Anatomy-Based Frequency Allocation in Cochlear Implantation: The Importance of Cochlear Coverage.

OBJECTIVES/HYPOTHESIS: This study aimed to compare the predicted anatomy-based frequency allocation of cochlear implant electrodes with the default standard frequencies. STUDY DESIGN: Retrospective study. METHODS: A retrospective analysis was performed using computed tomography (CT) images of patients who received cochlear implants at a tertiary referral center. Patients were excluded if they had any congenital or acquired cochlear anatomical anomalies. The CT images of the patients were uploaded to the surgical planning software. Two independent reviewers allocated the anatomical parameters of the cochlea. The software then used these parameters to calculate the frequency allocation for each electrode according to the type of electrode and the length of the organ of Corti (OC) in each patient. These anatomy-based frequency allocations were compared with the default frequency settings. MAIN OUTCOME MEASURE: Frequency-to-place mismatch in semitones. RESULTS: A total of 169 implanted ears in 102 patients were included in this study. The readings of the two reviewers were homogenous, with a Cronbach's alpha of 0.98. The mean anatomy-based frequency allocation was 487.3 ± 202.9 Hz in electrode 1; 9,298.6 ± 490.6 Hz in electrode 12. The anatomy-based frequency allocations were found to be significantly higher than the frequencies of the default frequencies for each corresponding electrode (one-sample t-test, P < .001). The frequency-to-place mismatch was negatively correlated with cochlear coverage and positively correlated with the cochlear duct length (Pearson correlation > 0.65, P < .003). CONCLUSIONS: The anatomy-based frequency allocation of each electrode is significantly different from the default frequency setting. This frequency-to-place mismatch was affected mainly by the cochlear coverage. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:2224-2231, 2022.

Cognitive functioning in Deaf children using Cochlear implants.

BACKGROUND: Cognitive abilities like language, memory, reasoning, visualization, and perceptual functioning shape human action and are considered critical to the successful interaction with the environment. Alternatively, hearing loss can disrupt a child's ability to communicate, and negatively impact cognitive development. Cochlear implants (CI) restore auditory input thereby supporting communication and may enhance cognitive performance. This study compares general cognitive development after cochlear implantation (2017-2019) in two groups of Jordanian children implanted earlier (age:4-6 years, N = 22) and later (7-9 years, N = 16) to the development of randomly selected normal hearing peers (N = 48). DESIGN: Visualization, reasoning, memory, and attention were assessed using the Leiter-R scale at baseline (before implantation), 8 months and 16 months post implantation for children with hearing loss. Same times of testing (baseline, 8 months and 16 months) were used for normal hearing peers. RESULTS: Over the 16-month period, the cognitive improvement of 4-6-year-old deaf children was greater than that of their normal hearing peers on the scales of visualization (5.62 vs. 4.40), reasoning (2.53 vs. 2.38) and memory (17.19 vs. 11.67). while the improvement of 7-9-year-old was less major than that of their normal hearing peers on all scales. CONCLUSIONS: These results suggest that CI not only enhances communication skills but may improve cognitive functioning in deaf children. However, the extent of this improvement was dependent on age at intervention; current results demonstrated that the children received CI at young ages had better cognitive improvements.

Moderate aerobic training modulates cytokines and cortisol profiles in older adults with cognitive abilities.

