Effects of Body Position on Cochlear Function in Infants: An Otoacoustic Emission Study.

Background: Otoacoustic Emission (OAE) is frequently recorded in various body positions for infants. However, little is available about whether these deviations will produce non-pathological effects on the clinical results. The current study assessed body position's effect on infants' inner ear function. Methods: Sixty normally hearing infants participated in an analytical cross-sectional study. Distortion-product OAEs (DPOAEs) were measured in the supine, side-lying, and upright positions. The DPOAE amplitude and signal-to-noise ratio (SNR) were recorded across the 1500 to 6000 Hz range. Results: The mean DPOAE amplitude and SNR values were significantly greater in the upright position than supine and side-lying positions (p < 0.05). These differences were more pronounced in the 3000 to 6000 Hz range. The effects of gender and ear asymmetry on DPOAEs were not statistically significant. Conclusion: Our findings suggested that the upright position could be regarded as the best position for assessing DPOAEs in infants.

PEPS: Polygenic Epistatic Phenotype Simulation.

Genetic data is limited and generating new datasets is often an expensive, time-consuming process, involving countless moving parts to genotype and phenotype individuals. While sharing data is beneficial for quality control and software development, privacy and security are of utmost importance. Generating synthetic data is a practical solution to mitigate the cost, time and sensitivities that hamper developers and researchers in producing and validating novel biotechnological solutions to data intensive problems. Existing methods focus on mutation frequencies at specific loci while ignoring epistatic interactions. Alternatively, programs that do consider epistasis are limited to two-way interactions or apply genomic constraints that make synthetic data generation arduous or computationally intensive. To solve this, we developed Polygenic Epistatic Phenotype Simulator (PEPS). Our tool is a probabilistic model that can generate synthetic phenotypes with a controllable level of complexity.

Novel Alzheimer's disease genes and epistasis identified using machine learning GWAS platform.

Alzheimer's disease (AD) is a complex genetic disease, and variants identified through genome-wide association studies (GWAS) explain only part of its heritability. Epistasis has been proposed as a major contributor to this 'missing heritability', however, many current methods are limited to only modelling additive effects. We use VariantSpark, a machine learning approach to GWAS, and BitEpi, a tool for epistasis detection, to identify AD associated variants and interactions across two independent cohorts, ADNI and UK Biobank. By incorporating significant epistatic interactions, we captured 10.41% more phenotypic variance than logistic regression (LR). We validate the well-established AD loci, APOE, and identify two novel genome-wide significant AD associated loci in both cohorts, SH3BP4 and SASH1, which are also in significant epistatic interactions with APOE. We show that the SH3BP4 SNP has a modulating effect on the known pathogenic APOE SNP, demonstrating a possible protective mechanism against AD. SASH1 is involved in a triplet interaction with pathogenic APOE SNP and ACOT11, where the SASH1 SNP lowered the pathogenic interaction effect between ACOT11 and APOE. Finally, we demonstrate that VariantSpark detects disease associations with 80% fewer controls than LR, unlocking discoveries in well annotated but smaller cohorts.

Relationship Between Vocal Fatigue Index and Acoustic Voice Scales in Patients With Coronavirus Infection.

OBJECTIVES: The voice quality of patients with Coronavirus Disease 2019 (COVID-19) seems to be affected due to lower and upper respiratory involvement. Patient-based voice assessment scales are important clinical measures to diagnose voice disorders and monitor treatment outcomes in COVID-19 patients. This study compared vocal fatigue between COVID-19 patients and those with normal voices. Furthermore, the relationship between vocal fatigue and acoustic voice parameters of COVID-19 patients was evaluated. METHODS: This cross-sectional study enrolled 30 laboratory-confirmed patients with COVID-19 (18 males and 12 females) and 30 healthy individuals with normal voices (14 males and 16 females) to compare their respiratory or phonatory parameters. The Persian versions of the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) and the vocal fatigue index (VFI) were conducted before and after reading the text. The Jitter, shimmer, maximum phonation time, and harmonic-to-noise ratio (HNR) were analyzed by Praat software based on the recorded voices of CAPE-V tasks. The acoustic assessment and VFI questionnaire results were compared between COVID-19 patients and the control group. RESULTS: There were significant differences between COVID-19 patients and their healthy counterparts in all VFI subscales (P < 0.001). Moreover, after reading the text, we found significant differences between the two groups regarding Jitter, shimmer, and HNR of /a/ and /i/ vowels (P < 0.05). Our findings also indicated a significant correlation between symptom improvement with rest and acoustic parameters in all tasks, except the Jitter of /a/ before reading the text. CONCLUSION: Patients with COVID-19 showed significantly more vocal fatigue than people with normal voices after reading the text. Moreover, there was a significant relationship between Jitter, shimmer, and HNR and the tiredness of voice and physical discomfort subscales of VFI.

