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We examined horizontal directional hearing in patients with acquired severe unilateral conductive hearing loss (UCHL). Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Geert Grooteplein 21, 6525 EZ,, P.O.
JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser. Abstract???????Care of veterans and servicemembers with major traumatic limb loss from combat theaters is one of the highest priorities of the Department of Veteran Affairs.
The Department of Veterans Affairs (VA) was established to care for battle-injured veterans and their dependents.
Following limb loss, adjusting to life with a prosthesis and other mobility technologies is a complex rehabilitation process. We identified veterans aged 50 to 80 who sustained major traumatic limb loss in the Vietnam war combat theater (1961-1973) and received service-connected disability benefits for limb loss using VA Compensation and Pension Mini Master files in Austin, Texas. A group of rehabilitation and surgery clinicians and researchers developed the Survey for Prosthetic Use (Appendix 1, available online only) to address key issues for veterans and servicemembers with major upper- and lower-limb loss. Participants reported their combat-associated injuries including the date and site(s) of limb loss.
In addition to limb loss, participants specified other combat injuries: injury to limb(s) without limb loss, head injury, eye injury, hearing loss, chest injury, abdominal injury, burns, and other combat injuries. Participants with upper-limb loss reported cumulative trauma disorder (worn-limb syndrome) that may result from overuse of the nonamputated limb. Participants with lower-limb loss reported joint arthritis, stiff joints, heel pain, plantar fasciitis, and heterotrophic ossification. Self-reported health information used questions on health status from the previously validated 36-Item Short Form Health Survey [15-16]. We measured the number and type of prosthetic devices ever and currently used and the frequency of daily prosthetic use. Four prosthetic types are available for participants with limb loss at or proximal to the knee (knee, transfemoral, hip, or pelvis): specifically, advanced technology (microprocessor-type device requiring recharging or hybrid), mechanical (not requiring recharging), specialty (recrea-tional, athletic, or high-impact use), or waterproof (shower or swimming leg). Participants identified the number and type of prosthetic devices they wore out and the average time for replacement. We determined the source of prosthetic care (DOD, VA, private, or multiple sources) as well as satisfaction with devices and providers. Prosthetic and rehabilitation experts, including members of our Expert Panel (Appendix 2, available online only), reviewed the survey for content validity before we piloted it on 24 men and women with traumatic or combat-related limb loss.
We used the American Association for Public Opinion Research guidelines to determine survey response rates [22].
Person-level analysis for both conflicts is grouped into the following three categories: unilateral upper-limb loss, unilateral lower-limb loss, and multiple limb loss. We computed prosthetic device receipt, replacement, and rejection from the time of limb loss to the date of the survey.
Objective: This study investigates the incidence of auditory alterations and traces the audiological profile in children assisted at the Centro de Estudos da Educacao e da Saude. INTRODUCTIONMild hearing loss might not be noticed during childhood, when ear problems and other alterations that affect hearing ability. All patients (n?=?12) had been fitted with a bone conduction device (BCD) to restore bilateral hearing.
This is largely attributed to changes in protective gear and equipment, immediate battlefield triage, and forward surgical teams linked to comprehensive care [7-8]. Each day, individuals with limb loss balance issues of pain and physical and psychological limitations with decisions about activities of daily living (ADLs), use of prostheses, adaptive devices, and wheeled mobility. Upper-limb loss categories included partial hand, wrist disarticulation, transradial, elbow disarticulation, transhumeral, shoulder, or forequarter. Participants assessed the extent each combat injury affected current quality of life from 0 (does not affect at all) to 10 (strongly affects). Related conditions include carpal tunnel syndrome, cubital tunnel syndrome, tendonitis, arthritis, stiff or painful joints, and ganglion cysts. We assessed the presence or absence of 15 comorbid conditions, including chronic back pain, phantom limb pain, residual-limb pain, arthritis, migraines, posttraumatic stress disorder (PTSD), depression, and traumatic brain injury (TBI). Participants reported on the number and types of prostheses ever received as follows: prostheses received during their first year post limb loss and all prostheses received from 1 year post limb loss to the present.
For prostheses rejected because of dissatisfaction, we noted the number and type of device(s) as well as the reasons for discontinuation.
After refinements to the survey questions, we piloted the survey on 6 of the 9 servicemembers with major traumatic limb loss from the Desert Storm conflict. If we received no response within a month, we mailed a second copy of the survey; and if we received no response in another month, we placed telephone calls.
This group met by telephone multiple times and in person for 3 days in Seattle, Washington, in June 2008. The numerator is the number of participants with major traumatic limb loss who completed a survey divided by the number of eligible veterans and servicemembers (those who completed the survey, declined participation, and did not respond). We created a variable to summarize limb loss and ambulation-related pain and a variable to summarize mental health issues. For univariate analyses, we based statistical significance on chi-square (categorical data), Mann-Whitney U-test (ordinal data), Student t-test (continuous data), and Fisher exact test if cell numbers were ≤5. Therefore, it is important to be aware of it, thus childhood represents an important period for the learning development.