Excessive expression of cortisol and pro-inflammatory cytokines exerts a negative affect on cognitive functioning and hippocampal structure in older adults. Although the interrelation between cortisol and cytokines was fully elucidated previously, few studies considered how their association with exercise can affect brain structures or play an anti-inflammatory role in preserving cognitive function among older adults. To evaluate both the neuro-protective and anti-inflammatory activities of moderate aerobic exercise in improving cognitive performance among healthy older adults, the serum levels of CRP, TNF-α, IL-6, and cortisol and their correlation with cognitive performance were estimated in all participants. A total of 60 healthy older adults aged 50-85 years were included in this study. The Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) test, colorimetric testing, and ELISA immunoassays were used to measure cognitive abilities; blood sugar; and glycated hemoglobin (HbA1c), cortisol, IL-6, TNF-α, and CRP, respectively, in older adults before and after 12-week exercise interventions. Exactly 50% of the participants showed moderate cognitive impairment (MCI) (LOTCA scores: 84.8 ± 8.2), and the remaining 50% of the participants (n = 30) were diagnosed as normal healthy subjects (LOTCA scores: 98.7 ± 8.1). There was a significant association between cognitive decline in LOTCA scores of motor praxis, vasomotor organization, thinking operations, and attention and concentration and higher levels of cortisol, CRP, TNF-α, and IL-6, as well as adiposity markers BMI and WHR, in the MCI group compared to control subjects. However, significant improvements in the same LOTCA score domains in MCI subjects were recorded along with decrements in the levels of cortisol and cytokine CRP, TNF-α, and IL-6, as well as improved adiposity markers, following a 12-week moderate exercise program. Cognitive performance correlated positively with cortisol levels and negatively with physical activity, adiposity markers, and cytokine levels. Also, in participants with normal and abnormal cortisol profiles, there was a positive interrelation between cytokine levels and cortisol. Moderate aerobic exercise for 12 weeks showed beneficial effects on cognitive performance in older adults. Our results suggest that 12 weeks of aerobic exercise improves cognitive disorders in older adults via modulating stress and pro-inflammatory cytokines. This may have been due to significant changes in the levels of cortisol, IL-6, TNF-α, and CRP, and physical activity may thus be used as non-drug strategy for treating cognitive disorders.

Performance of the Arabic Population on the Adolescent-Adult Sensory Profile: An Observational Study.

BACKGROUND: The Adult-Adolescent Sensory Profile (AASP) is a questionnaire developed to measure the way in which people in different age groups respond to different sensory stimuli. These sensory stimuli may uncover different behavioral problems that may affect activities of daily living. This observational study aimed to validate the Arabic version of the AASP used to assess the sensory processing abilities of healthy individuals. METHODS: Participants comprised 560 Jordanians aged 11 years and older. Participants were recruited from different community centers in Amman, Jordan during 10th March 2017 to 10th September 2017. The English version of the AASP was translated into Arabic and all participants were instructed to complete this version of the scale. RESULTS: Internal consistency was 0.78 and 0.79 for the Arabic and the English version, respectively. The ranges of cut-off scores in the Arabic version were higher than the English version for all the quadrants of the scale. The biggest differences were found in the sensation seeking and sensory sensitivity quadrants. In certain age groups (11-17 and 18-64 years), women were more sensitive compared with men. CONCLUSION: The Arabic version of the AASP showed good internal consistency and can be used to assess the sensory processing abilities of healthy individuals.

Construct validity and internal consistency reliability of the Loewenstein occupational therapy cognitive assessment (LOTCA).

BACKGROUND: Cognitive abilities are essential for children's development and independence. Various cognitive assessments, standardized in Western cultures, have yet to be investigated for their multicultural suitability. AIMS: To explore the suitability of the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) for a Jordanian population. METHODS: Observed cases of 442 Jordanian children aged 6-12 were used to perform exploratory factor analyses using principal components with Varimax rotation (construct validity evidence) and to compute Cronbach's α coefficient (internal consistency reliability). RESULTS: High total performance on four subscales and a slightly lower total performance on two subscales were observed. Observed performance increased with age on three subtests, whereas a more modest increase was observed on the other three subscales. The expected one-factorial solution confirming the LOTCA's subscales homogeneity (unidimensionality) structure was found on five of six subscales. Variance explained by the subscales ranged from 39 to 82% and internal consistency reliability measured by Cronbach's alpha ranged from .42 to .78. CONCLUSIONS: Satisfactory construct validity and internal consistency reliability were demonstrated on two subscales applicable to Jordanian children without adaptation. With adequate cross-cultural adaptation, increasing internal consistency reliability in other subscales could make the LOTCA an effective tool for assessing cognitive abilities in this population.

