Reduced Handgrip Strength Is Associated with 1 Year-Mortality in Brazilian Frail Nonagenarians and Centenarians.

The aim of the present study was to investigate the association between handgrip strength and mortality in Brazilian frail nonagenarians and centenarians. Eighty-one oldest old were included (mean age [SD]: 94.2 [3.8] years). Data on strength was assessed by handgrip strength. Mortality rate of the participants was evaluated at 1-year follow-up after the functional assessment. A logistic regression analysis was used to assess differences in categories of handgrip strength between groups regarding the mortality rate. Forty-six participants (56.8%) had reduced handgrip strength. After 1 year, there were 16 deaths. Those older adults with a low handgrip strength had higher prevalence (28.3% vs. 8.6%) and increased risk of mortality than those with preserved handgrip strength (Odds ratio=4.4, confidence interval 95% 1.1, 18.4) (p=0.042). Reduced handgrip strength is associated with higher mortality rate at 1-year follow-up in Brazilian frail nonagenarians and centenarians.

[Audiometric test battery for presbycusis]. / Audiometrische Testbatterie bei Presbyakusis.

Old people often complain that they can no longer sufficiently participate in communication with spoken language. The reasons for this lie in pathophysiological processes as well as in acoustic parameters and the decline in cognitive performance that frequently occurs in old age, which together severely limit the individual benefits of speech. Age-related hearing loss consists of a variety of pathophysiological and cognitive factors. Several audiometric procedures are necessary for profound diagnostics, planning and implementation of interventions for hearing improvement as well as interventions for the individual improvement of the benefits of hearing in everyday life. In a basic test battery, the subjective and objective procedures for the primary detailed quantification and differentiation of the pathophysiological effects of presbycusis are listed, which serve as a basis for interventions to improve hearing. If necessary, audiometric procedures for more in-depth pathophysiological analyses can be used as part of the extended test battery. They are mainly used to differentiate between peripheral and retrocochlear factors of age-related hearing loss. The aim of the methods in the test battery for the evaluation of communication impairment in everyday life is the quantitative and qualitative evaluation of the ability to participate in communication with spoken language under realistic acoustic everyday conditions. From the results, acoustic and cognitive factors can be identified which determine the limited benefits of speech. Thus, strategies and procedures for the improvement of speech communication can be derived which, despite the pathophysiological conditions, can lead to an improved participation in speech communication in the everyday life of the patients.

[Significance of deviations in hearing thresholds in pure-tone audiograms]. / Zur Signifikanz von Abweichungen der Hörschwellen im Tonschwellenaudiogramm.

Variations in tone hearing thresholds can occur with a certain probability at random or due to systematic changes in hearing, the test system or the test methodology. Therefore, a significance analysis is essential for diagnostic statements and expert opinions. The random probability tables published here can be used in a simple way to identify any significant alterations in hearing thresholds with a probability of error of ≤0.05.

[Basic knowledge on the efficacy of hearing aids depending on the type of hearing impairment for Ear, Nose & Throat specialists]. / Fachärztliches Basiswissen zur Wirksamkeit von Hörgeräten in Abhängigkeit der Art und Pathophysiologie einer Hörstörung.

For Ear, Nose & Throat specialists, the physiological and psychoacoustical deficits related to hearing impairment and the compensatory capabilities of hearing aids are topics of prime importance. In conductive hearing loss, the foremost deficit is decreased audibility, for which hearing aids can compensate almost entirely through the use of level independent gain. In the instance of sensorineural hearing loss, however, the irreversible loss of outer and inner hair cells causes a distorted sound perception, which is particularly troublesome when trying to understand speech in noisy environments. Unfortunately, this distortion cannot be compensated through the use of hearing aids. Nevertheless, in particular listening environments, its effects can be lessened by reducing background noise levels through the use of directional microphones and, to a lesser extent, digital noise reduction. Noise reduction is in many cases also the main effect to improve speech discrimination in retrocochlear hearing loss.

Development of a valid and reliable test to assess trauma radiograph interpretation performance.

OBJECTIVES: The purpose of this investigation was to develop and examine the preliminary validity and reliability among radiographers of a test to assess trauma radiograph interpretation performance suitable for use among health professionals. METHODS: Stage 1 examined 14,159 consecutive appendicular and axial examinations from a hospital emergency department over a 12 month period to quantify a typical anatomical region case-mix of trauma radiographs. A sample of radiographic cases representative of affected anatomical regions was then developed into the Image Interpretation Test (IIT). Stage 2 involved prospective investigations of the IIT's reliability (inter-rater, intra-rater, internal consistency) and validity (concurrent) among 41 radiographers. RESULTS: The IIT included 60 cases. The median (interquartile range) clinical experience of participants was 5 (2-10) years. Case scores were internally consistent (Cronbach's alpha = 0.90). Favourable inter-rater reliability (kappa > 0.70 for 58/60 cases, Intra-class correlation coefficient (ICC) > 0.99 for total score) and intra-rater reliability (kappa > 0.90 for 60/60 cases, ICC > 0.99 for total score) was observed. There was a positive association between radiographers' confidence in image interpretation and IIT score (coefficient = 1.52, r-squared = 0.60, p < 0.001). CONCLUSIONS: The IIT developed during this investigation included a selection of radiographic cases consistent with anatomical regions represented in an adult trauma case-mix. This study has also provided foundational preliminary evidence to support the reliability and validity of the IIT among radiographers. The findings suggest that it is possible to assess image interpretation performance of adult trauma radiographs with this test.

