RESUMEN
Cochlear implant (CI) is currently the vital technological device for assisting deaf patients in hearing sounds and greatly enhances their sound listening appreciation. Unfortunately, it performs poorly for music listening because of the insufficient number of electrodes and inaccurate identification of music features. Therefore, this study applied source separation technology with a self-adjustment function to enhance the music listening benefits for CI users. In the objective analysis method, this study showed that the results of the source-to-distortion, source-to-interference, and source-to-artifact ratios were 4.88, 5.92, and 15.28 dB, respectively, and significantly better than the Demucs baseline model. For the subjective analysis method, it scored higher than the traditional baseline method VIR6 (vocal to instrument ratio, 6 dB) by approximately 28.1 and 26.4 (out of 100) in the multi-stimulus test with hidden reference and anchor test, respectively. The experimental results showed that the proposed method can benefit CI users in identifying music in a live concert, and the personal self-fitting signal separation method had better results than any other default baselines (vocal to instrument ratio of 6 dB or vocal to instrument ratio of 0 dB) did. This finding suggests that the proposed system is a potential method for enhancing the music listening benefits for CI users.
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Implantación Coclear , Implantes Cocleares , Sordera , Aprendizaje Profundo , Música , Humanos , Sordera/rehabilitación , Percepción AuditivaRESUMEN
Trapping and manipulating mesoscopic biological cells with high precision and flexibility are very important for numerous biomedical applications. In particular, a photonic nanojet based on a non-resonance focusing phenomenon can serve as a powerful tool for manipulating red blood cells and tumor cells in blood. In this study, we demonstrate an approach to trap and drive cells using a high-quality photonic nanojet which is produced by a specific microcone-shaped optical-fiber tip. The dynamic chemical etching method is used to fabricate optical-fiber probes with a microcone-shaped tip. Optical forces and potentials exerted on a red blood cell by a microcone-shaped fiber tips are analyzed based on finite-difference time-domain calculations. Optical trapping and driving experiments are done using breast cancer cells and red blood cells. Furthermore, a cell chain is formed by adjusting the magnitude of the optical force. The real-time backscattering intensities of multiple cells are detected, and highly sensitive trapping is achieved. This microcone-shaped optical fiber probe is potentially a powerful device for dynamic cell assembly, optical sorting, and the precise diagnosis of vascular diseases.
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Eritrocitos , Fibras Ópticas , Pinzas Ópticas , FotonesRESUMEN
BACKGROUND: Cochlear implant technology is a well-known approach to help deaf individuals hear speech again and can improve speech intelligibility in quiet conditions; however, it still has room for improvement in noisy conditions. More recently, it has been proven that deep learning-based noise reduction, such as noise classification and deep denoising autoencoder (NC+DDAE), can benefit the intelligibility performance of patients with cochlear implants compared to classical noise reduction algorithms. OBJECTIVE: Following the successful implementation of the NC+DDAE model in our previous study, this study aimed to propose an advanced noise reduction system using knowledge transfer technology, called NC+DDAE_T; examine the proposed NC+DDAE_T noise reduction system using objective evaluations and subjective listening tests; and investigate which layer substitution of the knowledge transfer technology in the NC+DDAE_T noise reduction system provides the best outcome. METHODS: The knowledge transfer technology was adopted to reduce the number of parameters of the NC+DDAE_T compared with the NC+DDAE. We investigated which layer should be substituted using short-time objective intelligibility and perceptual evaluation of speech quality scores as well as t-distributed stochastic neighbor embedding to visualize the features in each model layer. Moreover, we enrolled 10 cochlear implant users for listening tests to evaluate the benefits of the newly developed NC+DDAE_T. RESULTS: The experimental results showed that substituting the middle layer (ie, the second layer in this study) of the noise-independent DDAE (NI-DDAE) model achieved the best performance gain regarding short-time objective intelligibility and perceptual evaluation of speech quality scores. Therefore, the parameters of layer 3 in the NI-DDAE were chosen to be replaced, thereby establishing the NC+DDAE_T. Both objective and listening test results showed that the proposed NC+DDAE_T noise reduction system achieved similar performances compared with the previous NC+DDAE in several noisy test conditions. However, the proposed NC+DDAE_T only required a quarter of the number of parameters compared to the NC+DDAE. CONCLUSIONS: This study demonstrated that knowledge transfer technology can help reduce the number of parameters in an NC+DDAE while keeping similar performance rates. This suggests that the proposed NC+DDAE_T model may reduce the implementation costs of this noise reduction system and provide more benefits for cochlear implant users.
