Health consequences of exposure to aircraft contaminated air and fume events: a narrative review and medical protocol for the investigation of exposed aircrew and passengers.

Thermally degraded engine oil and hydraulic fluid fumes contaminating aircraft cabin air conditioning systems have been well documented since the 1950s. Whilst organophosphates have been the main subject of interest, oil and hydraulic fumes in the air supply also contain ultrafine particles, numerous volatile organic hydrocarbons and thermally degraded products. We review the literature on the effects of fume events on aircrew health. Inhalation of these potentially toxic fumes is increasingly recognised to cause acute and long-term neurological, respiratory, cardiological and other symptoms. Cumulative exposure to regular small doses of toxic fumes is potentially damaging to health and may be exacerbated by a single higher-level exposure. Assessment is complex because of the limitations of considering the toxicity of individual substances in complex heated mixtures.There is a need for a systematic and consistent approach to diagnosis and treatment of persons who have been exposed to toxic fumes in aircraft cabins. The medical protocol presented in this paper has been written by internationally recognised experts and presents a consensus approach to the recognition, investigation and management of persons suffering from the toxic effects of inhaling thermally degraded engine oil and other fluids contaminating the air conditioning systems in aircraft, and includes actions and investigations for in-flight, immediately post-flight and late subsequent follow up.

Mass Spectrometric Lipid Profiles of Picosecond Infrared Laser-Generated Tissue Aerosols Discriminate Different Brain Tissues.

BACKGROUND AND OBJECTIVES: A picosecond infrared laser (PIRL) has recently been demonstrated to cut biological tissue without scar formation based on the minimal destructive action on the surrounding cells. During cutting with PIRL, the irradiated tissue is ablated by a cold vaporization process termed desorption by impulsive vibrational excitation. In the resulting aerosol, all molecules are dissolved in small droplets and even labile biomolecules like proteins remain intact after ablation. It is hypothesized that these properties enable the PIRL in combination with mass spectrometry as an intelligent laser scalpel for guided surgery. In this study, it was tested if PIRL-generated tissue aerosols are applicable for direct analysis with mass spectrometry, and if the acquired mass spectra can be used to discriminate different brain areas. MATERIALS AND METHODS: Brain tissues were irradiated with PIRL. The aerosols were collected and directly infused into a mass spectrometer via electrospray ionization without any sample preparation or lipid extraction. RESULTS: The laser produced clear cuts with no marks of burning. Lipids from five different classes were identified in the mass spectra of all samples. By principal component analysis the different brain areas were clearly distinguishable from each other. CONCLUSIONS: The results demonstrate the potential for real-time analysis of lipids with a PIRL-based laser scalpel, coupled to a mass spectrometer, for the discrimination of tissues during surgeries. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Multi-sensory training and wrist fractures: a randomized, controlled trial.

BACKGROUND: Asymmetric vestibular function, decreased plantar sensation, postural control and functional ability have been associated with fall-related wrist fractures. OBJECTIVE: To investigate whether multi-sensory training (MST) improves postural control, vestibular function, foot sensation and functional ability among people with fall-related wrist fractures compared to wrist stabilization training (WT). METHODS: This was an assessor-blinded, randomized controlled trial. Ninety-eight participants, age 50-75 years, were randomized to MST or WT. Pre- and post-training measurements: Head Shake Test (HST), Video-Head Impulse Test (vHIT), Semmes-Weinstein Monofilaments (SWF), Biothesiometer (BT), Sensory Organization Test (SOT), 10-m Walk Test (10MWT), Five Times Sit to Stand Test (FTSTS), Activities-Specific Balance Confidence (ABC) and Dizziness Handicap Inventory Scales (DHI). The training period was 12 weeks, with six supervised sessions by a physical therapist and daily home exercises for both groups. RESULTS: There were significant endpoint differences in SOT (p = 0.01) between the two groups, in favor of the MST group, but no changes were seen in other outcome variables. Subgroup analysis with participants below normal baseline SOT composite scores indicated that the MST was more effective in improving 10MWT fast (p = 0.04), FTSTS (p = 0.04), SWF (p = 0.04) and SOT scores (p = 0.04) than the WT. CONCLUSIONS: MST improves postural control among people with a fall-related wrist fracture. The results further suggest that the program is more effective for those with SOT balance scores below age-related norms.