Cochlear Implantation Outcomes in Pediatrics with Inner Ear Malformations in a Tertiary Care Hospital in Ahvaz.

Cochlear implantation (CI) has been successful in individuals with sensorineural hearing loss (SNHL) over the last few years. This study assessed the auditory and speech performance results of pediatrics with inner ear malformations (IEMs) following cochlear implantation at the Ahvaz cochlear implantation center and compared the outcomes of various malformations. All pediatrics with IEMs undergoing CI were included in the study. This retrospective study was performed on pediatrics with congenital IEMs who underwent cochlear implantation in Ahvaz cochlear implantation center between 2014 and 2019. The Category of Auditory Performance (CAP) and the Speech Intelligibility Rating (SIR) scores are two of the most frequently administered tests. The CAP with ranging from 0 (displays no awareness of environmental sounds) to 7 (can use the telephone with a familiar talker), was used to measure the speech perception performance of the implanted children. Furthermore, SIR consists of five performance categories ranging from "prerecognizable words in spoken language" to "connected speech is intelligible to all listeners". Finally, the study included 22 patients. The evaluation of the CT-Scan revealed three types of inner ear malformation: Incomplete Partition (IP)-I in 2 (9.1%), IP-II in 12 (54.5%), and common cavity in 8 (36.4%) individuals. The results were shown that the median CAP score preoperative was 0.5 (interquartile range (IQR): 0-2) and postoperative was 3.5 (IQR: 3-7). There were statistically significant differences in CAP scores between preoperative and second-year follow-up postoperative (p value = 0.036). The results were shown that the median SIR score preoperative was 1 (IQR: 1-5) and postoperative was 2 (IQR: 1-5). There were statistically significant differences in SIR scores between preoperative and second-year follow-up postoperative (p value = 0.001). Following a thorough preoperative screening, patients with specific IEMs can be candidates for CI and not a contraindication. There were statistically significant differences in CAP and SIR scores between preoperative and second-year follow-up postoperative in the common cavity and IP-II groups.

Complications and outcomes of cochlear implantation in children younger than 12 months: A multicenter study.

OBJECTIVES: Evidence suggests that Cochlear Implantation (CI) is a beneficial approach for auditory and speech skills improvement in children with severe to profound hearing loss. However, it remains controversial if implantation in children <12 months is safe and effective compared to older children. The present study aimed to determine whether children's ages affect surgical complications and auditory and speech development. METHODS: The current multicenter study enrolled 86 children who underwent CI surgery at <12 months of age (group A) and 362 children who underwent implantation between 12 and 24 months of age (group B). The Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores were determined pre-impanation, and "one-year" and "two-year" post-implantation. RESULTS: All children had full insertions of the electrode array. Four complications (overall rate: 4.65%; three minor) occurred in group A and 12 complications (overall rate: 4.41%; nine minor) occurred in group B. We found no statistically significant difference in the complication rates between the groups (p > 0.05). The mean SIR and CAP scores improved over time following CI activation in both groups. However, we did not find significant differences in CAP and SIR scores between the groups across different time points. CONCLUSION: Cochlear implantation in children younger than 12 months is a safe and efficient procedure, providing substantial auditory and speech benefits. Furthermore, rates and nature of minor and major complications in infants are similar to those of children undergoing the CI at an older age.

