Development of Digit in Noise Test in Hindi.

BACKGROUND: The digit in the noise test is a simple hearing screening tool that can identify hearing loss at the early stage. This screening tool takes less time than traditional pure-tone audiometry. There is a scarcity of hearing health professionals with few resources for carrying out hearing screening on a large scale in India. Hence, a hearing screening tool for the Hindi-speaking population is needed. AIM AND OBJECTIVE: The study aimed to develop and validate the Digit in Noise test in Hindi (DIN-H). METHODS: A native Hindi female speaker recorded single digits from 1 to 9 made into triplet combinations, which were binaurally presented to 20 normal hearing subjects having hearing thresholds less than 25 dBHL from 250 to 8000 Hz in the presence of broadband speech-shaped noise. The digit triplets were homogenized using speech intelligibility function for similar difficulty levels across stimuli. The homogenized stimuli were evaluated by obtaining the Speech Recognition Threshold (SRT) of 20 normal hearing subjects. RESULTS: The Mean SRT was - 10.4 and - 11.3 dB before and after homogenization. A strong positive correlation existed between test and retest SRTs (0.78). Mean SRT and slope obtained before and after optimization were comparable to other languages like Korean and English. This test can act as a reliable screening tool for assessing individuals. The test was administered to 106 normal hearing participants. The 95th percentile of the SRT value obtained was - 5.6 dB, which was kept as a cut-off score for the screening test. CONCLUSION: DIN-H can be used as a screening tool for assessing the integrity of the auditory system on a large scale in less time for the Hindi-speaking population.

"The impact of orthognathic surgery on articulation proficiency and speech intelligibility in skeletal Class III malocclusion: 18 months follow up".

Introduction: Orthognathic surgery results in the positional change of the maxilla and mandible that may affect speech. The present study evaluated the effect of combined maxillary advancement and mandibular setback surgery on articulation proficiency and speech intelligibility in patients with non-syndromic skeletal Class III malocclusion. Methods: In this prospective study, twenty-five patients with skeletal class III malocclusion and consecutively treated with Lefort-1 maxillary advancement and mandibular setback (BSSO) orthognathic surgery were included in this study. The speech sample was recorded with a digital audio tape recorder one day before surgery and at 3, 6, 9, 12 and 18 months after surgery. Three qualified and experienced speech and language pathologists evaluated articulation errors and intelligibility of speech samples. Repeated One-way analysis of variance was used to compare articulation proficiency and speech intelligibility at different time intervals. Results: The substitution, omission, distortion and addition errors showed no significant changes at 3 months and 6 months. The total articulation errors decreased to zero at 9 months and no significant increase was observed till 18 months (P < 0.05). Speech intelligibility showed statistically non-significant improvement at any time interval. Cephalometric skeletal parameters SNA and N l A°. were significantly correlated with addition and total articulation errors at 18 months follow up. Conclusions: The ortho-surgical treatment improves speech (decreases. articulation errors) in most of the patients usually 6-9 months post-surgery. Speech intelligibility is not affected by bimaxillary orthognathic surgery in skeletal class III patients. The articulation errors were correlated to changes in position of maxilla.

Unveiling the Allergy-Meniere Connection: Exploring the Impact of Allergen Positivity on Meniere's Disease Severity.