Memory and potential correlates among children in Jordan.

BACKGROUND: Cognitive functioning hugely affects the performance of tasks of different complexity. Memory, one of the most important cognitive skills, allows children to practice and acquire necessary skills and knowledge and interact with the surrounding environment. Therefore, it is crucial to study the factors that influence the memory of children. The main purpose of his study was to investigate different variables related to memory in school aged children (5-9 years, N = 434). METHODS: Parents of the participants provided information about child's daily behavior, child's school academic achievement, work and family income data and demographics. Memory skills in children were assessed by using the Leiter International Performance Scale -Revised. RESULTS: The score of memory increased 2.53 points with upsurge in maternal occupation level, 3.08 points when the child ate breakfast and 4.51 points when the child daily slept nine hours and more. By contrast, increased family income and smoking by father resulted in decreased scores in memory. CONCLUSION: Screening for and understanding of memory and relevant factors are vital for broad understanding of children's capabilities and weaknesses as well as for developing appropriate interventions.

Reasoning Abilities and Potential Correlates Among Jordanian School Children.

Objectives To investigate factors related to reasoning skills in 434 school children aged 5-9 years. Methods The Leiter International Performance Scale-Revised was used to assess reasoning skills. Demographic, work and family income data, information on child's daily behavior and school academic achievement were provided by the participating children's parents. Results Reasoning scores increased by 4.56 points with increasing subject's age, 1.71 points with increasing level of father's occupation, 1.86 points with each increase in the subject's GPA, 1.13 points with consumption of breakfast at home and 1.81 points when child slept more hours. Having a father who smoked and living in a rural area decreased scores in reasoning. Conclusions for Practice Screening of reasoning and associated factors is essential for a comprehensive and accurate understanding of the child's abilities and limitations. Understanding the child's reasoning abilities is critical for establishing intervention goals and planning therapeutic activities.

Effectiveness of stapedotomy in improving hearing sensitivity for 53 otosclerotic patients: retrospective review.

BACKGROUND: Otosclerosis is a common cause of progressive hearing impairment that causes fixation of the stapes. Surgical intervention is the preferred treatment approach to ameliorate the conductive hearing loss associated with stapedial otosclerosis. However, given that it is a difficult and delicate procedure, the surgery may fail for a number of reasons. Therefore, it is very important to evaluate the success rate of the surgical approach used in each regional center. OBJECTIVE: To examine the effectiveness of stapedotomy in improving hearing sensitivity for otosclerotic patients at King Abdul Aziz University Hospital in Riyadh. DESIGN: Retrospective chart review with an analysis of pre- and postoperative surgical treatment. SETTING: Tertiary referral otolaryngology clinic. PATIENTS AND METHODS: All cases who underwent stapedotomy between 1997 and 2009 were retrospectively reviewed. Preoperative and postoperative audiometric assessments were conducted using conventional pure tone audiometry. Differences were analyzed by two-way repeated measures ANOVA. MAIN OUTCOME MEASURE(S): Pre- and postoperative pure tone thresholds for air and bone conduction. RESULT: Fifty-three patients underwent stapedotomy. Stapedotomy yielded significant improvements in mean (SD) postoperative air-conduction thresholds of about 18.7 (11.7) dB (P < .0001) and mean (SD) post.operative bone-conduction thresholds of about 2 (7.2) dB (P < .05). Additionally, a significant correlation was found between improvement in air-conduction thresholds and the size of preoperatve air-bone gap (P < .01) About 70%of patients achieved an air-bone gap of 20 dB or better. None of the cases examined in this study exhibited sensorineural hearing loss or adverse complications following stapedotomy. CONCLUSIONS: Stapedotomy is a safe and effective treatment option for patients with otosclerosis. Given that the majority of participants in this study exhibited mixed hearing loss preoperatively, the results further suggest that stapedotomy can also be effective in improving thresholds for these patients. LIMITATIONS: The sample size was relatively small.