[The systematic selection of speech audiometric procedures]. / Die systematische Auswahl von sprachaudiometrischen Verfahren.

BACKGROUND: The impact of hearing loss on the ability to participate in verbal communication can be directly quantified through the use of speech audiometry. Advances in technology and the associated reduction in background noise interference for hearing aids have allowed the reproduction of very complex acoustic environments, analogous to those in which conversations occur in daily life. These capabilities have led to the creation of numerous advanced speech audiometry measures, test procedures and environments, far beyond the presentation of isolated words in an otherwise noise-free testing booth. OBJECTIVE: The aim of this study was to develop a set of systematic criteria for the appropriate selection of speech audiometric material, which are presented in this article in relationship to the most widely used test procedures. RESULTS: Before an appropriate speech test can be selected from the numerous procedures available, the precise aims of the evaluation should be basically defined. Specific test characteristics, such as validity, objectivity, reliability and sensitivity are important for the selection of the correct test for the specific goals. CONCLUSION: A concrete understanding of the goals of the evaluation as well as of specific test criteria play a crucial role in the selection of speech audiometry testing procedures.

[Use of Freiburg monosyllabic test words in the contemporary German language : Currentness of the test words]. / Verwendungshäufigkeit der Freiburger Einsilber in der Gegenwartssprache : Aktualität der Testwörter.

The Freiburg monosyllabic test has a word inventory based on the word frequency in written sources from the 19th century, the distribution of which is not even between the test lists. The median distributions of word frequency ranking in contemporary language of nine test lists deviate significantly from the overall median of all 400 monosyllables. Lists 1, 6, 9, 10, and 17 include significantly more very rarely used words; lists 2, 3, 5, and 15, include significantly more very frequently used words. Compared with the word frequency in the contemporary spoken German language, about 45 % of the test words are practically no longer used. Due to this high proportion of extremely rarely or no longer used words, the word inventory is no longer representative of the contemporary German language-neither for the written, nor for the spoken language. Highly educated persons with a large vocabulary are thereby favored. The reference values for normal-hearing persons should therefore be reevaluated.

[Hearing loss in adolescents due to leisure noise. The OHRKAN study]. / Hörst du noch oder pfeift es schon? Hörschäden durch Freizeitlärm bei Jugendlichen und die Studie OHRKAN.

Alarming reports have been published about hearing loss in adolescents, and increasing leisure time noise exposure has been blamed. If the exposure limits from the Noise at Work Regulations are applied, discotheque music as well as music from portable music players are associated with the risk of hearing loss. The empirical evidence for this association, however, is not sufficient. Not even an increase in the prevalence of noise-induced hearing loss among adolescents can be documented. OHRKAN is a prospective cohort study aimed to produce information on the prevalence of hearing loss as well as its risk factors in adolescents. Currently, a total of 2,240 pupils in grade 9 at schools in the city of Regensburg, Germany, have been recruited. Data on noise exposure were collected using standardized questionnaires. In addition, hearing status was assessed by medical examination including tympanometry, audiometry, and distortion-product otoacoustic emissions. Developments in noise exposure as well as hearing status will be assessed in follow-up data collections. Independent of this empirical assessment preventive measures are already needed now to reduce the risk of hearing loss in adolescents and young adults.

Transcranial magnetic stimulation (TMS) for treatment of chronic tinnitus: clinical effects.

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive method used to induce electrical current in the brain through impulses of strong magnetic fields applied externally. The technique can relieve tinnitus by modulating the excitability of neurons in the auditory cortex to decrease the hyperexcitability that is associated with generating the neural activity that causes some form of tinnitus. This chapter will review clinical studies using rTMS for the treatment of tinnitus.

Structural brain alterations following 5 days of intervention: dynamic aspects of neuroplasticity.

Activation-dependent brain plasticity in humans on a structural level has been demonstrated in adults after 3 months of training a visio-motor skill. The exact timescale of usage-dependent structural changes, whether days, months, or years, is, however, still debated. A better understanding of the temporal parameters may help elucidate to what extent this type of cortical plasticity contributes to fast adapting cortical processes that may be relevant to learning and effects of treatments. Using voxel-based morphometry, we are able to show that repetitive transcranial magnetic stimulation delivered to the superior temporal cortex causes macroscopic cortical changes in gray matter (GM) in the auditory cortex as early as within 5 days of continuous intervention. These structural alterations are mirrored by changes in cortical evoked potentials attributed to the GM changes and demonstrate the rapid dynamics of these processes, which occur within a time range characteristic for the onset of behavioral effects induced by a variety of treatment methods for neuropsychiatric diseases. Our finding suggests that cortical plasticity on a structural level in adult humans is already detectable after 1 week, which provides support for fast adjusting neuronal systems, such as spine and synapse turnover, and contradicts slow evolving mechanisms, such as neuronal or glial cell genesis.