Patient-reported Outcomes and Clinical Response in Patients with Moderate-to-severe Plaque Psoriasis Treated with Tonsillectomy: A Randomized Controlled Trial.

Psoriasis is a chronic inflammatory skin disease with profound effects on patients' health-related quality of life (HRQoL). Twenty-nine patients with plaque psoriasis and a history of streptococcal-associated psoriasis exacerbations were randomly assigned to tonsillectomy (n = 15) or control (n = 14) groups and followed for 24 months. Patients were evaluated with the Psoriasis Disability Index, Psoriasis Life Stress Inventory and Psoriasis Area and Severity Index. HRQoL and psoriasis-related stress improved significantly in the tonsillectomy group compared with the control group (p = 0.037 and p = 0.002, respectively), with a mean 50% improvement in HRQoL and a mean 59% improvement in psoriasis-induced stress. Clinical improvement correlated significantly with improved HRQoL (r = 0.297, p = 0.008) and psoriasis-related stress (r = 0.310, p = 0.005). Of the tonsillectomized patients, 87% concluded that the procedure was worthwhile. Tonsillectomy may improve quality of life for selected patients with plaque psoriasis.

HLA-Cw6 homozygosity in plaque psoriasis is associated with streptococcal throat infections and pronounced improvement after tonsillectomy: A prospective case series.

BACKGROUND: Carriage of the HLA-Cw*0602 allele is associated with a particular set of clinical features and treatment responses in psoriasis. Tonsillectomy can improve psoriasis. OBJECTIVES: We sought to evaluate whether HLA-Cw*0602 predicts a favorable outcome after tonsillectomy of patients with psoriasis. METHODS: This prospective case series followed up 28 tonsillectomized patients with plaque psoriasis for 24 months. The Psoriasis Area and Severity Index, Psoriasis Disability Index, and Psoriasis Life Stress Inventory were used for assessment. Tonsils were swabbed for bacteria and patients genotyped for HLA-Cw*0602. RESULTS: After tonsillectomy, HLA-Cw*0602 homozygotes showed significantly more improvement, compared with heterozygous and HLA-Cw*0602-negative patients. Thus, Psoriasis Area and Severity Index score was reduced by 82% in the homozygous patients compared with 42% and 31%, respectively (P < .001), Psoriasis Disability Index score improved by 87% compared with 38% and 41%, respectively (P < .001), and Psoriasis Life Stress Inventory score was 82% reduced compared with 60% and 54%, respectively (P < .001). The homozygotes more often had psoriasis onset associated with a throat infection (P = .007) and an increased frequency of streptococcal throat infections per lifetime (P = .038). LIMITATIONS: Few patients were included and some data were retrospective. CONCLUSIONS: Homozygous HLA-Cw*0602 carriage in plaque psoriasis may predict a favorable outcome after tonsillectomy.

Comparative study of wound healing in rat skin following incision with a novel picosecond infrared laser (PIRL) and different surgical modalities.