Age-related changes in auditory temporal processing assessed using forward masking.

One of the main complaints of older adults is difficulty understanding speech in noise. For older adults with audiometric thresholds within the normal range this difficulty may partly reflect deficits in temporal processing. The purpose of this study was to evaluate the effect of age on the rate of recovery from forward masking. There were seven young participants (four females; mean age 26 years) and seven older participants (six females; mean age 62 years) with normal audiometric thresholds, designated YNH and ONH groups. Signal frequencies of 500, 1000, 2000, and 4000 Hz were used. The level of the 20-ms signal was fixed at 15 dB SL for each participant and frequency. The 200-ms masker was a band of noise centered at the signal frequency with a bandwidth equal to the center frequency. The masker level was varied to determine the masker-to-signal ratio (MSR) required for threshold for masker-signal intervals (MSIs) of 5, 10, 20, 30, and 50 ms. The MSRs were smaller for the ONH group than for the YNH group, perhaps indicating lower processing efficiency for the former. Importantly, there was a significant interaction between MSI and the group. The change in MSR with increasing MSI was greater for the YNH than for the ONH group, indicating poorer temporal resolution for the latter.

The effects of cochlear implantation on middle ear function: A prospective study.

OBJECTIVES: Although sound conduction mechanisms may influence by cochlear implantation (CI), it is not very clear whether, how, and to what extent these mechanisms may be influenced the pediatric population. Wideband tympanometry (WBT) is a sensitive tool to evaluate alternations in the middle ear mechanics in a wide frequency range. The current study aimed to explore CI's impacts on sound conduction across the middle ear cavity using WBT in pediatrics. METHODS: In a prospective design, 35 unilaterally implanted children (<24 months of age) with normal temporal bone anatomy were included in this study. Traditional tympanometry (226-Hz) and WBT measures were compared for each child in the implanted and non-implanted ears preoperatively and three months postoperatively. RESULTS: No significant changes in the "static acoustic admittance" and "peak pressure" parameters were observed between the pre-CI and post-CI conditions in the implanted and non-implanted ears in the 226-Hz tympanometry test. Wideband absorbance recordings before CI surgery exhibited a double-peaked pattern over a frequency range of 250 to 8000 Hz. The pre- and postoperative acoustic energy absorbance comparisons indicated a significantly reduced mid-frequency (1260 to 3175 Hz) and high-frequency (5040 to 8000 Hz) absorbance in the implanted ears. However, our results indicated no significant differences in sound absorbance between the pre- and postoperative conditions in non-implanted ears. CONCLUSION: Our findings suggested that WBT is a more sensitive method than traditional tympanometry for monitoring the mechanical status of the middle ear after cochlear implantation in pediatrics. Cochlear implantation in young children can significantly reduce mid- and high-frequency acoustic absorbance measured by WBT.

Vestibular rehabilitation therapy in combination with transcranial direct current stimulation (tDCS) for treatment of chronic vestibular dysfunction in the elderly: a double-blind randomized controlled trial / Terapia de reabilitação vestibular em combinação com estimulação transcraniana por corrente contínua (ETCC) para o tratamento de disfunção vestibular crônica em idosos: um ensaio clínico duplo‐cego randomizado