Meniere's Disease is a rare ear disorder that can cause severe morbidity to the patient and has no definitive treatment to date. Endolymphatic hydrops is the critical event. Though symptomatology is well understood, the exact etiology of Endolymphatic hydrops attack is still unclear. Twenty-five consecutive patients of Meniere's Disease diagnosed in the Vertigo clinic aged 12 to 70 years were included. Their allergic status was evaluated using a skin prick test. Allergic and non-allergic patients were then identified. Comparison between the two groups was made to identify the effect of allergy on the severity of symptoms using vertigo scales, Functional level scale, Dizziness handicap index, and Pure tone average staging. The prevalence of allergy among Meniere's Disease patients was 56%. The most common allergen found in our study was tyrophagus(n = 8). Polysensitization was more common(n = 12). Airborne allergens were more common than food allergens. There was no significant relationship between the severity scales and the allergen positivity status (p > 0.05). The prevalence of allergy is more among patients with Meniere's Disease. The Endolymphatic sac is allergy prone. The occurrence of endolymphatic hydrops may be due to a cross-reaction of allergen-induced IgE antibodies to self-antigen. Management of the specific allergen may help decrease symptomatology in these patients. Allergen-specific therapies have a promising role in the treatment of allergic conditions and provide a long-term symptom-free period in affected individuals. This can be applied in patients with Meniere's Disease having associated allergic features based on their skin prick test results.

Healthcare Cost of Cochlear Implantation in India.

Making evidence-based policy decisions is challenging when there is a lack of information, especially when deciding provider payment rates for publicly funded health insurance plans. Therefore, the goal of this study was to estimate the cost of a cochlear implant operation in a tertiary care setting in India. We also looked at the patients' out-of-pocket (OOP) expenses for the cochlear implant surgery. From the perspectives of the patients and the healthcare systems, we assessed the financial costs of the cochlear implantation procedure. A bottom-up pricing model was used to assess the cost that the healthcare system would bear for a cochlear implant procedure. Information on all the resources (both capital and ongoing) required to offer cochlear implantation services for hearing loss was gathered over the course of a year. 120 individuals with hearing loss who had cochlear implantation surgery disclosed their out-of-pocket (OOP) costs, which included both direct medical and non-medical expenses. All costs for the budgetary year 2018-2019 were anticipated. The unit health system spent ₹ 151($2), ₹ 578($7.34) and ₹ 37,449($478) on ear exams, audiological evaluations, and cochlear implant surgeries, respectively. Per bed-day in the otolaryngology ward, hospitalization cost ₹ 202($2.6), or ₹ 1211($15.5). The estimated average out-of-pocket cost for a cochlear implant operation was ₹ 682,230($8710). Our research can be used to establish package rates for publicly funded insurance plans in India, plan the growth of public sector hearing care services, and do cost-effectiveness assessments on various hearing care models. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04389-7.

Association of Cochlear Implant Management Skills of Parents and Outcomes in Their Cochlear Implanted Wards: An Indian Perspective.

Parental involvement in the rehabilitation process is one of the critical factors for the success of cochlear implants in their wards. Skills to use a cochlear implant (CI) device appropriately and manipulate the different settings are essential to gain maximum benefits. There was a need to have a tool in Hindi to assess the skills of parents to manage the CI device. The study was conducted with the following aims: To translate and adapt Self-administered Cochlear Implant Management Skills (CIMSSelf) into the Hindi language. To find an association between the CI management skills of parents and outcomes in their implanted wards. To compare pre-post retraining scores on CIMS-self in Hindi (HN) and to find out factors affecting the scores. CIMS-self (English) was translated into Hindi using the forward and backward translation method. CIMS-self (HN) was administered to 22 parents of cochlear implanted children to evaluate their CI device management skills in the pretraining phase. The questionnaire was re-administered between 2 and 4 weeks to check the reliability. The outcome of CI in the children was assessed using the test tools viz. Categories of Auditory Perception, Integrated Scales of Development, Speech Intelligibility Rating, and Meaningful Auditory Integration Scale (MAIS). Subjects with less than 100% score received retraining on CI device management skills. CIMS-self (HN) was readministered two weeks after completing training, and results were compared between pre-post training sessions. There was no significant correlation between CIMS-self (HN) scores and demographic of the parents and their implanted wards, CI device factors, and clinical outcomes. A significant correlation was found between the CIMS-self (HN) and MAIS scores (p < .05). The Cronbach's alpha for test-retest reliability of the CIMS-self (HN) survey was 0.998. Participants showed a significant improvement in CIMS-self (HN) scores following the intervention, demonstrating that the CIMS-self (HN) is sensitive enough to detect changes in CI device management following retraining. A client who self-reports difficulty may benefit from consultation if it helps to improve their confidence in CI device management. The CIMS-self (HN) survey can be used to evaluate and re-evaluate CI device management skills at regular intervals and may save clinical time.