Factors related to gait and balance deficits in older adults.

PURPOSE: The aim of this study was to investigate the effects of physical, mental, and cognitive disabilities on gait and balance deficits among nursing home residents with different diseases in Jordan and also to find the risk of fall associated with or without these diseases. METHODS: A sample of 221 nursing home residents aged 18-100 years in Jordan was recruited for this study. All participants were assessed using the Arabic versions of the Tinetti assessment battery (TAB) for gait and balance, mini-mental state examination, and disability of arm, shoulder, and hand assessment test. RESULTS: A total of 221 nursing home residents were included in this study. Different chronic diseases were medically reported in this study. Psychiatric disorders (45.7%) were shown to be the most prevalent disease seen among the participants, followed by hypertension and diabetes mellitus affecting 33.5% and 23.5% of the participants, respectively. However, the least prevalent diseases were stroke (17.2%), joint inflammation (17.2%), and arthritis (9.0%). Based on TAB scores, the participants were classified into three groups: high risk of falls (≤18; n=116), moderate risk of falls (19-23; n=25), and low risk of falls (≥24; n=80). The correlation between physical activity and mental health problems with risks of falls was reported in all participants. The data showed that participants with over 50% upper extremity disability, stroke, heart disease, arthritis, joint diseases, diabetes, and hypertension recorded higher risks of falls as measured by TAB test compared to those with low and moderate TAB scores. Also, impairment in cognitive abilities and psychiatric disorders was shown to be associated with gait and balance problems, with a higher risk of falls in 47.5% and 46.1% of the residents, respectively. CONCLUSION: This study revealed a significant impact of upper limb disability, stroke, heart disease, arthritis, joint diseases, diabetes, and hypertension as well as psychiatric disorders and cognitive disabilities on gait and balance deficits among home-resident older adults.

The activities-specific balance confidence scale and berg balance scale: Reliability and validity in Arabic-speaking vestibular patients.

Persons with vestibular disorders are susceptible to imbalance. The Activities-specific Balance Confidence (ABC) scale and Berg Balance Scale (BBS) have been validated in persons with vestibular disorders. The purpose of this study was to examine the reliability and validity of the Arabic versions of ABC and BBS among Arabic-speaking persons with vestibular disorders in Jordan and Saudi Arabia. Therefore, the A-ABC and A-BBS were administered to a convenience sample of 82 persons with vestibular disorders (age = 43 ± 14), (56% female). The test-retest reliability of the A-ABC item and total score as well as the inter-rater and intra-rater reliability of the A-BBS total score reflected high agreement. Significant and large correlations were found between the A-ABC and the A-BBS (r= 0.54, P< 0.05), the A-ABC and the Arabic Dizziness Handicap Inventory (A-DHI) (r= -0.76, P< 0.05), and the A-BBS and the A-DHI (r= -0.56, P< 0.05). The A-ABC and the A-BBS demonstrated good reliability and validity and can be utilized with Arabic-speaking persons with vestibular disorders.

Cross-cultural adaptation and measurement properties of the Arabic version of the Fall Efficacy Scale International.