Abstract Introduction Dizziness and imbalance are common dysfunctions in the elderly. Vestibular rehabilitation therapy is an effective method to alleviate chronic dizziness in patients with vestibular dysfunction. Transcranial direct current stimulation has reportedly improved balance function in patients with vestibular dysfunction. Objective This study was conducted to investigate the therapeutic efficacy of vestibular rehabilitation combined with transcranial direct current stimulation in elderly patients with vestibular dysfunction. Methods In a double-blinded randomized controlled trial, 36 elderly patients with chronic vestibular dysfunction were randomly assigned to either vestibular rehabilitation and transcranial direct current stimulation (n = 18) or vestibular rehabilitation alone (n = 18) group. The transcranial stimulation protocol consisted of multisession bifrontal electrical stimulation of the dorsolateral prefrontal cortex (2 mA intensity and 20 min duration), followed by rehabilitation exercises. The vestibular rehabilitation protocol consisted of habituation and adaptation exercises combined with gait exercises during a three week period. The primary outcome of this study was the dizziness handicap inventory score, and the secondary outcomes were activities-specific balance confidence and Beck anxiety inventory scores. Results For the dizziness handicap score, the repeated-measures analysis of variance showed a significant main effect of "time", "stimulation" and stimulation × time interaction effect. There was a significant reduction in the overall dizziness handicap score with "time" for both the groups, which was more pronounced in the vestibular rehabilitation and electrical stimulation group. In terms of activities-specific balance confidence change scores, we found a significant main effect of "time" and "stimulation" main factors, but this effect for stimulation × time interaction was not significant. For the Beck anxiety score, we observed a significant main effect of "time", but no evidence for the main effect of the "stimulation" factor. Conclusion Bifrontal transcranial direct current stimulation in combination with vestibular rehabilitation therapy is a promising approach to improve chronic vestibular symptoms in the elderly.

Resumo Introdução Tontura e desequilíbrio são disfunções comuns em idosos. A terapia de reabilitação vestibular é um método eficaz para o alívio da tontura crônica em pacientes com disfunção vestibular. A estimulação transcraniana por corrente contínua tem melhorado a função de equilíbrio em pacientes com disfunção vestibular. Objetivo Investigar a eficácia terapêutica da reabilitação vestibular combinada com a estimulação transcraniana por corrente contínua em pacientes idosos com disfunção vestibular. Método Em um estudo duplo‐cego randomizado e controlado, 36 idosos com disfunção vestibular crônica foram aleatoriamente designados para o grupo reabilitação vestibular e estimulação transcraniana por corrente contínua (n = 18) ou reabilitação vestibular isolada (n = 18). O protocolo de estimulação transcraniana consistiu em estimulação elétrica bifrontal multissessão do córtex pré‐frontal dorsolateral (intensidade de 2 mA e duração de 20 minutos), seguida de exercícios de reabilitação. O protocolo de reabilitação vestibular consistiu em exercícios de habituação e adaptação combinados com exercícios de marcha por um período de três semanas. O desfecho primário deste estudo foi o escore do dizziness handicap inventory e os desfechos secundários foram os escores da escala activities‐specific balance confidence e Beck anxiety inventory. Resultados Em relação ao escore do dizziness handicap inventory, a análise de variância de medidas repetidas mostrou um efeito principal significativo do efeito de interação do "tempo", "estimulação"' e estimulação x tempo. Houve redução significativa do escore geral do dizziness handicap com o "tempo" em ambos os grupos, foi mais pronunciada no grupo reabilitação vestibular e estimulação elétrica. Em relação à mudança nos escores do activities‐specific balance confidence, encontramos um efeito principal significativo dos fatores principais de "tempo" e "estimulação", mas esse efeito não foi significativo para a interação estimulação × tempo. Para o escore do Beck anxiety inventory, observamos um efeito principal significativo do "tempo", mas nenhuma evidência do efeito principal do fator "estimulação". Conclusão A estimulação transcraniana por corrente contínua bifrontal em combinação com a terapia de reabilitação vestibular é uma abordagem promissora para melhorar os sintomas vestibulares crônicos em idosos.

Progression of Contralateral Hearing Loss in Patients with Unilateral Ear Involvement: A Scoping Review.