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Implantación Coclear , Implantes Cocleares , Percepción del Habla , Humanos , Ruido , Inteligibilidad del HablaRESUMEN
Hearing aids are increasingly essential for people with hearing loss. For this purpose, environmental noise estimation and classification are some of the required technologies. However, some noise classifiers utilize multiple audio features, which cause intense computation. In addition, such noise classifiers employ inputs of different time lengths, which may affect classification performance. Thus, this paper proposes a model architecture for noise classification, and performs experiments with three different audio segment time lengths. The proposed model attains fewer floating-point operations and parameters by utilizing the log-scaled mel-spectrogram as an input feature. The proposed models are evaluated with classification accuracy, computational complexity, trainable parameters, and inference time on the UrbanSound8k dataset and HANS dataset. The experimental results showed that the proposed model outperforms other models on two datasets. Furthermore, compared with other models, the proposed model reduces model complexity and inference time while maintaining classification accuracy. As a result, the proposed noise classification for hearing aids offers less computational complexity without compromising performance.
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Audífonos , Pérdida Auditiva , Humanos , Redes Neurales de la Computación , RuidoRESUMEN
BACKGROUND: Auditory steady-state response (ASSR) induced by repetitive auditory stimulus is commonly used for audiometric testing. ASSR can be measured using electro-encephalography (EEG) and magnetoencephalography (MEG), referred to as steady-state auditory evoked potential (SSAEP) and steady-state auditory evoked field (SSAEF), respectively. However, the signal level of SSAEP and SSAEF are weak so that signal processing technique is required to increase its signal-to-noise ratio. In this study, a complementary ensemble empirical mode decomposition (CEEMD)-based approach is proposed in MEG study and the extraction of SSAEF has been demonstrated in normal subjects and tinnitus patients. METHODS: The CEEMD utilizes noise assisted data analysis (NADA) approach by adding positive and negative noise to decompose MEG signals into complementary intrinsic mode functions (IMF). Ten subjects (five normal and five tinnitus patients) were studied. The auditory stimulus was designed as 1 kHz carrier frequency with 37 Hz modulation frequency. Two channels in the vicinities of right and left temporal areas were chosen as channel-of-interests (COI) and decomposed into IMFs. The spatial distribution of each IMF was correlated with a pair of left- and right-hemisphere spatial templates, designed from each subject's N100m responses in pure-tone auditory stimulation. IMFs with spatial distributions highly correlated with spatial templates were identified using K-means and those SSAEF-related IMFs were used to reconstruct noise-suppressed SSAEFs. RESULTS: The current strengths estimated from CEEMD processed SSAEF showed neural activities greater or comparable to those processed by conventional filtering method. Both the normal and tinnitus groups showed the phenomenon of right-hemisphere dominance. The mean current strengths of auditory-induced neural activities in tinnitus group were larger than the normal group. CONCLUSIONS: The present study proposes an effective method for SSAEF extraction. The enhanced SSAEF in tinnitus group echoes the decreased inhibition in tinnitus's central auditory structures as reported in previous studies.
