The effect of strabismus surgery on the dynamic balance in children with strabismus.

Purpose: To evaluate the effect of strabismus surgery on dynamic balance by using computerized dynamic posturography in children with strabismus. Methods: This study was designed as a prospective observational study. Hearing tests and complete ophthalmological examinations were performed for all subjects. Patients with moderate and severe amblyopia, hearing loss at any level, and/or any suspicion of balance impairment were excluded from the study. Postural stability evaluation was performed by computerized dynamic posturography including sensory organization test, adaptation test, and rhythmic weight shift test. All tests were applied preoperatively and in the postoperative 1st and 3rd months, respectively. Results: Fifteen female and twelve male pre-adolescents aged between 7 and 12 (9.67 ± 1.62 years) were included in the current study. In the sensory organization test, the preoperative visual ratio percentages (73.19 ± 14.95%) improved statistically significantly at the postoperative 1st and 3rd months (78.59 ± 16.21% and 81.44 ± 14.18; p = .026, p = .021, respectively). The preoperative toes up (110.66 ± 33,48) and toes down (81.46 ± 28.36) adaptation tests improved statistically significantly in the postoperative 3rd month (88.74 ± 20.94 and 63.36 ± 16.03; p < .001, p = .001, respectively). In the Rhythmic Weight Shift test, the postoperative 3rd-month directional control (forward-backward) value (74.25 ± 11.51%) was statistically significantly higher compared to the preoperative directional control (forward-backward) value (67.76 ± 11.38%) (p = .011). The postoperative 3rd-month directional control (forward-backward) value (74.25 ± 11.51%) was statistically significantly higher compared to the postoperative 1st-month directional control (forward-backward) value (68.43 ± 14.00%) (p = .028). Conclusion: Surgical treatment resulted in an improvement in the maintenance of dynamic balance in children with strabismus.

Effect of Digital Noise Reduction in Hearing Aids on Speech Intelligibility in Both Quiet and Noisy Environments.

AIMS: Digital noise reduction (DNR) minimizes the effect of noise on speech signals by continuously monitoring frequency bands in the presence of noise. In the present study, we explored the effect of DNR technology on speech intelligibility in individuals using hearing aids (HAs) and investigated implications for daily use. METHODS AND MATERIAL: Eighteen participants with bilateral moderate sensorineural hearing loss (aged 16-45 years) were included. Bilateral receiver-in-the-ear HAs were fitted in the participants. The adaptive and nonadaptive (with a signal-to-noise ratio (SNR) of +5 and -5 dB, respectively) Turkish matrix sentence test (TURMatrix) in noise and free-field hearing assessments, including hearing thresholds with hearing aids, speech recognition thresholds (SRT), and speech discrimination scores, were conducted in two different conditions: HA in the DNR-on and DNR-off conditions. RESULTS: No significant difference was observed between free-field hearing assessments with the HA in the DNR-off and DNR-on conditions (P > 0.05). Furthermore, the adaptive and nonadaptive TURMatrix revealed significant differences between the scores under the DNR-on and DNR-off conditions (P < 0.05). Nevertheless, under the DNR-on condition, there was no correlation between free-field hearing assessments with HA and TURMatrix results (P > 0.05). However, a significant correlation was observed between SRT scores with HA and TURMatrix scores (adaptive and nonadaptive, +5 and -5 dB SNR, respectively) under the DNR-off condition (P < 0.05). CONCLUSION: Our study findings suggest that DNR can improve speech intelligibility in noisy environments. Therefore, DNR can enhance an individual's auditory comfort by improving their capacity to grasp speech in background noise.

Effect of External Ear Deformity on Hearing in Wrestlers.