BACKGROUND: Progression of contralateral hearing loss following otologic and neuro-otologic surgeries is a distressing and rare complication. The aim of this study was to systematically review the suspected etiologies and audiological findings in adults who experienced contralateral hearing loss. METHODS: PubMed/MEDLINE, PsycINFO, CINAHL, ISI Web of Science, Cochrane Library, EMBASE, and Scopus databases were searched for this scoping review. The current review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. No limits were placed on language or year of publication. RESULTS: Of a total of 46 studies, 43 studies met the inclusion criteria reporting contralateral hearing loss. The included studies were classified into 3 different categories: contralateral hearing loss after skull base surgeries (n=21), contralateral hearing loss after middle ear surgeries (n=17), and contralateral hearing loss after traumatic lesions (n=5). The cerebrospinal fluid leakage and drill-generated noise were reported as the most reported etiology of contralateral hearing loss following skull base and middle ear surgeries, respectively. The onset of contralateral hearing loss varied from immediately to 18 months after surgery. The severity of contralateral hearing loss varied from a slight to a profound degree of hearing loss. CONCLUSION: Our results highlighted that contralateral hearing loss should be considered following the skull base and middle ear surgeries. Furthermore, this rare complication should be noticed after traumatic lesions.

The Outcome of Cochlear Implantations in Deaf-Blind Patients: A Multicenter Observational Study.

OBJECTIVE: This multicenter study aimed to evaluate the auditory and speech outcomes of cochlear implantation (CI) in deaf-blind patients compared with deaf-only patients. STUDY DESIGN: Retrospective cohort study. SETTING: Multiple cochlear implant centers. PATIENTS: The current study was conducted on 17 prelingual deaf-blind children and 12 postlingual deaf-blind adults who underwent CI surgery. As a control group, 17 prelingual deaf children and 12 postlingual deaf adults were selected. INTERVENTION: Cochlear implantation. MAIN OUTCOME MEASURES: Auditory and linguistic performances in children were assessed using the categories of auditory performance (CAP) and Speech Intelligibility Rating (SIR) scales, respectively. The word recognition score (WRS) was also used to measure speech perception ability in adults. The mean CAP, SIR, and WRS cores were compared between the deaf-only and deaf-blind groups before CI surgery and at "12 months" and "24 months" after device activation. Cohen's d was used for effect size estimation. RESULTS: We found no significant differences in the mean CAP and SIR scores between the deaf-blind and deaf-only children before the CI surgery. For both groups, SIR and CAP scores improved with increasing time after the device activation. The mean CAP scores in the deaf-only children were either equivalent or slightly higher than those of the deaf-blind children at "12 months post-CI" (3.94 ± 0.74 vs 3.24 ± 1.25; mean difference score, 0.706) and "24 months post-CI" (6.01 ± 0.79 vs 5.47 ± 1.06; mean difference score, 0.529) time intervals, but these differences were not statistically significant. The SIR scores in deaf-only implanted children were, on average, 0.870 scores greater than the deaf-blind children at "12 months post-CI" (2.94 ± 0.55 vs 2.07 ± 1.4; p = 0.01, d = 0.97) and, on average, 1.067 scores greater than deaf-blind children at "24 months post-CI" (4.35 ± 0.49 vs 3.29 ± 1.20; p = 0.002; d = 1.15) time intervals. We also found an improvement in WRS scores from the "preimplantation" to the "12-month post-CI" and "24-month post-CI" time intervals in both groups. Pairwise comparisons indicated that the mean WRS in the deaf-only adults was, on average, 10.61% better than deaf-blind implanted adults at "12 months post-CI" (62.33 ± 9.09% vs 51.71 ± 10.73%, p = 0.034, d = 1.06) and, on average, 15.81% better than deaf-blind adults at "24-months post-CI" (72.67 ± 8.66% vs 56.8 ± 9.78%, p = 0.002, d = 1.61) follow-ups. CONCLUSION: Cochlear implantation is a beneficial method for the rehabilitation of deaf-blind patients. Both deaf-blind and deaf-only implanted children revealed similar auditory performances. However, speech perception ability in deaf-blind patients was slightly lower than the deaf-only patients in both children and adults.

Parent's Satisfaction of Universal Newborn Hearing Screening Program in Iran.