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Potenciales Evocados Auditivos , Procesamiento de Señales Asistido por Computador , Acúfeno/fisiopatología , Estimulación Acústica , Electroencefalografía , Femenino , Humanos , Magnetoencefalografía , Masculino , Persona de Mediana Edad , Relación Señal-Ruido , Acúfeno/diagnósticoAsunto(s)
Implantes Cocleares , Impedancia Eléctrica , Diseño de Prótesis , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Implantación Coclear , Electrodos Implantados , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , TaiwánRESUMEN
The neuromagnetic index of hemispheric asymmetry in terms of ipsilateral/contralateral ratio at acute stage was previously revealed to prognosticate the 1-month hearing outcome of acute unilateral idiopathic sudden sensorineural hearing loss (ISSNHL), showing a dynamic relationship between top- and down-levels of auditory pathway. However, the prognostic effect of reorganization pattern for the long-term results remained elusive. This study aimed to probe the prognosticating relevance of hemispheric asymmetry to the hearing at chronic stage of ISSNHL. Using magnetoencephalography (MEG), inter-hemispheric differences in peak dipole of N100m responses to monaural tones were evaluated in 21 controls and 21 ISSNHL patients at initial and final (12 months later) stages. Predictive value of hemispheric asymmetry was assessed by correlating hearing level and ipsilateral/contralateral ratio (I/C) of N100m latency and amplitude. Healthy-side dominance of N100m was observed in ISSNHL initially, and remained in three final prognostic subgroups (complete, partial, and no recovery) of ISSNHL. The initial I/C(amplitude) on affected-ear stimulation strongly correlated with the hearing level of final stage in ISSNHL. However, there was no prognostic effect of hemispheric asymmetry pattern for the 12-month hearing improvement. The heterogeneity between neuromagnetic index and hearing levels possibly echoed different pathogeneses of ISSNHL. Since a restored hearing status did not necessarily lead toward a normal functional organization, the dynamics of hemispheric asymmetry could actually index a central resilient reorganization in the brain for sound processing in ISSNHL. Our finding showed not only a clinically relevant measure to predict final hearing of ISSNHL, but also a linkage between central plasticity and cochlear lesion. This finding suggests a new perspective, and perhaps new interventions, to diagnose and treat unilateral ISSNHL.
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Corteza Auditiva/fisiopatología , Mapeo Encefálico/métodos , Diagnóstico por Computador/métodos , Potenciales Evocados Auditivos , Pérdida Auditiva Súbita/diagnóstico , Pérdida Auditiva Súbita/fisiopatología , Magnetoencefalografía/métodos , Adulto , Anciano , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pronóstico , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
Cochlear implantation is a major treatment option for severe-to-profound hearing loss. By insertion into the cochlea and stimulation of the cochlear nerve, cochlear implantation can improve the performance of hearing and speech performance of the implantees. The microenvironment of the cochlea is innate and gets disturbed in response to the insertion of a foreign body. However, real-time changes inside the cochlea in terms of electrophysiology at the molecular level can never be investigated in vivo in human beings. Thus, impedance is a good guide that reflects the electrophysiology inside the cochlea. Because the initial measurement of impedance cannot be performed earlier than the traditional interval of 1 month postoperatively, early changes in impedance have not been explored until recently; however, surgeons are now trying the initial switch-on earlier than 1 month after implantation. This review discusses the scenario of electrophysiological variation after early switch-on in <1 day postimplantation. Evidence has shown that fluctuations in impedance after implantation depend on the interplay between cell cover formation, fibrosis, electrode design, and electrical stimulation. Further studies addressing the correlation between impedance and clinical parameters are required to develop reliable biomarkers for better performance of cochlear implantation.
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Implantación Coclear , Implantes Cocleares , Humanos , Impedancia Eléctrica , Cóclea/cirugía , Cóclea/fisiología , AudiciónRESUMEN
Cochlear implantation (CI) has become the standard treatment for patients with severe-to-profound hearing loss. To date, an estimated 750,000 individuals spanning the entire lifecycle have benefited from this life-changing technology. Traditionally, the device is not "activated" for 3 to 4 weeks after surgery. However, an increasing number of centers have recently begun to question the conventional wisdom that several weeks are necessary and are activating their patients' device sooner after CI. This review aimed to provide a comprehensive insight to better understand the feasibility, outcomes, benefits, and limitations of very early cochlear implant activation. Data sources from published medical literature were reviewed. A detailed examination and summary were provided. History and safety were also emphasized. It was observed that approximately 20 studies have reported their experience with very early cochlear implant activation, ranging from the day of surgery to 1 week. Outcome measures are disparate, although there is general agreement that early activation is not only feasible but also provides some real-life benefits to patients and caregivers. The surgical, electrophysiological, audiological, and other outcomes were also reviewed. Very early activation is safe and beneficial in patients with cochlear implants. Many CI centers believe that such a process can lead to improvements in both patient-centered and fiscally responsible care. Although not ideal for all patients, cochlear implant programs may consider this option for their patients.
