Effects of Cognitive Functions on Speech Recognition in Noise in Cochlear Implant Recipients.

INTRODUCTION: There are substantial differences in speech recognition performance of adult cochlear implant (CI) recipients. This study investigated the effects of cognitive function on speech recognition in CI recipients. METHODS: The verbal working memory of 36 adults with unilateral CIs was tested using digit span tests. Attention and inhibition abilities were assessed by using the Stroop test (both congruent and incongruent tasks). Speech recognition in noise was measured using the Turkish matrix test. RESULTS: A moderate negative correlation was observed between the critical signal-to-noise ratio obtained via speech recognition in noise test and the digit span test scores (backward and digit span total scores). There was no correlation between Stroop test scores and speech recognition in noise in CI recipients. CONCLUSION: The findings indicated that verbal working memory correlated well with speech recognition outcomes in adult CI recipients and that higher working memory capacity led to better speech recognition performance in noise.

Appropriate Image Selection With Virtual Reality in Vestibular Rehabilitation: Cross-sectional Study.

BACKGROUND: While vestibular rehabilitation with virtual reality (VR) is becoming more popular every day, the disadvantages of this method are not yet clear. OBJECTIVE: The aim of this study is to examine the effect of the image to be used in vestibular rehabilitation with VR on the systems that provide body posture. METHODS: The study was carried out with 36 participants (18 women and 18 men) aged 18 to 30 years. To assess balance control components separately, a sensory organization test was administered to the participants in the presence of stressful and relaxing environment images with VR technology. The State-Trait Anxiety Inventory survey was also used to measure the stress values in the created environments. RESULTS: The State-Trait Anxiety Inventory survey revealed that while stressful videos significantly increased stress, relaxing videos reduced stress. Among measurements obtained in the presence of VR, significant decreases were observed mostly in the visual system data. A significant increase in vestibular system data (P=.01) was observed with a decrease in visual system data (P<.001) when the relaxing image was presented. Additionally, there was a significant difference in the somatosensory (P=.001), composite (P=.002), and visual system (P<.001) data in the presence of stressful videos. CONCLUSIONS: Although the use of a VR system for vestibular rehabilitation is relatively new, no extant studies have examined how the image type used in VR can affect the integration of visual system data. Therefore, this study is unique in terms of showing the effects of the stress created by the change in the type of the image used in VR. When VR technology is used for therapeutic vestibular rehabilitation for patients whose balance disorder is due to the vestibular system, stress-free videos should be used. However, the use of stressful videos in VR technology will be beneficial in the rehabilitation of those with balance disorders due to the somatosensory system.

Can Auditory and Vestibular Findings Differentiate Vestibular Migraine and Meniere's Disease?

BACKGROUND AND OBJECTIVES: Besides evaluating the auditory and vestibular systems of patients with vestibular migraine (VM) and Meniere's disease (MD), this study aimed to examine the clinical overlaps between these two conditions by detailed evaluation of the patient's symptoms. Subjects and. METHODS: The ears of the patients with VM and MD were evaluated and patients' vestibular and auditory complaints were questioned particularly. Pure tone audiometry, vestibular evoked myogenic potential (VEMP) responses, and caloric test results were evaluated for objective measurements. RESULTS: The VM group had better air-conduction and boneconduction threshold and speech reception threshold and speech discrimination score test values (p<0.05). Regarding the interaural N1-P1 asymmetry ratio, the cervical VEMP between the groups had significant differences (p=0.019). The MD group had more unilateral tinnitus and ear fullness complaints and canal paresis results (p<0.01). The VM group had more motion sickness complaints (p<0.01). CONCLUSIONS: If only ears with hearing loss are evaluated; there was no significant difference between VM and MD, but regardless of hearing level or only the patients with normal hearing were evaluated, the VM group had better hearing levels. It should be considered that patients with VM may have VM-independent hearing loss, and patient complaints should be sufficiently detailed to make an accurate distinction from MD.

Perspectives of Emergency Physicians, Primary Care Physicians, and Otolaryngologists on the Diagnosis and Treatment of Acute Vertigo.