Challenges faced by Indian parents in raising a child with a cochlear implant - Impact on communication outcomes.

OBJECTIVES: The objectives of the present study were to understand the parental views regarding stress, and its affect language, and auditory outcomes. The study also aims to understand the relationship between parental stress, and child's age. DESIGN, SETTING AND PARTICIPANTS: A retrospective study was performed at a tertiary medical hospital. 50 parents of cochlear implant recipients were recruited for the study. The parents were interviewed and the children were tested using a test battery. The average age of implantation was 4.29 years, and the average hearing age was 3.23 years. MAIN OUTCOME MEASURES: The parents were interviewed about their child's needs, and experience with the cochlear implant using the Strength, and Difficulty questionnaire in Hindi, Questionnaire on Resources, and Stress-Short Form, and the Family Environment Scale, Closed - format Questionnaire to understand parental views, and experiences. The language outcomes were studied using the Integrated Scales of Development (ISD), Revised Categories of Auditory Performance. Factor analysis, and Chi-square tests were performed to understand potential relationships between parental stress, and child language, and/or auditory outcomes. RESULTS: The results provide five main factors that accounted for significant variance including financial stress (30.1%), hyperactivity (15.2%), lack of personal rewards (13%), peer problems (10.9%), and emotional problems (9.2%). Acquisition of language was highly influenced by stress and caregiver's 'lack of personal rewards. 'Financial stress', and 'hyperactive behavior' of the child significantly affected the receptive language acquisition of a HI child. The most concerning factors for parents were well-being, and happiness (0.885), followed by social relationships (0.830), communication (0.736), the process of implantation (0.695), and the decision to implant (0.681). The stress regarding finance among parents increased marginally (0.024) as the child's age progressed. CONCLUSION: Parental stress is ongoing. The impact on the expressive language development of the child is significant. The maximum concern of parents is regarding the financial aspects of a cochlear implant, and the lifespan care of their child. Hence, professionals should provide regular, and context-specific counseling to parents after implantation to understand the parents' concerns, and provide appropriate remediation.

Development of Phonemically Balanced Passage, Oral Passage, and Nasal Passage in the Punjabi Language.

The primary aim of the study was to develop phonemically balanced passage, Oral passage and Nasal passage in Punjabi language. Development of the passage: The words in the passage were chosen to represent the way sounds are distributed in spoken Punjabi language, and the relative phonemic distribution of each word inside each paragraph matched how frequently each sound occurs in Punjabi. The paragraph was constructed using words that were rated as extremely familiar and familiar. The developed passages were given to five speech-language pathologists for the purpose of content validation. 100 people with normal hearing between the ages of 18 and 25 were enrolled in the study (50 female and 50 male). Each subject's nasalence was measured using a Nasometer. The individuals were given passages written in Punjabi to read, and their nasalence scores for each text were recorded. The nasalance mean for Punjabi phonemically balanced passage was 36.41 ± 4.61% and 38.57 ± 4.22% in male and female subjects. The Punjabi oral passage mean were 27.36 ± 4.14% and 28.46 ± 4.01% in male and female subjects. The means for Punjabi nasal passage were 46.15 ± 4.09% in male subjects and 47.04 ± 4.91% in the female subjects. The Intraclass correlation coefficient for Female and male subjects for the Punjabi Phonemically balanced passage, Punjabi oral passage, Punjabi nasal passage were 0.904, 0.945; 0.807, 0.909, and 0.956, 0.913 respectively. The developed passages have good test retest reliability and their normative scores can be used for assessment of different resonance disorders.