BACKGROUND AND OBJECTIVE: As a result of wound healing the original tissue is replaced by dysfunctional scar tissue. Reduced tissue damage during surgical procedures beneficially affects the size of the resulting scar and overall healing time. Thus the choice of a particular surgical instrument can have a significant influence on the postoperative wound healing. To overcome these problems of wound healing we applied a novel picosecond infrared laser (PIRL) system to surgical incisions. Previous studies indicated that negligible thermal, acoustic, or ionization stress effects to the surrounding tissue results in a superior wound healing. STUDY DESIGN/MATERIALS AND METHODS: Using the PIRL system as a surgical scalpel, we performed a prospective wound healing study on rat skin and assessed its final impact on scar formation compared to the electrosurgical device and cold steel. As for the incisions, 6 full-thickness, 1-cm long-linear skin wounds were created on the dorsum of four rats using the PIRL, an electrosurgical device, and a conventional surgical scalpel, respectively. Rats were euthanized after 21 days of wound healing. The thickness of the subepithelial fibrosis, the depth and the transverse section of the total scar area of each wound were analyzed histologically. RESULTS: After 21 days of wound healing the incisions made by PIRL showed minor scar tissue formation as compared to the electrosurgical device and the scalpel. Highly significant differences (P < 0.001) were noted by comparing the electrosurgical device with PIRL and scalpel. The transverse section of the scar area also showed significant differences (P = 0.043) when comparing PIRL (mean: 141.46 mm2; 95% CI: 105.8-189.0 mm2) with scalpel incisions (mean: 206.82 mm2; 95% CI: 154.8-276.32 mm2). The subepithelial width of the scars that resulted from using the scalpel were 1.3 times larger than those obtained by using the PIRL (95% CI: 1.0-1.6) though the difference was not significant (P < 0.083). CONCLUSIONS: The hypothesis that PIRL results in minimal scar formation with improved cosmetic outcomes was positively verified. In particular the resection of skin tumors or pathological scars, such as hypertrophic scars or keloids, are promising future fields of PIRL application.

Decreased postural control in adolescents born with extremely low birth weight.

The survival rates of infants born preterm with extremely low birth weight (ELBW ≤ 1000 g) have gradually improved over the last decades. However, these infants risk to sustain long-term disorders related to poor neurodevelopment. The objective was to determine whether adolescents born with ELBW have decreased postural control and stability adaptation. Twenty-nine ELBW subjects performed posturography with eyes open and closed under unperturbed and perturbed standing by repeated calf vibration. Their results were compared with twenty-one age- and gender-matched controls born after full-term pregnancy. The ELBW group had significantly decreased stability compared with controls in anteroposterior direction, both during the easier quiet stance posturography (p = 0.007) and during balance perturbations (p = 0.007). The ELBW group had similar stability decrease in lateral direction during balance perturbations (p = 0.013). Statistically, the stability decreases were similar with eyes closed and open, but proportionally larger with eyes open in both directions. Both groups manifested significant adaptation (p ≤ 0.023) to the balance perturbations in anteroposterior direction, though this adaptation process could not compensate for the general stability deficits caused by ELBW on postural control. Hence, adolescent survivors of ELBW commonly suffer long-term deficits in postural control, manifested as use of substantially more recorded energy on performing stability regulating high-frequency movements and declined stability with closed and open eyes both in anteroposterior and lateral direction. The determined relationship between premature birth and long-term functional deficits advocates that interventions should be developed to provide preventive care in neonatal care units and later on in life.

Sex-specific predictors of hearing-aid use in older persons: The age, gene/environment susceptibility - Reykjavik study.

OBJECTIVE: We estimate the prevalence of hearing-aid use in Iceland and identify sex-specific factors associated with use. DESIGN: Population-based cohort study. STUDY SAMPLE: A total of 5172 age, gene/environment susceptibility - Reykjavik study (AGES-RS) participants, aged 67 to 96 years (mean age 76.5 years), who completed air-conduction and pure-tone audiometry. RESULTS: Hearing-aid use was reported by 23.0% of men and 15.9% of women in the cohort, although among participants with at least moderate hearing loss in the better ear (pure-tone average [PTA] of thresholds at 0.5, 1, 2, and 4 kHz ≥ 35 dB hearing level [HL]) it was 49.9% and did not differ by sex. Self-reported hearing loss was the strongest predictor of hearing-aid use in men [OR: 2.68 (95% CI: 1.77, 4.08)] and women [OR: 3.07 (95% CI: 1.94, 4.86)], followed by hearing loss severity based on audiometry. Having diabetes or osteoarthritis were significant positive predictors of use in men, whereas greater physical activity and unimpaired cognitive status were important in women. CONCLUSIONS: Hearing-aid use was comparable in Icelandic men and women with moderate or greater hearing loss. Self-recognition of hearing loss was the factor most predictive of hearing-aid use; other influential factors differed for men and women.

