The Effect of Music and White Noise on Electroencephalographic (EEG) Functional Connectivity in Neonates in the Neonatal Intensive Care Unit.

The purpose of this study is to investigate whether listening to music and white noise affects functional connectivity on scalp electroencephalography (EEG) in neonates in the neonatal intensive care unit.Nine neonates of ≥34 weeks' gestational age, who were already undergoing clinical continuous EEG monitoring in the neonatal intensive care unit, listened to lullaby-like music and white noise for 1 hour each separated by a 2-hour interval of no intervention. EEG segments during periods of music, white noise, and no intervention were band-pass filtered as delta (0.5-4 Hz), theta (4-8 Hz), lower alpha (8-10 Hz), upper alpha (10-13 Hz), beta (13-30 Hz), and gamma (30-45 Hz). Synchronization likelihood was used as a measure of connectivity between any 2 electrodes.In theta, lower alpha, and upper alpha frequency bands, the synchronization likelihood values yielded statistical significance with sound (music, white noise and no intervention) and with edge (between any 2 electrodes) factors. In theta, lower alpha, and upper alpha frequency bands, statistical significance was obtained between music and white noise (t = 3.12, 3.32, and 3.68, respectively; P < .017), and between white noise and no intervention (t = 4.51, 3.09, and 2.95, respectively, P < .017). However, there was no difference between music and no intervention.Although limited by a small sample size and the 1-time only auditory intervention, these preliminary results demonstrate the feasibility of EEG connectivity analyses even at bedside in neonates on continuous EEG monitoring in the neonatal intensive care unit. They also point to the possibility of detecting significant changes in functional connectivity related to the theta and alpha bands using auditory interventions.

Olfactory testing in children using objective tools: comparison of Sniffin' Sticks and University of Pennsylvania Smell Identification Test (UPSIT).

BACKGROUND: Detection of olfactory dysfunction is important for fire and food safety. Clinical tests of olfaction have been developed for adults but their use in children has been limited because they were felt to be unreliable in children under six years of age. We therefore administered two olfactory tests to children and compared results across tests. METHODS: Two olfactory tests (Sniffin' Sticks and University of Pennsylvania Smell Identification Test (UPSIT)) were administered to 78 healthy children ages 3 to 12 years. Children were randomized to one of two groups: Group 1 performed the UPSIT first and Sniffin' Sticks second, and Group 2 performed Sniffin' Sticks first and UPSIT second. RESULTS: All children were able to complete both olfactory tests. Performance on both tests was similar for children 5 and 6 years of age. There was an age-dependent increase in score on both tests (p < .01). Children performed better on the Sniffin' Sticks than the UPSIT (65.3% versus 59.7%, p < .01). There was no difference in performance due to order of test presentation. CONCLUSIONS: The Sniffin' Sticks and UPSIT olfactory tests can both be completed by children as young as 5 years of age. Performance on both tests increased with increasing age. Better performance on the Sniffin' Sticks than the UPSIT may be due to a decreased number of test items, better ability to maintain attention, or decreased olfactory fatigue. The ability to reuse Sniffin' Sticks on multiple children may make it more practical for clinical use.

Infant sleep machines and hazardous sound pressure levels.

BACKGROUND AND OBJECTIVE: Infant "sleep machines" (ISMs) produce ambient noise or noise to mask other sounds in an infant's room with the goal of increasing uninterrupted sleep. We suggest that the consistent use of these devices raises concerns for increasing an infant's risk of noise-induced hearing loss. We therefore sought to determine the maximum output levels of these sleep machines. METHODS: Sound levels of 14 ISMs played at maximum volume were measured at 30, 100, and 200 cm from the machine using correction factors to account for a 6-month-old's ear canal. RESULTS: Maximum sound levels at 30 cm were >50 A-weighted dB for all devices, which is the current recommended noise limit for infants in hospital nurseries. Three machines produced output levels >85 A-weighted dB, which, if played at these levels for >8 hours, exceeds current occupational limits for accumulated noise exposure in adults and risks noise-induced hearing loss. CONCLUSIONS: ISMs are capable of producing output sound pressure levels that may be damaging to infant hearing and auditory development. We outline recommendations for safer operation of these machines.

When do we choose the 'better balance' ear for cochlear implants?

OBJECTIVES: In cochlear implant planning, the ear with poorer vestibular function, as determined through electronystagmography (ENG), is often selected as the site for implantation since surgery carries a low risk of iatrogenic labyrinthine injury. We sought to determine reasons for placing a cochlear implant in the 'better balance' ear. METHODS: A retrospective cohort study of patients implanted with a cochlear implant at a tertiary care center from 1984 to June 2009 was performed. Based on ENG results, patients with asymmetric caloric reduction were identified. Of these patients, those who were implanted in the 'better balance' ear were selected for chart review. The charts were reviewed to determine rationale for ear selection. RESULTS: Of the 724 cochlear implant patients implanted from 1984 to June 2009, ENG tests demonstrated that 130 (18%) had asymmetric abnormal responses. Thirty five (27%) of the patients with asymmetric abnormal responses were implanted in the 'better balance' ear. Review of these 35 patient charts revealed that reasons for selection of the 'better balance' ear fell into four categories: anatomical contraindications, attempting to attain binaural hearing, avoiding implantation of an ear with marked auditory deprivation, and patient preference. DISCUSSION: Based on our current practice, we have identified four situations in which patients were implanted in the 'better balance' ear, and subsequently developed an algorithm to aid surgeons in side selection for cochlear implantation. Further study and validation of this algorithm is recommended.