PURPOSE: Cauliflower ear in wrestlers can lead to hearing impairment. This study primarily aims to assess the hearing of wrestlers with bilateral cauliflower ears and determine their external ear canal (EEC) resonance frequencies. Our second aim is to evaluate their hearing quality, speech, and spatial perception. METHOD: This study included 28 male wrestlers aged 18-35 years with bilateral cauliflower ears, as well as 27 male participants in the control group with no wrestling history. The participants' hearing thresholds were determined across the frequency range of 125-16000 Hz for air-conduction and 500-4000 Hz for bone conduction. EEC resonance frequencies were measured. Additionally, all participants completed the Turkish version of the Speech, Spatial, and Qualities of Hearing Scale (SSQ) questionnaire. RESULTS: Wrestlers with cauliflower ears exhibited significantly higher hearing thresholds, particularly at frequencies above 4000 Hz (p < .05). Analysis of EEC resonance showed a shift to higher frequencies in the second resonance peak of the right ear (p < .001) and the first resonance peak of the left ear (p = .045). SSQ scores revealed that wrestlers had higher spatial perception (p = .046), hearing quality (p = .004), and general scores (p = .042) in comparison to the control group. CONCLUSIONS: Blunt traumas in wrestlers, leading to cauliflower ear, can result in hearing loss. Moreover, deformities in the external ear affect the resonance frequencies of the EEC. Therefore, it is crucial to advocate for the use of ear protection equipment among wrestlers. When fitting hearing aids, attention should be given to changes in the EEC resonance frequency.

Family Resilience in Primary Caregivers of Children Who Are Deaf and Hard of Hearing.

PURPOSE: This study aimed to investigate family resilience-defined as the capacity of a family to harness its collective strengths and resources to recover from and adapt to significant adversities or crises effectively-in primary caregivers of children who are deaf and hard of hearing (cDHH) and its association with quality of life, life satisfaction, perceived social support, and loneliness. METHOD: The study involved 108 primary caregivers of cDHH and 139 primary caregivers of children with normal hearing. Participants underwent psychometric evaluations including the Family Resilience Scale, World Health Organization Quality of Life Assessment-Brief Form, Satisfaction with Life Scale, UCLA Loneliness Scale, and Multidimensional Scale of Perceived Social Support. RESULTS: Significant differences were found in almost every scale and its subdimension between the two groups (p < .05). Correlation analysis revealed significant correlations between all scale total scores for both groups (p < .05, .153 < | r | < .737). Quality of life was found to be a significant predictor of family resilience, F(1, 139) = 41.824, R2 = .279, B = 0.495, t = 6.467, p < .001. CONCLUSIONS: Our study highlights the significant impact of having cDHH on caregivers' family resilience, quality of life, life satisfaction, feelings of loneliness, and perceived social support. The results underscore the importance of enhancing caregivers' quality of life as a potential strategy to improve their family resilience. Further research is needed to understand the complex interplay of factors influencing these outcomes.

Reduced Tolerance for Risky Play in Primary Caregivers of Children With Hearing Loss.

PURPOSE: It is known that taking appropriate risks during play is crucial for the development of a child's creativity, problem-solving abilities, resilience, self-confidence, and skills in evaluating risky situations. However, communication problems resulting from hearing loss (HL) can affect a child's ability to hear danger and warning signals during play, potentially leading to injury. This study investigates the attitudes of parents or caregivers with children with HL toward risky play. METHOD: The study included 170 caregivers of children with normal hearing (NH; n = 103) and cochlear implant and/or hearing aids users (n = 67) aged 3-13 years. The primary caregiver completed the Tolerance for Risk in Play Scale (TRIPS), and the caregivers of children with HL also completed the Auditory Behavior in Everyday Life (ABEL) questionnaire. RESULTS: TRIPS total scores were significantly higher in the NH group (p < .05). Mothers of children with HL had lower TRIPS scores than mothers of children with NH (p < .05). Similarly, lower TRIPS scores were found in the lower income group with HL (p < .05). A weak positive correlation was observed between TRIPS and both the ABEL total score (p < .05, r = .207) and ABEL auditory awareness score (p < .05, r = .204) in the hard of hearing group. CONCLUSIONS: The study found that caregivers of children with HL have less tolerance for risky play. Additionally, caregivers of children with better auditory skills were more tolerant of risky play. Therefore, it is suggested that caregivers of children using appropriate hearing devices should be informed that they do not need to be overly restrictive during play, and these children should be encouraged to engage in risky play.