Manifestation of eosinophilic granulomatosis with polyangiitis in head and neck.

INTRODUCTION: Besides an obvious clinical involvement of the ear, nose and throat (ENT)-region in Eosinophilic Granulomatosis with Polyangiitis (EGPA), systematic data is sparse. Only a few case series and case reports are available that particularly describe rhinological, otological or other manifestations of EGPA in the ENT-region. Therefore, the objective of this study is to systematically describe data on ENT-region involvement in a large series of EGPA patients. METHOD: EGPA patients examined in the Department of Otorhinolaryngology of the Christian-Albrechts-University of Kiel between 1990 and 2010 were included in the study. Criteria for ENT-manifestation were assigned to five subgroups (history, ENT examination, audiological and rhinological diagnostic findings and cranial MRI) and documented cumulatively. EGPA patients were examined in a standardized way based on the validated Ear Nose and Throat Activity Score (ENTAS) or its precursor, including audiological and rhinological diagnostic findings. MRI scans were analysed to further evaluate ENT involvement. RESULTS: A total of 95 EGPA patients were included in the study. In approximately 80% of them, ENT-involvement was documented and the assumption of a frequent rhinological manifestation in patients with EGPA was confirmed. Moreover, the data reveals remarkable evidence for an otological manifestation. A missing correlation between the rhinological and the otological manifestation indicates an independent autoimmune-inflammatory process for this manifestation. CONCLUSION: The data of the largest monocentric study presented here confirms the hypothesis of a frequent ENT involvement in EGPA patients, in whom rhinological and otological manifestations are most common. Therefore, treatment should include long term follow-up and should be managed interdisciplinary.

Improvement of psoriasis after tonsillectomy is associated with a decrease in the frequency of circulating T cells that recognize streptococcal determinants and homologous skin determinants.

Exacerbation of chronic psoriasis can be associated with streptococcal throat infections, and T cells that respond to peptide sequences common to streptococcal M proteins and skin keratins have been detected in patients' blood. To our knowledge, we have conducted the first blinded, prospective study to assess the impact of tonsillectomy on psoriasis. Twenty-nine patients with chronic psoriasis and history of exacerbation after sore throat were randomly assigned to tonsillectomy (n = 15) or control (n = 14) groups and monitored for 2 y clinically and by enumeration of circulating skin homing T cells that respond to short homologous M protein or keratin peptides. Thirteen patients (86%) showed sustained improvement after tonsillectomy ranging from 30 to 90% reduction in disease severity. Furthermore, there was a close correlation between the degree of clinical improvement in individual patients and reduction in the frequency of peptide-reactive skin-homing T cells in their circulation. No corresponding clinical or immunologic changes were observed among the controls. These findings indicate that tonsillectomy may have a beneficial effect on chronic psoriasis because the palatine tonsils generate effector T cells that recognize keratin determinants in the skin.

Impairments in hearing and vision impact on mortality in older people: the AGES-Reykjavik Study.

