Relationship Between Parental Stress and their Attitudes Towards Cochlear Implantation Outcomes in Children Referred to Besat Cochlear Implant Center in Hamadan 2018.

PURPOSE: This study aimed to investigate the relationship between parental stress and their attitudes towards post-cochlear implantation outcomes in children referred to Besat cochlear implant center in Hamadan during 2018. DESIGN AND METHODS: In this descriptive cross-sectional study, 100 parents of children with cochlear implantation were selected from Besat cochlear implant center in Hamadan through census method from April to October 2018. The data were collected using a demographic characteristic questionnaire, parental stress scale developed by Berry and Jones, and Parental Attitudes of Various Aspects of Cochlear Implantation. The data were analyzed using SPSS software (version 16) through correlation coefficient, one-way ANOVA, and t-test. P-value <0.05 was considered statistically significant. RESULTS: The results of this study indicated that parental stress negatively correlated with their attitudes towards the outcomes of cochlear implantation (r = -0.420), including the aspects of communication (r = -0.462), educational (r = -0.398), and social skills (r = -0.445), as well as services provided by the health care centers (r = -0.277), and the efficiencies of cochlear implantation center (r = -0.118) (P < 0.05). CONCLUSION: According to the results, parents with more positive attitudes towards the areas of communication, educational, and social skills, as well as services provided by the health care centers, and the efficiencies of cochlear implantation center experienced lower levels of stress. PRACTICE IMPLICATIONS: Nurses can measure the stress and attitudes towards cochlear implantation outcomes in children to accurately assess the needs of the family in order to improve their nursing process and advance the child's rehabilitation program.

A National Iranian Cochlear Implant Registry (ICIR): cochlear implanted recipient observational study.

BACKGROUND AND OBJECTIVE: Patients who receive cochlear implants (CIs) constitutes a significant population in Iran. This population needs regular monitor on long-term outcomes, educational placement and quality of life. Currently, there is no national or regional registry on the long term outcomes of CI users in Iran. The present study aims to introduce the design and implementation of a national patient-outcomes registry on CI recipients for Iran. This Iranian CI registry (ICIR) provides an integrated framework for data collection and sharing, scientific communication and collaboration inCI research. METHODS: The national ICIR is a prospective patient-outcomes registry for patients who are implanted in one of Iranian centers. The registry is based on an integrated database that utilizes a secure web-based platform to collect response data from clinicians and patient's proxy via electronic case report forms (e-CRFs) at predefined intervals. The CI candidates are evaluated with a set of standardized and non-standardized questionnaires prior to initial device activation(as baseline variables) and at three-monthly interval follow-up intervals up to 24 months and annually thereafter. RESULTS: The software application of the ICIR registry is designed in a user-friendly graphical interface with different entry fields. The collected data are categorized into four subsets including personal information, clinical data, surgery data and commission results. The main parameters include audiometric performance of patient, device use, patient comorbidities, device use, quality of life and health-related utilities, across different types of CI devices from different manufacturers. CONCLUSION: The ICIR database could be used by the increasingly growing network of CI centers in Iran. Clinicians, academic and industrial researchers as well as healthcare policy makers could use this database to develop more effective CI devices and better management of the recipients as well as to develop national guidelines.

Evaluation of Neurological and Auditory Development in Children with Congenital Heart Disease using Essence Q Questionnaire and Auditory Brainstem Response (ABR) Test.

Objectives: The progress of cardiac surgery in children and the increase in the survival of children with Congenital Heart Disease (CHD) has led to consider another issue called a neurodevelopmental disorder. In this study, 53 children with CHD were evaluated in terms of development with the Essence Q questionnaire, Otoacoustic Emission (OAE), and Auditory Brainstem Response (ABR) regarding these patients' hearing and risk factors. The Essence Q scores were also examined. Materials & Methods: In this prospective, cross-sectional study, the researchers included 53 children diagnosed with CHD. Initially, each child underwent ABR and OAE tests. Subsequently, data on potential risk factors associated with neurodevelopmental delay were collected. A trained project associate administered the Essence Q questionnaire, using parents' information as a guide. Following data collection, this study proceeded with an in-depth analysis of the information. Results: Thirty-six boys (67.92%) and 17 girls (32.08%) with CHD were included in the study. The mean age of children was 26.98±10.64 months. The mean Essence Q score for boys was 7.48±2.57. Moreover, the average score for girls was 2.23 ± 8.11. According to this questionnaire, 39 patients (73.58%) had hyperactivity disorder, 46 patients (86.79%) had behavioral disorders, and ten patients (16.98%) had a motor delay. Unlike previous studies, all patients had normal OAE and ABR hearing. Conclusion: This study demonstrated that factors such as developmental delay in the first year, a known genetic disease, and a history of seizures significantly impacted the Essence Q score. However, elements like prematurity, the use of ventilation, abnormalities on the dorsum, and the number of days post-surgery did not significantly affect the Essence Q score. Essence Q can be a reliable tool in screening for neurodevelopment in children with CHD.

