Some remarks concerning the treatment of the conductive hearing loss

The author points out a decrease tendency in using middle ear reconstruction surgery due to the development and the accessibility of hearing aids. Such an attitude inevitably leads to ordering hearing aids especially air conductive ones in cases which ought to be operated. The author thus wants to underline the fact that bone conductive hearing aids are very rarely recommended, even though the should be used more often. He also recommends a precise analysis of one's unsuccessful surgical results as a method of gaining skills and proficiency. The author also points out the fact that one should never neglect quoting native bibliography.     

Comparison of two digital hearing aids

OBJECTIVE: The objective of this investigation was to compare real and perceived benefit for two currently marketed digital hearing aids, the Oticon DigiFocus and the Widex Senso. The hearing aids have different philosophies of design and fitting strategies; as a result, it was hypothesized that there would be performance differences. DESIGN: Twenty subjects with documented sensorineural hearing losses were fit with each of the two digital hearing aids. After 4 wk of use with each hearing aid, a battery of objective and subjective tests was completed to assess hearing aid benefit. RESULTS: No significant differences were found between the hearing aids as revealed by the objective testing of speech recognition and self-report inventories of hearing aid benefit. The DigiFocus was shown by real ear measurements to provide more high-frequency gain than the Senso. The Widex Senso was preferred by 13 of the 20 subjects (seven of 10 of the new hearing aid users). This may be explained, in part, by the increased high-frequency gain provided by the Oticon DigiFocus, which was perceived as having greater "harshness." CONCLUSIONS: Based on the results of this investigation, neither hearing aid processor was shown to be superior to the other. In addition, the least amount of objective benefit was shown in the presence of background noise.     

Reliability of monosyllabic discrimination tests in white noise for differentiating among hearing aids

In spite of criticism, monosyllabic discrimination tests are widely employed for hearing aid selection. The current study was designed to investigate the following questions: (1) How reliable is aided speech discrimination of monosyllables in a background of white noise? (2) Can differences among hearing aids be reliably demonstrated by measuring intelligibility of monosyllables in a background of white noise? and (3) Do hearing aids interact with hearing loss? Twenty subjects with mild-moderate sensorineural hearing losses participated in two experimental sessions. Four hearing aids were evaluated using the NU-6 monosyllables in a background of white noise (s/n = +20 dB). Since the standard deviation of the test-retest differences was 6%, differences between aids were not considered significant unless they exceeded 12%. An interaction between subjects and hearing aids was found; that is, the best aid for one person was not the best for all. Measuring monosyllabic word intelligibility in a background of white noise does not reliably identify a single best aid. However, one or more inferior aids were consistently eliminated in 80% of the subjects.     

Presbyacusis, hearing aids and aging

This paper considers the factors of presbyacusis and age-related psychological changes in older adults in terms of their effects on the use or potential use of hearing aids as a means of improving aural communication. Data are presented on the prevalence of hearing impairment and the extent of hearing aid use in aging listeners. Four major classes of presbyacusis are described (sensory, neural, metabolic, and cochlear conduvtive) and a hearing aid prognosis is made for each type of disorder. It is shown that aging produces deficits in pure-tone thresholds, the speech reception threshold, and speech discrimination, but not all losses can be 'corrected' with a hearing aid. Binaural (stereophonic) devices are psychoacoustically superior to monaural devices; however, behavioral and personality changes in older patients often create problems of adaptation to the binaural aid. These changes may also affect the fitting of an aid and the patient's ability to learn to use it. Some practical suggestions are offered on the evaluation of hearing aids and it is emphasized that adequate orientation and counseling are typically required if hearing aid treatment is to be successful in presbyacusis.     

Impact of an audiology clinic in one general practice

There is a large demand for the provision of hearing aids. However, there are lengthy delays involved between referral and fitment of National Health Service (NHS) hearing aids. This report shows that a general practice based audiology clinic can lead to an increase in the number of patients referred and fitted with a hearing aid. The introduction of the clinic also led to reduced waiting times for patients to be fitted with hearing aids.     

Immobilization effects on contractile properties of aging rat skeletal muscle

Recent advances in miniaturization have provided clinicians with hearing aids that can be comfortably inserted as far as the bony portion of the ear canal. It is possible to take advantage of these deeply inserted hearing aids in new ways. For example, the physical vibrations of microphone and receiver components may be used to improve hearing aid gain through bone conduction. Three cases are presented that will introduce this phenomenon for two transcranial CROS fittings and for one unilateral otosclerosis fitting. In each case, functional gain measurements under headphones were obtained with the hearing aid receivers acoustically plugged. Considerable gain was still present. Potential benefits, ramifications, and side effects are discussed.     