OBJECTIVE: to examine the relationships between impairments in hearing and vision and mortality from all-causes and cardiovascular disease (CVD) among older people. DESIGN: population-based cohort study. PARTICIPANTS: the study population included 4,926 Icelandic individuals, aged ≥67 years, 43.4% male, who completed vision and hearing examinations between 2002 and 2006 in the Age, Gene/Environment Susceptibility-Reykjavik Study (AGES-RS) and were followed prospectively for mortality through 2009. METHODS: participants were classified as having 'moderate or greater' degree of impairment for vision only (VI), hearing only (HI), and both vision and hearing (dual sensory impairment, DSI). Cox proportional hazard regression, with age as the time scale, was used to calculate hazard ratios (HR) associated with impairment and mortality due to all-causes and specifically CVD after a median follow-up of 5.3 years. RESULTS: the prevalence of HI, VI and DSI were 25.4, 9.2 and 7.0%, respectively. After adjusting for age, significantly (P < 0.01) increased mortality from all causes, and CVD was observed for HI and DSI, especially among men. After further adjustment for established mortality risk factors, people with HI remained at higher risk for CVD mortality [HR: 1.70 (1.27-2.27)], whereas people with DSI remained at higher risk of all-cause mortality [HR: 1.43 (1.11-1.85)] and CVD mortality [HR: 1.78 (1.18-2.69)]. Mortality rates were significantly higher in men with HI and DSI and were elevated, although not significantly, among women with HI. CONCLUSIONS: older men with HI or DSI had a greater risk of dying from any cause and particularly cardiovascular causes within a median 5-year follow-up. Women with hearing impairment had a non-significantly elevated risk. Vision impairment alone was not associated with increased mortality.

Adaptation strategies and neurophysiological response in early-stage Parkinson's disease: BioVRSea approach.

Introduction: There is accumulating evidence that many pathological conditions affecting human balance are consequence of postural control (PC) failure or overstimulation such as in motion sickness. Our research shows the potential of using the response to a complex postural control task to assess patients with early-stage Parkinson's Disease (PD). Methods: We developed a unique measurement model, where the PC task is triggered by a moving platform in a virtual reality environment while simultaneously recording EEG, EMG and CoP signals. This novel paradigm of assessment is called BioVRSea. We studied the interplay between biosignals and their differences in healthy subjects and with early-stage PD. Results: Despite the limited number of subjects (29 healthy and nine PD) the results of our work show significant differences in several biosignals features, demonstrating that the combined output of posturography, muscle activation and cortical response is capable of distinguishing healthy from pathological. Discussion: The differences measured following the end of the platform movement are remarkable, as the induced sway is different between the two groups and triggers statistically relevant cortical activities in α and θ bands. This is a first important step to develop a multi-metric signature able to quantify PC and distinguish healthy from pathological response.

Seasickness among Icelandic seamen.

INTRODUCTION: The working environment abroad a ship is unique, with constant stimuli such as rolling of the vessel, noise, and vibration. Fishing industry is important for Icelandic economy, still the effect of seasickness-related symptoms on seamen´s health is not fully understood. Thus, the objective of this study is to explore the impact of seasickness-related symptoms, i.e., seasickness, seasickness symptoms and mal de débarquement on seaman´s health, and how their working environment may affect those factors. METHODS: Cross-sectional data was collected from 262 seamen answering questionnaire. Majority of the seamen participated while attending a compulsory course held by the Maritime Safety and Survival Training Centre. The majority of participants were men. A chi-square test was used to detect the difference between variables. RESULTS: The majority of seamen had experienced seasickness (87.8%) or mal de débarquement (85.8%). Having a history of tension headache (38.1%) and tinnitus (37.9%) was quite common. A total of 30.6% of the participants had been admitted to hospital once or more due to mishaps or accidents on land. DISCUSSION: Seasickness and seasickness symptoms together with mal de débarquement are common in Icelandic seamen. Working conditions at sea are demanding and seam to affect the seamen´s health both at sea and ashore, making further research needed.

Cortical Pathways During Postural Control: New Insights From Functional EEG Source Connectivity.

