Automatic Classification of Healthy Subjects and Patients With Essential Vocal Tremor Using Probabilistic Source-Filter Model Based Noise Robust Pitch Estimation.

Essential voice tremor (EVT) is a voice disorder resulting from dyscoordination within the laryngeal musculature. A low-frequency fluctuations of fundamental voice frequency or the strength of excitation amplitude is the main consequence of the disorder. The automatic classification of healthy control and EVT is useful tool for the clinicians. A typical automatic EVT classification involves three steps. The first step is to compute the pitch contour from the speech. The second step is to compute the features from the pitch contour, and the final step is to use a classifier to classify the features into healthy or EVT. It is shown that a high-resolution pitch contour estimated from the glottal closure instants (GCIs) is useful for EVT classification. The HPRC estimation can be very poor in the presence of noise. Hence, a probabilistic source filter model based noise robust GCI detection is used for HPRC estimation. The Empirical mode decomposition based feature extraction is used followed by a support vector machine classifier. The EVT classification performance is evaluated using recordings from 45 subjects. The proposed method is found to perform better than the baseline techniques in eight different additive noise conditions with six SNR levels.

Assessment of Voice Outcomes Post Chemo-Radiotherapy in Non-Laryngeal Head & Neck Cancers Using Electroglottography and Voice Symptom Scale (VoiSS) Questionnaire.

BACKGROUND: Laryngeal toxicity (LT) following concurrent chemo-radiotherapy (CCRT) for non-laryngeal head & neck cancers(NLHNC) has been inadequately studied. Electroglottography (EGG), a non-invasive technique for objective quantification of LT, measures the change in electrical impedance generated by glottic closure. AIM: Objective and subjective assessment of acute LT post-CCRT in NLHNC. MATERIALS AND METHODS: A prospective study on 30 NLHNC patients, treated with CCRT; 66-70Gy/33- 35fractions with weekly Cisplatin. Flexible laryngoscopic examination and EGG were performed at baseline, 6weeks, and 3months post-CCRT; Grades of LT and contact quotients(CQ) were documented. Patientreported outcomes of voice-related quality of life(QoL) performed at the same intervals, using a 30-item Voice Symptom Scale (VoiSS) questionnaire. STATISTICAL ANALYSIS: Results of continuous measurements were studied by mean +/- standard deviation. Analysis of variance (ANOVA) was used for comparison of pretreatment and post-treatment results in more than two groups. Significance was assessed at 5% level ofsignificance. Post- hoc analysis has been done using Tukey-Krammer method for multiple comparisons. Correlation analysis was performed using Pearson correlation test. RESULTS: 26/30 patients completed CCRT; 14 were available at 6weeks; 10 at 3months post-CCRT for analysis. At 6 weeks, 3/14(21.5%) patients had Grade II LT; 11/14(78.57%) had grade III. At 3months, 2/10(20%) had Grade I, 6/10(60%) had grade II but 2/10(20%) had worsened to grade IV. Mean CQ at baseline was 50.77 +/- 5.55; which decreased at 6 weeks to 48.56 +/- 4.66 and further at 3months to 45.56 +/- 4.66 (>0.05) suggestive of glottic hypo-adduction. VoiSS responses showed a significant impact on QoL in all three domains at six weeks and three months post-CCRT, compared to baseline (P < 0.0001). CONCLUSION: Electroglottography is a potential tool to quantify acute LT post CCRT. Patient-reported outcomes may not correlate to the objective measures of laryngeal toxicity and require separate recording and reporting. A larger sample size would be required to draw further significant correlations. Key Words: Electroglottography; laryngeal toxicity; head neck cancer; voice; chemo-radiotherapy.

EEG-based P300 in mesial temporal lobe epilepsy and its correlation with cognitive functions: A case-control study.