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Implantación Coclear , Implantes Cocleares , Humanos , Evaluación de Resultado en la Atención de SaludRESUMEN
BACKGROUND: Steady-state auditory evoked responses (SSAERs) are promising indicators of major auditory function. The improvement in accessibility in the clinical setting depends on the standardization and definition of the characteristics of SSAERs. There have been some insights into the changes in the interhemispheric dominance of SSAERs in some clinical entities. However, the hemispheric asymmetry of SSAERs in healthy controls remains inconclusive. METHODS: Twelve right-handed healthy volunteers with normal hearing were recruited. Steady-state auditory evoked fields (SSAEFs) were measured binaurally using magnetoencephalography (MEG) under pure-tone auditory stimuli at 1000 Hz with an amplitude modulation frequency of 43 Hz. The laterality index, based on the ratio of SSAEF strength over the right hemisphere to that over the left hemisphere, was also analyzed. RESULTS: The SSAEFs source was localized bilaterally on the superior temporal plane, with an orientation centripetal to the auditory cortex. The laterality index ranged from 1.1 to 2.3, and there were no sex differences. In all subjects, the strength of the SSAEFs was significantly weaker in the left hemisphere than in the right hemisphere ( p = 0.014). CONCLUSION: Right-sided dominance of the SSAEFs was verified in subjects with normal hearing. Acoustic sources clinically available in audiometric tests were used as stimuli. Such a simplification of parameters would be helpful for the standardization of precise production and the definition of the characteristics of SSAERs. Because MEG is still not easily accessible clinically, further studies using electroencephalography with larger sample sizes are necessary to address these issues.
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Potenciales Evocados Auditivos , Magnetoencefalografía , Humanos , Estimulación Acústica , Potenciales Evocados Auditivos/fisiología , Lateralidad Funcional/fisiología , AudiciónRESUMEN
Tinnitus, a frequent disorder, is the conscious perception of a sound in the absence of a corresponding external acoustic sound source in the sense of a phantom sound. Although the majority of people who perceive a tinnitus sound can cope with it and are only minimaly impaired in their quality of lfe, 2-3% of the population perceive tinnitus as a major problem. Recently it has been proposed that the two groups should be differentiated by distict terms: "Tinnitus" describes the auditory or sensory component, whereas "Tinnitus Disorder" reflects the auditory component and the associated suffering. There is overwhelming evidence that a high tinnitus burden is associated with the increased occurrence of comorbidities, including depression. Since no causal therapeutic options are available for patients with tinnitus at the present time, the identification and adequate treatment of relevant comorbidities is of great importance for the reduction of tinnitus distress. This chapter deals with the relationship between tinnitus and depression. The neuronal mechanisms underlying tinnitus will first be discussed. There will also be an overview about depression and treatment resistant depression (TRD). A comprehensive review about the state-of-the-art evidences of the relationship between tinnitus and TRD will then be provided.