Postural control is a complex feedback system that relies on vast array of sensory inputs in order to maintain a stable upright stance. The brain cortex plays a crucial role in the processing of this information and in the elaboration of a successful adaptive strategy to external stimulation preventing loss of balance and falls. In the present work, the participants postural control system was challenged by disrupting the upright stance via a mechanical skeletal muscle vibration applied to the calves. The EEG source connectivity method was used to investigate the cortical response to the external stimulation and highlight the brain network primarily involved in high-level coordination of the postural control system. The cortical network reconfiguration was assessed during two experimental conditions of eyes open and eyes closed and the network flexibility (i.e. its dynamic reconfiguration over time) was correlated with the sample entropy of the stabilogram sway. The results highlight two different cortical strategies in the alpha band: the predominance of frontal lobe connections during open eyes and the strengthening of temporal-parietal network connections in the absence of visual cues. Furthermore, a high correlation emerges between the flexibility in the regions surrounding the right temporo-parietal junction and the sample entropy of the CoP sway, suggesting their centrality in the postural control system. These results open the possibility to employ network-based flexibility metrics as markers of a healthy postural control system, with implications in the diagnosis and treatment of postural impairing diseases.

Evolution of postural control assessment: From dynamic posturography to virtual reality.

During the early years of spaceflight it was documented that astronauts were impaired and incapacitated upon return to earth. Computerized Dynamic Posturography (CDP) was devised to investigate and quantify this deficit, and eventually progressed into a clinical assessment tool. The current sprouting of virtual reality (VR) technologies has allowed for the development of an alternative approach that could be more informative. Many low-cost VR systems (including desktop gaming programs designed for rehabilitation) are now available. Continued improvements in this technology indicate a high probability that VR will become an integral component of posturography by replacing present mechanical CDP techniques. We researched the relevant literature to evaluate the strengths and weaknesses of CDP using the Equitest (Neurocom International; Clackamas USA), and the added benefits of incorporating VR to help clinicians assess the complex task of balance maintenance. VR is capable of manipulating task and environmental demands in order to assess functional postural behavior. VR is also a useful tool for clinical testing of postural disorders resulting from sensory mismatch. Although posturography is still a useful clinical tool, VR provides an inherent conflict between the visual and vestibular senses and can elevate the effectiveness of CDP for both assessment and intervention. We conclude that, when initially developed, CDP was innovative and ahead of its time. However, with the advent of VR, we have a chance to modernize CDP and enhance its value as a clinical instrument.

Motion sickness susceptibility and visually induced motion sickness as diagnostic signs in Parkinson's disease.

Postural instability and loss of vestibular and somatosensory acuity can be part of the signs encountered in Parkinson's Disease (PD). Visual dependency is described in PD. These modifications of sensory input hierarchy are predictors of motion sickness (MS). The aim of this study was to assess MS susceptibility and effects of real induced MS in posture. 63 PD patients, whose medication levels (levodopa) reflected the pathology were evaluated, and 27 healthy controls, filled a MS questionnaire; 9 PD patients and 43 healthy controls were assessed by posturography using virtual reality. Drug amount predicted visual MS (p=0.01), but not real induced MS susceptibility. PD patients did not experience postural instability in virtual reality, contrary to healthy controls. Since PD patients do not seem to feel vestibular stimulated MS, they may not rely on vestibular and somatosensory inputs during the stimulation. However, they feel visually induced MS more with increased levodopa drug effect. Levodopa amount can increase visual dependency. The strongest MS predictors must be studied in PD to better understand the effect of visual stimulation and its absence in vestibular stimulation.

Predicting postural control adaptation measuring EEG, EMG, and center of pressure changes: BioVRSea paradigm.