Translation and Adaptation of the Nijmegen Cochlear Implant Questionnaire in Hindi: A Health-Related Quality of Life Questionnaire for Adults with Cochlear Implants.

Nijmegen Cochlear Implant Questionnaire is an HRQoL tool that was developed by Dutch researchers to assess the QoL in adult CI users in the English language. It is used to measure the impact of the use of CI on the daily life situations of its users, on the perception of speech sounds, and on the cost-benefit assessment CI in adult CI users. There is no specific instrument available to assess the QoL in adult CI users in India, hence there was a need to take up this study. The primary aim of the study was to adapt and translate NCIQ into Hindi with a secondary aim to describe the effect of CI on quality of life in adult CI users. For translation, permission was taken from the authors of the original tool. The Forward-backward translation method was utilized for translation. The final version of the NCIQ-H was administered to the study participants (25 no.) 25, aged 18-60 years; High School as the minimum level of education; post-lingual hearing impairment, and CI use ≥ 12 months. The Cronbach's α coefficient was calculated for all domains and subdomains in the NCIQ-H showed the overall reliability of the questionnaire (0.82), showing good internal consistency. The CI users reported high scores across all the domains indicating improved quality of life. No significant correlation was found between the CI usage time and NCIQ scores on Spearman's correlation test. Also, there was no significant difference in NCIQ-H scores between genders on the Kruskal-Wallis test. The NCIQ (H) can be used to assess QoL in adults with cochlear implants. The scores suggest improvement in physical, social and psychological domains of life. No correlation was observed between the NCIQ-H scores and duration of CI usage as well as with gender differences.

Endoscopic evaluation of velopharyngeal function in cleft lip palate patients - A correlation with speech analysis.

BACKGROUND: Speech abnormalities due to velopharyngeal insufficiency (VPI) significantly affect communication skills, self-esteem, and scholastic performance. It leads to a poor social, emotional, educational, and behavioral development and a poor quality of life overall in cleft lip palate (CLP) patients. Its early diagnosis and severity assessment using video-nasoendoscopy and speech assessment can significantly contribute to management. The present study evaluated VPI in CLP patients using both tools. METHODS: A total of 48 patients with repaired cleft palate were subjected to speech and video-nasoendoscopic assessment. Speech assessment measured severity of hypernasality, speech intelligibility, and voice quality. Video-nasoendoscopy evaluated velopharyngeal port closure to grade the severity of VPI. The speech assessment and video-nasoendoscopy findings were analyzed and correlated. RESULTS: There was a moderately strong statistically significant negative correlation between the grade of VPI and hypernasality (r = -0.542, p = 0.000). There was a stronger statistically significant negative correlation of grade of velopharyngeal port insufficiency with speech intelligibility (r = -0.634, p = 0.000). About 72% of the patients had abnormal voice quality. CONCLUSION: This study is the first attempt at diagnosing and grading VPI on a quantitative scoring based on a ratio scale for the motion of soft palate and pharyngeal walls. The strong correlation between endoscopic grading and speech analysis findings warrants further evaluation of nasoendoscopic grading of VPI in more studies.

Neuropsychological Differences between the Unilateral and Bilateral Tinnitus Participants with Normal Hearing.

