[Characterization of a closed-set logatome test : Documentation of audiometric data: discrimination function and reproducibility]. / Charakterisierung eines geschlossenen Logatomtests : Erhebung audiometrischer Kenndaten: Diskriminationsfunktion und Reproduzierbarkeit.

BACKGROUND: Logatomes, nonsensical combinations of consonants and vowels, are suitable for a precise capture and analysis of individual phonemes as fundamental modules of speech in audiometric diagnostics. OBJECTIVE: The aim of this prospective study was to capture the audiometric characteristics of a closed-set logatome test. The slope of the discrimination function at the speech reception threshold (SRT) and the reproducibility were analyzed. MATERIAL AND METHODS: A set of 102 intensity varied and randomized logatomes were presented in the form of consonant-vowel-consonant to 25 hearing unimpaired adults. The measurements were performed in a free field setting and were each repeated after a 2-week interval. The subjects were requested to repeat the heard logatome in a closed response test of 10 items per sound item on a touchscreen. RESULTS: The slope of the mean discrimination function at the SRT was on average 4%/dB; however, the mean discrimination function slope was steeper for the initial consonant than for the final one. The differences of the test and retest results at the SRT showed a standard deviation of 13% for consonants. These differences were normally distributed. There were no significant differences between test and retest. CONCLUSION: The slope of the discrimination function at the SRT appeared to be shallow but was comparable to established word tests. Finally, there was no evidence of a learning effect in the retest, which emphasizes the low redundancy of the speech material and makes it an attractive complementary option to routine audiometric diagnostics.

Speech audiometry and data logging in CI patients : Implications for adequate test levels.

BACKGROUND: As part of postoperative cochlear implant (CI) diagnostics, speech comprehension tests are performed to monitor audiological outcome. In recent years, a trend toward improved suprathreshold speech intelligibility in quiet and an extension of intelligibility to softer sounds has been observed. Parallel to audiometric data, analysis of the patients' acoustic environment can take place by means of data logging in modern CI systems. OBJECTIVES: Which speech test levels reflect the individual listening environment in a relevant manner and how can these be reflected in a clinical audiometric setting? PATIENTS AND METHODS: In a retrospective analysis, data logs of 263 adult CI patients were evaluated for sound level and the listening situation (quiet, speech in quiet, noise, speech in noise, music, and wind). Additionally, monosyllabic word comprehension in quiet was analyzed in experienced CI users at presentation levels of 40-80 dB. RESULTS: For the sound level in the acoustic environment of postlingually deafened adult CI users, data logging shows a maximum occurrence of speech signals in the range of 50-59 dB. This demonstrates the relevance of everyday speech comprehension at levels below 60 dB. CONCLUSION: Individual optimization of speech intelligibility with a CI speech processor should not be performed in the range of 65-70 dB only, but also at lower levels. Measurements at 50 dB currently seem to be a useful addition.

[Speech audiometry and data logging in CI patients : Implications for adequate test levels. German version]. / Sprachaudiometrie und Datalogging bei CI-Patienten : Überlegungen zu geeigneten Sprachpegeln.

BACKGROUND: As part of postoperative cochlear implant (CI) diagnostics, speech comprehension tests are performed to monitor audiological outcome. In recent years, a trend toward improved suprathreshold speech intelligibility in quiet and an extension of intelligibility to softer sounds has been observed. Parallel to audiometric data, analysis of the patients' acoustic environment can take place by means of data logging in modern CI systems. OBJECTIVES: Which test levels reflect the individual listening environment in a relevant manner and how can these be reflected in a clinical audiometric setting? PATIENTS AND METHODS: In a retrospective analysis, data logs of 263 adult CI patients were evaluated for sound level and the listening situation (quiet, speech in quiet, noise, speech in noise, music, and wind). Additionally, monosyllabic word comprehension in quiet was analyzed in experienced CI users at presentation levels of 40-80 dB. RESULTS: For the sound level in the acoustic environment of postlingually deafened adult CI users, data logging shows a maximum occurrence of speech signals in the range 50-59 dB. This demonstrates the relevance of everyday speech comprehension at levels below 60 dB. CONCLUSIONS: Individual optimization of speech intelligibility with a CI speech processor should not be performed in the range of 65-70 dB only, but also at lower levels. Measurements at 50 dB currently seem to be a useful addition.

[The Freiburg monosyllable word test in postoperative cochlear implant diagnostics]. / Der Freiburger Einsilbertest in der postoperativen CI-Diagnostik.