OBJECTIVE: To translate the Falls Efficacy Scale International (FES-I) into Arabic according to the World Health Organization`s (WHO) criteria and to evaluate the concurrent validity of the FES-I in persons living with balance and vestibular disorders. METHODS: This cross-sectional descriptive study included 43 persons with balance and vestibular disorders presenting to an outpatient dizziness center at King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia between June 2012 and May 2013. All participants completed the Arabic version of the FES-I and the Dizziness Handicap Inventory (DHI) during their assessment with the clinical audiologist. In addition, subjects completed the Dynamic Gait Index 4-item (DGI-4) gait test. An additional 55 control participants also completed the Arabic FES-I, the DGI-4, and the Arabic DHI. RESULTS: Forty-three participants with vestibular disorders (36 females, 7 males) with a mean age of 32 years (standard deviation (SD) 10 years, range 18-56 years) and 55 control participants (27 females, 28 males) with a mean age of 33, (SD-12), and age range of 18-78 participated. The correlation between the Arabic FES-I and the Arabic DHI was 0.75 in patients and 0.77 in control participants. The correlation between the Arabic FES-I and the DGI-4 was r=-0.30 (p=0.003). CONCLUSION: The Arabic FES-I has established concurrent validity and may be helpful for measuring an individual`s concern of falling in people with vestibular and balance disorders.

Feasibility of one-day activation in cochlear implant recipients.

OBJECTIVE: To determine if cochlear implants recipients can be safely and effectively fitted with their sound processor one day after their implant surgery. DESIGN: All subjects were implanted with MED-EL Concerto cochlear implant. Subjects' electrode impedance levels, maximum comfortable levels, and threshold levels were measured one day after surgery and compared to measurements obtained one month post implantation using the non-parametric Wilcoxon signed-rank test. STUDY SAMPLE: Twenty-nine participants in the age range of 1 to 42 years (average of 5 years). RESULTS: No adverse events were reported post-operatively. Measures after one day of surgery were significantly less than those measured one month post implantation. CONCLUSION: Early activation of the implant did not impact the healing process of the incision site, suggesting that one-day activation of the implant is feasible for some patients when medically possible. The evolution of the impedance and stimulation levels were consistent with that reported in previous studies, which indicates that early activation did not interfere with the physiological changes taking place after implantation.

Subscales of the vestibular activities and participation questionnaire could be applied across cultures.

OBJECTIVES: The objective of this study was to assess the objectivity, cross-cultural validity, and convergent validity of the Vestibular Activities and Participation (VAP) questionnaire among four countries, Germany, United States, Jordan, and Saudi Arabia. STUDY DESIGN AND SETTING: This was a cross-sectional study conducted in four specialized outpatient dizziness clinics in Germany, United States, Jordan, and Saudi Arabia. RESULTS: A total of 453 participants were included in the study. The Rasch analysis revealed two separate subscales. Subscale 1 items included focusing attention, lying down, standing, bending, lifting and carrying objects, and sports. Subscale 2 items included walking long distances, climbing, running, moving around within buildings other than home, using transportation, and driving. The Pearson product-moment correlation between the Dizziness Handicap Inventory and the summary score of the VAP subscale 1 was 0.66 and was 0.64 for subscale 2. CONCLUSION: Owing to its shortness and intercultural adaptability, the new two-scale version of the VAP questionnaire lends itself to clinical practice and research across countries to estimate the effect of vertigo and dizziness on activity limitation and participation restrictions. Psychometrically sound summary scores can be calculated. More extended versions of the VAP can be used for comprehensive clinical assessment where summary scores are not needed or a more detailed documentation is warranted.

Cochlear implant device activation and programming: 5 days postimplantation.

OBJECTIVE: Cochlear implants (CIs) are typically activated 3 to 6 weeks after the surgery. For some patients who live in remote areas, this waiting period could impose some personal and financial burdens. The current study examined whether CI recipients can be safely and effectively fitted with their speech processor five days after their implantation. STUDY DESIGN: Randomized controlled trial. SETTING: Tertiary referral center. PATIENTS: A total of 23 patients (2-30 yr of age) undergoing traditional CI surgery were recruited to participate in this study. Participants were divided into 2 groups: an early-fit group whose devices were activated 5 days after surgery and standard-fit group whose devices were activated using the recommended waiting period. MAIN OUTCOME MEASURES: Measures of impedance and most comfortable levels were used to compare differences across the 2 groups of patients. Data were measured at the activation session and also at 4 weeks after the initial session. RESULTS: No adverse events were reported postoperatively. Electrode impedances were significantly lower for the early-fit group than that for the standard-fit group in the initial activation session but not in the 4-week follow-up session. There were no significant differences between the 2 groups in the stimulation fitting levels in any of the sessions. CONCLUSION: The results presented in this article demonstrated that early activation for this sample did not seem to interfere with wound healing or with the fitting parameters suggesting that early activation should be considered as viable option to better serve CI patients' individual needs.