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Trastorno Depresivo Resistente al Tratamiento , Acúfeno , Humanos , Acúfeno/terapia , Acúfeno/etiología , Trastorno Depresivo Resistente al Tratamiento/complicaciones , Depresión , Estimulación Acústica , SonidoRESUMEN
Interactions among cortical areas of tinnitus brain remained unclear. Weaker alpha and stronger delta activities in tinnitus have been noted over auditory cortices. However, the interplay between a single substrate with whole brain within alpha/delta band remained unknown. Thirty-one patients with chronic tinnitus were recruited. Thirty-four healthy volunteers served as controls. Magnetoencephalographic measurements of spontaneous activities were performed. The strength of alpha/delta activities was analyzed. By dividing cortices into 38 regions of interest (ROIs), measurements of connectivity were performed using amplitude envelope correlation (AEC). Global connectivity was calculated by adding and averaging connectivity of single ROI with every other region. There were no significant differences in mean power of alpha and delta band between groups, despite the trend of stronger alpha and weaker delta band in controls. The global connectivity of alpha wave was significantly stronger in tinnitus for left frontal pole, and of delta wave for bilateral pars orbitalis, bilateral superior temporal, bilateral middle temporal, right pars triangularis, right transverse temporal, right inferior temporal, and right supra-marginal. The global connectivity of alpha/delta waves was enhanced for tinnitus in designated ROIs of frontal/temporal/parietal lobes. The underlying mechanism(s) might be associated with augmentation/modulation of tinnitus perception. Our results corroborated the evolving consensus about neural correlates inside frontal/temporal/parietal lobes as essential elements of hubs for central processing of tinnitus. Further study to explore the resolution of effective connectivity between those ROIs and respective substrates by using AEC will be necessary for the evaluation of pathogenetic scenario for tinnitus.
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Ritmo alfa , Encéfalo/fisiopatología , Ritmo Delta , Magnetoencefalografía , Vías Nerviosas , Acúfeno/fisiopatología , Corteza Auditiva , Femenino , Humanos , Masculino , Persona de Mediana Edad , Corteza Prefrontal/fisiopatología , Lóbulo Temporal/fisiopatologíaRESUMEN
OBJECTIVE: To characterize early changes in impedance in patients undergoing cochlear implantation with and without enlarged vestibular aqueducts (EVA). METHODS: Case-control retrospective study of patients undergoing cochlear implantation with and without EVA. Impedance was measured across all channels intraoperatively and within 24âhours of surgery. All patients received the same electrode array. RESULTS: Ten patients with EVA (and matched controls were identified). The average intraoperative impedance across all electrodes was significantly higher in patients with EVA (13.1â±â1.4âkΩ) than in controls (9.6â±â2.5âkΩ, pâ <â0.001). At 24-hour activation, the average impedance across all electrodes was roughly equal in both groups (6.8â±â2.7âkΩ versus 6.5â±â2.1âkΩ, pâ =â0.72). CONCLUSIONS: This study is the first identify differences in intraoperative impedance between patients with and without EVA. In addition, these data demonstrate rapid normalization within 24âhours of surgery. Such findings can give a window of insight into both the intracochlear microenvironment of patients with EVA and the important early electrode-fluid-tissue interface changes that occur within hours of surgery for all patients.
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Implantación Coclear , Implantes Cocleares , Pérdida Auditiva Sensorineural , Acueducto Vestibular , Impedancia Eléctrica , Electrodos , Pérdida Auditiva Sensorineural/cirugía , Humanos , Estudios Retrospectivos , Acueducto Vestibular/anomalías , Acueducto Vestibular/cirugíaRESUMEN
Cochlear implantation is currently the most effective treatment modality for severe to profound sensorineural hearing loss. Over the past few years, at the Department of Otolaryngology, Cheng Hsin General Hospital (Taipei, Taiwan), cochlear implant devices have been switched on within 24 hours of their implantation. Differences in impedance evolution after early switch-on for different devices have not been previously discussed. The present study aimed to investigate the impedance evolution of one device and the factors influencing this after early activation. Results are compared to published results of other devices. A total of 16 patients who received Advanced BionicsTM devices and had early activation within 24 hours of implantation, were included in the study. Impedance telemetry was recorded intraoperatively and postoperatively at 1 day, 1 week, 2 weeks, 4 weeks and 8 weeks. A stepwise increase was observed in the impedance evolution. To the best of our knowledge, the present study is the first to investigate the impedance evolution of the different devices after early switch-on within 24 hours of implantation and its influencing factors. Further research with a longitudinal design to compare the differences in electrode impedances between patients activated early versus those activated after a few weeks will be necessary for the disclosure of the underlying mechanisms.