BACKGROUND: The Freiburg monosyllable word test represents a central tool of postoperative cochlear implant (CI) diagnostics. OBJECTIVES: The objective of this study is to test the equivalence of different word lists by analysing word comprehension. For patients whose CI has been implanted for more than 5 years, the distribution of suprathreshold speech intelligibility outcomes will also be analysed. PATIENTS AND METHODS: In a retrospective data analysis, speech understanding for 626 CI users word correct scores were evaluated using a total of 5211 lists with 20 words each. RESULTS: The analysis of word comprehension within each list shows differences in mean and in the kind of distribution function. There are lists which show a significant difference of their mean word recognition to the overall mean. The Freiburg monosyllable word test is easy to administer at suprathreshold speech level for CI recipients, and typically has a saturation level above 80 %. CONCLUSION: The Freiburg monosyllable word test can be performed successfully by the majority of CI patients. The limited balance of the test lists elicits the conclusion that an adaptive test procedure with the Freiburg monosyllable test does not make sense. The Freiburg monosyllable test can be restructured by resorting all words across lists, or by omitting individual words of a test list to increase the reliability of the test. The results show that speech intelligibility in quiet should also be investigated in CI recipients al levels below 70 dB.

Stellate ganglion blockade (SGB) for refractory index finger pain - a case report.

OBJECTIVE: To identify through case study the presentation and possible pathophysiological cause of complex regional pain syndrome and its preferential response to stellate ganglion blockade. SETTING: Complex regional pain syndrome can occur in an extremity after minor injury, fracture, surgery, peripheral nerve insult or spontaneously and is characterised by spontaneous pain, changes in skin temperature and colour, oedema, and motor disturbances. Pathophysiology is likely to involve peripheral and central components and neurological and inflammatory elements. There is no consistent approach to treatment with a wide variety of specialists involved. Diagnosis can be difficult, with over-diagnosis resulting from undue emphasis placed upon pain disproportionate to an inciting event despite the absence of other symptoms or under-diagnosed when subtle symptoms are not recognised. The International Association for the Study of Pain supports the use of sympathetic blocks to reduce sympathetic nervous system overactivity and relieve complex regional pain symptoms. Educational reviews promote stellate ganglion blockade as beneficial. Three blocks were given at 8, 10 and 13 months after the initial injury under local anaesthesia and sterile conditions. Physiotherapeutic input was delivered under block conditions to maximise joint and tissue mobility and facilitate restoration of function. CONCLUSION: This case demonstrates the need for practitioners from all disciplines to be able to identify the clinical characteristics of complex regional pain syndrome to instigate immediate treatment and supports the notion that stellate ganglion blockade is preferable to upper limb intravenous regional anaesthetic block for refractory index finger pain associated with complex regional pain syndrome.

[Influence of mixing ratios of a FM-system on speech understanding of CI-users]. / Untersuchungen zum Einfluss des Mischungsverhältnisses der FM-Anlage auf das Sprachverständnis im Störschall bei CI-Patienten.

BACKGROUND: At school we find two major acoustic situations: (first) the "teacher is talking" being disturbed by the pupils making noise and (second) another "pupil is talking" disturbed by other pupils. The understanding of words and sentences in hearing impaired patients with a cochlear implant (CI) in a noisy situation can be improved by using a FM system. The aim of this study is to test speech understanding depending on mixing ratios between FM input and microphone input to the speech processor in different circumstances. METHODS: Speech understanding was evaluated using the adaptive Oldenburger sentence test (OLSA) in background noise. CI patients used the FM system Microlink for Freedom CIs together with a Campus transmitter (Phonak AG). PATIENTS: 17 postlingually deafened adults were tested, using unilateral Freedom cochlear implant systems (Cochlear Ltd). A group of eight normally hearing adults was used as a control group in the same setup. RESULTS: We found that the median value of L (50)=1.6 dB in CI patients without a FM system is higher than the median value of L(50)=-13 dB in normally hearing subjects. The sentence recognition in CI patients with FM system increased with increasing mixing ratio. The benefit using the FM system to understand the teacher is of high advantage in any mixing ratio. The difference between the L(50) values in situations with or without a FM-system is 15 dB for the mixing ratio 3:1 (FM to microphone). If we take into account an increase of 15% per dB in the OLSA (at L(50)) in CI patients, the difference of 15 dB means a calculated advantage of 225%. The speech understanding during the second condition ("pupil is talking") however remained nearly the same in all used mixing ratios. The calculations showed no statistical difference between these situations with and without a FM system. CONCLUSION: The speaker comprehension for the two investigated listening conditions showed different results. Understanding in the "teacher is talking" situation increased with increasing mixing ratio (FM to microphone) and in the "pupil is talking" situation remained on the same level. We could not find an optimal FM setting for both listening conditions. This leads to different suggestions for different listening conditions. All patients showed an increased speech understanding in noisy environments. This result strongly encourages the use of a FM-system in a classroom.

