Unilateral hearing loss and cochlear implants essay,ear nose throat doctor tulsa 31st,chronic sinus infection tinnitus xtc - Test Out

27.12.2015
Basic information for the concerned parent: Ear Infections and Early Learning has information that sheds light on the effects of hearing loss that comes and goes on children’s development.
Research Summary: Otitis media with effusion (OME) often results in hearing loss for children with the condition.
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Conductive hearing loss causes a progressive decline in cochlear activity that may result in functional and structural modifications in auditory neurons. Conductive hearing loss is a condition that results in diminished cochlear nerve synaptic activity due to an inefficient sound transmission from the middle to the inner ear (Conlee and Parks, 1981; Tucci and Rubel, 1985). All animal protocols were approved by the Institutional Animal Care and Use Committee at the University of Castilla-La Mancha (Permit Number: PR-2013-02-03).
All surgical procedures were performed under aseptic conditions and unilaterally on the right ear. Sections were rinsed four times in TBS-Tx 0.2% and blocked for 1 h in the same buffer solution containing 10% NGS.
As glial cells could modify their phenotype in response to minor changes in their cellular environment, the cross-sectional area, was used as an indicator of possible changes in the soma size of glial cells at the different time points after the UCHL. Immunostained sections from control and experimental animals were examined with bright field illumination using a Nikon Eclipse photomicroscope with a 40× objective and images captured with a DXM 1200C digital camera attached to the microscope. To evaluate alterations in auditory function following UCHL, ABR recordings were performed in rats before (pre-lesion ABR) and after (post-lesion ABR) unilateral ossicle removal for each of the time points described in the Materials and Methods Section. Classic stigmata of congenital syphilis SNHL, interstitial keratitis, Hutchinson teeth (notched incisors), mulberry molars, Clutton joints (bilateral painless knee effusions), nasal septal perforation & saddle deformity& frontal bossing. In order to provide appropriate and effective audiologic management, it is important to understand the impact of OME on speech recognition ability when hearing loss is present. This means that you will not need to remember your user name and password in the future and you will be able to login with the account you choose to sync, with the click of a button.
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However, whether these activity-dependent changes are accompanied by a glial response involving microglia, astrocytes, or both has not yet been fully elucidated. Subdermal needle electrodes (Rochester Electro-Medical, Tampa, FL, USA) were placed at the vertex (positive) and under the right (negative) and left (ground) ears. After fixation, the brains were removed, and sectioned at 40 μm on a vibratome in the coronal plane.
Color images of each field were digitized and the resultant 8-bit image contained a grayscale of pixel intensities that ranged from 0 (white) to 255 (black). Therefore, the mean gray level was used as an indirect measure of intracellular protein levels within cells after UCHL providing a general estimation of the effect of the unilateral deprivation on the immunostaining of neurons and glia. Similar to the control condition, the pre-lesion recordings showed a distinctive wave pattern characterized by four to five positive peaks generated after a stimulus (Figure 1A). Line graphs depicting ABR recordings at 80 dB SPL for all frequencies tested in control (A) and experimental animals following UCHL (B–F). Line graphs illustrating the effects of UCHL over the auditory thresholds at all frequencies tested. A microglial reaction in the ipsilateral AVCN of experimental animals was first detectable 1 day after the lesion, at which time glial cells had larger cell bodies along with thicker and less branched processes than resting microglia (Figures 3C,H). Skeletal findings osteochondritis& periostitis of long bones SNHL, interstitial keratitis, Hutchinson teeth (notched incisors), mulberry molars, Clutton joints (bilateral painless knee effusions), nasal septal perforation & saddle deformity& frontal bossing. The gain of the poorer ear can be further adjusted according to the patienta€™s preference. Refer to the webpage on cholesteatomas for more information about this disease and how it can effect learning. This study examined the speech recognition abilities of normal-hearing six- and seven-year-old children (n = 12) and adults (n = 12) using monosyllabic words and nonsense syllables presented at two levels of simulated conductive hearing loss characteristic of OME. Average speech recognition scores decreased as the degree of simulated conductive hearing loss increased. Accordingly, the present study was designed to determine the involvement of glial related mechanisms in the anteroventral cochlear nucleus (AVCN) of adult rats at 1, 4, 7, and 15 d after removing middle ear ossicles.
In both adult and juvenile populations, ABR recordings showed significant delays in wave V and in the III-IV interwave intervals. These observations support the idea that although these non-neuronal elements have different temporal patterns of activation, they both are implicated in reestablishing synaptic function following deafness.
The stimulation and recording were performed with a Tucker-Davis (TDT) BioSig System III (Tucker-Davis Technologies, Alachua, FL, USA). Once the skin behind the ears was shaved, a retroauricular incision was made in order to identify the external auditory canal, which was followed to the tympanic membrane. After several washes in PBS, sections were pre-incubated for 1 h in 10% NGS and then incubated overnight at 4°C with either Iba1 or GFAP polyclonal antibodies diluted in PBS.