PURPOSE: This study aimed to explore the differences in diagnosis (Dix-Hallpike test; the head impulse, nystagmus, and the test of skew [HINTS] procedures; imaging modalities; and audiological battery) and treatment (pharmacological treatments and the Epley maneuver) of acute vertigo (AV) by examining the perspectives of otolaryngologists, emergency physicians (EPs), and primary care physicians (PCPs). METHOD: A total of 123 physicians (otolaryngologists [n = 40], EPs [n = 41], PCPs [n = 42]) were included in this study. This study was conducted using an online questionnaire created in Google Forms. The questionnaire included five demographic questions and eight questions assessing the diagnosis and treatment of four case scenarios (benign paroxysmal positional vertigo [BPPV], vestibular neuronitis, Meniere's disease [MD], and vertebrobasilar insufficiency). Multiple-response and chi-square tests were used to analyze the data. RESULTS: In the case of BPPV, 82.5% of otolaryngologists, 73.2% of EPs, and 59.6% of PCPs preferred the "Dix-Hallpike maneuver" (p = .067). In addition, 72.5% of otolaryngologists, 48.8% of EPs, and 47.6% of PCPs preferred the Epley maneuver for treatment in a case with BPPV (p = .032). It was found that physicians preferred the most (18.9%) "videonystagmography (VNG)-caloric" test for diagnosis in the MD case. There was a statistically significant difference in the intravenous serum therapy and rest, and Epley maneuver preferences of physicians for the treatment of cases with MD (p = .002 and p = .046). CONCLUSIONS: In this study, significant differences were found in the AV care provided by different specialties. Standardized education systems for AV (symposiums, congresses, scientific activities, etc., with multidisciplinary participation) may be beneficial for improving the diagnosis and treatment process of AV in our country.

Auditory Short-Term Memory Evaluation in Noise in Musicians.

BACKGROUND: Working memory, a short-term memory component, is a multicomponent system that manages attention and short-term memory in speech perception in challenging listening conditions. These challenging conditions cause listening effort that can be objectively evaluated by pupillometry. Studies show that auditory working memory is more developed in musicians for complex auditory tasks. PURPOSE: This study aims to compare the listening effort and short-term memory in noise between musicians and nonmusicians. RESEARCH DESIGN: An experimental research design was adopted for the study. STUDY SAMPLE: The study was conducted on 22 musicians and 20 nonmusicians between the ages of 20 and 45. DATA COLLECTION AND ANALYSIS: Participants' effort analysis was measured with pupillometry; performance analysis was measured with short-term memory score by listening to the 15 word lists of Verbal Memory Processes Test. Participants are tested under three conditions: quiet, +15 signal-to-noise ratio (SNR), and +5 SNR. RESULTS: While nonmusicians showed significantly higher short-term memory score (STMS) than musicians in the quiet condition, musicians' STMS were significantly higher in both noise conditions (+15 SNR and +5 SNR). The nonmusician's percentage of pupil growth averages were higher than the musicians for three conditions. CONCLUSION: As a result, musicians had better memory performance in noise and less effort in the listening task according to lower pupil growth. This study objectively evaluated the differences between participants' listening efforts by pupillometry. It is also observed that the SNR and music training affect memory performance.

Effect of General Anesthesia on Auditory Brainstem Response Testing.

Objective: The auditory brainstem response (ABR) test is usually applied during natural sleep, but it can also be conducted under anesthesia. This retrospective study aimed to compare the ABR findings of a general anesthesia group and a control group that underwent ABR test during natural sleep. Methods: The anesthesia group consisted of 42 (mean age 44.5±20.3 months) children, and the control group included 58 children (36.1±16.1 months). The results of the click ABR test of the two groups were compared in terms of amplitude, latency, interpeak latencies, and hearing thresholds. Results: The amplitudes of waves III and V were significantly decreased in the general anesthesia group compared with that in the control group. The ABR latencies of waves I and V and the interpeak latencies for I-V and III-V were prolonged in the anesthesia group compared with that in the control group. Moreover, the click threshold obtained in the anesthesia group was significantly higher than those of the control group. Conclusions: Clinicians and audiologists should advise families to know the effects of general anesthesia on ABR and be cautious in interpreting the results obtained in ABR test performed under anesthesia.

Effectiveness of virtual reality-based vestibular rehabilitation in patients with peripheral vestibular hypofunction.