Studying of Distortion Product of Otoacoustic Emissions in Menopausal Women.

Introduction: The sex hormones; estrogen and progesterone have a direct effect on the mechanisms of the inner cochlea and they control the functions of the ascending auditory pathway from the auditory nerve to the cerebral cortex. Therefore, the aim of this study was to determine the amplitude of distortion product of otoacoustic emissions (DPOAE) in postmenopausal women. Materials and Methods: This cross-sectional case-control study included 60 women who were naturally menopausal and were in the age range of 55 - 45 years (case group). The other 60 included women of the same age and non-menopause (control group). Both groups were selected from individuals who had normal auditory function based on pure tone audiometry, immitance audiometry (tympanometry + ipsilateral and contralateral reflex), speech tests and auditory brainstem responses. Then both groups were evaluated by DPOAE and its findings were analyzed in two groups based on independent t-test and the significance level of the test was determined to be less than 0.05. Results: The difference between the mean DPOAE domains in the two groups was not significant (P-value = 0.484). Conclusion: Menopause is not an etiological factor to be created of abnormalities in the cochlea of ​​the inner ear. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03210-1.

Examining the Health-Related Needs of Females during Menopause: A Systematic Review Study.

Menopause is one the most crucial stages in a female's life. Identifying the education gaps regarding menopause is important, thus this study aims to explain the health-related needs of females during menopause. Scopus, PubMed, Scientific Information Database, and Web of Science databases were searched for the available observational (cohort, case-control, and cross-sectional), systematic review, meta-analysis, and clinical trial studies (2007-2021) using keywords, such as 'Educational Needs Assessment,' 'Assessment of Healthcare Needs,' 'menopause,' 'climacteric,' 'premenopause,' and 'postmenopause.' A total of 180 out of 5,705 papers were evaluated after considering the inclusion and exclusion criteria. The educational needs of females during menopause in the reviewed studies include osteoporosis, oral and dental problems, metabolic disorders, cardiovascular diseases, hypertension, lung diseases, infectious diseases, musculoskeletal problems, urinary problems, breast cancer, defecation problems, genital disorders, special diseases such as eye diseases and hypothyroidism and hormone therapy, mental disorders, cognitive function, sleep disorders, sexual disorders, physical activity, supplement consumption, public health issues, health education, fall, and nutrition. The study results reveal that females during postmenopause require training, counseling, and support in all aspects to get through this challenging time, and providing these services, infrastructure, appropriate policy, and the use and support of the medical team's capacity are all required.

Ewing's Sarcoma of Mandible: Practical Approach to a Challenging Case.

As a rare entity, sarcomas of the head and neck are challenging cases. In this paper, we represent a unique case of Ewing sarcoma of mandible, serving as an example of multidisciplinary team importance in a developing country.

Importance of hyperglycemia in COVID-19 intensive-care patients: Mechanism and treatment strategy.

This review reported that coronavirus disease 2019 (COVID-19) infected patients with short time bed rest or quarantine and airway inflammation are at more risk of developing hyperglycemia and insulin resistance. This condition can induce oxidative stress, decrease immune system function, impair endothelial function, induce apoptosis, and reduce antioxidant in the lungs. We provide a possible mechanism in severe COVID-19 patients and recommend treatment strategy to reduce mortality rate and prevent adverse outcomes after intensive care unit (ICU).

Possibility of mixed progenitor cells in sea star arm regeneration.

In contrast to most vertebrates, invertebrate deuterostome echinoderms, such as the sea star Asterias rubens, undergo regeneration of lost body parts. The current hypothesis suggests that differentiated cells are the main source for regenerating arm in sea stars, but there is little information regarding the origin and identity of these cells. Here, we show that several organs distant to the regenerating arm responded by proliferation, most significantly in the coelomic epithelium and larger cells of the pyloric caeca. Analyzing markers for proliferating cells and parameters indicating cell ageing, such as levels of DNA damage, pigment, and lipofuscin contents as well as telomere length and telomerase activity, we suggest that cells contributing to the new arm likely originate from progenitors rather than differentiated cells. This is the first study showing that cells of mixed origin may be recruited from more distant sources of stem/progenitor cells in a sea star, and the first described indication of a role for pyloric caeca in arm regeneration. Data on growth rate during arm regeneration further indicate that regeneration is at the expense of whole animal growth. We propose a new working hypothesis for arm regeneration in sea stars involving four phases: wound healing by coelomocytes, migration of distant progenitor cells of mixed origin including from pyloric caeca, proliferation in these organs to compensate for cell loss, and finally, local proliferation in the regenerating arm.