Additionally, the immunostained area was used as an indicator of the area occupied by microglial cells and astrocytes at each survival time in comparison to control rats. Comparisons among groups were analyzed statistically using the one-factor analysis of variance and the Scheffe's post-hoc analysis to evaluate the effect of the survival time after unilateral conductive hearing loss over the immunostaining in the cochlear nucleus. In control animals (A) and in the contralateral side (B), ABR recordings show a normal wave pattern, which was characterized by positive peaks generated following the stimulus onset (dashed lines).
Other permanent damage can also be caused from longstanding hearing loss due to middle ear infection. Both age groups scored significantly poorer for nonsense syllables than for monosyllabic words. Quantitative immunohistochemistry analyses at light microscopy with specific markers of microglia or astroglia along with immunocytochemistry at the electron microscopy level were used.
This observation has led to the suggestion that conductive hearing loss is associated with alterations at the central level that might have a significant impact on auditory processing. In the present study, we interrupted the conduction of sound from the middle ear to the inner ear to assess whether or not glial cells express NT-3 and contribute to the recovery of synaptic deficits associated with UCHL.
For light and confocal microscopy, 16 experimental and 4 age-matched unmanipulated control rats were used.
As previously reported (Alvarado et al., 2012, 2014), the ABR recordings were performed the day before the surgical procedure and at the end of each survival time.
Using fine forceps, the tympanic membrane was punctured and the malleus and incus were removed.
Sections were examined with a laser scanning confocal microscope (LSM 710; Zeiss, Germany) with excitation laser lines at 405, 488, and 594 nm, using the ZEN 2009 Light Edition software. The following day, after several rinses in PBS, sections were incubated in a dilution of anti-rabbit secondary antibody (1:200) for 2 h at RT and after several rinses they were incubated in ABC for 1 h.
Only cells with a well-defined cell body, nucleus and nucleolus were measured and included in the analysis.
Cochlear nucleus subdivisions were defined in accordance with previous terminology (for review, see Cant and Benson, 2003). It was calculated as the summed area of all profiles (cells and processes) labeled above the threshold in each field. Experimental rats had significant thresholds elevations at all frequencies and time points studied after UCHL which were indicative of decreased activity in the ipsilateral auditory nuclei (Figure 2). However, post-lesion (pl) ABRs at all timepoints, showed reduction of the responses following stimulus onset (dashed lines) at all frequencies evaluated (C–F).


Cells were larger, darker and occupied a larger area when compared to those observed at 1d post-lesion. In general, the children performed more poorly than the adults with the exception of the easiest listening condition for word stimuli.
Also, in order to test whether trophic support by neurotrophins is modulated in glial cells by auditory activity, the expression and distribution of neurotrophin-3 (NT-3) and its colocalization with microglial or astroglial markers was investigated.
In an attempt to improve the diagnosis and treatment of these patients, animal models of conductive hearing loss have been developed to elucidate the morphological and functional anomalies associated with these pathological responses.
An additional group of 12 experimental and 3 age-matched unmanipulated control rats was used for electron microscopy.
During the surgical procedure a heating pad was used to maintain normal body temperature and recovery from anesthesia. Peroxidase activity was visualized with a nickel-intensified DAB reaction to produce a black reaction product.
The analysis of Iba1, GFAP and NT-3 immunostaining was performed in 6 coronal sections, 120 μm apart, through the rostrocaudal extent of the AVCN.
These qualitative observations were confirmed by significant increases in their cross-sectional area, mean gray level of Iba1 immunostaining and immunostained area (Figure 4; Table 2).
Furthermore, children appeared less able than adults to use their knowledge of familiar words to improve performance. These findings suggest that rehabilitative strategies may best be focused on combining familiarization techniques and amplification options.
Diminished cochlear activity after middle ear ossicle removal leads to a significant ipsilateral increase in the mean gray levels and stained area of microglial cells but not astrocytes in the AVCN at 1 and 4 d post-lesion as compared to the contralateral side and control animals. These findings support the idea that additional synthesis of IGF-1 and IL-1β by glial cells is not essential to re-establish damaged auditory synaptic connections and that other molecular mediators might be involved in this process.
They were delivered monaurally (right ear) using an EDC1 electrostatic speaker driver (Tucker-Davis Technologies) and the EC-1 electrostatic speaker (Tucker-Davis Technologies) which was placed into the external auditory meatus of the rat. Once awake, animals were returned to their cages and maintained with free access to food and water for the survival period. Then, after several rinses in TBS-Tx 0.2%, sections were incubated in an avidin-biotinylated peroxidase complex (ABC) and rinsed in TBS.