Electrically evoked auditory brainstem response in cochlear implant users.

The waveforms and parameters of electrically evoked auditory brainstem responses, eeABRs, registered in cochlear implant users, were compared with those of acoustically evoked auditory brainstem responses, aeABRs, recorded in normally hearing subjects. The eeABRs, in contrast to the aeABRs, contained dubious Wave IV, while missed Waves VI and VII. The eeABRs possessed also shorter peak-latencies, shorter inter-peak intervals, and greater amplitudes. The revealed differences have been explained by the lack of cochlear mechanisms in cochlear implant recipients. On the other hand, eeABRs and aeABRs exhibited similar stimulus intensity dependence. Both had also lower thresholds, shorter peak-latencies, and greater amplitudes in females than in males.

Comparison of the TEMPO+ ear-level speech processor and the cis pro+ body-worn processor in adult MED-EL cochlear implant users.

A study was conducted to compare the new MED-EL TEMPO+ ear-level speech processor with the CIS PRO+ body-worn processor in the COMBI 40/COMBI 40+ implant system. Speech tests were performed in 46 experienced subjects in two test sessions approximately 4 weeks apart. Subjects were switched over from the CIS PRO+ to the TEMPO+ in the first session and used only the TEMPO+ in the time between the two sessions. Speech tests included monosyllabic word tests and sentence tests via the telephone. An adaptive noise method was used to adjust each subject's scores to approximately 50%. Additionally, subjects had to complete a questionnaire based on their 4 weeks of experience with the TEMPO+. The speech test results showed a statistically significant improvement in the monosyllabic word scores with the TEMPO+. In addition, in the second session, subjects showed a significant improvement when using the telephone with the TEMPO+, indicating some learning in this task. In the questionnaire, the vast majority of subjects found that the TEMPO+ allows equal or better speech understanding and rated the sound quality of the TEMPO+ higher. All these objective and subjective results indicate the superiority of the TEMPO+ and are mainly attributed to a new coding strategy called CIS+ and its implementation in the TEMPO+. In other words, based on the results of this study, it appears that after switching over from the CIS PRO+ to the TEMPO+, subjects are able to maintain or even improve their own speech understanding capability.

High-speed digital videoimaging of fast eardrum motions during Valsalva maneuver.

Digital high-speed camera systems are used to record high-frequency video-clips. After adapting this technology to the analysis of eardrum motions, fast motions of the eardrum can be recorded using an endoscope. Under specific static pressure conditions during the Valsalva maneuver, recordings of eardrum motions were made. The use of a Kodak Image Ektapro 1000 Motion Analyzer allowed only conventional videosignal processing and storage. A new type of data interface made it possible to save and process the complete video-clip digitally. Using an image-processing workstation and special mathematical algorithms, three-dimensional computer animations of fast eardrum motions under static pressure can be generated. In the present study, several animations of fast eardrum movements are described. High-speed digital videoimaging is an adequate method to describe fast eardrum displacements under static pressure (Valsalva maneuver). It is possible to create visible timeshift images of separate eardrum parts during the fast Valsalva maneuver.

[Methodological aspects of observations of rapid tympanic membrane movements due to changes in static pressure (Valsalva maneuver) using digital high speech video recordings]. / Methodische Aspekte von Beobachtungen schneller Trommelfellbewegungen bei Anderung des statischen Druckes (Valsalva-Manöver) mittels digitaler Hochgeschwindigkeitsvideoaufnahmen.

BACKGROUND: CCD-high speed camera systems are used to record high frequency videoclips. Introducing this technology in the analysis of eardrum motions, fast motions of the eardrum can be taped using an endoscope. METHODS: Records of the eardrum were made under specific static pressure conditions during the Valsalva maneuver. Initial experience with the help of a Kodak image (I 3) Ektapro 1000 Motion Analyzer allowed only conventional video signal processing and storage. A new data interface makes it possible to save and process the complete videoclip digitally. RESULTS: Using an image processing workstation and special mathematical algorithms, three-dimensional computer animations of rapid eardrum motions on static pressure can be performed. The present study describes different animations of fast motion eardrum movements. CONCLUSIONS: Digital high-speed video imaging is a suitable method to describe rapid eardrum motions on static pressure (Valsalva maneuver). It is possible to visualize the motion of the eardrum over time on the fast Valsalva movement at high resolution.