Effect of music integrated phonological awareness program on preschool cochlear implant users.

OBJECTIVES: Children with cochlear implants exhibit lower phonological awareness and sound discrimination skills compared to their normal-hearing peers. However, music training has been shown to have a positive effect on speech discrimination and awareness skills. METHODS: Our study included 23 cochlear implant users and 23 normal hearing participants aged 5-6 years with language skills. The aim was to observe the effect of a music-integrated phonological awareness program on cochlear implant users and to compare the phonological awareness skills of children with cochlear implants before and after online training with their normal hearing peers. RESULTS: Results showed that the trained study group scored higher on the Scale of Early Childhood Phonological Awareness (PASECP) after training than the control group (p < 0.05). In addition, SMRT scores increased between before and after training in the study group, and Mismatch Negativity (MMN) amplitudes increased and latencies decreased as a result of training (p < 0.05). CONCLUSIONS: The study suggests that phonological awareness training integrated with music can effectively improve the phonological awareness skills of children with cochlear implants and has the potential to enable them to achieve phonological awareness levels similar to or even better than their normal hearing peers.

Investigation of the relationship between hyperacusis and auditory processing difficulties in individuals with normal hearing.

PURPOSE: This study aimed to investigate the prevalence of hyperacusis and auditory processing (listening) difficulties (APDiff) in normal-hearing young adults and to explore the relationship between these two conditions. METHODS: A total of 333 participants aged 18-24 underwent pure-tone audiometry tests and completed the Khalfa Hyperacusis Questionnaire (KHQ) and the University of Cincinnati Auditory Processing Inventory (UCAPI) online. RESULTS: Hyperacusis was identified in 26.43% of participants, and APDiff in 36.04%. A strong, positive correlation was found between KHQ and UCAPI scores (r = 0.603, p < 0.001). Logistic regression models indicated that hyperacusis significantly increased the likelihood of having APDiff (OR 7.688, p < 0.001). CONCLUSION: Despite the high prevalence of hyperacusis and APDiff in young adults, few seek help from audiology clinics. Our findings highlight a significant link between hyperacusis and APDiff, emphasizing the need for screening protocols for auditory processing skills in young adults due to these conditions' potential social and academic impacts.

Comparison of Dynamic-Static Balance Parameters of Elite Ice Hockey Players and Normal Individuals.

INTRODUCTION: Our study aimed at stressing the significance of the vestibular system for ice hockey players, meanwhile focusing on the relation between the vestibular system and ice hockey for which balance is a significant factor. Our main aim was to compare the balance parameters of hockey players and normal individuals. METHODS: Our experimental group consisted of 37 professional elite ice hockey players, and our control group consisted of 37 young males who have not previously been involved in sports as professionals. Participants had been subject to sensor organization test, adaptation test, weight-bearing/squat, unilateral stance, rhythmic weight-shifting tests of computerized dynamic posturography device. RESULTS: Overall results indicate no significant difference between the control group and ice hockey players in the sensor organization test, which is caused by control group's comprising adolescents with amateur sport involvement. In adaptation test and unilateral stance test, a significant difference was found between experimental and control groups. DISCUSSION/CONCLUSIONS: This study determined the dynamic and static balance characteristics of ice hockey players. For this reason, it is useful to test the balance abilities of ice hockey players in static and dynamic conditions to evaluate their performance level. After testing individuals with vestibular problems with dynamic balance tests, appropriate sports exercises can be given to improve dynamic and static balance.

Does size of the cochlear nerve affect postoperative auditory performance in pediatric cochlear implant patients with normal cochlear nerves? / O tamanho do nervo coclear afeta o desempenho auditivo pós-operatório em pacientes pediátricos com implante coclear e nervos cocleares normais?