INTRODUCTION: This paper attempts to describe the neuropsychological differences between subgroups of tinnitus with normal hearing. METHODS: The study compared 150 normal-hearing participants with and without tinnitus in the 18-55 age-group. The participants completed nine neuropsychological tests, namely, Rey's auditory verbal learning test (RAVLT), Rey complex figure test (RCFT), digit vigilance test (DVT), Verbal N-back test (N Back), controlled oral word association test (COWA), animal names test (ANT), digit symbol substitution test (DSST), Wechsler digit span test (DST), and Stroop test. RESULTS: Poor verbal memory was demonstrated by a unilateral tinnitus group (p = 0.0001) for the total RAVLT score, immediate score, delayed recall, hits, and omissions). Significant deficits were observed in working memory functioning by the unilateral and bilateral tinnitus participants (p < 0.001) for one-back and two-back hit and error scores). In addition, there was a significant impairment in the auditory attention of single-sided tinnitus participants (p < 0.03, 0.02). Selective attention was affected in bilateral tinnitus participants (p < 0.05). DISCUSSION/CONCLUSION: Tinnitus, whether unilateral or bilateral, has an effect on working memory. The RAVLT and DST results, on the other hand, demonstrated that unilateral tinnitus suffers from significant deficits in auditory memory and attention, whereas bilateral tinnitus suffers from selective attention issues. When treating individuals with unilateral and bilateral tinnitus, these findings must be addressed.

Efficacy of Jellow app as an adjunct to stimulation therapy in improvement in language and quality of life in patients with chronic Broca's Aphasia.

Purpose: Stimulation approach is a therapy technique to improve language production using auditory and visual stimulation. Jellow app is a mobile app designed for compensating for impaired language skills and may be used in the intervention of persons with aphasia. The study aimed to determine the benefits of using the Jellow app as a facilitator of stimulus therapy to improve language and psychosocial domains in chronic Broca's Aphasia.Methods: Ten right-handed male adults with Broca's Aphasia were assessed on WAB and SIQOL39g tests. The control group (n = 5) was enrolled only for stimulation therapy. Pictures of objects were used for therapy with the help of auditory or auditory and visual cues. In the study group (n = 5), along with stimulus therapy, subjects were also trained on the use of icons in the Jellow app to facilitate functional communication needs. After six-months tests were readministered. Results: Post-therapy, on WAB, the improvement in spontaneous speech, repetition, and naming were found to be significantly more in the study group (4.6 ± 0.55, 4.89 ± 0.56, 5.74 ± 0.24 respectively) than the control group (2.6 ± 0.89, 3.22 ± 0.49, 3.97 ± 0.3 respectively) on 2-sample t-test. Similarly, significantly more improvement was seen in the communication domain of SAQOL39g in the study group (2.03 ± 0.17) compared to the control group (1.14 ± 0.45).Conclusion: Use of the Jellow app may be a beneficial adjunct to stimulation therapy for improving linguistic abilities and quality of life in persons with chronic Broca's aphasia.IMPLICATIONS FOR REHABILITATIONFollowing are the implications of this study in the rehabilitation of persons with chronic Broca's Aphasia:• Multimodality in therapy approach in traditional stimulation therapy is beneficial.• AAC Apps like the Jellow app can be used as an adjunct to the traditional stimulation approach of language intervention which facilitates the language abilities like spontaneous speech, repetition, and naming.• Language improvement due to rehabilitation is beneficial in improving the quality of life in this population.• The caregivers must be involved in the therapy program as they act as communication partners and can repeat the therapy tasks at home.• Similar type of study is warranted in a larger population so that people with chronic Broca's aphasia may get the benefit of the latest technology which may be cheaper and easier to use.

Effect of face masks on speech understanding: A clinical perspective during speech audiometry.

The objective was to measure the effect of various face masks on speech recognition threshold and the word recognition score in the presence of varying background noise levels. 20 normal-hearing adult subjects (a total of 40 ears) participated. Pure tone audiometry followed by speech recognition threshold and word recognition score at the most comfortable level in varying signal-to-noise ratios (SNR0, SNR10, and SNR15) using surgical, pleated cloth, and N95 masks. Using surgical, cloth, and N95 masks, speech recognition thresholds increased by 1.8 dB, 4.4 dB, and 5.05 dB, respectively. Word recognition scores decreased by 32% without a mask, 43.7% in a surgical mask, 46.3% in a cloth mask, and 46.7% in N95 mask conditions, between SNR15 and SNR0. The speech recognition threshold was negatively affected with cloth and N95 masks. Surgical masks do not affect the word recognition scores at lower background noise levels. However, as the signal-to-noise ratio decreased, even the surgical, cloth, and N95 masks significantly impacted the word recognition score even in normal-hearing individuals.