[Diagnosis and therapy of auditory synaptopathy/neuropathy]. / Diagnostik und Therapie der auditorischen Synaptopathie/Neuropathie.

Pathological auditory brainstem responses (lack of responses, elevated thresholds and perturbed waveforms) in combination with present otoacoustic emissions are typical audiometric findings in patients with a hearing impairment that particularly affects speech comprehension or complete deafness. This heterogenous group of disorders first described as "auditory neuropathy" includes dysfunction of peripheral synaptic coding of sound by inner hair cells (synaptopathy) and/or of the generation and propagation of action potentials in the auditory nerve (neuropathy). This joint statement provides prevailing background information as well as recommendations on diagnosis and treatment. The statement focuses on the handling in the german language area but also refers to current international statements.

[Treatment of chronic tinnitus with neuronavigated repetitive Transcranial Magnetic Stimulation (rTMS)]. / Neuronavigierte repetitive transkranielle Magnetstimulation (rTMS). Ein neuartiges Therapieverfahren zur Behandlung des chronischen Tinnitus.

BACKGROUND AND OBJECTIVE: Idiopathic tinnitus is a frequent and debilitating disorder of largely unknown pathophysiology. Focal brain activation in the auditory cortex has recently been demonstrated in chronic tinnitus. Low-frequency rTMS can reduce cortical hyperexcitability. PATIENTS AND METHODS: In 12 patients with chronic tinnitus, fusion of [18F]deoxyglucose-PET and structural MRI (T1, MPRAGE) scans allowed the area of increased metabolic activity in the auditory cortex to be exactly identified; this area was selected as the target for rTMS. A neuronavigational system adapted for TMS positioning enabled the relative positions of the figure-8 coil and the target area to be monitored. Repetitive TMS (110% motor threshold; 1 Hz; 2000 stimuli per day over 5 days) was performed using a placebo-controlled crossover design. A sham coil system was used for the placebo stimulation. Treatment outcome was assessed with a specific tinnitus questionnaire (Goebel and Hiller). RESULTS: In all 12 patients an asymmetrically increased metabolic activation of the gyrus of Heschl was detected. The tinnitus score was significantly improved after 5 days of active rTMS, an effect not seen after placebo stimulation. CONCLUSION: These preliminary results show that neuronavigated rTMS may improve our understanding and treatment of chronic tinnitus.

[The Oldenburg children's rhyme test during speech simulating noise disturbance (Regensburg variant). Modification of the test and normal values for the ages 7-10 years]. / Oldenburger Kinderreimtest (OLKI) im sprachsimulierenden Störgeräusch (Regensburger Variante). Testmodifikationen und Normalwerte für die Altersklasse 7-10 Jahre.

OBJECTIVE: Of the German language speech audiometry tests used for children, only the Oldenburg children's rhyme test is constructed to allow measurements in noise. Unfortunately, no reference values exist for such measurements. Many of children admitted to test speech discrimination in noise are suspected of suffering from central auditory processing disorders and/or attention deficits. Thus, the objective of the present study is the development of a speech-in-noise test that focuses the children's attention on the target words. DESIGN: A speech-simulating noise was added to the Oldenburg children's rhyme test and the discrimination function was estimated. First, the total power of all target words was equalised and the total power of the noise adjusted to obtain a constant signal-to-noise ratio (SNR) for all target words. Second, speech and noise were presented binaurally with headphones. Speech was presented at 65 dB SPL and the noise level varied to obtain SNRs of 0, -5 and -10 dB SN. A total of 55 normal children, 7-10 years of age, were also tested. RESULTS: Mean speech discrimination was 91+/-7% at 0 dB SN, 75+/-11% at -5 dB SN and 55+/-14% at -10 dB SN. The discrimination function results in a speech reception threshold (SRT) of -10.9 dB SN and a maximum slope of 4.95%/dB SN. CONCLUSION: The "Regensburg" variation of the "Oldenburg children's rhyme test" was easily feasible in all tested children. The results can be used as normative data for children between 7 and 10 years.

Measurement of iris color using computerized image analysis.

PURPOSE: To develop a standardized method for measuring from iris photographs, light and dark segments of areas and densities of iris color. METHODS: Computerized image analysis was used to measure the iris photographs. The reproducibility of this method was studied in 30 normal eyes with three different colored irides, green-brown, blue-grey brown and yellow-brown. Three photographs were taken of each iris with a slit lamp camera at three different exposures at baseline. The photographs were repeated with exposure providing for the best reproducibility at 6.5 +/- 1.7 months as a first follow-up after baseline and 3.6 +/- 0.8 months following the first follow-up visit. At least one measurement was made for each photograph. RESULTS: The mean percent coefficient of variation (standard deviation of triplicate measurements/mean x 100) ranged from 1.0 to 4.1% for area and density measurements. Furthermore, the range of mean percent differences between baseline and follow-up visits ranged from 1.2 to 6.3%. CONCLUSION: We have developed a standardized method which appears suitable for measuring changes over time in iris color.