Abstract Introduction Cochlear implantation is an effective treatment method for severe to profound hearing loss. Many factors that may influence cochlear implantation success have been explained in previous studies. Apart from those, minor differences in size of normal cochlear nerves may affect postoperative performance. Objective To investigate whether the minor differences in cochlear nerve size in normal cochlear nerves affect postoperative cochlear implant performance. Methods 30 pediatric prelingually deaf patients who were treated with cochlear implantation were included in this study. From the reconstructed parasagittal magnetic resonance images, the diameter and cross-sectional area of the cochlear nerve on the ipsilateral and contralateral side were measured. Auditory evaluations were performed 1, 3, 6 and 12 months following the first fitting. All the analysis was performed by using EARS®, evaluation of auditory responses to speech tool. Correlation between cochlear nerve diameter, cross-sectional area and postoperative auditory perception was analyzed to determine whether variation in cochlear nerve size contributes to postoperative auditory performance. Results The mean diameter of the cochlear nerve on the ipsilateral side was 718.4 μm (504.5 − 904.3 μm) and mean cross sectional area was 0.015 cm2 (0.012 − 0.018 cm2). On the contralateral side the mean cochlear nerve diameter was 714.4 μm (502.6 − 951.4 μm) and mean cross sectional area was 0.014 cm2 (0.011 − 0.019 cm2). The correlation between the diameter and cross-sectional area of the ipsilateral and contralateral cochlear nerve revealed no significance. Mean score at first month monosyllable-trochee-polysyllable test, MTP1, was 0.17 (0.08 − 0.33), at 6th month with 6 words test, 6th month MTP6 was 0.72 (0.39 − 1.0), at 6th month with 12 words, 6th month MTP 12 was 0.46 (0.17 − 0.75) and at 12th month with 12 words, 12th month MTP12 was 0.73 (0.25 − 1.0). There was no correlation between the monosyllable-trochee-polysyllable test, values at any time with the diameter of the ipsilateral cochlear nerve. However, the first month MTP, 6th month MTP6 and 12th month MTP12 correlated with the cross-sectional area of the ipsilateral cochlear nerve. Conclusion Measuring the cross sectional area of the normal- appearing cochlear nerve may give important prognostic knowledge on cochlear implant outcomes. In patients with a larger cross sectional area the auditory performance was better and faster. Although normal appearing, slight differences on cross sectional area of the cochlear nerve may affect performance. Measuring the size of the cochlear nerve on parasagittal magnetic resonance images may provide beneficial information on the postoperative rehabilitation process.

Resumo Introdução O implante coclear é um método de tratamento eficaz para a perda auditiva grave a profunda. Muitos fatores que podem influenciar o sucesso do implante coclear foram explicados em estudos anteriores. Além desses fatores, pequenas diferenças no tamanho dos nervos cocleares normais podem afetar o desempenho pós-operatório. Objetivo Investigar se pequenas diferenças no tamanho dos nervos cocleares normais afetam o desempenho pós-operatório do implante coclear. Método Foram incluídos neste estudo 30 pacientes pediátricos surdos pré-linguais, tratados com implante coclear. A partir de imagens de ressonância magnética parassagitais reconstruídas, foram medidos o diâmetro e a área de seção transversal do nervo coclear no lado ipsilateral e contralateral. As avaliações auditivas foram feitas 1, 3, 6 e 12 meses após a primeira adaptação. Todas as análises foram feitas com a ferramenta EARS® (do inglês evaluation of auditory responses to speech). A correlação entre o diâmetro do nervo coclear, a área transversal e a percepção auditiva pós-operatória foi analisada para determinar se a variação no tamanho do nervo coclear contribui para o desempenho auditivo pós-operatório. Resultados O diâmetro médio do nervo coclear no lado ipsilateral foi de 718,4 μm (504,5 a 904,3 μm) e a área da seção transversal média foi de 0,015 cm2 (0,012-0,018 cm2). No lado contralateral, o diâmetro médio do nervo coclear foi de 714,4 μm (502,6 a 951,4 μm) e a área da seção transversal média foi de 0,014 cm2 (0,011 a 0,019 cm2). A correlação entre o diâmetro e a área transversal do nervo coclear ipsilateral e contralateral não revelou qualquer significância. O escore médio do teste monosyllable-trochee-polysyllable no primeiro mês, denominado MTP1, foi de 0,17 (0,08-0,33), no sexto mês com teste de 6 palavras, MTP6, foi de 0,72 (0,39-1,0), no sexto mês com 12 palavras, MTP12, foi de 0,46 (0,17-0,75) e no 12° mês com 12 palavras, MTP12, foi de 0,73 (0,25-1,0). Não houve correlação entre os valores do teste monosyllable-trochee-polysyllable em qualquer momento com o diâmetro do nervo coclear ipsilateral. Entretanto, o teste monosyllable-trochee-polysyllable do primeiro mês, do 6° mês, e o do 12° mês correlacionaram-se com a área transversal do nervo coclear ipsilateral. Conclusão Medir a área da secção transversal do nervo coclear de aparência normal pode fornecer conhecimento prognóstico importante sobre os resultados do implante coclear. Em pacientes com área da secção transversal maior, o desempenho auditivo foi melhor e mais rápido. Embora o nervo coclear pareça normal, pequenas diferenças na área da secção transversal do nervo coclear podem afetar o desempenho, de forma que a medida do tamanho do nervo coclear nas imagens de ressonância magnética na projeção parassagital pode fornecer informações benéficas sobre o processo de reabilitação pós-operatória.