Translation and Validation of Penn Acoustic Neuroma Quality of Life Scale for Hindi-Speaking Population.

Background: The Penn Acoustic Neuroma Quality-of-life Scale (PANQOL) was specifically developed for assessing the quality of life (QOL) in patients with vestibular schwannoma (VS). Its utility has been established in many populations, but it has not been validated for use in India. Objective: The objective of this study was to translate PANQOL into Hindi and validate it for use in India. Materials and Methods: PANQOL was translated into Hindi by using the standardized procedure. Its conceptual equivalence was established by administering. For validation, PANQOL-Hindi and SF-36 were administered to 78 patients aged above 18 years and recently diagnosed to have VS. Test-retest reliability was established by readministering PANQOL-Hindi on 15 patients after 2 weeks. Results: Internal consistency was good for the composite scale (α = 0.87). The Cronbach's alpha for all domains except facial dysfunction was in an acceptable range. Intercorrelations between various domains showed that anxiety and energy were strongly correlated. All domains except pain had a strong correlation with the total PANQOL score. The intraclass correlation coefficient test indicated high test-retest reliability for the composite scale (ICC = 0.97; 95% CI, 0.93-0.99). Test-retest reliability for various domains was also good. The construct validity of PANQOL was assessed by correlating its specific domains with SF-36 domains. The meaningful correlations between domains of PANQOL and SF-36 indicated good construct validity. Conclusions: PANQOL-Hindi has been adequately translated and has satisfactory psychometric properties.

Impact of Hearing Loss on Cognitive Abilities in Subjects with Tinnitus.

Background: This study aimed to delineate the underlying pathophysiology of tinnitus between normal hearing and hearing loss subjects. Objective: The study aimed to characterize the neuropsychological aspects of two types of groups with tinnitus having variable hearing thresholds. Materials and Methods: The study sample comprises 75 subjects in a group with tinnitus and normal hearing, and 100 subjects in the tinnitus and hearing loss group. Subjects were matched to their respective controls for age, gender, and education levels. Subjects underwent verbal learning and memory tasks, visual learning, memory, listening attention, sustained visual attention, work memory, category control, phonemic mastery, response inhibition, and data processing velocity. Results and Conclusions: Subjects having hearing loss with bilateral tinnitus showed significantly reduced performance on total learning capacity (P = 0.02) and recognition (P = 0.05) (Rey's auditory verbal learning test), auditory attention tasks, digit forward span test (DFST) (P = 0.03), digit span test score (P = 0.01), and working memory (P = 0.02) (digit backward span test). For response inhibition tasks and Stroop interference (P = 0.03), subjects with normal hearing with bilateral tinnitus displayed lower performance. This study proves a relationship between poor working memory, auditory memory, total learning capacity, and recognition due to hearing impairment in bilateral Tinnitus subjects. The study has substantial implications for effective assessment and treatment recommendations in hearing loss with bilateral tinnitus subjects.

Acoustic, Perceptual, and Laryngoscopic Changes Post Vocal Abuse at a College Fest.

