A feasible repetitive transcranial magnetic stimulation clinical protocol in migraine prevention

Objective: This case series was conducted to determine the clinical feasibility of a repetitive transcranial magnetic stimulation protocol for the prevention of migraine (with and without aura). Methods: Five patients with migraines underwent five repetitive transcranial magnetic stimulation sessions separated in 1- to 2-week intervals for a period of 2 months at a single tertiary medical center. Repetitive transcranial magnetic stimulation was applied to the left motor cortex with 2000 pulses (20 trains with 1s inter-train interval) delivered per session, at a frequency of 10 Hz and 80% resting motor threshold. Pre- and post-treatment numerical rating pain scales were collected, and percent reductions in intensity, frequency, and duration were generated. Results: An average decrease in 37.8%, 32.1%, and 31.2% were noted in the intensity, frequency, and duration of migraines post-repetitive transcranial magnetic stimulation, respectively. A mean decrease in 1.9±1.0 (numerical rating pain scale ± standard deviation; range: 0.4–2.8) in headache intensity scores was noted after the repetitive transcranial magnetic stimulation sessions. Conclusion: The tested repetitive transcranial magnetic stimulation protocol is a well-tolerated, safe, and effective method for migraine prevention

Efficacy of commercial earplugs in preventing water intrusion during swimming.

ObjectiveTo evaluate and compare the efficacy of commercially available earplugs in preventing water intrusion in healthy individuals.Study designExperimental study.SettingTertiary care medical center.Subjects and methodsTen subjects (20 ears) were assessed. After insertion of the earplugs, subjects underwent 3 standardized head-wetting protocols, including (1) surface swimming for 10 minutes, which entailed no head submersion and moderate splashing; (2) head submersion at a 90-cm depth for 20 seconds with their head upright; and (3) head submersion at a 90-cm depth with head tilted 90 degrees left and then tilted 90 degrees right for 10 seconds on each side to apply vertical pressure. Color change of a wetness indicator was used to determine water intrusion after each protocol. The same protocol was repeated for all 9 earplugs.ResultsWater intrusion was observed in 44%, 67%, and 88% of ears after surface swimming, horizontal submersion, and vertical submersion, respectively. The results revealed a significant difference in the waterproofing qualities of the various types of earplugs. The soft silicone type (Pillow Soft) earplug had the lowest rate of water penetration during all 3 protocols (P < .001). The difference between the most effective earplugs, Pillow Soft and Aquaseal, were only significant during the horizontal submersion protocol (P = .008).ConclusionWater intrusion occurred even with the use of earplugs. The intrusion was more significant with horizontal or vertical head submersion. The soft silicone Pillow Soft earplug was the most effective earplug for preventing water intrusion in surface swimming

Systematic assessment of noise amplitude generated by toys intended for young children.

ObjectiveTo systematically evaluate the noise generated by toys targeted for children and to compare the results over the course of 4 consecutive holiday shopping seasons.Study designExperimental study.SettingAcademic medical center.Subjects and methodsDuring 2008-2011, more than 200 toys marketed for children older than 6 months were screened for loudness. The toys with sound output of more than 80 dBA at speaker level were retested in a soundproof audiometry booth. The generated sound amplitude of each toy was measured at speaker level and at 30 cm away from the speaker.ResultsNinety different toys were analyzed. The mean (SD) noise amplitude was 100 (8) dBA (range, 80-121 dBA) at the speaker level and 80 (11) dBA (range, 60-109 dBA) at 30 cm away from the speaker. Eighty-eight (98%) had more than an 85-dBA noise amplitude at speaker level, whereas 19 (26%) had more than an 85-dBA noise amplitude at a 30-cm distance. Only the mean noise amplitude at 30 cm significantly declined during the studied period (P < .001). There was no significant difference in mean noise amplitude of different toys specified for different age groups.ConclusionOur findings demonstrate the persistence of extremely loud toys marketed for very young children. Acoustic trauma from toys remains a potential risk factor for noise-induced hearing loss in this age group, warranting promotion of public awareness and regulatory considerations for manufacture and marketing of toys

Noise-induced hearing threshold shift among US adults and implications for noise-induced hearing loss: National Health and Nutrition Examination Surveys.