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Implantación Coclear/métodos , Adolescente , Adulto , Anciano , Niño , Preescolar , Impedancia Eléctrica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Taiwán , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: The purpose of this study is to determine if different facial muscle groups demonstrate different responses to facial nerve stimulation, the results of which could potentially improve intraoperative facial nerve monitoring (IOFNM). METHODS: IOFNM data were prospectively collected from patients undergoing cochlear implantation. At different stages of nerve exposure, three sites were stimulated using a monopolar pulse. Peak electromyography (EMG) amplitude (µV) in four muscle groups innervated by four different branches of the facial nerve (frontalis-temporal, inferior orbicularis oculi-zygomatic, superior oribularis oris-buccal, and mentalis-marginal mandibular) were recorded. RESULTS: A total of 279 peak EMG amplitudes were recorded in 93 patients. At all three stimulating sites, the zygomatic branch mean peak EMG amplitudes were statistically greater than those of the temporal, buccal, and marginal mandibular branches (P < .05). At stimulating Site C, the marginal mandibular branch mean peak EMG was stronger than the temporal or buccal branches (P < .05). Of the 279 stimulations, the zygomatic branch demonstrated the highest amplitude in 128 (45.9%) trials, followed by the marginal mandibular branch (22.2%). CONCLUSIONS: When utilized, IOFNM should be performed with at least two electrodes, one of which is placed in the orbicularis oculi muscles and the other in the mentalis muscle. However, there is wide variability between patients. As such, in cases of suspected variant nerve anatomy or increased risk of injury (intradural procedures), surgeons should consider using more than two recording electrodes, with at least one in the orbicularis oculi muscle. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E2329-E2334, 2021.
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Implantación Coclear/efectos adversos , Electromiografía/métodos , Traumatismos del Nervio Facial/prevención & control , Monitoreo Intraoperatorio/métodos , Estimulación Eléctrica Transcutánea del Nervio/métodos , Adolescente , Adulto , Anciano , Niño , Preescolar , Electrodos , Electromiografía/instrumentación , Músculos Faciales/inervación , Nervio Facial/fisiología , Traumatismos del Nervio Facial/diagnóstico por imagen , Traumatismos del Nervio Facial/etiología , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio/instrumentación , Estudios Prospectivos , Estudios Retrospectivos , Estimulación Eléctrica Transcutánea del Nervio/instrumentación , Adulto JovenRESUMEN
OBJECTIVES: Severe pain on swallowing (or dynamic pain) has long been a problem in patients receiving tonsillectomy and uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea syndrome and/or snoring. We have previously verified that dynamic pain after laser-assisted uvulopalatoplasty could immediately be mitigated by local treatments with topical triamcinolone on the "sweet spots" of the wounds. This study aimed to assess the efficacy of applying triamcinolone on "sweet spot" in surgical incisions instead of whole surgical wounds to alleviate dynamic pain of some oropharyngeal surgeries such as tonsillectomy and uvulopalatopharyngoplasty. METHODS: This study is a retrospective case series based on chart review of the participants. Forty-five subjects (31 males; 12~68 years, mean 34 years) with obstructive sleep apnea syndrome and/or snoring treated with tonsillectomy or uvulopalatopharyngoplasty were studied. Local treatments were done to sweet spots with triamcinolone on the 1st, 2nd, 3rd, and 7th days after the surgery. Evaluation of dynamic pain relief was performed by using a visual analogous scale. RESULTS: Sweet spots treatment led to instantaneous reduction of dynamic pain. The average improvement level was ≥72% (P ≤ .002). No gender effect was noted. CONCLUSION: Dynamic pain after tonsillectomy and uvulopalatopharyngoplasty could immediately be mitigated by local treatments upon sweet spots. Local treatments upon sweet spots were highly suggested to begin early post-operatively and be included in the take-home routines for patients receiving tonsillectomy and uvulopalatopharyngoplasty.