Louis Children's Hospital and an Associate Professor in the Department of Otolaryngology at Washington University School of Medicine and has many research interests. Only 2 to 7 percent of servicemembers serving in prior conflicts returned to Active Duty after major limb loss [1-2]. The total number of servicemembers with traumatic limb loss from the Vietnam war is estimated at 3.4 percent of battle injured or 5,283 individuals [9]. Over time, those with limb loss select and use prosthetic devices and other technologies that maximize their function and conserve their time. From the roster of 2,531 Vietnam war veterans with major limb loss, we selected 501 individuals: all with major unilateral upper-limb loss (96), all with multiple limb loss (73), and a random sample of 332 individuals with unilateral lower-limb loss.
Exclusion criteria included being cognitively unable to respond to the survey, no valid contact information, amputation to only fingers or toes, or being deceased. Lower-limb loss categories included partial foot, ankle disarticulation, transtibial, knee disarticulation, transfemoral, hip, and transpelvic. We assessed upper-limb function on 23 ADLs, including eating, dressing, housekeeping, community activities, automobile operation, use of tools, and sporting activities. We summarized prosthetic devices and prototype devices into major groups defined by the degree of technology and level of limb loss.
We excluded cosmetic devices at more proximal lower-limb loss sites that were not used for ambulation from the functional limb analysis but included them in the cost analysis reported elsewhere [17].
We adapted questions on prosthesis satisfaction from the Orthotic and Prosthetic User's Survey (OPUS) and the Prosthetic Evaluation Questionnaire (PEQ) [19-20]. A generic version of the Survey for Prosthetic Use, including both upper- and lower-limb loss sections, is available in Appendix 1 (available online only). Staff contacted participants to resolve these and other issues identified in the data quality review.
Expert Panel members advised study staff on prosthetics, function, limb loss, transition probability, and cost issues.
We excluded deceased veterans and servicemembers and those with no contact information from the computation (Figure 1). The sum of positive responses to three dichotomized pain questions (phantom limb, residual limb, and back) is the pain summary. No valid contact information was available for 22 veterans, and 21 did not meet eligibility criteria.
Data from audiological anamnesis, pure tone threshold audiometry and acoustic immittance measurements were obtained.
Five listeners without hearing loss were tested as a control group while listening with a monaural plug and earmuff, or with both ears (binaural). MIT, CambridgeColburn HS (1982) Binaural interaction and localization with various hearing impairments. 25% or more of hearing loss in babies is due to "environmentala€? causes such as maternal infections during pregnancy and complications after birth. We verified participant contact information for these 501 veterans through the VA Corporate Data Warehouse. We identified 541 servicemembers and veterans who were 1 year since limb loss by February 21, 2007; of these servicemembers and veterans, 110 had unilateral upper-limb loss, 317 had unilateral lower-limb loss, and 114 had multiple limb loss.
Participants indicated whether they performed each ADL (1) using their prostheses, (2) using a one-arm technique, (3) assisted by another person, or (4) not at all. We grouped upper-limb prostheses into three categories: advanced technology (myoelectric, microprocessor-type devices, or hybrid [mix of electronic and body-powered parts]), mechanical (body-powered with no batteries needed), and cosmetic (nonfunctional). We collected data on current assistive technology use (walkers, canes, crutches, car modifications, wheelchairs, terminal upper-limb devices, etc.). We collected current overall prosthetic satisfaction only for participants using prostheses. We telephoned participants with major traumatic limb loss reporting no current prosthetic use to collect information on reasons prostheses were abandoned and on their use of wheelchairs. The sum of three dichotomized mental health questions (depression, PTSD, and TBI) is the mental health summary. In this manner, procedures regarding its identification and treatment should be applied early. We randomly varied stimulus presentation levels to assess whether listeners relied on the acoustic head-shadow effect (HSE) for horizontal (azimuth) localization.
Survey exclusion criteria included amputation to only fingers or toes, being cognitively unable to respond to the survey, no valid contact information, or being deceased. We verified participant contact information through the VA Corporate Data Warehouse and other Federal sources. We asked participants what assistive technology they anticipated using in the next 3 years.
They rated their prosthetic satisfaction from 0 (not at all satisfied) to 10 (completely satisfied).
Survey findings discussed by the investigative team and Expert Panel are the basis for recommendations for improved prosthetic and rehabilitation care and are presented elsewhere in this issue [21].
We described categories for evaluation of upper-limb loss and the mutually exclusive 1 to 7 scale for evaluation of lower-limb physical function earlier. The pure tone threshold audiometry results revealed that 93 children had normal hearing thresholds, 36 had bilateral hearing loss and 21 had unilateral hearing loss.
Preventive actions would supply better health condition for such a population, by preventing hearing loss and its severe consequences (1).