The objective of this study was to estimate the prevalence and evaluate the associated risk factors of the noise-induced hearing threshold shift (NITS) in the US adult population based on the National Health and Nutrition Examination Surveys (NHANES). The study population consisted of 5,418 individuals aged 20-69 years who had complete audiologic data from the NHANES database. Stringent criteria were used to define NITS. Prevalence of unilateral, bilateral, and total NITS and their association with several socio-demographic and hearing-related factors were evaluated. The prevalence of unilateral, bilateral, and total NITS was 9.4, 3.4 and 12.8%, respectively. Prevalence of bilateral NITS was higher in subjects with older age, male gender, white (non-Hispanic) and Hispanic ethnicities, education level less than or equal to high school diploma, married/living with partner status, Mexico as country of birth, service in armed forces, smoking history, diabetes, and different kinds of noise exposure. Odds of NITS were only higher in older people, males, and smokers. This study provides comprehensive information on the prevalence of NITS in the US adult population and its associated risk factors. More targeted interventions may be done for educational, preventative, and screening purposes

Optical coherence tomography of cholesteatoma.

ObjectivesTo image cholesteatoma using optical coherence tomography (OCT) and correlate the results with clinical findings and conventional observations obtained using binocular microscopy and histology. OCT is a high-resolution optical imaging modality that generates cross-sectional images of turbid media, such as tissue with resolution approaching that of light microscopy. OCT relies on intrinsic differences in tissue optical properties for image contrast.Study designIn vivo prospective clinical study.SettingUniversity Medical Center.PatientsPatients with cholesteatoma undergoing otologic surgery.InterventionUsing a commercial OCT imaging system, we obtained cross-sectional images (resolution, approximately 10 microm; depth penetration, approximately 1 mm) of cholesteatomas.Main outcome measuresImages are obtained by raster scanning a single mode fiber across the interior of the probe. The imaging probe is sterilized and inserted into the middle ear or mastoid under microscopic guidance, and still images of the middle ear or mastoid mucosa and cholesteatoma when present were obtained.ResultsOCT images of cholesteatomas demonstrate differences in signal intensity, which are distinct from those of normal or inflamed middle ear/mastoid mucosa. Identification of keratin in cholesteatoma, even if very thin, distinguished it from inflamed mucosa.ConclusionThis is the first study that systematically used OCT to image cholesteatoma during otologic surgery. Cholesteatomas can be distinguished from normal or inflamed adjacent mucosa

Factors Influencing Access to Cochlear Implantation in Deaf and Hard-of-Hearing Children in Southern California.

ObjectiveTo determine the epidemiologic relationship of family demographics and educational resources with parental knowledge of and willingness for their children to receive cochlear implantation (CI) for deaf and hard-of-hearing (DHH) children.MethodsA total of 213 parents of DHH children were surveyed at local schools, specialized camps, and clinics in Southern California. Data on parents were solicited, including income, insurance status, education level, hearing status, primary language, and motivations towards CI.ResultsSixty-six surveys were included in the analysis. Three of these patients had already undergone CI, thus of the 63 children without CI, 59% had been presented with the option of CI by a healthcare professional and 27% were willing to have their child undergo CI. Willingness for children to undergo CI was statistically higher in families with an annual income less than $15,000 or more than$75,000 (p = 0.02), and children enrolled in specialized schools for DHH (p = 0.02). The leading reasons for unwillingness to undergo CI were risks of surgery (17%) and discouragement from others (14%).ConclusionA significant gap exists between the number of CI candidates and families and willingness to undergo CI. The difference could be related to socioeconomic status and the patient's school type. This underscores the importance of parental education through the use of a multi-disciplinary team to ensure all hearing rehabilitation options are explained

Factors Influencing Access to Cochlear Implantation in Deaf and Hard-of-Hearing Children in Southern California.

ObjectiveTo determine the epidemiologic relationship of family demographics and educational resources with parental knowledge of and willingness for their children to receive cochlear implantation (CI) for deaf and hard-of-hearing (DHH) children.MethodsA total of 213 parents of DHH children were surveyed at local schools, specialized camps, and clinics in Southern California. Data on parents were solicited, including income, insurance status, education level, hearing status, primary language, and motivations towards CI.ResultsSixty-six surveys were included in the analysis. Three of these patients had already undergone CI, thus of the 63 children without CI, 59% had been presented with the option of CI by a healthcare professional and 27% were willing to have their child undergo CI. Willingness for children to undergo CI was statistically higher in families with an annual income less than $15,000 or more than$75,000 (p = 0.02), and children enrolled in specialized schools for DHH (p = 0.02). The leading reasons for unwillingness to undergo CI were risks of surgery (17%) and discouragement from others (14%).ConclusionA significant gap exists between the number of CI candidates and families and willingness to undergo CI. The difference could be related to socioeconomic status and the patient's school type. This underscores the importance of parental education through the use of a multi-disciplinary team to ensure all hearing rehabilitation options are explained