Spoken Language Skills in Children With Bilateral Hearing Aids or Bilateral Cochlear Implants at the Age of Three Years.

OBJECTIVES: Early hearing aid (HA) fitting and cochlear implants (CIs) aim to reduce the effects of hearing loss (HL) on spoken language development. The goals of this study were (1) to examine spoken language skills of children with bilateral HAs and children with bilateral CIs; (2) to compare their language skills to the age-norms of peers with normal hearing (NH); and (3) to investigate factors associated with spoken language outcomes. DESIGN: Spoken language results of 56 Finnish children with HL were obtained from a nationwide prospective multicenter study. Children with HL comprised two groups: children with mild-to-severe HL who used bilateral HAs (BiHA group, n = 28) and children with profound HL who used bilateral CIs (BiCI group, n = 28). Children's spoken language comprehension, expressive and receptive vocabulary, and phonological skills were compared with normative values of children with NH at the age of three years. Odds ratio (OR) was calculated to compare proportions of children below age-norms in BiHA and BiCI groups. Factors associated with spoken language outcomes were modeled with analysis of covariance. RESULTS: At the age of 3 years, 50%-96% of children with HL performed 1 SD or more below the mean of the normative sample of age-peers with NH in spoken language skills, depending on the language domain. Receptive vocabulary and phonological skills were the most vulnerable language domains. In receptive vocabulary, 82% of the children in the BiHA group and 50% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 4.4 times more likely to have poorer receptive vocabulary than the BiCI group. In phonological skills, 96% of children in the BiHA group and 60% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 18.0 times more likely to have poorer phonological skills than the BiCI group. The analysis of covariance models showed that unaided pure-tone average, PTA0.5-4 kHz, had a significant effect on spoken language comprehension in the BiHA group. For the BiCI group, age at HL diagnosis and age at CI activation had a significant effect on expressive vocabulary. High maternal level of education had a significant effect on language comprehension and expressive vocabulary and female gender on phonological skills. CONCLUSIONS: At the age of 3 years, especially receptive vocabulary and phonological skills caused difficulties for children with HL showing also considerable individual variation. Children with bilateral HAs seemed to be more likely to have poorer receptive vocabulary and phonological skills than children with bilateral CIs. A variety of factors was associated with outcomes in both groups. Close monitoring of spoken language skills of children with HL is important for ensuring similar opportunities for all children with HL and timely intervention, when needed.

Development of otology specific outcome measure: Ear Outcome Survey-16 (EOS-16).

PURPOSE: An important outcome measure of patient care is the impact on the patient's health-related quality of life (HRQoL). Current ear-specific HRQoL instruments are designed for one diagnosis and emphasize different subdivisions such as symptoms, hearing problems, psychosocial impact, and the need for care. The optimal length of the recall period has not been studied. For these reasons, a new survey is needed that would cover most chronic ear diseases. METHODS: A preliminary 24-item survey (EOS-24) was created. Untreated adult patients (included n = 186) with one of seven different chronic otologic conditions from all university hospitals in Finland were recruited to respond to EOS-24 and the 15D general HRQoL instrument. The recruiting otologists evaluated the severity of the disease and the disability caused by it. A control group was recruited. Based on the patients' responses in different diagnosis groups, the items were reduced according to pre-defined criteria. The resulting survey was validated using a thorough statistical analysis. RESULTS: The relevance and necessity of the original 24 items were thoroughly investigated, leading to the exclusion of 8 items and the modification of 1. The remaining 16 items were well-balanced between subdivisions and were useful in all seven diagnosis groups, thus constituting the final instrument, EOS-16. The most suitable recall period was three months. CONCLUSIONS: EOS-16 has been created according to the HRQoL survey guidelines with a versatile nationwide patient population. The survey has been validated and can be used for a wide range of chronic ear diseases as a HRQoL instrument.

[Functional examinations of the ear and auditory pathway]. / Mitä korvan ja kuuloratojen toimintatutkimukset kertovat kuulosta?

Hearing is usually examined by means of pure tone and speech audiometry. Alternative examinations are required when the level of hearing defect needs to be more closely defined or hearing is being measured from a patient who is unable to give reliable feedback on a test sound. Neonatal hearing screening involves measuring of otoacoustic emissions generated in the cochlea of the inner ear or brain stem responses formed within the auditory pathway. Immittance measurements are used to evaluate the function of the middle ear. Most commonly used methods include tympanometry probing the mobility of the tympanic membrane and middle ear pressure, and acoustic reflex assessing the functionality of the ossicular chain.

Vowel confusion patterns in adults during initial 4 years of implant use.