Diagnosis and treatment of coronavirus disease 2019 (COVID-19): Laboratory, PCR, and chest CT imaging findings.

Since December 2019, more than 3 million cases of coronavirus disease 2019 (COVID-19) and about 200,000 deaths have been reported worldwide. The outbreak of this novel disease has become a global health emergency and continues to rapidly spread around the world. Based on the clinical data, approved cases are divided into four classes including mild, moderate, severe, and critical. About 5% of cases were considered critically ill and 14% were considered to have the severe classification of the disease. In China, the fatality rate of this infection was about 4%. This review focuses on currently available information on the etiology, clinical symptoms, diagnosis, and mechanism of action of COVID-19. Furthermore, we present an overview of diagnostic approaches and treatment of this disease according to available findings. This review paper will help the physician to diagnose and successfully treat COVID-19.

Comparison of the Transient Evoked Otoacoustic Emissions (TEOAEs) and Distortion Products Otoacoustic Emissions (DPOAEs) in Normal Hearing Subjects With and Without Tinnitus.

The aim of this study was to investigate the possible role of cochlear outer hair cell function with TEOAE and DPOAE tests in patients with normal hearing and tinnitus. 25 tinnitus patients with normal hearing sensitivity selected as study group. Control group consist of 50 normal hearing subjects without tinnitus. All subjects had thresholds below 25 dBHL at frequencies 250-8,000 Hz, tympanogram type A and normal acoustic reflex thresholds. TEOAE were recorded with click stimulus at 80 dB SPL at 1,000, 2,000, 3,000 and 4000 Hz. DPOAE were measured at frequencies 1,000-8,000 Hz and intensity of L1 55 dB SPL and L2 65 dB SPL. Amplitude of DPOAE and TEOAE were decreased in all frequencies in study group. There was significant difference regarding prevalence abnormal TEOAE and DPOAE between study group and control group. There was relationship between dysfunction of outer hair cells and tinnitus in subjects with normal hearing.

Spoken and Written Narrative in Persian-Speaking Students Who Received Cochlear Implant and/or Hearing Aid.

OBJECTIVES: To compare narrative skills between fourth and fifth grades of Persian-speaking students with hearing impairments and typical hearing students of the same grade and also to evaluate the effects of group, sex, hearing age, and educational grade of the students on their spoken/written narrative performance. METHODS: The subjects were 174 students aged 10-13 years, 54 of whom wore cochlear implants, 60 suffered from moderate to severe hearing losses and wore hearing aids, with the remaining 60 students being typical hearing in terms of the sense of hearing. The micro- and macrostructure components of spoken and written narrative were elicited from a pictorial story (The Playful Little Elephant) and then scored by raters. RESULTS: Compared to the typical hearing, the students with hearing impairments had significantly lower scores in all of the microstructure components of narratives. However, the findings showed no significant difference among different groups in macrostructure components of narratives. It was also revealed that the students had equal performance in spoken and written narrative. Finally, factor analysis manifested that group, sex, hearing age, and educational level of children might alter the outcome measures in various interactions. CONCLUSION: Although cochlear implantation was more effective than hearing aid on spoken and written narrative skills, the Persian-speaking students with hearing impairments were seen to need additional trainings on microstructure components of spoken/written narrative.

The Effect of Mode of Delivery and Hospital Type on Newborn Hearing Screening Results Using Otoacoustic Emissions: Based on Screening Age.

It is well known that false positive on newborn hearing screening increases cost and maternal anxiety and worry. We aimed to evaluate the influence of mode of delivery (cesarean, vaginal) and hospital type (private, public) on false positives first screening test based on screening age. Identification and control of these factors can reduce the rate of false positives. Overall, 2784 infants were evaluated by otoacoustic emissions test. Hearing screening test was performed before hospital discharge. Finally, rate of the false-positive between both delivery group and hospital types were compared on the basis of screening age. False-positive results are obtained when a condition is not present, but the test results indicate that it is present. False positive rate in the first screening test in vaginal delivery was significantly higher than cesarean delivery and rate of significantly decreased with screening age. This reduction was observed only in cesarean delivery. Also the rate of false positives in public hospital is 2.2 fold higher than private hospital (P = 0.000) and with increase in screening age, the rate of False positive is significantly reduced in private hospitals while this decrease is not observed in public hospital. Screening test be retarded as much as possible in cesarean group and private hospital and be conducted just prior to hospital discharge also in public hospital, screening test are done in a separate room. In this way, false positive can be reduced by about six times and the cost and concerns imposed by the rate of false positives minimized.