Stapedectomy in profound cochlear loss

Stapedectomy can be used in certain patients with profound sensorineural hearing loss and stapes fixation to improve hearing to a level at which a hearing aid may be effective. This study reviews the outcomes of 11 patients with profound cochlear loss secondary to otosclerosis who underwent stapes surgery performed by the senior author (M.E.G.) over a 25-year period. Postoperative hearing aid usage was effective in 9 of 11 patients. Preoperatively, these patients derived no benefits from hearing aids. Stapedectomy may be of immense value in patients with the proper history and profound cochlear loss.     

The action of perchlorate on malignant-hyperthermia-susceptible muscle

We developed two types of implantable hearing aids, a totally implantable hearing aid (TIHA) and a partially implantable hearing aid (PIHA) in 1983. In both types a piezoelectric ceramic bimorph was used as an ossicular vibrator which was coupled to the stapes to transmit sound signals to the inner ear efficiently. Due to technological immaturities, clinical application of the TIHA has not yet been realized. But the PIHA is available for clinical use at present. In the PIHA only the ossicular vibrator is implanted with inner link coil. The rest of components such as microphone, amplifier, battery, and outer link coil remain in their usual location behind the auricle. Since 1984, we have applied the PIHA to 37 patients with mixed deafness. Careful follow-up studies have been conducted on all of them to assess clinical and audiological results. We have confirmed that the device could function safely for more than 10 years affording natural quality of hearing without howling and wearing discomforts. Our studies suggest that the PIHA can be a choice of rehabilitation for mixed deafness due to middle ear diseases which cannot be rehabilitated satisfactorily by either surgical means or a conventional hearing aid. Functional principle of device, indications and surgical methods of implantation were described. Failures and delayed problems we experienced were also presented together with the preventive measures. We believe that an implantable hearing aid of this type will be an otologic breakthrough if substantial technological difficulties are cleared.     

Cochlear implants: selection criteria and shifting borders

Cochlear implants have proven to be effective and reliable in postlingually deaf adults. This is also true for congenitally deaf and perilingually deaf children up to the age of six years. Due to the increasing experience, the improvement of implant technology and the proven reliability the selection criteria are broadened with shifting borders. The main extensions are related to age, additional handicaps, residual hearing and special etiologies of deafness. Increasing evidence shows that very early implantation results in better performance and better hearing and speech development. Near-normal language acquisition can be achieved in children implanted under the age of four. Additional handicaps do not automatically exclude a candidate from cochlear implantation. A case-to-case decision has to be made based on additional diagnostics and the experience of the implant centre. A list of suitable handicaps is provided. Severely hearing impaired patients may also be considered for cochlear implantation if their residual hearing provides no benefit for speech discrimination. The same holds true for children. Cochlear implantation in obliterated cochleae and inner ear malformation requires a special surgical technique and special electrode arrays. In this way even difficult cases can be managed with remarkable outcome. Over all, the selection criteria have been broadened with increasing experience and technological improvement. This development may continue and the borderline between hearing aids and cochlear implants will shift further towards severe hearing loss. However, the basis for success still remains good rehabilitation, a team approach and the willingness of the patient to undergo the whole process of cochlear implantation.     

Implantation of electromagnetic ossicular replacement device

Semi-implantable hearing aids consisting of permanent middle ear implanted magnet, either partial ossicular replacement prostheses (PORP's) or total ossicular replacement prostheses (TORP's) driven by an electromagnet placed in the ear canal have been tested on six patients undergoing surgery for chronic otitis. The surgical and audiological problems are described. The audiological results were excellent in all six cases. A functional gain of 40-70 dB can be obtained for entire frequency range of the audiogram.     

Brainstem auditory evoked response (BER) in paedaudiological diagnosis (author's transl)

Intention of paedaudiology is to detect and to evaluate hearing loss in children. In new born and small infants, in children with behavioral disorders and multiple disabilities, the clinical techniques of audiometry are often not useful. The brainstem audiometry is a reliable alternative and not so cost intensive and time consuming as it is often assumed. Encouraging is this technique in regard of hearing aids: prevention of attaching unnecessary hearing aids, ruling out not appropriate fitted hearing aids and proper habilitation of unilateral hearing loss.     