Measuring parent satisfaction is an important factor in pediatric health care service programs because parents play a major role in their child's life. The parental decisions are a basis for the success or failure of the child's treatment in many cases. The purpose of this study was to determine levels of parents' satisfaction following the implementation of universal newborn hearing screening (UNHS) program in Iran. In this study, the Persain version of the parent satisfaction questionnaire with neonatal hearing screening program (PSQ-NHSP) was used to measure parents' satisfaction on information of newborn hearing screening program, personnel in charge of the hearing testing, hearing screening activities, and overall satisfaction. Newborns were screened using transient evoked otoacoustic emissions and automatic auditory brainstem response tests within the first 48 h of life for each ear. Of the 312 questionnaires distributed, 217 parents (67%) responded. The mean scores of the "overall satisfaction" items ranged from 4.07 to 4.29, demonstrating high levels of parent satisfaction with this aspect of the program. More than 86% of parents were overally satisfied with the hearing screening program. In open-ended items, 84% of parents comments showed their satisfaction. The findings of the present study revealed that parents were generally satisfied with the UNHS program. The PSQ-NHSP questionnaire is easily employed and effective method for assessing parental satisfaction with newborn hearing screening programs.

Data-driven platform for identifying variants of interest in COVID-19 virus.

New SARS-CoV-2 variants emerge as part of the virus' adaptation to the human host. The Health Organizations are monitoring newly emerging variants with suspected impact on disease or vaccination efficacy as Variants Being Monitored (VBM), like Delta and Omicron. Genetic changes (SNVs) compared to the Wuhan variant characterize VBMs with current emphasis on the spike protein and lineage markers. However, monitoring VBMs in such a way might miss SNVs with functional effect on disease. Here we introduce a lineage-agnostic genome-wide approach to identify SNVs associated with disease. We curated a case-control dataset of 10,520 samples and identified 117 SNVs significantly associated with adverse patient outcome. While 40% (47) SNV are already monitored and 36% (43) are in the spike protein, we also identified 70 new SNVs that are associated with disease outcome. 31 of these are disease-worsening and predominantly located in the 3'-5' exonuclease (NSP14) with structural modelling revealing a concise cluster in the Zn binding domain that has known host-immune modulating function. Furthermore, we generate clade-independent VBM groupings by identifying interacting SNVs (epistasis). We find 37 sets of higher-order epistatic interactions joining 5 genomic regions (nsp3, nsp14, Spike S1, ORF3a, N). Structural modelling of these regions provides insights into potential mechanistic pathways of increased virulence as well as orthogonal methods of validation. Clade-independent monitoring of functionally interacting (epistasis, co-evolution) SNVs detected emerging VBM a week before they were flagged by Health Organizations and in conjunction with structural modelling provides faster, mechanistic insight into emerging strains to guide public health interventions.

Acoustic Voice Analysis in Postlingual Deaf Adult Cochlear Implant Users: A Within-Group Comparison Study.

OBJECTIVES: Cochlear implantation (CI) improves the quality of voice and speech output. However, there are various factors that may interfere with the use of CI to accede desirable voice outcomes. The primary aim of the current study was first to measure three acoustic voice outcomes in postlingual deaf adult CI users who were Persian-speaking, and then, to compare these according to surgery- and auditory-related factors. Of interest was also to determine whether these acoustic measures were influenced by surgery- and auditory-related factors. METHODS: A number of 113 postlingual deaf adults with CI were recruited. The voice samples were recorded in the same silent room to equalize the noise of the environment. The measures of interest were analyzed with the Praat software. RESULTS: Our findings revealed that time duration of CI use (P ≤ 0.008), pattern of deafness onset (P ≤ 0.011), and the interaction between them (P ≤ 0.022) significantly affected all vocal parameters. This means that the quality of voice was significantly better in the participants using CI for more than 2 years than in those using CIs for less than 2 years. On the other hand, patients suffering sudden postlingual deafness for less than 2 years had the best acoustic voice parameters compared with those suffering gradual postlingual deafness for more than 2 years. CONCLUSIONS: Some of the surgery- and auditory-related factors could be the reason for changes of voice parameters in postlingual deaf adult CI users.

Auditory-Perceptual Evaluation of Vocal Characteristics in Patients with the New Coronavirus Disease 2019.