Electrically Evoked Auditory Late Responses as a Novel Method for Cochlear Implant Programming.

HYPOTHESIS: Electrically evoked auditory late responses (eALR) are useful as an objective cochlear implant (CI) fitting method. BACKGROUND: Different objective and behavioral methods are used for CI fitting. However, there is no objective method that indicates that the electrical signal reaches the auditory cortex. eALR is an indicator that electrical signals reach the auditory cortex, so our aim was to investigate the use of eALR as an objective method for CI programming. METHODS: Two different programs were created for 21 unilateral Med-El CI users. In the first program, the most comfortable level (MCL) was adjusted with the electrical stapes reflex threshold (eSRT), and the threshold levels (THR) were behaviorally adjusted according to the user's feedback. In the second program, the MCL level was adjusted to a level where all the components of the eALR were clearly seen, and the user did not feel uncomfortable; the THR levels were adjusted to the lowest level where the eALR P1 wave could be seen. The results of the MCL and THR levels of the two programs and the free field tests conducted with both programs were compared. RESULTS: While MCL levels did not differ significantly between the two programs, a significant difference was observed between THR levels. In addition, no significant difference was found between hearing and speech tests with CI in the free field. CONCLUSION: The results revealed no significant performance difference between the two programs and that eALR could be preferred as an objective method for MCL determination.

Does size of the cochlear nerve affect postoperative auditory performance in pediatric cochlear implant patients with normal cochlear nerves?

INTRODUCTION: Cochlear implantation is an effective treatment method for severe to profound hearing loss. Many factors that may influence cochlear implantation success have been explained in previous studies. Apart from those, minor differences in size of normal cochlear nerves may affect postoperative performance. OBJECTIVE: To investigate whether the minor differences in cochlear nerve size in normal cochlear nerves affect postoperative cochlear implant performance. METHODS: 30 pediatric prelingually deaf patients who were treated with cochlear implantation were included in this study. From the reconstructed parasagittal magnetic resonance images, the diameter and cross-sectional area of the cochlear nerve on the ipsilateral and contralateral side were measured. Auditory evaluations were performed 1, 3, 6 and 12 months following the first fitting. All the analysis was performed by using EARS®, evaluation of auditory responses to speech tool. Correlation between cochlear nerve diameter, cross-sectional area and postoperative auditory perception was analyzed to determine whether variation in cochlear nerve size contributes to postoperative auditory performance. RESULTS: The mean diameter of the cochlear nerve on the ipsilateral side was 718.4 µm (504.5 - 904.3 µm) and mean cross sectional area was 0.015 cm2 (0.012 - 0.018 cm2). On the contralateral side the mean cochlear nerve diameter was 714.4 µm (502.6 - 951.4 µm) and mean cross sectional area was 0.014 cm2 (0.011 - 0.019 cm2). The correlation between the diameter and cross-sectional area of the ipsilateral and contralateral cochlear nerve revealed no significance. Mean score at first month monosyllable-trochee-polysyllable test, MTP1, was 0.17 (0.08 - 0.33), at 6th month with 6 words test, 6th month MTP6 was 0.72 (0.39 - 1.0), at 6th month with 12 words, 6th month MTP 12 was 0.46 (0.17 - 0.75) and at 12th month with 12 words, 12th month MTP12 was 0.73 (0.25 - 1.0). There was no correlation between the monosyllable-trochee-polysyllable test, values at any time with the diameter of the ipsilateral cochlear nerve. However, the first month MTP, 6th month MTP6 and 12th month MTP12 correlated with the cross-sectional area of the ipsilateral cochlear nerve. CONCLUSION: Measuring the cross sectional area of the normal- appearing cochlear nerve may give important prognostic knowledge on cochlear implant outcomes. In patients with a larger cross sectional area the auditory performance was better and faster. Although normal appearing, slight differences on cross sectional area of the cochlear nerve may affect performance. Measuring the size of the cochlear nerve on parasagittal magnetic resonance images may provide beneficial information on the postoperative rehabilitation process.

