif çalışmanın amacı, genel anestezi grubu ile doğal uykuda ABR testi uygulanan kontrol grubunu ABR test bulguları açısından karşılaştırmaktır. Yöntemler: Anestezi grubu 42 (yaş ortalaması 44,5±20,3 ay) ve kontrol grubu 58 (yaş ortalaması 36,1±16,1 ay) çocuktan oluşmaktaydı. İki grubun klik ABR test sonuçları amplitüd, latans, dalgalar arası latans ve işitme eşikleri açısından karşılaştırıldı. Bulgular: Genel anestezi grubunda, III ve V. dalganın amplitüdü kontrol grubuna göre anlamlı olarak azaldı. Genel anestezi grubunda, I. ve V. dalgaların latansları, I-V ve III-V dalgalar arası latanslarında kontrol grubuna göre uzama gözlendi. Ayrıca genel anestezi grubunda elde edilen klik eşiği kontrol grubuna göre anlamlı olarak daha yüksek elde edildi. Sonuçlar: Klinisyenler ve odyologlar, ailelere genel anestezinin ABR üzerindeki etkilerini bilmesini tavsiye etmeli ve anestezi ABR ile elde edilen sonuçları yorumlarken dikkatli olmalıdır

The effect of body mass index on traditional 226 Hz tympanometry and wideband tympanometry test results

Objectives: The aim of this study was to investigate the possible effects of body mass index (BMI) on traditional 226 Hz tympanometry and wideband tympanometry (WBT) to gain a better understanding of resonance frequency. Patients and Methods: A total of 158 ears of 79 volunteers (19 males, 60 females; mean age: 20.5 years; range, 18 to 27 years) who had normal hearing and normal otoscopic examination findings were included in the study between October 2019 and June 2020. By measuring the weight and height of the participants, their BMI values were classified into three groups: ≤18.5 kg/m2 (underweight), 18.5 to 24.9 kg/m2 (normal weight), and ≥25.0 kg/m2 (overweight). Tympanometric evaluations were conducted using the Interacoustics-Titan WBT. Results: The difference of ear canal volume (ECV) was significant between the two sexes (p<0.05), while there was no significant difference in the tympanometric peak pressure, compliance, gradient, and resonance frequency between the sexes (p>0.05). A significant difference was found in the ECV and resonance frequency among the three BMI groups (p<0.05). Accordingly, as the BMI increased, the ECV increased and the resonance frequency decreased (p<0.05). Conclusion: The BMI may affect ECV and resonance frequency values which should be considered during the examination

Evaluation of individuals with hearing loss in terms of social and emotional aspects: Cross-sectional research

Amaç: Bu çalışmada; işitme cihazı (İC), koklear implant (Kİ) kullanıcısı olan ve İC/Kİ endikasyonu olup, İC/Kİ kullanıcısı olmayan işitme kayıplı erişkinlere işitme kaybının yol açtığı sosyal ve emosyonel etkileniminin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Saf ses odyometri testi sonucuna göre orta, orta-ileri, ileri ve çok ileri derecede sensörinöral tip işitme kaybı tanısı almış 18-65 yaş aralığında 60 İC kullanıcısı (Grup I), 60 Kİ kullanıcısı (Grup II) olan ve orta, orta-ileri, ileri derecede işitme kayıplı olup İC/Kİ kullanıcısı olmayan (Grup III) 60 kişiye “Yetişkinler İçin İşitme Engeli Ölçeği (İEÖ-E)” uygulandı. Ölçeğin emosyonel ve sosyal alt başlıklarından elde edilen verilerin istatistiksel analizi için SPSS versiyon 25.0 (SPSS inc., Chicago, IL, ABD) programından Kruskal-Wallis, Mann-Whitney U ve Pearson korelasyon analiz test yöntemlerine başvuruldu. Bulgular: Ölçeğin, sosyal ve emosyonel Cronbach katsayısı sırasıyla α=0,88 ve α=0,92 olarak elde edilirken, genel Cronbach katsayısı α=0,95 olarak bulundu. Hem Grup I hem de Grup II, Grup İEÖ-E puanları Grup III’e göre düşük bulundu (p=0,000). Grup I ve Grup II kullanıcıları birbirleriyle karşılaştırıldığında, İEÖ-E sosyal etkilenim puanlarında anlamlı fark elde edilirken (p=0,032), emosyonel etkilenim ve toplam puanları arasında istatistiksel olarak anlamlı bir fark elde edilemedi (p=0,105). Sonuç: Bu çalışmanın sonucunda, İC/Kİ işitme kaybı endikasyonu olmasına rağmen herhangi bir işitme protezi İC/Kİ kullanmayan bireylerin İC/Kİ kullanan bireylere nazaran sosyal ve emosyonel yönden daha iyi oldukları ortaya çıkmıştır. Ayrıca işitme kayıplı bireylerin gereksinimine göre cihazlandırılmasının (İC ve/veya Kİ) yaşam kalitesini iyileştirebileceğini göstermiştir.Objective: Aim of this study was to evaluate the social and emotional effects of hearing aid (HA), cochlear implant (CI) users and adults with HA/CI indications without amplification HA/CI. Material and Methods: The inventory was applied to individuals aged 18-65 years who were diagnosed with moderate, moderate-to-profound, severe and very severe sensorineural hearing loss via pure tone audiometry. There were 60 participants with HA (Group I), 60 participants with CI (Group II) and 60 participants with diagnosed with moderate, moderate-to-severe, severe hearing loss but without amplification (HA/CI) (Group III). Kruskal-Wallis test, Mann-Whitney U test and Pearson correlation tests were used. Results: Cronbach’s coefficients of the social and emotional scale were found as α=0.88 and α=0.92, respectively. The overall Cronbach’s coefficient was found as α=0.95. The HHIA scores of Group I and Group II were found to be lower than Group III (p=0.000). There was a significant difference in the scores of group I and group II in terms of HHIA social subscale (p=0.032). Hovewer, there was no statistically significant difference between the HHIA general scores compared to the HA group and the CI group (p=0.105). Conclusion: It has been revealed that HA and CI users are socially and emotionally better than participants who do not use any hearing aid, even though they have HA/CI indications. Furthermore, our study has shown that providing hearing aids according to the needs of individuals with hearing loss (HA and/or CI) can improve their quality of life