Speech Intelligibility in Persian Hearing Impaired Children with Cochlear Implants and Hearing Aids.

The aim of present study is to evaluate and compare speech intelligibility in hearing impaired children with cochlear implants (CI) and hearing aid (HA) users and children with normal hearing (NH). The sample consisted of 45 Persian-speaking children aged 3 to 5-years-old. They were divided into three groups, and each group had 15, children, children with CI and children using hearing aids in Hamadan. Participants was evaluated by the test of speech intelligibility level. Results of ANOVA on speech intelligibility test showed that NH children had significantly better reading performance than hearing impaired children with CI and HA. Post-hoc analysis, using Scheffe test, indicated that the mean score of speech intelligibility of normal children was higher than the HA and CI groups; but the difference was not significant between mean of speech intelligibility in children with hearing loss that use cochlear implant and those using HA. It is clear that even with remarkabkle advances in HA technology, many hearing impaired children continue to find speech production a challenging problem. Given that speech intelligibility is a key element in proper communication and social interaction, consequently, educational and rehabilitation programs are essential to improve speech intelligibility of children with hearing loss.

Total Endoscopic Approach in Glomus Tympanicum Surgery.

INTRODUCTION: Glomus tympanicum (GT) is a benign primary tumor of the middle ear. The evolution of endoscopic ear surgery has allowed for an alternative approach to managing this vascular tumor. The purpose of this study was to evaluate an endoscopic approach in GT surgery, and also to investigate its applicability and feasibility. MATERIALS AND METHODS: Prospectively, 13 class I and II patients, according to the Glasscock-Jackson glomus classification, were candidates for management via a transcanal endoscopic approach. Patients were categorized into three groups according to the location of the tumor in the middle ear. Group A consisted of patients with tumors located anteriorly while occupying the Eustachian tube. Group B were patients with tumors located on the promontory with entirely visible tumor borders. Patients in Group C had tumors that occupied the entire middle ear. Under specially designed flap elevation and hemostasis, the tumors were completely removed using an endoscopic technique. RESULTS: Based on the classification criteria, three patients fell into Group A (30%), six into Group B (46%), and three into Group C (23%). The principal chief complaint was pulsatile tinnitus that disappeared after surgery in most cases. Hearing status was mostly mixed hearing loss. No change was detected in bone conduction after surgery, but air conduction was improved in nine cases. No major complication or recurrence was observed over 30 months of follow up. CONCLUSION: Improved exposure and access in the endoscopic transcanal approach to GT leads to safe, rapid, and reliable tumor removal, as well as allowing comfortable surgery for both the surgeon and most patients.

Auditory processing abilities in children with chronic otitis media with effusion.

CONCLUSION: The study results indicate that children with a history of otitis media with effusion (OME) suffer from auditory processing disorder to some degree. The findings support the hypothesis that fluctuating hearing loss may affect central auditory processing during critical periods. OBJECTIVES: Evidence suggests that prolonged OME in children can result in an auditory processing disorder, presumably because hearing has been disrupted during an important developmental period. A lack of auditory stimulation leads to the abnormal development of the hearing pathways in the brain. The aim of the present study was to determine the effects of OME on binaural auditory function and auditory temporal processing. METHOD: In the present study, the dichotic digit test (DDT) was used for binaural hearing, and the gap in noise (GIN) test was used to evaluate temporal hearing processing. RESULTS: The average values of GIN differed significantly between children with a history of OME and normal controls (p < 0.001). The mean values of the DDT score were significantly different between the two groups (p = 0.002).

Saccular dysfunction in children with sensorineural hearing loss and auditory neuropathy/auditory dys-synchrony.