INTRODUCTION: Due to the upper and lower respiratory involvement in coronavirus disease 2019 (COVID-19), the voice quality of these patients is expected to be impaired. In this study, we aimed to conduct an auditory-perceptual evaluation of the vocal characteristics of patients with different severities of COVID-19. METHODS: One hundred two patients with mild, moderate, or severe COVID-19 as well as 30 healthy individuals were recruited to compare their respiratory/phonatory parameters. The Persian version of the CAPE-V and GRBAS scales, along with the maximum phonation time and s/z ratio values were used to evaluate the severity of respiratory/phonatory disorders during verbal tasks in the participants. RESULTS: Significant differences were found between the subgroups of patients and their healthy counterparts in all respiratory/phonatory parameters (p ≤ 0.03) except the s/z ratio (p = 0.81). CONCLUSIONS: Based on auditory-perceptual assessments, patients with COVID-19 showed dysphonia. The severity of dysphonia was significantly different among patients with different severities of COVID-19. Smoking can also play a significant role in vocal dysfunction in COVID-19 patients.

Vestibular rehabilitation therapy in combination with transcranial direct current stimulation (tDCS) for treatment of chronic vestibular dysfunction in the elderly: a double-blind randomized controlled trial.

INTRODUCTION: Dizziness and imbalance are common dysfunctions in the elderly. Vestibular rehabilitation therapy is an effective method to alleviate chronic dizziness in patients with vestibular dysfunction. Transcranial direct current stimulation has reportedly improved balance function in patients with vestibular dysfunction. OBJECTIVE: This study was conducted to investigate the therapeutic efficacy of vestibular rehabilitation combined with transcranial direct current stimulation in elderly patients with vestibular dysfunction. METHODS: In a double-blinded randomized controlled trial, 36 elderly patients with chronic vestibular dysfunction were randomly assigned to either vestibular rehabilitation and transcranial direct current stimulation (n = 18) or vestibular rehabilitation alone (n = 18) group. The transcranial stimulation protocol consisted of multisession bifrontal electrical stimulation of the dorsolateral prefrontal cortex (2 mA intensity and 20 min duration), followed by rehabilitation exercises. The vestibular rehabilitation protocol consisted of habituation and adaptation exercises combined with gait exercises during a three week period. The primary outcome of this study was the dizziness handicap inventory score, and the secondary outcomes were activities-specific balance confidence and Beck anxiety inventory scores. RESULTS: For the dizziness handicap score, the repeated-measures analysis of variance showed a significant main effect of "time", "stimulation" and stimulation × time interaction effect. There was a significant reduction in the overall dizziness handicap score with "time" for both the groups, which was more pronounced in the vestibular rehabilitation and electrical stimulation group. In terms of activities-specific balance confidence change scores, we found a significant main effect of "time" and "stimulation" main factors, but this effect for stimulation × time interaction was not significant. For the Beck anxiety score, we observed a significant main effect of "time", but no evidence for the main effect of the "stimulation" factor. CONCLUSION: Bifrontal transcranial direct current stimulation in combination with vestibular rehabilitation therapy is a promising approach to improve chronic vestibular symptoms in the elderly.

Vestibular Hypersensitivity in Patients with Chronic Noise Exposure.

It has been demonstrated that high-intensity noise exposure adversely affects the human balance function. The Tullio phenomenon (TP) refers to sound-induced imbalance which is resulted from hypersensitivity of vestibular end organs to normal acoustic stimuli. Although different etiologies have been attributed to TP, evidence on the role of excessive noise exposure in the development of this symptom is limited. The present study aims to assess the vestibular functions in patients manifesting TP symptom who were exposed to long-term excessive noise levels. This was an analytic cross-sectional study conducted on 17 males diagnosed with TP with a history of chronic noise-induced hearing loss (TP group) and 17 healthy individuals. All subjects in both groups underwent complete otological, videonystagmography (VNG), and cervical vestibular myogenic potential (cVEMP) assessments. The most common complaint in TP subjects was vertigo and imbalance. During the VNG assessment, we found abnormal positional nystagmus and caloric irrigation (vestibular hyperfunction) results in 4 (23.53%) and 9 (52.94%) patients, respectively. Seven (41.17%) patients indicated cVEMP thresholds which were abnormally lower than the normal values ( ≤ 70 dB HL). However, when both VNG and cVEMP results were considered together, the abnormal rate reached 70.58% (12 of 17 cases). Our findings showed that both the semicircular canal as well as otolith stuctures could be affected in TP patients with a history of chronic noise exposure.