Effect of a hearing aid on progressive hearing loss

A group of 72 children with hearing aids followed in 4 different clinical settings presented progressive increase in sensorineural hearing loss. The mean hearing loss over time, the duration of hearing aid use and the gain were studied to test the hypothesis that continued progression in hearing loss was due to overly powerful amplification. No correlation was found between the progressive increased gain levels were associated with less progression in hearing loss than at lower gain levels. Therefore, the use of hearing aids was not directly and significantly related to the increase in hearing loss in the population studied. However according to the above criteria a few cases (4%) of progressive hearing loss did seem to be associated with hearing aid use.     

Bone anchored hearing aid: the Bordeaux experience

Bone anchored hearing aids (BAHA) based on the concept of osseointegration offer the possibility of restoring hearing in cases of conduction or mixed deafness. The authors report on their experience with 42 implants in 35 patients, dived into two major groups, with bilateral agenesia on the one hand (15 cases) and problems of chronic otitis media (20 cases) on the other hand. The functional results are excellent, with 30 patients fitted with 32 HC200 or HC300 prostheses. The authors stress the necessity of strictly observing the audiometric criteria and the determinant factors of osseointegration, essentially the surgical technique.     

The use of osseointegration of hearing aids

The principles of osseointegration defined by Branemark are reviewed. The authors describe the otological applications of titanium implants: bone anchored hearing aids (BAHA). The good results obtained depend on the selection of the patients and the observance of a rigorous surgical technique. The present paper summarizes our results with 32 BAHA implanted in 27 patients.     

Improvements in speech perception by children with profound prelingual hearing loss: effects of device, communication mode, and chronological age

The present investigation expanded on an earlier study by Miyamoto, Osberger, Todd, Robbins, Karasek, et al. (1994) who compared the speech perception skills of two groups of children with profound prelingual hearing loss. The first group had received the Nucleus multichannel cochlear implant and was tested longitudinally. The second group, who were not implanted and used conventional hearing aids, was tested at a single point in time. In the present study, speech perception scores were examined over time for both groups of children as a function of communication mode of the child. Separate linear regressions of speech perception scores as a function of age were computed to estimate the rate of improvement in speech perception abilities that might be expected due to maturation for the hearing aid users (n=58) within each communication mode. The resulting regression lines were used to compare the estimated rate of speech perception growth for each hearing aid group to the observed gains in speech perception made by the children with multichannel cochlear implants. A large number of children using cochlear implants (n=74) were tested over a long period of implant use (m=3.5 years) that ranged from zero to 8.5 years. In general, speech perception scores for the children using cochlear implants were higher than those predicted for a group of children with 101-110 dB HL of hearing loss using hearing aids, and they approached the scores predicted for a group of children with 90-100 dB HL of hearing loss using hearing aids.     

Sibling relationships for deaf children: The impact of child and family characteristics.

Objective: To examine factors that affect relationships between deaf children who use cochlear implants or hearing aids and their hearing siblings. Study Design: Qualitative analysis of interview data from parents of deaf children. Participants: Parents of 29 deaf children with at least 1 sibling; 20 children used cochlear implants and 9 used hearing aids. Main Outcome Measure: Quality of deaf-hearing sibling relationships as assessed by an ordinal scale developed by the authors. Results: Birth order, family size, parents' anxiety about deafness, and negative comparisons by parents of hearing and deaf siblings were key factors in sibling relationships. Conclusions: Family context is important in understanding experiences of deaf children and their hearing siblings. The model replaces assumptions of hearing loss as individual disability with an emphasis on the social determinants of managing differences in siblings' hearing status. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Removal and reinsertion of cemented femoral components during acetabular revision

The Mayo block is an extremely efficacious regional anesthetic technique used to provide anesthesia of the forefoot. Patients requiring surgical correction of hallux deformity, bunionectomy, and first metatarsal surgery may benefit from this technique. The Mayo block is a field block that anesthetizes the specific nerves of the forefoot that innervate the surgical field. This technique requires less local anesthesia than that required by direct local anesthetic infiltration and does not distort the surgical tissue planes. The Mayo block is effective. This technique has been used at one military hospital on more than 275 patients. The failure rate of the block is less than 1%. Learning this technique adds to the anesthetist's armamentarium of regional anesthesia, aids in rapid case turnover, and avoids the risks associated with major conduction and general anesthesia.