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Procedimientos Quirúrgicos Otorrinolaringológicos/efectos adversos , Dolor Postoperatorio , Hueso Paladar/cirugía , Tonsilectomía/efectos adversos , Triamcinolona/administración & dosificación , Úvula/cirugía , Administración Tópica , Adulto , Antiinflamatorios/administración & dosificación , Femenino , Humanos , Masculino , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/etiología , Faringe/cirugía , Polisomnografía/métodos , Periodo Posoperatorio , Tonsilectomía/métodos , Resultado del TratamientoRESUMEN
As for hypertension, chronic pain, epilepsy and other disorders with particular symptoms, a commonly accepted and unambiguous definition provides a common ground for researchers and clinicians to study and treat the problem. The WHO's ICD11 definition only mentions tinnitus as a nonspecific symptom of a hearing disorder, but not as a clinical entity in its own right, and the American Psychiatric Association's DSM-V doesn't mention tinnitus at all. Here we propose that the tinnitus without and with associated suffering should be differentiated by distinct terms: "Tinnitus" for the former and "Tinnitus Disorder" for the latter. The proposed definition then becomes "Tinnitus is the conscious awareness of a tonal or composite noise for which there is no identifiable corresponding external acoustic source, which becomes Tinnitus Disorder "when associated with emotional distress, cognitive dysfunction, and/or autonomic arousal, leading to behavioural changes and functional disability.". In other words "Tinnitus" describes the auditory or sensory component, whereas "Tinnitus Disorder" reflects the auditory component and the associated suffering. Whereas acute tinnitus may be a symptom secondary to a trauma or disease, chronic tinnitus may be considered a primary disorder in its own right. If adopted, this will advance the recognition of tinnitus disorder as a primary health condition in its own right. The capacity to measure the incidence, prevalence, and impact will help in identification of human, financial, and educational needs required to address acute tinnitus as a symptom but chronic tinnitus as a disorder.
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Acúfeno , Nivel de Alerta , Estado de Conciencia , Humanos , Acúfeno/complicacionesRESUMEN
To evaluate vestibular function in the clinic, current assessments are applied under static conditions, such as with the subject in a sitting or supine position. Considering the complexities of daily activities, the combination of dynamic activities, dynamic visual acuity (DVA) and postural control could produce an evaluation that better reflects vestibular function in daily activities. Objective: To develop a novel sensor-based system to investigate DVA, walking trajectory, head and trunk movements and the chest-pelvis rotation ratio during forward and backward overground walking in both healthy individuals and patients with vestibular hypofunction. Methods: Fifteen healthy subjects and 7 patients with bilateral vestibular hypofunction (BVH) were recruited for this study. Inertial measurement units were placed on each subject's head and torso. Each subject walked forward and backward for 5 m twice with 2 Hz head yaw. Our experiment comprised 2 stages. In stage 1, we measured forward (FW), backward (BW), and medial-lateral (MLW) walking trajectories; head and trunk movements; and the chest-pelvis rotation ratio. In stage 2, we measured standing and locomotion DVA (loDVA). Using Mann-Whitney U-test, we compared the abovementioned parameters between the 2 groups. Results: Patients exhibited an in-phase chest/pelvis reciprocal rotation ratio only in FW. The walking trajectory deviation, calculated by normalizing the summation of medial-lateral swaying with 1/2 body height (%), was significantly larger (FW mean ± standard deviation: 20.4 ± 7.1% (median (M)/interquartile range (IQR): 19.3/14.4-25.2)in healthy vs. 43.9 ± 27. 3% (M/IQR: 36.9/21.3-56.9) in patients, p = 0.020)/(BW mean ± standard deviation: 19.2 ± 11.5% (M/IQR: 13.6/10.4-25.3) in healthy vs. 29.3 ± 6.4% (M/IQR: 27.7/26.5-34.4) in patients, p = 0.026), and the walking DVA was also significantly higher (LogMAR score in the patient group [FW LogMAR: rightDVA: mean ± standard deviation:0.127 ± 0.081 (M/IQR: 0.127/0.036-0.159) in healthy vs. 0.243 ± 0.101 (M/IQR: 0.247/0.143-0.337) in patients (p = 0.013) and leftDVA: 0.136 ± 0.096 (M/IQR: 0.127/0.036-0.176) in healthy vs. 0.258 ± 0.092 (M/IQR: 0.247/0.176-0.301) in patients (p = 0.016); BW LogMAR: rightDVA: mean ± standard deviation: 0.162 ± 0.097 (M/IQR: 0.159/0.097-0.273) in healthy vs. 0.281 ± 0.130 (M/IQR: 0.273/0.176-0.418) in patients(p = 0.047) and leftDVA: 0.156 ± 0.101 (M/IQR: 0.159/0.097-0.198) in healthy vs. 0.298 ± 0.153 (M/IQR: 0.2730/0.159-0.484) in patients (p = 0.038)]. Conclusions: Our sensor-based vestibular evaluation system provided a more functionally relevant assessment for the identification of BVH patients.