OBJECTIVE: P300 is an event-related potential, being explored as an objective tool to assess cognition. This study aimed to investigate the characteristics of auditory and visual P300 in patients with TLE having unilateral HS using electroencephalography (EEG) and to study its correlation with cognition. METHODS: This is a cross-sectional case-control study, where P300 characteristics in thirty patients with unilateral hippocampal sclerosis with refractory epilepsy were compared with fifteen age-, gender-, and years of education-matched healthy controls (M: F-10:5, mean age-28 ±â€¯4.76 years). Among patients, 15 belonged to the right HS group (M: F-9:6, age at onset-12.92 ±â€¯10.22 years, duration of epilepsy-16.67 ±â€¯9.38 years) and 15 to the left HS group (M: F-8:7, age at onset-10.62 ±â€¯7.18 years, duration of epilepsy-15.53 ±â€¯10.14 years). All subjects underwent EEG-based auditory and visual oddball tasks and cognitive assessment. The P300 latencies (in milliseconds) as well as amplitudes (in microvolts) were predicted in EEG and were correlated with cognitive scores. Source localization of P300 was performed with the CLARA algorithm. RESULTS: The auditory P300 latencies in controls, right HS, and left HS were 323.93 ±â€¯40.28, 351.06 ±â€¯47.23, and 328.80 ±â€¯36.03, respectively (p = 0.18) and its amplitudes were 2.3040 ±â€¯1.46, 2.77 ±â€¯1.19, and 2.68 ±â€¯1.78, respectively (p = 0.48). Visual P300 latencies in controls, right HS, and left HS were 365.87 ±â€¯47.37, 359.67 ±â€¯64.45, and 376.00 ±â€¯60.06, respectively (p = 0.51) and its amplitudes were 3.93 ±â€¯2.28, 2.09 ±â€¯1.45, and 3.56 ±â€¯1.74, respectively (p = 0.014). Further, when compared to the control group the cognitive scores were lower in the patient group (p < 0.05). SIGNIFICANCE: In comparison to the controls, patients with right HS recorded lesser amplitude on visual P300 and lower scores on cognitive tests. P300 and cognitive parameters exhibited varied relationship. P300 could be a complementary objective tool to assess cognition in patients with TLE.

P300 in mesial temporal lobe epilepsy and its correlation with cognition - A MEG based prospective case-control study.

PURPOSE: To assess the role of P300 in patients with temporal lobe epilepsy (TLE) with unilateral hippocampal sclerosis (HS) using magnetoencephalography (MEG) based auditory and visual oddball tasks, and to assess its correlation with neuropsychological tests. METHODS: Thirty-patients (M:F-17:13, onset-11.77 ±â€¯8.75 years, duration-16.10 ±â€¯9.61 years) with TLE-HS (Left:15, Right:15) and fifteen-healthy age, gender and years of education matched controls (M:F-10:5, age-28.13 ±â€¯4.76 years) underwent auditory and visual oddball tasks in MEG and cognition assessment using Indian Council of Medical Research (ICMR)-cognitive test battery. Independent component analysis (ICA) was applied to the magnetic evoked field responses for the detection of the P300 component. Source localization of P300 was performed with Classical LORETA Analysis Recursively Applied (CLARA). The latency and amplitude of P300 were estimated and subsequently correlated with cognitive scores. RESULTS: The visual P300 amplitude in the TLE group was lower when compared to the control group. In subgroup comparison (controls vs. right HS vs. left HS), visual P300 amplitudes were lower in the right HS group compared to both left HS and control groups (p-value = 0.014). On the other hand, no significant difference for auditory P300 latency or amplitude was noted between patients and controls as well as between subgroups. A negative correlation found between the MEG visual P300 amplitude and Indian Trial Making Test (TMT)-B duration in the patient group. CONCLUSION: Patients with TLE-HS have decreased visual-P300 amplitude. A significant correlation found between visual P300 amplitude and cognitive tests of visuospatial attention and working memory. Overall, MEG based visual P300 amplitude can be further explored with large sample size studies to establish as a complementary objective test for cognitive assessment in TLE.

Audiovestibular findings in a 6 year old child with pilocytic astrocytoma - a case report.

Objective: Pilocytic astrocytoma commonly occurs in children and depending on the extension of the lesion may cause varied audiovestibular dysfunctions. However, audiovestibular findings are scarcely reported in the literature.Design: Audiovestibular testing was performed on a single subject on two occasions pre-surgically.Study sample: A 6 year old girl with pilocytic astrocytoma.Results: All audiological tests revealed normal findings except for the cervical vestibular evoked myogenic potential testing (cVEMP). The amplitude of cVEMP was higher in the lesion side indicating a hypersensitive vestibulocollic reflex pathway functioning.Conclusions: This case study reported a unique finding of hypersensitive cVEMP findings in the lesion side in a patient with pilocytic astrocytoma. The pathophysiological basis for this hypersensitivity is attributed to anatomical connections between the cerebellum and the vestibular nuclei through the inferior cerebellar peduncle.

Acoustic analysis of voice in nonlaryngeal head and neck cancer patients post chemoradiotherapy.