Investigation of the effects of narrowband and wideband noise on central inhibition in pure tone audiometry in individuals with hearing loss

Amaç: Bu çalışmada dar bant ve geniş bant gürültü kullanımının işitme kayıplı bireylerde santral inhibisyon değerlerine olan etkilerinin karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: 37 kişiye öncelikli olarak otoskopik bakı, saf ses odyometrisi, konuşma odyometrisi ve timpanometrik değerlendirmeleri yapılarak işitme kaybının lokalizasyonu, tipi ve derecesi belirlenmiştir. Ardından katılımcıların saf ses işitme eşiklerindeki değişiklikler test edilmeyen kulağa sırasıyla gürültü verilmeden, dar bant ve geniş bant gürültü verilerek test edilmiştir. Bulgular: Sensörinöral işitme kayıplı olgularda 250, 500, 2000 ve 8000 Hz frekanslarında; iletim tipi işitme kayıplı olgularda ise 250,500 ve 1000 Hz frekanslarında geniş bant gürültü kullanımı, eşik kaymasını azaltarak eşiklerde istatistiksel olarak anlamlı değişikliğe neden olmuştur (p<0,05). Sonuç: Çalışmamızda iletim tipi ve sensörinöral tip işitme kayıplarında geniş bant gürültünün kullanımının eşik kaymasını azaltarak daha güvenilir eşik tayinine neden olduğu tespit edildi.Objective: This is a study which compares the effects of narrowband noise versus wideband noise on central inhibition values in individuals with hearing loss. Material and Methods: Thirty-seven subjects were primarily examined for otoscopic examination, pure tone audiometry, speech audiometry, and tympanometric evaluations; then demonstrated localization of hearing loss, type and degree of hearing loss. Similarly, pure tone thresholds were tested in three different conditions while applying narrowband and wideband noise as well as without any masking noise using contralateral route. Results: In cases with sensorineural hearing loss, at frequencies of 250, 500, 2000 and 8000 Hz; In cases with conductive hearing loss, the use of wideband noise at frequencies of 250,500 and 1000 Hz reduced the threshold shift, causing a statistically significant change in the thresholds (p<0.05). Conclusion: In our study, it was found that the use of wideband noise in conductive and sensorineural hearing losses decreased threshold shift and caused more reliable threshold determination

Preliminary Study: The Test Technique for the Evaluation on Spatial Navigation in the Absence of Visual Data in Healthy Individuals

Background and Aim: Path integration refers to the capability of utilizing self-motion information produced by one’s own bodily movements to accurately determine and maintain one’s position in space. Typically, path integration mechanisms come into play when visual information is limited or absent. The objective of this study was to develop a path integration test that relies solely on self-motion cues derived from body movements, without the involvement of visual cues. Methods: The study involved 157 volunteers (86 females and 71 males) aged between 18 and 70 years. Participants were asked to walk on a coordinated ground with their closed eyes and follow the six different commands. They were, after that, requested to return their initial position. Movement time was manually measured by the stopwatch. The distance between the original reference point and estimated starting point was recorded. Results: The second command that showed the lowest standard deviation out of the six commands given to the participants was observed as the more reliable test among the other commands (47.51±33.75). In addition, the completion time of the second command increased with increasing age (p<0.001). Conclusion: This study introduces an innovative spatial navigation approach utilizing the second command set. As an alternative, this command can be used to assess the human spatial navigation system

The research of the primary care clinic doctors’ awareness levels about the national hearing screening program