INTRODUCTION: College students use their voices at excessively loud intensities and long durations during college fests. The accumulative effect of vocally abusive behaviors in the presence of high ambient noise, poor vocal hygiene, and other environmental factors contribute significantly towards reducing vocal effectiveness in college students. OBJECTIVE: The present study aimed to study the effect of a vocally demanding situation (college Fest) on perceptual and objective voice features of college students. METHODOLOGY: In this study, a total number of 27 undergraduate female students participated in the age range of 18-27 years. Pre-test-post-test research design was applied. Data analysis consisted of video stroboscopic examination, acoustic analysis using the Multi-dimensional voice program (MDVP), and perceptual evaluation with the GRBAS scale. The data obtained were processed using descriptive statistics and non-parametric tests to determine the difference in each measured parameter pre- and postfest. RESULTS AND DISCUSSION: Incomplete glottis closure, asymmetric vibration of vocal folds, and aperiodicity of vocal folds increased significantly postcollege Fest. GRBAS parameters also showed a change from pre Fest scores on grade (hoarseness) increased by 38%, breathiness in 34%, roughness in 26%, Asthenia in 15%, and strain increased in 38% participants. A P-value estimation revealed significantly higher scores in Jitter percent, Shimmer percent, and relative average perturbation than pre-fest scores. CONCLUSION: The results of the present study indicate a high risk of vocal disorders among college students post Fest. This study suggests a potential unmet need for college students to receive education before cultural events on optimal vocal usage, vocal hygiene, and an appropriate period of vocal rest.

Perceptual, Aerodynamic and Acoustic Evaluation of Vocal Characteristics in Subjects With Obesity.

INTRODUCTION: Obesity has tripled since 1975 and affects health across many domains. Increasing body mass index increases the risk to the obese subject of many non-communicable diseases. The study evaluated the perceptive, aerodynamic, and acoustic parameters that characterize the voice of the obese population. METHODOLOGY: Eighty adult subjects (40 participants in each obese and control group) aged 18-50 years were enrolled. The perceptual voice analysis was performed using the Consensus Auditory Perceptual Evaluation of Voice. The aerodynamic and acoustic voice analyses were performed using the MIR Spiro lab instrument and Doctor's Speech software. A digital stopwatch was also used to measure maximum phonation time. RESULTS: Statistical analysis revealed a significant difference (P-value <0.05 and t value >2) between two groups on acoustic parameters, specifically Normalized noise energy and fundamental frequency tremor (F0 tremor). Normalized noise energy and fundamental frequency tremor were greater in the obese group. Moreover, maximum phonation time and expiratory reserve volume were significantly reduced in the obese group. DISCUSSION AND CONCLUSION: Results of the present study showed poor voice quality and reduced expiratory reserve volume in obese individuals. This could be credited to the adverse effects of accrued adipose on the functioning of the laryngeal and respiratory systems. Increasing body mass index escalates the risk to the obese subjects of many non-communicable diseases.

Language Outcomes in Cochlear Implanted Children with White Matter Disturbances.

INTRODUCTION: The present study reviews our experience with children with white matter disturbances and the benefits they get from rehabilitation post cochlear implantation. MATERIALS AND METHODS: It is a retrospective cohort study of 7 cochlear implanted children with white matter disturbances. Preoperatively all the subjects had undergone a complete Audiological test battery for confirmation of hearing thresholds. Post assessment, a digital hearing aid trial was followed by three months' therapy. Unilateral cochlear implant surgery and monitored auditory-verbal therapy sessions were the next line of treatment for at least one year. The therapist regularly monitored hearing and communication outcomes on an Auditory verbal ongoing scale, revised CAP, MAIS, word, and sentence discrimination scores. RESULTS: The age range of Implantation was between 48 to 60 months. 5 out of 7 participants showed remarkable improvement with regular therapy. Their Meaningful Auditory Integration Scale (MAIS) scores were greater than 35 indicating good auditory integration and Categories of Auditory Performance (CAP) revealed scores of even 9 and higher indicating good telephone conversation. Speech Intelligibility Rating (SIR) showed a rating of 4 meaning thereby that an unfamiliar Listener could understand Speech without additional cues. However, all of them reported difficulty perceiving speech in noisy environments. Two cochlear implantees needed speech reading cues in conjunction with the audition. CONCLUSION: Our experience with cochlear Implantation in children with white matter abnormalities has been positive and satisfactory. The presence of white matter abnormalities on MRI should not be a contraindication for Implantation. Successful outcomes can be expected with regular and dedicated auditory-verbal therapy sessions.