Factors related to cognitive function among elementary school children.

OBJECTIVE: The purpose of this study was to investigate cognitive functioning among elementary school children in Jordan. METHODS: A total of 468 children aged 6-12 years were recruited to participate in this study. Cognitive functioning was assessed using the LOTCA battery (Loewenstein Occupational Therapy Cognitive Assessment; Itzkovich et al., 2000). Information obtained from the parents included demographics, work and income data and child's daily behavior and school achievement. RESULTS: The results of this study showed that the cognitive functioning increased by 3.8 points for each increase in the child's GPA and increased by 2.35 points when the child ate breakfast regularly. By contrast, living in rural areas and smoking by a parent decreased cognitive functioning. CONCLUSIONS: Understanding of the child's cognitive abilities is critical to establishing intervention goals and to planning therapeutic activities. Screening of cognitive abilities and associated factors is essential for a comprehensive and accurate understanding of the child's abilities and limitations. Further research is recommended to investigate other factors in different populations.

The acute auditory effects of exposure for 60 minutes to mobile`s electromagnetic field.

OBJECTIVE: To assess the immediate consequences of 60 minutes exposure to mobile phones on hearing function by determining changes in distortion product otoacoustic emission (DPOAE) and hearing threshold levels (HTLs). METHODS: This prospective control clinical trial study was carried out at the Ear, Nose and Throat Department, King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia from July 2009 to July 2011. The data collected included age, symptoms experienced after exposure, and HTLs and DPOAE were recorded before, and immediately after 60 minutes of exposure to the same model of mobile phone. RESULTS: Heat/pain was the most commonly reported symptom. In the test-ears, significant shift (p<0.05) was noticed in HTLs at 1000 and 2000 Hz but not at other frequencies, while non test-ears did not reveal significant shift in HTLs. Additionally, test-ears revealed significant differences (p<0.05) in DPOAE at 1000 Hz, 1400 Hz, 2000 Hz, and at the average of all frequencies, while non test-ears did not show significant differences. CONCLUSION: Sixty minutes of close exposure to electromagnetic fields emitted by a mobile phone had an immediate effect on HTL assessed by pure-tone audiogram and inner ear (assessed by DPOAE) in young human subjects. It also caused a number of other otologic symptoms.

Improved sensitivity of electrocochleography in the diagnosis of Meniere's disease.

ECochG has long been shown to complement the diagnosis of MD, primarily through measurement of the SP/AP amplitude ratio. While reported in the literature to be highly specific to this disorder, ECochG's sensitivity in the general MD population remains relatively low (ranging from 20-65%). The current study assessed the sensitivity and specificity of the ECochG protocol we employ for suspected MD patients, which includes measuring both the amplitudes and areas of the SP and AP to clicks (to derive the SP/AP amplitude and area ratios), and the SP amplitudes to 1000 and 2000 Hz tone bursts. A retrospective chart review was conducted to compare ECochG results from 178 suspected MD patients with their eventual diagnoses. Measurements of highest sensitivity and specificity (determined using a logistic regression analysis) included: SP amplitude, SP area, SP/AP area ratio, and total SP-AP area. Sensitivity and specificity values associated with these measures were 92% and 84%, respectively. The sensitivity value is considerably higher than previously reported, and is attributable to the inclusion of area measurements in our protocol.