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Patients with bilateral vestibular hypofunction (BVH) often suffer from imbalance, gait problems, and oscillopsia. Noisy galvanic vestibular stimulation (GVS), a technique that non-invasively stimulates the vestibular afferents, has been shown to enhance postural and walking stability. However, no study has investigated how it affects stability and neural activities while standing and walking with a 2 Hz head yaw turning. Herein, we investigated this issue by comparing differences in neural activities during standing and walking with a 2 Hz head turning, before and after noisy GVS. We applied zero-mean gaussian white noise signal stimulations in the mastoid processes of 10 healthy individuals and seven patients with BVH, and simultaneously recorded electroencephalography (EEG) signals with 32 channels. We analyzed the root mean square (RMS) of the center of pressure (COP) sway during 30 s of standing, utilizing AMTI force plates (Advanced Mechanical Technology Inc., Watertown, MA, USA). Head rotation quality when walking with a 2 Hz head yaw, with and without GVS, was analyzed using a VICON system (Vicon Motion Systems Ltd., Oxford, UK) to evaluate GVS effects on static and dynamic postural control. The RMS of COP sway was significantly reduced during GVS while standing, for both patients and healthy subjects. During walking, 2 Hz head yaw movements was significantly improved by noisy GVS in both groups. Accordingly, the EEG power of theta, alpha, beta, and gamma bands significantly increased in the left parietal lobe after noisy GVS during walking and standing in both groups. GVS post-stimulation effect changed EEG activities in the left and right precentral gyrus, and the right parietal lobe. After stimulation, EEG activity changes were greater in healthy subjects than in patients. Our findings reveal noisy GVS as a non-invasive therapeutic alternative to improve postural stability in patients with BVH. This novel approach provides insight to clinicians and researchers on brain activities during noisy GVS in standing and walking conditions in both healthy and BVH patients.
RESUMEN
Cochlear implantation is a surgical procedure, which is performed on severely hearing-impaired patients. Impedance field telemetry is commonly used to determine the integrity of the cochlear implant device during and after surgery. At the Department of Otolaryngology, Cheng Hsin General Hospital (Taipei, Taiwan), the cochlear implant devices are switched on within 24 hours of their implantation. In the present study, the impedance changes of Advanced Bionics™ cochlear implant devices were compared with previous studies and other devices. The aim was to confirm previous hypotheses and to explore other potential associated factors that could influence impedance following cochlear implantation. The current study included 12 patients who underwent cochlear implantation at Cheng Hsin General Hospital with Advanced Bionics cochlear implant devices. The cochlear devices were all switched on within 24 hours of their implantation. The impedance was measured and compared across all contact channels of the electrode, both intra-operatively and post-operatively. The intra-operative impedance was compared with the switch-on impedance (within 24 hours of the cochlear implantation); the impedance was notably increased for all contact channels at switch-on. Of the 16 channels examined, 4 channels had a significant increase in impedance between the intra-operative measurement and the switch-on measurement. To the best of our knowledge, the impedance of a cochlear implant device can be affected by the diameter of the electrode, the position of the electrode arrays in the scala tympani, sheath formation and fibrosis surrounding the electrode after implantation and electrical stimulation during or after surgery. When the results of the current study were compared with previous studies, it was found that the impedance changes were opposite to that of Cochlear™ implant devices. This may be explained by the position of the electrode arrays, sheath formation, the blow-out effect and differences in electrical stimulation.