Effect of Earmuffs on Physiological Parameters of Preterm Neonates Nursed in Incubators: A Before-and-After Study.

OBJECTIVE: To determine the effect of earmuffs on stability of physiological parameters i.e. heart rate, respiratory rate, and oximeter saturation (SpO2) in preterm neonates. METHODS: Non-randomized, cross-over study. 60 stable preterm neonates observed without and with earmuffs for 2 hours each (control and intervention periods, respectively). The above parameters were recorded every 60 seconds. Spikes of parameters and fluctuation [by coefficient of variation (CoV)] were compared between periods. RESULTS: Spikes of all parameters, as a proportion of observations, were significantly less in intervention period. Median (IQR) spikes per subject were lower in intervention vs control: tachycardia [2.5 (2.5, 18) vs. 20.5 (2.2, 37.7); P<0.01]; tachypnea [11.5 (11.5, 25) vs. 18 (2, 40) vs; P=0.01] and hypoxia [0 (0, 0) vs. 0 (0, 1.75); P<0.01]. There was significantly less fluctuation of heart rate and SpO2 with earmuffs. CONCLUSIONS: Earmuffs improve physiological stability of preterms.

Childhood neurodevelopmental outcomes of survivors of acute bilirubin encephalopathy: A retrospective cohort study.

BACKGROUND: Reports on childhood neurodevelopmental and neurosensory outcomes following acute bilirubin encephalopathy from low- and middle-income countries are scarce. AIM: This study aimed to analyze the neurodevelopmental and neurosensory outcomes of survivors of acute bilirubin encephalopathy. STUDY DESIGN: Retrospective cohort. SUBJECTS: Neonates with admission diagnosis of acute bilirubin encephalopathy were followed up and assessed for neuromotor, neurodevelopmental and neurosensory functions between 18 m and 12.5 years of age. RESULTS: In 67 neonates with acute bilirubin encephalopathy, a composite outcome of cerebral palsy or death was observed in 33 (49%) subjects. Choreo-athetoid cerebral palsy [19 (73%)] was the most common type observed. Sensori-neural hearing loss was observed in 46 (79%) subjects. Subjects with cerebral palsy had significantly low Developmental profile-3 scores in all assessed domains. Neonates with an early-stage acute bilirubin encephalopathy (aOR (95% C.I): 0.12 (0.05-0.71); p = 0.02) and those with a normal neurological examination at discharge (aOR (95% C.I): 0.11 (0.06-0.7); p = 0.049) had significantly lower odds of the primary outcome. CONCLUSIONS: Majority of survivors of acute bilirubin encephalopathy had adverse outcomes during childhood in the form of cerebral palsy and sensory-neural hearing loss. Cognitive functions were better preserved than the language and general development in the affected children.

Perception of Tinnitus Handicap And Stress Across Age Groups in Normal Hearing.

INTRODUCTION: This research was conducted to investigate the severity of tinnitus, its impact on subject's daily, personal and emotional life, which varies widely across the age groups. METHODOLOGY: Sample population of 60 unilateral tinnitus subjects with normal hearing between the age ranges of 15-55years were divided into four age groups. Tinnitus severity was measured using tinnitus severity index, impact of tinnitus on daily life was documented through tinnitus handicap inventory and the stress levels through perceived stress scale. RESULTS: A high frequency tinnitus was observed in age group of 56-65years, in contrast to noise like tinnitus in subjects aged 15-25years. The tinnitus was found to be most handicapping (38-56; moderate handicap) in Group 4(56-65years), the perceived stress levels were also falling in very high range (21 and over). Tinnitus severity index did not show any significant difference between the Group 1:15-25yrs, Group 2: 26-40yrs, Group 3:41-55yrs, and however group 4(56-65 yrs) did report with mild severity. The outcomes of present study demonstrated that elderly subjects certainly require modifications in the test protocols and referrals to address to their significant responses to tinnitus.