Group cognitive behavioral therapy for bipolar disorder: a feasibility and effectiveness study.

BACKGROUND: Bipolar disorder (BD) is a common disorder that results in significant psychosocial impairment, including diminished quality of life and functioning, despite aggressive pharmacotherapy. Psychosocial interventions that target functional factors could be beneficial for this population, and we hypothesized that the addition of group cognitive behavioral therapy (CBT) to maintenance pharmacotherapy would improve functioning and quality of life. METHODS: Patients diagnosed (by SCID) with bipolar disorder attending an outpatient clinic of a mood disorders program participated in the study. All patients were on maintenance mood stabilizers, and were required to have controlled symptoms before entering the study. Mood symptoms were assessed with the Hamilton Depression Rating scale and Young Mania scale at baseline and 14 weeks. Objective and subjective functioning was rated at the same interval using the Global Assessment of Functioning scale and the Medical Outcomes Survey SF-36. Treatment was provided via a specific manual based on CBT principles that could be applied to this population. RESULTS: Forty nine patients participated in this open trial, and 38 patients completed treatment. Objective and subjective indices of impairment showed improvement after 14 weeks. Both GAF and MOS scores increased significantly by the end of treatment. LIMITATIONS: This study was an open trial, and lack of control groups limits the interpretation of results. Because the study concerned effectiveness, the results do not clarify whether the improvement represents the normal course of illness or whether it is the result of the CBT intervention. CONCLUSIONS: The addition of group CBT to standard pharmacological treatment was acceptable to patients, and nearly 80% of patients complied with treatment. Despite the fact that mood symptoms were controlled at entry into the study, psychosocial functioning increased significantly at the end of treatment. Adjunctive CBT should be further investigated in this population.

Evolution of a universal infant hearing screening program in an inner city hospital.

This study reports the evolution of a newborn hearing screening program which began in 1988. Data are reported from the period of time that universal newborn hearing screening was initiated, i.e. April 1996 to December 2000 (total screened=7128 babies). From 1996 to the present, the program has developed to the current form. During 2000, 1713 infants in the well-baby nursery and neonatal intensive care unit were screened at a cost of 18.44 dollars per child. Thirty (1.7%) infants failed the screen, of which 26 (86%) returned for follow-up testing. Fifteen infants were documented with hearing loss, 10 with conductive and five with sensorineural losses. The false positive rate was 0.96% and the overall sensorineural impairment rate was 1/343.

Brainstem evoked response audiometry in the premature infant population.

Auditory brainstem response (ABR) audiometry was performed on 76 non-selected premature infants from 32 to 40 weeks conceptional age. Follow-up ABR was completed on 45 infants at 4 months of age. The results were compared to data from selected, relatively low risk infants of comparable age. No significant differences were seen between the two groups, which indicates that normative data from non-selected premature infants can be obtained to identify ABR abnormality.

Longitudinal ABR in the NICU infant.

To assess the reliability of ABR testing of NICU infants, longitudinal ABR testing was accomplished on 50 NICU infants while hospitalized and subsequently at 4 and at 20-24 months of age. The results indicate that ABR testing in the NICU may be a poor predictor of subsequent permanent hearing loss. The implications of these findings are discussed with the recommendation that ABR testing in the NICU be used in concert with follow-up testing.

Otologic findings in a pediatric cohort with sickle cell disease.

OBJECTIVE: Sensorineural hearing loss (SNHL) has been associated with sickle cell disease (SCD) in older children and adults. Few studies have investigated this association in younger children. DESIGN: In a cohort of pediatric patients followed at our sickle cell clinic, with a mean age of 7.8 years, 154 audiograms were completed on 84 patients. RESULTS: This produced 22 subjects with abnormal audiograms. Middle ear effusion was the etiology of 19 subjects' audiometric findings. Three children were found to have mild SNHL. None of the subjects had hearing loss of severity which would warrant amplification. The prevalence rate for SNHL in our cohort of pediatric patients was 3.5%. CONCLUSION: This differs from past reports, and may reflect an age dependent prevalence of SNHL in this disease.

Patient with audible popping sounds emanating from the ear canal.

We describe a most unusual case of a 40-year-old male who presented with audible popping sounds emanating from his left ear canal. The process of identifying the source of the sounds and treating the underlying cause is presented in detail.

Large vestibular aqueduct syndrome: a tutorial and three case studies.

The large vestibular aqueduct (LVA) syndrome is a congenital malformation that predisposes the patient ultimately to a loss of hearing and possible continuing vestibular disorder. If the LVA patient is diagnosed, it typically is not until later life, when he/she exhibits profound sensorineural hearing loss. To better understand this disorder and to bring it to the attention of audiologists, we provide a brief tutorial of LVA and present three case studies that illustrate the syndrome.

Utility of EMLA in the relief of pain associated with electroneurography.

Electroneurography (ENoG) is an electrodiagnostic procedure used to evaluate facial nerve deficit. A problem with application, however, is pain. Several studies have demonstrated that topical application of the eutectic mixture of lidocaine and prilocaine has an anesthetic effect on superficial and deep tissues. The present study was intended to determine if successful anesthesia of the trigeminal nerve could be achieved without altering the impulse transmission on the facial nerve. ENoG responses were measured at stimulation levels of 8, 16, 24, and 30 to 40 ma before and after Eutectic Mixture of Local Anesthetic (EMLA) application. A significant reduction in pain sensation was observed at stimulation levels of 8 and 16 ma while the amplitude of the response was not significantly changed. At the higher stimulation levels, namely, 24 and 30 to 40 ma, no significant reduction in pain or amplitude was observed. We concluded that, at moderate stimulation levels (> or =16 ma), EMLA reduces the pain associated with ENoG testing without affecting the amplitude of the muscular response.