BACKGROUND: Concurrent chemoradiotherapy (CCRT) used for definitive management of locally advanced head and neck squamous cell carcinoma (HNSCC) allows organ preservation at the cost of preservation of function. Vocal cords, being within the field of irradiation, undergo acute and chronic changes which adversely impacts the patients' voice. AIMS: To assess the acute changes in the acoustic characteristics of voice post-CCRT in patients with nonlaryngeal HNSCC. MATERIALS AND METHODS: Thirty patients with HNSCC treated with CCRT, a total dose of 66-70 Gy/33-35 fractions at five fractions/week, with weekly cisplatin. Acoustic analysis (AA) and laryngoscopic examination performed at baseline, 6 weeks, and 3 months post-CCRT. Statistical analysis of the parameters using ANOVA and Student's t-test was performed. RESULTS: Of the thirty patients, 26 patients completed CCRT. At 6 weeks post-CCRT, among 14/26 patients, most (11/14 [78.57%]) developed Grade III toxicity. On AA, both increase and decrease in mean F0 from baseline was observed. An increase (P < 0.05) in each, i.e., jitter, shimmer, and noise to harmonics ratio (NHR) were recorded. At 3 months post-CCRT, among 8/14 available, most (6/8 [75%]) showed Grade II toxicity. The mean F0 reduced for both genders; jitter and shimmer, and NHR values maintained an increase (P > 0.05). CONCLUSIONS: Periodic AA allows quantification of voice changes and mapping of vocal toxicity induced by CCRT.

Translation of the Broad Autism Phenotype Questionnaire to an Indian language: A description of the process.

The Broad Autism Phenotype Questionnaire (BAPQ) which is a reliable, efficient and easy to administer instrument is used to assess the Broad Autism Phenotype (BAP). In order to understand cross cultural perspectives using this instrument, a key process is translation of the instrument. The process of translation is often overlooked and hence the quality of the translated instrument may suffer. This paper highlights the robust process adopted for translating the BAPQ into one of the Indian languages - Kannada, using the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and World Health Organisation (WHO) guidelines. The translated instrument was tested on a pilot sample of parents of 10 children with ASD and parents of 11 typically developing children. The results are in congruence with the published literature.

Brief report: an unusual manifestation of diagnostic overshadowing of pervasive developmental disorder--not otherwise specified: a five year longitudinal case study.

Children with communication disorders present with a range of comorbid conditions. Occasionally one of the comorbid conditions manifests so strongly that the primary condition goes unnoticed by the clinician. This tendency to overlook comorbid health problems in the presence of a disability is referred to as diagnostic overshadowing. This is a five-year follow up case study of a 9-year-old female child. The child was initially diagnosed to have Separation anxiety disorder (SAD), but during the course of follow up she began to exhibit features of pervasive developmental disorder-not otherwise specified (PDD-NOS). This case report throws light on the severity of SAD which overshadowed PDD-NOS. Importance of follow-up and the need for a multidisciplinary team to be sensitive to the phenomenon of diagnostic overshadowing is discussed.

Temporal resolution deficits in patients with refractory complex partial seizures and mesial temporal sclerosis (MTS).

We studied the temporal resolution ability in patients with refractory complex partial seizures and mesial temporal sclerosis (MTS) using Gaps-In-Noise (GIN) test in a prospective cross-sectional study. Thirteen patients with right MTS (age: 31±7.67 years; M:F=8:5) and 13 patients with left MTS (age: 25.76±8.26 years; M:F=9:4) having normal hearing and mini-mental state examination (MMSE) score of >23/30 were recruited. Fifty healthy volunteers (26.3±5.17 years; M:F=28:22) formed the control group. Gaps-In-Noise test demonstrated impaired temporal resolution: 69.2% of patients with right MTS (RMTS) and 76.9% of patients with left MTS (LMTS) had abnormal scores in the right ear for gap detection threshold (GDT) measure. Similarly, 53.8% of patients in the RMTS group and 76.9% of patients in the LMTS group had abnormal scores in the left ear. In percentage of correct identification (PCI), 46.1% of patients with RMTS and 69.2% of patients with LMTS had poorer scores in the right ear, whereas 46.1% of patients with RMTS and 61.5% of patients with LMTS had poorer scores in the left ear. Both patient groups, viz., RMTS and LMTS, demonstrated bilateral temporal resolution deficits.

Non-motor features in essential tremor.

INTRODUCTION: Essential tremor (ET) is increasingly recognized to have several non-motor manifestations. The aim of this study was to determine the prevalence of non-motor manifestations in ET and its impact on the quality of life (QOL). METHODS: This was a cross-sectional case-control questionnaire-based study. The subjects were 50 patients with ET and 50 matched healthy controls. All subjects were assessed by Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Parkinson Fatigue Scale, Brief Pain Inventory, Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale. In addition, QOL in Essential Tremor questionnaire was administered to patients with ET. RESULTS: Patients with ET, when compared with controls, had significantly higher prevalence and higher mean scores of sleep disturbances (46% vs 8%, P < 0.001; 5.9 ± 4.6 vs 2.6 ± 2.3, P < 0.001), fatigue (30% vs 8%, P = 0.009; 5.8 ± 0.8 vs 2.5 ± 0.4, P < 0.001), anxiety (66% vs 18%, P = 0.009; 7.4 ± 9.0 vs 0.7 ± 2.6, P < 0.001), depression (44% vs 8%, P = 0.009; 7.8 ± 7.9 vs 1.7 ± 3.3, P < 0.001) as well as higher mean score of pain severity (1.9 ± 2.3 vs 0.6 ± 1.2, P = 0.001) and interference owing to pain (2.0 ± 2.9 vs 0.5 ± 1.2, P = 0.001). Following hierarchical regression analysis, depression was the only non-motor feature that affected the QOL. CONCLUSION: There was a significantly higher prevalence and greater severity of sleep disturbances, fatigue, pain, anxiety, and depression in patients with ET and depression significantly affected the QOL.