BACKGROUND: The rehabilitation of classical peripheral vestibular disorders is long and costly. Recently, interactive systems based on virtual reality (VR) technology have reduced the cost of vestibular rehabilitation therapy (VRT) and made the process more enjoyable. This study aims to investigate the effects of VR-based VRT in patients diagnosed with peripheral vestibular hypofunction (PVH). METHODS: In this study, a VR-based VRT program that utilized Sony Playstation®4 VR Head Mounted Display was applied to 25 patients (between 18-60) diagnosed with PVH. PVH was diagnosed by evaluating the patients' clinical histories, the findings in the "Micromedical Technologies VisualEyes Spectrum" videonystagmography (VNG) and the "Micromedical Aqua Stim" model bithermal water caloric tests. VR-based VRT program was applied to the patients for 4 weeks, 2 sessions per week, 8 sessions in total. Each session lasted around 30 to 40 min. All patients underwent the Dizziness Handicap Inventory (DHI), Sensory Organization Test (SOT), Adaptation Test (ADT), Limits of Stability (LOS), and Rhythmic Weight Shift (RWS) before, after, and 8-week follow-up of the VRT program. In addition, the Cybersickness Survey was applied to the patients at the end of the VR-based VRT session every week. RESULTS: The DHI mean scores of the patients were 54.60, 19.20, and 16.84, respectively, before, just after, and at the 8-week follow-up VRT (p < 0.001). The mean SOT composite score of the patients was obtained as 58.08 before VRT; 77.16 after VRT and 76.40 at 8-week after VRT (p < 0.000). On the other hand, the values in the 'movement velocity' and "direction control" parameters of the patients in LOS and RWS showed a significant improvement after VRT compared to before VRT (p < 0.000). From before VRT to 8 weeks after VRT, the patient's oscillation averages in the 'toes up' and 'toes down' positions in ADT reduced progressively (p < 0.000). DISCUSSION: This study demonstrates that implementing a VR-based VRT protocol may be an efficient option to improve posture stability and the quality of life in patients with PVH. In addition, VR-based vestibular rehabilitation therapy has shown to be effective for PVH patients in the mid-term.

The Effect of Somatosensorial System on Vestibular System.

The aim of this study was to investigate the effects of the somatosensory system on the vestibular system and the interconnected ways they work together to maintain balance. The study was conducted on 54 individuals (27 females and 27 males), aged between 18-25 years. vHIT as well as cVEMP tests were used to evaluate the participants. Tests were carried out while sitting, standing on firm surface and standing on foam respectively. According to the posterior vHIT results, there was a significant difference between VOR gains obtained while sitting and standing on firm surface in right side as well as on the left side (p < 0,01). Moreover, when VOR gains in standing on firm and standing on foam results were compared to each other, statistical significance was found right and left posterior canals (p < 0,05). Concerning the results obtained from VEMP, a statistically significant difference was seen in the comparison of P1-N1 amplitudes of the right side on firm surface and standing on foam (p < 0,01). When the inputs from somatosensorial system are disturbed, the parts of the vestibular system that are primarily affected are the posterior SSC, saccule and inferior vestibular nerve. This can be interpreted as the inferior vestibular nerve being more affected than the superior vestibular nerve when posture is disturbed due to somatosensory cues being unavailable or unstable.

The Impact of Optical Illusions on the Vestibular System.

BACKGROUND AND OBJECTIVES: Balance control is maintained in stationary and dynamic conditions, with coordinated muscle responses generated by somatosensory, vestibular, and visual inputs. This study aimed to investigate how the vestibular system is affected in the presence of an optical illusion to better understand the interconnected pathways of the visual and vestibular systems. Subjects and. METHODS: The study involved 54 young adults (27 males and 27 females) aged 18-25 years. The recruited participants were subjected to the cervical vestibular evoked myogenic potentials (cVEMP) test and video head impulse test (vHIT). The cVEMP and vHIT tests were performed once each in the absence and presence of an optical illusion. In addition, after each test, whether the individuals felt balanced was determined using a questionnaire. RESULTS: cVEMP results in the presence of the optical illusion showed shortened latencies and increased amplitudes for the left side in comparison to the results in the absence of the optical illusion (p≤0.05). When vHIT results were compared, it was seen that the right lateral and bilateral anterior canal gains were increased, almost to 1.0 (p<0.05). CONCLUSIONS: It is thought that when the visual-vestibular inputs are incompatible with each other, the sensory reweighting mechanism is activated, and this mechanism strengthens the more reliable (vestibular) inputs, while suppressing the less reliable (visual) inputs. As long as the incompatible condition persists, the sensory reweighting mechanism will continue to operate, thanks to the feedback loop from the efferent vestibular system.