CONCLUSION: There is a correlation between the AN/AD disorder and the saccular dysfunction in children with severe sensorineural hearing loss, which means that saccular dysfunction can be a concomitant sign of AN/AD. In conclusion, the term of audio-vestibular dys-synchrony (AVS) is a more suitable description for this condition. OBJECTIVES: Patients with auditory neuropathy/auditory dys-synchrony (AN/AD) characteristically demonstrate poor neural responses from the vestibulocochlear nerve and brainstem while displaying evidence of intact outer hair cells function. Therefore, the objective of this study is studying of the relationship of the saccular dysfunction with AN/AD disorder in children with sensorineural hearing loss. METHODS: In this cross-sectional study, 100 children with bilateral severe-to-profound sensorineural hearing losses underwent audiologic tests and cervical vestibular-evoked myogenic potentials (cVEMPs) at the Audiology Department of Hamadan University of Medical Sciences (Hamadan, Iran). RESULTS: Eleven children with bilateral severe sensorineural hearing loss were given to unilateral AN/AD disorder (11 ears), and two children (4 ears) had bilateral AN/AD (total = 13 children). The ears with AN/AD took the form of unrepeatable or absent waves of ABR and presence of OAEs. The statistical analysis of an independent t-test between AN/AD ears as compared to non-AN/AD ears of these 13 children showed that the mean latencies of p13 and the mean latencies of n23 and the mean peak-to-peak amplitude had significant differences.

Diagnostic Performance of Endoscopic and Microscopic Procedures for Identifying Different Middle Ear Structures and Remaining Disease in Patients with Chronic Otitis Media: A Prospective Cohort Study.

BACKGROUND: The diagnostic performance of endoscopic and microscopic procedures for detecting diseases of the middle ear in patients with chronic otitis media (COM) has rarely been investigated. This study was conducted to compare the performance of these procedures for identifying middle ear structures and their associated diseases in COM patients. METHODS: In this prospective cohort study, 58 patients with chronic COM, who were candidates for tympanoplasty with or without a mastoidectomy, were enrolled. Before the surgical intervention, the middle ear was examined via an operating microscope and then through an endoscope to identify the middle ear structures as well as diseases associated with the middle ear. RESULTS: The patients were 15 years of age or older. The anatomical parts of the middle ear - the epitympanic, posterior mesotympanic, and hypotympanic structures - were more visible through an endoscope than through a microscope. In addition, the various segments of the mesotympanum, oval window, round window, and Eustachian tube were more visible via endoscopy. The post-operative endoscopic reevaluation of the middle ear revealed that a cholesteatoma had remained in four of 13 patients after surgery. CONCLUSION: According to the results of this study, in cases in which there is poor visibility with the operating microscope or the surgeon suspects remaining disease within the middle ear, endoscopy could be utilized to improve the evaluation of more hidden middle ear pits and structures, particularly if there is a potentially recrudescent pathology.

Results of Acellular Dermis Matrix graft used for Tympanoplasty in Guinea pig model.

INTRODUCTION: To describe the underlay tympanoplasty technique using an acellular dermal graft(AlloDerm) for tympanic membrane (TM) reconstruction in a guinea pig model and to demonstrate the feasibility of the technique using AlloDerm tissue harvested from the prepuce as a source of tissue for future grafting in human TM reconstruction. MATERIALS AND METHODS: The prepuce was divided during circumcision and the acellular dermis was prepared using a number of standard processes. Two groups of guinea pigs were prepared. In the case group (20 guinea pigs and 40 ears) removal of TM was performed with tympanoplasty using AlloDerm, and in the control group (eight guinea pigs and 16 ears), removal of TM was performed without tympanoplasty. In each group, the TM was completely removed in one ear and partially removed on the other side, and the integrity of the TMs was re-evaluated after 8 weeks. RESULTS: In the case group, the healing rates in the completely and partially removed TMs were 83.3% and 94.4%, respectively. The difference in healing rate (0% and 66.7%, respectively) was statistically significant (P<0.05). CONCLUSION: The use of AlloDerm is safe and effective in the repair of TM perforations in a guinea pig model. Acceptable results of AlloDerm tympanoplasty in a guinea pig model may pave the way for the effective use of this material in human TM reconstructions.

Vowel Production in Persian Deaf Children with Cochlear Implant: is the Age of Implantation an Important Factor?

Proper production of vowels has great significance in speech intelligibility. Evidence shows that cochlear implantation has a significant impact on language and reading abilities in some children immediately after the surgery. The aim of the present study is comparing the quality of 6 simple Persian vowels between two groups of cochlear-implanted children under and over 2 years old. This was a cross-sectional analytic study conducted on 70 children who were implanted under the age of 2, 70 children who were implanted over the age of 2 and 238 normal children as control group. For data analysis, the SFS win acoustic analysis was used. Result of this study showed that F2/i/, f1/e/, f2/e/, f2/∞/, f1/a/, F2/a/, f1/o/, F2/o/and F2/u/means had significant difference between three groups (P < 0.05). Children implanted under the age of 2 showed similar performance as normal children in vowel production. Early cochlear implantation (under the age of 2) affects the quality of simple Persian vowel production significantly as well as the increase of speech intelligibility.