Cognitive behavior therapy for stuttering: a case series.

The present investigation was aimed at studying the efficacy of cognitive behavior therapy (CBT) in reducing the symptoms of stuttering and dysfunctional cognitions and in enhancing assertiveness and quality of life in clients with stuttering. Five clients with stuttering who met the inclusion criteria (male clients with diagnosis of stuttering) and exclusion criteria (clients with brian damage), substance abuse or mental retardation were enrolled for the study. A single-case design was adopted. The pre-, mid- and post-assessment were carried out using Stuttering Severity Scale (SSI), Perception of Stuttering Inventory (PSI), Beck's Anxiety Inventory (BAI), Dysfunctional Attitude (DAS), Fear of Negative Evaluation (FNE), Assertiveness Scale (AS), Rosenberg's Self-Esteem Scale (RSES), and World Health Organization - Quality of Life Scale (WHO-QOL). Five clients received cognitive behavioral intervention comprising of psycho-education, relaxation, deep breathing, humming, prolongation, cognitive restructuring, problem-solving strategies and assertiveness. At post-treatment assessment, there was improvement. The findings of the study are discussed in the light of available research work, implications, limitations of the study and suggestions for future research.

Comprehensive management of psychogenic dysphonia: a case illustration.

UNLABELLED: Psychogenic dysphonia refers to the loss of voice, in the absence of apparent structural or neurological pathology. It is a disorder seen more often in women and is usually associated with significant life events and emotional difficulties that may lead to conflict over speaking. Therapeutic interventions in voice disorders recommend the adoption of a multidisciplinary approach to treatment. The following is a case illustration of a 50-year-old married lady with dysphonia and significant marital difficulties. LEARNING OUTCOMES: The case demonstrates the psychological issues in the onset and maintenance of psychogenic voice disorders. It also emphasizes the use of a multidisciplinary approach consisting of cognitive behavioural strategies, pharmacological inputs and voice therapy. The case illustration will also help the reader to focus on cultural issues relevant in the development of problems and the need to address these in psychotherapeutic interventions, as well as difficulties that are likely to be encountered in therapeutic interventions.

Primary auditory neuropathy - an enigma.

OBJECTIVES: To report audiological and neuroradiological findings in patients with primary auditory neuropathy (PAN) from a tertiary institution in south India. MATERIAL AND METHODS: The auditory profiles in 24 patients were analyzed along with neurological and radiological findings. RESULTS: Puretone audiometry showed varied hearing acuity and configuration. The syllable recognition score (n=15) was above 80% except in three. The dichotic digit test (n=11) showed bilateral suppression except in two who showed unilateral suppression. The auditory brainstem responses and the acoustic stapedius reflex were absent with distortion product otoacoustic emission (DPOAE) present in all. The neurological and radiological studies were normal. CONCLUSION: The audiological profile is consistent with the presence of DPOAE and absence of acoustic stapedius reflex and auditory brainstem responses. In patients with adequately preserved syllable recognition in quiet conditions, there was a significantly poor performance on dichotic digit test. As these patients had no neurological deficits and absence of specific etiological factors, we propose to use the term PAN for this entity.

Pure word deafness in two patients with subcortical lesions.

We report two patients with pure word deafness (PWD) with tumour in the III ventricle region with obstructive hydrocephalus. A diagnosis of PWD was made in these two patients in view of impaired verbal comprehension in the presence of adequate hearing, intact acoustic stapedius reflex and well preserved environmental sound perception. Return of verbal comprehension following the radiation therapy observed is probably due to the reduction of the tumour mass and the release of thalamocortical auditory pathways from its compressive effect. Our findings support the hypothesis of the presence of discrete auditory pathways for mediation of verbal and non-verbal stimuli independently.

Crossed aphasia in a dextral.

A case of crossed aphasia in a monolingual dextral with detailed clinical, neuropsychological and language assessment is described. The presence of Gerstmann-syndrome suggested cross-over of even dominant parietal lobe functions. Lateralization and localization of various language functions in relation to crossed aphasia are discussed.