Role of Long-Term Vestibular Rehabilitation in a Patient with Posterior Fossa Tumor: A Case Report with 2 Years of Follow-Up.

BACKGROUND Lhermitte-Duclos disease (LDD) is caused by a rare slow-growing mass in the cerebellum. LDD generally is experienced by young adults, but also it has been encountered in the pediatric population. Lhermitte and Duclos first described cerebellar dysplastic gangliocytoma in 1920. The first case they described included occipital headache, paroxysmal vertigo, falls, hearing problems, and memory deficits. Our patient had typical symptoms of the disorder such as headache, nausea, vomiting, blurred vision, and imbalance. The purpose of this case report was to describe the outcome of a computerized dynamic posturography (CDP) vestibular training program combined with home-based exercises designed to improve balance function and reduce the risk of falling by an individual with a posterior fossa tumor. CASE REPORT A 36-year-old male patient was diagnosed with dysplastic gangliocytoma/ganglioglioma according to magnetic resonance imaging, computed tomography, and pathology reports on March 28, 2016. The patient was treated by partial cerebellar tumor resection on April 7, 2016. After the operation, he reported severe imbalance, nausea, and vomiting for 1 month and visited the Audiology Department on October 20, 2016. The patient was evaluated with the CDP-sensory organization test (SOT) and his composite equilibrium score of this examination was 48, 31% below normal. We administered a 6-week posturography-assisted vestibular rehabilitation (VR) protocol (extending an hour per week) combined with a home-based exercise program twice in 2 years. In the second evaluation we applied in 2018, SOT composite equilibrium score increased to 72 after VR, reaching normal limits. After 2 years, his complaints slightly alleviated and his SOT scores were better when we compared the VR results in 2016. CONCLUSIONS We demonstrated that long-term VR may affect a patient with dysplastic cerebellar gangliocytoma (LDD) presenting imbalance or dizziness.

Assessment of Synaptic Plasticity via Long-Term Potentiation in Young Mice on the Day after Acoustic Trauma: Implications for Tinnitus.

OBJECTIVE: This experimental study evaluated the pathophysiological association of long-term potentiation (LTP)-mediated synaptic plasticity in tinnitus in 30 BALB/c mice. MATERIALS AND METHODS: Baseline hearing levels and tinnitus perception were examined with startle reflex time and gap detection time measurements using an acoustic stimulus of a 6-kHz pure tone at 90 dB sound pressure level (SPL) on post-natal day 16. The acoustic trauma group was exposed to 6-kHz pure tone at 120 dB SPL on post-natal day 16. On post-natal day 17, the acoustic trauma group underwent re-measurements of hearing levels and tinnitus perception using an acoustic stimulus of 6-kHz pure tone at 100 dB SPL. Fifteen tinnitus-induced and fifteen control subjects were sacrificed on post-natal day 17, and LTP in the dorsal cochlear nuclei of each animal was examined. RESULTS: With respect to gap detection time, there were no statistically significant between-group differences; however, there was a statistically significant difference between the pre- and post-trauma period in the acoustic trauma group. Moreover, LTP was significantly higher in the acoustic trauma group than in the control group. CONCLUSION: The results suggest that LTP underlies tinnitus pathogenesis.

[Audiological evaluation of a child with Klippel-Feil syndrome]. / Klippel-Feil sendromlu bir çocukta odyolojik degerlendirme.

A 6-year-old boy with formerly diagnosed Klippel-Feil syndrome (KFS) presented with complaints of hearing loss, speech disorder, and problems related to his hearing aid. Clinical examination and computed tomography showed bilateral external and middle ear anomalies and audiological examination revealed bilateral severe conductive hearing impairment. The patient was prescribed a bone conduction hearing aid and, with necessary consultations, was examined for additional physical anomalies. All children with a diagnosis of KFS should be evaluated with audiologic and otologic examinations, consultations should be implemented with other disciplines concerning the presenting problems, a regular follow-up should be scheduled, and the parents should be informed on possible complications.