Early ABRs in infants undergoing assisted ventilation.

ABR was performed on 42 preterm infants undergoing assisted ventilation with conventional or high-frequency oscillatory ventilation (HFOV). ABRs from these very young neonates were evaluated to further detail the emerging response and to determine if type of ventilation or other perinatal factors had effects on the ABR. While responses were present down to 26 weeks gestational age, the only factors which appeared related to absent ABRs were birthweight and gestational age.

Use of acoustic reflectometry in the detection of middle ear effusion.

The purpose of the present investigation was to compare the performance of the acoustic otoscope/DPU-411 printer and acoustic immittance with otoscopic examinations by a physician for the detection of middle ear effusion (MEE). Three hundred and two patients (11 months to 69 years) were evaluated with the acoustic otoscope, acoustic immittance, and otoscopic examinations. The patients were divided into two age groups for data analysis: 1 to 12 years (children) and 13 to 69 years (adults). Reflectivity and angle data were evaluated at different cut-off points and receiver operating characteristics (ROC) curves were determined. The variables were analyzed in different combinations for each study group. Sensitivity and specificity were poorest for the acoustic otoscope in children. Furthermore, acoustic immittance data compared more favorably with otoscopy than did the acoustic otoscope for all ages.

Historic perspective of the acoustic otoscope.

The acoustic otoscope, originally called the acoustic reflectometer, was developed and produced by John and David Teele in the early 1980s. Since initial production, two different instrument versions have been developed by two separate companies. During the period of time in which the acoustic otoscope has been in production, there have been numerous studies reported with the two instrument versions. We provide a historic summary of the acoustic otoscope, summarize the pertinent studies, and address the contrasting results found in the literature.

Bizarre "sawtooth" tympanogram in a patient with otitis media.

A patient evaluated for otitis media had a bizarre tympanogram with a "sawtooth" configuration. Acute otitis media with a pinpoint perforation was diagnosed. After resolution of the acute infection, a 2-mm diameter perforation remained and the presence of a patulous eustachian tube was documented. Tympanoplasty was eventually required, after which a normal tympanogram was recorded. Our interpretation of the tympanogram is discussed and the literature reviewed.

The current status of auditory brainstem response testing in neonatal populations.

The use of auditory brainstem response (ABR) for assessment of hearing in the neonate has not been without challenge. Although numerous articles have appeared, agreement regarding the utility of neonatal ABR testing does not exist. In review of the current studies and commentaries, a clear majority are favorable to neonatal ABR testing. These studies along with current test procedures are discussed.

Effects of human middle ear muscle contractions on speech intelligibility.

The present study assessed the relationship between the acoustic reflex and speech intelligibility. Monosyllabic words mixed with noise were presented at -6, -3.0 and +3 dB signal-to-noise ratios. The word lists were presented with a 2000-Hz tone in the contralateral ear at a level 15 dB above or 20 dB below the acoustic reflex threshold to evaluate intelligibility differences with the acoustic reflex contracted and relaxed. The results indicated that a significant decrement in speech intelligibility differences with the acoustic reflex contracted and relaxed. The results indicated that a significant decrement in speech intelligibility occurred with the reflex contracted at signal-to-noise ratios of -3, and 0 dB. Slight but not significant decrements were seen at -6 and +3 dB signal-to-noise ratios. These results are discussed along with possible reasons for the lack of agreement with previous research.

Intratympanic gentamicin therapy for vertigo in nonserviceable ears.

PURPOSE: Intratympanic ototoxic agents have become a widely accepted means of managing vertigo in patients with Meniere's disease while preserving residual hearing. We investigated expanding the indications for intratympanic gentamicin to include control of vertigo in patients without serviceable hearing in the involved ear caused by a variety of end-organ pathologies. MATERIALS AND METHODS: We present a retrospective series of 6 patients suffering from vertigo caused by end-organ disease, in an ear without serviceable hearing. Two patients suffered from delayed endolymphatic hydrops, 3 from Meniere's disease, and 1 from poststapedectomy vertigo. These patients chose unilateral vestibular ablation with serial intratympanic gentamicin injection rather than labyrinthectomy for a variety of reasons. Conventional electronystagmography (ENG) testing and audiometry were completed on all patients. The ENG testing included bithermal calorics and rotational testing. All patients had a magnetic resonance image with gadolinium to exclude retrocochlear or central pathology. Rotational testing was repeated before each injection and at the conclusion of therapy to assess changes in the peripheral vestibular response. The patients' subjective response to therapy was followed. RESULTS: Follow-up has been 10 to 69 months with successful control of vertigo in all patients. CONCLUSIONS: Intratympanic gentamicin therapy offers a minimally invasive, ambulatory, low morbidity, cost-effective means of managing vertigo in patients with nonserviceable hearing.

Auditory brain stem response abnormalities in the very low birthweight infant: incidence and risk factors.

Auditory brain stem evoked response (ABR) testing was performed on 50 very low birthweight infants in an effort to assess the effects of multiple neonatal risk factors on auditory function. The results suggested that no single risk factor was predictive of ABR abnormality while combined risk factors were shown to be very predictive.