The priority of audiological procedures during the COVID-19 pandemic.

Since the discovery of coronavirus disease 2019 (COVID-19), which started in Wuhan, China, the epidemic has not only swept through China but also spread throughout the world in spite of the concerted attempts from the governments to contain it. Thus, prevention and control of COVID-19 infection is very effective in ensuring the safety of medical specialists, health care workers, and patients. Audiology clinics are also crucial in the fight against the infection epidemic, as audiologists provide their diagnostic and rehabilitative services in an environment with different contaminated objects that come in either direct or indirect contact with multiple patients. The current article explains the importance of infection control in audiology and priority setting for audiologic evaluation in COVID-19 pandemic.

Fast and accurate exhaustive higher-order epistasis search with BitEpi.

Complex genetic diseases may be modulated by a large number of epistatic interactions affecting a polygenic phenotype. Identifying these interactions is difficult due to computational complexity, especially in the case of higher-order interactions where more than two genomic variants are involved. In this paper, we present BitEpi, a fast and accurate method to test all possible combinations of up to four bi-allelic variants (i.e. Single Nucleotide Variant or SNV for short). BitEpi introduces a novel bitwise algorithm that is 1.7 and 56 times faster for 3-SNV and 4-SNV search, than established software. The novel entropy statistic used in BitEpi is 44% more accurate to identify interactive SNVs, incorporating a p-value-based significance testing. We demonstrate BitEpi on real world data of 4900 samples and 87,000 SNPs. We also present EpiExplorer to visualize the potentially large number of individual and interacting SNVs in an interactive Cytoscape graph. EpiExplorer uses various visual elements to facilitate the discovery of true biological events in a complex polygenic environment.

Cortical Auditory Plasticity Following Cochlear Implantation in Children With Auditory Neuropathy Spectrum Disorder: A Prospective Study.

OBJECTIVES: The cortical auditory evoked potential (CAEP) can provide an insight into the maturation of the central auditory nervous system by recording the auditory cortex responses to speech stimuli. This study aimed to explore the central auditory system development in children with auditory neuropathy spectrum disorder (ANSD) using cochlear implants (CIs) and to find the correlation of CAEP biomarkers with speech perception. METHODS: This study was performed on 23 children with prelingual deafness, diagnosed with ANSD, as well as 23 children with prelingual deafness, without ANSD as the control group. All children underwent unilateral CI before the age of 3 years. Children with ANSD were classified into two groups, based on their CAEP results prior to implantation: children with a clear CAEP response (ANSD-I) and children without an identifiable CAEP (ANSD-II). The P1 component of CAEPs and speech intelligibility rating (SIR) were recorded before the initial device activation (baseline) and at 6, 12, and 24 months postimplantation. RESULTS: The P1 CAEP responses were present in all children in the control group, while they were recorded in only 52% of ANSD children before the CI surgery. The longitudinal analysis revealed a significant reduction in the P1 latency and a significant improvement in the P1 amplitude across different time points in all study groups. However, the P1 latency and P1 amplitude were significantly shorter and larger in the control group than the ANSD group, respectively. Also, children in the ANSD-I group exhibited a slightly shorter P1 latency, a larger P1 amplitude, and a higher SIR score than the ANSD-II group after 2 years of follow-up. The P1 CAEP latency was significantly correlated with the SIR score. CONCLUSION: The CAEP can be used as an objective indicator of auditory cortical maturation and a predictor of speech perception performance in implanted children with ANSD.