For example, there are some medicines that can cause hearing loss, but only in people who have certain mutations in their genes.Genes contain the instructions that tell the cells of peoplea€™s bodies how to grow and work. The goal of early rehabilitation for servicemembers with traumatic limb loss in center-based comprehensive rehabilitation programs is to restore function and quality of life to the fullest extent possible and provide state-of-the-art prostheses, wheeled mobility, and other assistive devices.
Regarding the type of hearing loss, forty eight had conductive, seven mixed and two sensorineural. The World Health Report (2) describes hearing loss as a serious problem due to its influence on the language development in children as well as to its impact on school life.The relation of hearing loss in children, due to disorders in the middle ear that damaged the reading ability, showed that the performance of such ability was not affected in children who were healed of otological alterations.
Yet, the development of children with non-healed chronic otitis was worse if compared to the healthy children group (3). Findings from this cross-conflict survey identify many strengths in prosthetic rehabilitation for those with limb loss and several areas for future attention. Our multiple regression analysis shows that all patients relied on the ambiguous HSE for localization.
Academic, LondonMiddlebrooks JC (1992) Narrow-band sound localization related to external ear acoustics.
In addition, in 63% of these cases, the hearing loss was unilateral or a minimum degree of hearing loss was presented in at least one ear.
Our data confirm and further extend results of recent studies on the use of sound localization cues in chronic and acute monaural listening. Regarding configuration, horizontal, ascendant and irregular curves correspond altogether to 90.5% of the examined ears. The chronic otitis media is the main cause of hearing loss in developing countries (7) and it can lead to other severe complications such as mastoiditis and encephalitis.Histopathological studies on otitis media have shown the possibility of diffusion of bacterial toxins and cytokines from the middle ear to the cochlea through the membrane of the round window (8,9), which would cause ultrastructural injuries in the inner ear such as rupture of the cochlear membranes (10). Despite the fact that conductive hearing losses are responsible for most cases of auditory alterations in children, sensorineural losses have also been studied by researchers who are concerned about the auditory rehabilitation of these children (11). Although progressive sensorineural loss in children is diagnosed as a rare clinical manifestation, it is often bilateral and asymmetric, and hereditary succession is its main cause (12).Auditory thresholds in high frequencies in children with bilateral otitis media with effusion history were investigated, and the results do not show any statistical significant difference between the thresholds of the right and left ear (13).
That is, it does not run in the family.About 70% of all mutations causing hearing loss are non-syndromic.
There are few epidemiological studies on the prevalence and on the impact of the chronic otitis media in Brazil.
For example, some people with hearing loss are also blind.The cochlea (the part of the ear that changes sounds in the air into nerve signals to the brain) is a very complex and specialized part of the body that needs many instructions to guide its development and function. The GJB2 gene is one of the genes that contains the instructions for a protein called connexin 26; this protein plays an important role in the functioning of the cochlea. Twelve of them were diagnosed through audiometry and tympanometry tests; nineteen ears presented otitis media with effusion, and only four ears were identified when only audiometry test was performed (17). A total of 121 students (242 ears) from the city of Goiania were examined through anamnesis, audiometry and immitanciometry tests. J Acoust Soc Am 118:2373–2391Van Wanrooij MM, Van Opstal AJ (2004) Contribution of head shadow and pinna cues to chronic monaural sound localization.
The threshold were considered 'normal' up to 15dB and 'mild hearing loss' was considered up to 25dB. The cases in which hearing losses occurred, the curve configuration was plane (horizontal).
184 ears (76%) presented normal threshold and 58 of them (24%) presented altered audiometry. The most frequent alterations were mild conductive and mild sensorineural hearing losses in 26 ears (12%) and in 15 ears (7%) respectively. The author considers that sanitation education, socioeconomic improvement and sanitation infrastructure are important factor for reducing the occurrences of chronic purulent otitis media (19).
A comparative study between audiometric configuration of children and adults classified curves as ascending, descending, horizontal and 'U' form. This study could identify 93 cases in normal condition and 57 with hearing loss, with prevalence of the conductive type. The data presented in the audiological anamnesis was also related to the conductive profile, as the main complaints were otitis, otorrhea, upper airways infections, amygdalitis and adenoid hypertrophy. The literature that was studied highlights otitis media as the most common disease in children (1), and refers the conductive alteration as the cause for most cases of hearing loss in the same population (11). Seven cases (4.6%) were diagnosed as mixed hearing loss, which was related to recurrent otitis media.
These cases were likely to have injuries in the inner ear due to the worsening of these infections (8-10).Literature reports that sensorineural hearing loss is a rare alteration in children (12).
Regarding the degree of hearing loss in the group which suffered alterations, 36 (63%) cases had either unilateral loss or presented minimal degree of loss, at least in one ear.
This information is important to health and education professionals, as there is the need of an early specific evaluation before any suspicions of hearing loss. This allows an early diagnosis and treatment of the auditory alteration with the purpose of avoiding damages related to language development (4). Curves of type B are found in individuals with fluid in the middle ear and curves of type C refer to the alterations of the auditory curve.
Regarding configuration, horizontal, ascending and irregular curves, together, correspond to 90.5% of the researched ears.

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