Amaç: Ulusal Yenidoğan İşitme Tarama Programı (UYİTP)nın sağlık sistemine entegrasyonu, hasta takiplerinin yapılabilmesi, ailelerin bilgilendirilmesi ve işitme kayıplı bebeklerin, uygun merkezlere sevklerinin sağlanması konusunda aile sağlığı merkezleri (ASM) anahtar pozisyondadır. Programın, amacına uygun ve en verimli şekilde yürütülebilmesi için burada çalışan doktorların UYİTP hakkında bilgi ve ilgi seviyeleri kritik bir öneme sahiptir. Bu merkezlerde çalışan doktorların UYİTP hakkındaki bilgileri, farkındalıkları ve konuyla ilgilenme seviyeleri hakkında bilgilerimiz sınırlıdır. Bu çalışmanın amacı, aile hekimlerinin UYİTP hakkında bilgi ve farkındalık seviyelerini tespit ederek, ihtiyaç duyulan alanlarda nasıl bilgilendirme yapılması gerektiğine dair veri toplamaktır. Gereç ve Yöntemler: Birinci basamak hekimler için 29 sorudan oluşan bir anket oluşturulmuştur. Çalışmaya, İstanbul ilindeki değişik ilçelerde ASM’lerde çalışan 129 hekim katılmıştır. Bu anket kapsamında UYİTP’nin amacı, işleyişi, kullanılan testler ve tedavi yöntemleri hakkında hekimlerin bilgi seviyelerinin ölçülmesi planlanmış ve UYİTP ile ilgili bilgilendirilmek isteyip istemedikleri sorgulanmıştır. Ayrıca UYİTP ile ilgili bilgilerin ailelere doğru şekilde aktarılabilmesi maksadıyla nasıl bir yöntem uygulanması gerektiği de değerlendirilmiş, alternatifler önerilmiştir. Yapılan istatistiksel testlerde anlamlılık seviyesi %5 (0,05) olarak alınmıştır. Bulgular: Yaptığımız çalışmada katılımcıların UYİTP hakkında genel bilgi seviyesinin düşük olduğu saptanmıştır. Anket sonuçlarına göre katılan hekimlerin %71,3 (92)’ü UYİTP hakkında, %76 (98)’sı test yöntemleri hakkında, %69 (89)’u işitme kayıplı bir çocuğun ailesinin bilgilendirilmesi ve yönlendirilmesi hakkında eğitim almak istediğini belirtmiştir. Katılımcıların %25,6 (33)’sı kendilerini değerlendirdiklerinde bilgilerinin yetersiz olduğunu belirtirken, %23,3 (30)’ü bilgilerini yeterli bulduğunu belirtmiştir. Bu 2 grup kendi arasında, tanı basamaklarını içeren sorulara (Soru 11, Soru 12, Soru 13, Soru 16) verdikleri cevaplara bakılarak kıyaslandığında, kendini yeterli görenler ve görmeyenler arasında istatistiksel olarak anlamlı bir fark bulunmamıştır (p=0,180, p=0,360, p=0,08, p=0,115). Sonuç: UYİTP alanında bir ekip anlayışı ile çalışılması gerekliliği ve ekip içerisinde yer alan tüm birimlerin, bilgi seviyelerinin en üst düzeye çekilmesinin önemi ortadadır. Buna bağlı olarak UYİTP’nin daha etkin ve verimli olabilmesi açısından çeşitli kanallar aracılığıyla bilgilendirme faaliyetlerinin yapılması ve artırılmasının uygun olacağı düşünülmektedir.Objective: Primary health care centers are in a central position to integrate National Neonatal Hearing Screening Program (NNHSP) into the health system. Physicians provide patient follow-up, inform families, and refer infants with hearing loss to the appropriate centers. We have minimal information about the knowledge, awareness, and interest levels of the physicians. This study aims to determine the knowledge and awareness levels of family physicians about NNHSP and to collect data on how to inform them in the areas needed. Material and Methods: A questionnaire consisting of 29 questions was prepared for primary care physicians. 129 physicians working in Primary Health Care Centers in different districts participated in the study. During this study, the physicians' knowledge levels about the objective, functioning, tests and treatment methods of the NNHSP were measured. In addition, possible methods regarding informing the families about NNHSP correctly has been proposed. The significance level used in the statistical tests was of 5% (0.05). Results: Our study found that the general level of knowledge of the participants about NNHSP was low. According to the results of the survey, 71.3% of the attending physicians (92 of them) wanted to be informed about NNHSP, 76% (98 of them) wanted to be informed about the test methods, while 69% (89 of them) wanted to be informed about the hearing impaired children and the orientation process. While 25.6% (33) of the participants stated that their knowledge was insufficient when they evaluated themselves, 23.3% (30) stated that they found their knowledge sufficient. When these two groups were compared by looking at their answers to the questions (questions 11, questions 12, questions 13, questions 16) including the diagnostic steps, no statistically significant difference was found between those who felt competent and those who did not (p=0.180, p=0.360, p=0.08, p=0.115). Conclusion: The necessity of working with a team spirit in NNHSP and the importance of maximizing the units' knowledge levels are obvious. Accordingly, it is considered appropriate to carry out and increase information activities through various channels for the UYITP to be more productive and efficient