This study investigated adult cochlear implant users' (n = 39) vowel recognition and confusions by an open-set syllable test during 4 years of implant use, in a prospective repeated-measures design. Subjects' responses were coded for phoneme errors and estimated by the generalized mixed model. Improvement in overall vowel recognition was highest during the first 6 months, showing statistically significant change until 4 years, especially for the mediocre performers. The best performers improved statistically significantly until 18 months. The poorest performers improved until 12 months and exhibited more vowel confusions. No differences were found in overall vowel recognition between Nucleus24M/24R and Med-ElC40+ device users (matched comparison), but certain vowels showed statistically significant differences. Vowel confusions between adjacent vowels were evident, probably due to the implant users' inability to discriminate formant frequencies. Vowel confusions were also dominated by vowels whose average F1 and/or F2 frequencies were higher than the target vowel, indicating a basalward shift in the confusions.

Morphometric analysis using automated image analysis of CD34-positive vessels in salivary gland acinic cell carcinoma.

CONCLUSIONS: In computer-assisted analysis of acinic cell cancer (ACC) morphological characteristics of CD34 immunoreactivity were detected. Bigger vessel size, vessel irregularity, and lower intensity of CD34-positive vessel staining may indicate unfavorable prognosis. OBJECTIVES: Salivary gland cancer (SGC) is a morphologically diverse group of malignancies, the most common histological types being mucoepidermoid, adenoid cystic and ACC, which has the most favorable prognosis of the three. The aim of this research was to study the applicability of automated image analysis as prognostic criteria in ACC. PATIENTS AND METHODS: In a nationwide study covering SGC patients in Finland during 1991-1996, 34 patients with ACC (15 males, 19 females, aged 19-95 years, mean 55 years) were included. Parameters were measured from CD34-stained samples. RESULTS: In all, 10 385 vessels were measured, of which 9873 were from specimens from patients who were alive 5 years after treatment (n=32, group I) and 512 were from patients who died of disease (n=2, group II). The following results were found in group II versus group I: mean vessel size 469 microm vs 272 microm (p=0.024); vessel irregularity 28.3 microm vs 22.3 microm (p<0.001); CD34 staining intensity 0.555 microm vs 0.584 microm (p=0.024).

Stage-dependent expression of an angiogenic agent and vascular organization in experimental skin tumor development.

Increased angiogenesis and expression of antibodies to vascular endothelial growth factor (VEGF), an angiogenic agent, have been shown in the tumor development of many tissues. Areas of skin expressing VEGF and total volume of vessels expressing laminin in the wall were measured in chemical carcinogen-exposed mice using CAS-200 morphometry apparatus having a sensitivity exceeding 99% and reproducibility exceeding 99%. The area of VEGF expression was increased in carcinogen-exposed skin, dysplasia and in well-differentiated squamous cell carcinomas, but decreased in squamous cell carcinomas with decreased degree of differentiation. The vessel volume increased prior to the formation of tumors in carcinogen-exposed skin as well as in highly malignant neoplasms. In well-differentiated squamous cell carcinomas with an expansive growth pattern, the vessels were parallel to the basal membrane, in moderately differentiated tumors the vessels were in the direction of tumor invasion, and in poorly differentiated tumors, active angiogenesis consisted of numerous, enlarged vessels within the tumor. This study showed increased VEGF expression and number of vessels occurring in early stages of skin tumor development, pointing to a role of angiogenesis in chemical risk assessment and in cancer prevention. Altered vessel structure and vessel arrangement were distinct in later stages of tumor growth and in malignant neoplasms, pointing to the utility of detailed vessel analysis in neoplasm characterization.

Automated image analysis of proliferating cells in carcinoma of the larynx.

OBJECTIVE: To determine the role of cell proliferation neoplastic progression in the larynx and possibly derive criteria of clinical significance using automated quantitative image analysis. MATERIAL AND METHODS: In a retrospective study involving archival material, the occurrence and location, size, shape and staining intensity of proliferating cell nuclear antigen (PCNA)-positive cells (12,538 cells in total) were analyzed in squamous cell carcinoma (SCC), as well as in pre- and non-neoplastic conditions, using computer-assisted morphometry with reproducibility and sensitivity exceeding 99%. RESULTS: Immunohistochemically detectable PCNA-positive cells were located in the basal layer in non-neoplastic states, in well-differentiated SCCs in layers adjacent to the basal membrane and in poorly differentiated neoplasms in the neoplastic epithelial islets. An increased degree of dysplasia was associated with an increased number of PCNA-immunoreactive cells of increased nuclear size and staining intensity. There was a significant difference between carcinomas and dysplasia in terms of altered nuclear shape. With increasing malignancy of SCCs, nuclear shape alterations and PCNA staining intensity increased, whilst nuclear size decreased. CONCLUSIONS: Automated image analysis of cell populations allowed the identification of populations of malignant cells and provided information on the severity of preneoplastic and neoplastic conditions of use in studies of tumor behavior and with potential clinical application.