Introduction: Postural control is a sensorimotor mechanism that can reveal neurophysiological disorder. The present work studies the quantitative response to a complex postural control task. Methods: We measure electroencephalography (EEG), electromyography (EMG), and center of pressure (CoP) signals during a virtual reality (VR) experience called BioVRSea with the aim of classifying different postural control responses. The BioVRSea paradigm is based on six different phases where motion and visual stimulation are modulated throughout the experiment, inducing subjects to a different adaptive postural control strategy. The goal of the study is to assess the predictability of those responses. During the experiment, brain activity was recorded from a 64-channel EEG, muscle activity was determined with six wireless EMG sensors placed on lower leg muscles, and individual movement measured by the CoP. One-hundred and seventy-two healthy individuals underwent the BioVRSea paradigm and 318 features were extracted from each phase of the experiment. Machine learning techniques were employed to: (1) classify the phases of the experiment; (2) assess the most notable features; and (3) identify a quantitative pattern for healthy responses. Results: The results show that the EEG features are not sufficient to predict the distinct phases of the experiment, but they can distinguish visual and motion onset stimulation. EMG features and CoP features, when used jointly, can predict five out of six phases with a mean accuracy of 74.4% (±8%) and an AUC of 0.92. The most important feature to identify the different adaptive strategies is the Squared Root Mean Distance of points on Medio-Lateral axis (RDIST_ML). Discussion: This work shows the importance and the feasibility of a quantitative evaluation in a complex postural control task and demonstrates the potential of EEG, CoP, and EMG for assessing pathological conditions. These predictive systems pave the way for developing an objective assessment of pathological behavior PC responses. This will be a first step in identifying individual disorders and treatment options.

Towards defining biomarkers to evaluate concussions using virtual reality and a moving platform (BioVRSea).

Current diagnosis of concussion relies on self-reported symptoms and medical records rather than objective biomarkers. This work uses a novel measurement setup called BioVRSea to quantify concussion status. The paradigm is based on brain and muscle signals (EEG, EMG), heart rate and center of pressure (CoP) measurements during a postural control task triggered by a moving platform and a virtual reality environment. Measurements were performed on 54 professional athletes who self-reported their history of concussion or non-concussion. Both groups completed a concussion symptom scale (SCAT5) before the measurement. We analyzed biosignals and CoP parameters before and after the platform movements, to compare the net response of individual postural control. The results showed that BioVRSea discriminated between the concussion and non-concussion groups. Particularly, EEG power spectral density in delta and theta bands showed significant changes in the concussion group and right soleus median frequency from the EMG signal differentiated concussed individuals with balance problems from the other groups. Anterior-posterior CoP frequency-based parameters discriminated concussed individuals with balance problems. Finally, we used machine learning to classify concussion and non-concussion, demonstrating that combining SCAT5 and BioVRSea parameters gives an accuracy up to 95.5%. This study is a step towards quantitative assessment of concussion.

Severe difficulties with word recognition in noise after platinum chemotherapy in childhood, and improvements with open-fitting hearing-aids.

OBJECTIVE: To investigate word recognition in noise in subjects treated in childhood with chemotherapy, study benefits of open-fitting hearing-aids for word recognition, and investigate whether self-reported hearing-handicap corresponded to subjects' word recognition ability. DESIGN: Subjects diagnosed with cancer and treated with platinum-based chemotherapy in childhood underwent audiometric evaluations. STUDY SAMPLE: Fifteen subjects (eight females and seven males) fulfilled the criteria set for the study, and four of those received customized open-fitting hearing-aids. RESULTS: Subjects with cisplatin-induced ototoxicity had severe difficulties recognizing words in noise, and scored as low as 54% below reference scores standardized for age and degree of hearing loss. Hearing-impaired subjects' self-reported hearing-handicap correlated significantly with word recognition in a quiet environment but not in noise. Word recognition in noise improved markedly (up to 46%) with hearing-aids, and the self-reported hearing-handicap and disability score were reduced by more than 50%. CONCLUSIONS: This study demonstrates the importance of testing word recognition in noise in subjects treated with platinum-based chemotherapy in childhood, and to use specific custom-made questionnaires to evaluate the experienced hearing-handicap. Open-fitting hearing-aids are a good alternative for subjects suffering from poor word recognition in noise.