Assessment of Hidden Hearing Loss in Normal Hearing Individuals with and Without Tinnitus.

OBJECTIVES: To evaluate the functions of cochlear structures and the distal part of auditory nerve as well as dead regions within the cochlea in individuals with normal hearing with or without tinnitus by using electrophysiological tests. MATERIALS AND METHODS: Nine individuals (ages: 21-59 years) with normal hearing with tinnitus were included in the study group. Thirteen individuals (ages: 25-60 years) with normal hearing without tinnitus were included in the control group. Immitancemetric examination, pure-tone audiometry (125Hz-16kHz), speech audiometry in quiet and noise environments, transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs), threshold equalizing noise (TEN test (500Hz-4kHz), and ECochG tests, Beck Depression Questionnaire, Tinnitus Handicap Questionnaire, and Visual Analog Scale were performed. RESULTS: In the study group, three patients were found to have a minimal depression and six were found to have a mild depression. In pure-tone audiometry, the threshold (6-16 kHz) in the study group was significantly higher than that of the control group at all frequencies. In the study group, lower performance scores were obtained in speech discrimination in noise in both ears. In the control group, no dead region was detected in the TEN test whereas 75% of subjects in the study group had dead regions. DPOAE and TEOAE responses between study and control group subjects were not different. In the ECochG test, subjects in the study group showed an increase in the summating potential/action potential (SP/AP) ratio in both ears. CONCLUSION: Determination of the SP/AP ratio in patients with tinnitus may be useful in diagnosing hidden hearing loss. Detection of dead regions in 75% of patients in the TEN test may indicate that inner hair cells may be responsible for tinnitus.

The impact of social and demographic features on comprehensive receptive and expressive performance in cochlear implant patients.

OBJECTIVES: This study aims to observe the effects of social and demographic factors on the language development of prelingual pediatric cochlear implant patients. PATIENTS AND METHODS: Between April 2006 and April 2010, 44 children (26 boys, 18 girls; mean age 81.1±16.9 months; range 54 to 115 months) who were prelingually implanted and who had an implant experience of at least 36 months were retrospectively analyzed. Only the patients without mental-motor retardation, cochlear anomaly and revision surgery and who continued their education without any interruption were selected. Receptive and expressive vocabulary tests were performed on these patients. Social and demographic features including gender, implant age, parents' education status and annual income were recorded. The relationship between language development and socio-demographic factors were investigated. RESULTS: Patients implanted before the age of 36 months showed better levels of receptive and expressive language. Children with higher maternal education levels showed significantly better expressive and receptive equivalent language ages. Annual income of the families had significant positive impacts on the language development of the children who were implanted before the age of 36 months. CONCLUSION: Both expressive and receptive language skills over 36 months of implant experience are significantly associated with age at the time of the implant and socio-economic status of the parents.