Sections containing the cochlear nucleus were post-fixed with osmium tetraoxide (1% in 0.1 M PB) for 1 h, block-stained with 1% uranyl acetate for 30 min, dehydrated in graded series of ethanol and embedded in Durcupan (Fluka) resin.
These results suggest that microglial cells but not astrocytes may act as dynamic modulators of synaptic transmission in the cochlear nucleus immediately following unilateral hearing loss. Prior to the experiments, stimuli were calibrated using the SigCal software (Tucker-Davis Technologies) and the ER-10B+ low noise microphone system (Etymotic Research Inc, Elk, Groove, IL, USA). Thin sections (~75 nm) in the silver-gold range were cut on an ultramicrotome (Reichert Ultracut E, Leica, Austria) and collected on 200-mesh copper grids.
In order to perform an appropriate comparison of the immunostaining among cases, a macro was designed to process and analyze the captured images (Alvarado et al., 2004). On the other hand, NT-3 immunostaining was localized mainly in neuronal cell bodies and axons and was upregulated at 1, 4 and 7 d post-lesion.
Apart from its role as a survival factor that, when injected into the cochlea, increases the survival of spiral ganglion neurons after deafness (Wise et al., 2011), NT-3 also participates in the reestablishment of lost synaptic connections. Care was taken to ensure that incubation times in DAB were identical across control and experimental cases.
Briefly, images were normalized by using an algorithm, based on the signal-to noise ratio that normalizes each pixel, adjusting the grayscales range of the image. At this time point, the microglial cross-sectional area was significantly decreased when compared with the other survival time points. While a program button to access multiple listening programs may be of little relevance for patients with UHL, a volume control is a must. Very few glial cells expressed this neurotrophin in both control and experimental rats, suggesting that NT-3 is primarily activated in neurons and not as much in glia after limiting auditory activity in the AVCN by conductive hearing loss.
Supporting this concept, increases in NT-3 levels have been found in adult guinea pigs at 7d following unilateral cochlear removal, a time point at which degeneration and synaptogenesis processes take place in the cochlear nucleus (Suneja et al., 2005). Auditory thresholds, for each of the frequencies evaluated, were determined comparing the evoked activity, recorded in 5 dB steps descending from a maximum stimulus intensity of 80 dB SPL, with the background activity measured before the stimulus onset.
Finally, the sections were washed thoroughly, mounted on gelatin-coated slides, air-dried, dehydrated in progressive ethanol solutions, cleared in xylene, and coverslipped with Cytoseal® (Stephens Scientific, Wayne, NJ, USA). Following normalization, the threshold level was set as two standard deviations above the mean gray level of the field and immunostained cells exceeding this threshold were identified as labeled.
However, it was increased when compared with the unmanipulated side and control animals (Figures 3, 4; Table 2). In the ensuing years, as the benefits of binaural hearing aid fittings became apparent, the proportion of monaural-to-binaural fittings did a dramatic flip-flop. This is because it wona€™t be known how the poor ear with amplification will interact with the good ear in real-world situations. It is not known, however, whether NT-3 is dynamically expressed in glial cells after auditory lesions like unilateral conductive hearing loss (UCHL).
Glial cells were still darkly immunostained as confirmed by significant decreases in the mean gray levels when compared with experimental animals at 4d post-lesion, but no differences were found when compared with 1d post-lesion animals (Figure 4; Table 2).
WDRC will automatically adjust the gain of the hearing aid based on the input sound level to ensure natural perception of loudness. Soft sounds will be soft but audible, and loud sounds are perceived as loud but not uncomfortable. 7 There is evidence that audibility is improved and speech recognition is either maintained or improved with WDRC as compared with linear amplification. 2,3 Children and UHL There has been tremendous interest in researching the impact of untreated UHL on children. Research shows sound localization test scores were significantly poorer for the children with UHL than for the children with normal hearing. Directional microphones can be fitted according to the patienta€™s communication needs for adults with UHL. For children, the use of directional microphone may be beneficial in some listening situations, such as when the target signal is located in front of the listener; however, decreased performance with directional response has been noted when the target signal was located to the side or behind the listener.
The children with UHL also had significantly poorer speech-recognition scores than their normal-hearing peers.
The use of directional microphones should be based on the childa€™s ability to orient toward the target signal. Other researchers have documented poor speech-recognition performance of children with UHL when measured in the presence of background noise. 14 Childrena€™s limited experience with receptive speech and the importance of overhearing will limit the use of directional microphones.
4 Recent research indicates school-aged children with UHL demonstrate worse oral language scores (worse language comprehension, oral expression, and oral composite) compared with siblings and normal-hearing age peers. When a directional microphone is used, it is recommended to keep it in the automatic mode.A  There is some evidence that directional microphones in the automatic mode will switch appropriately between a directional and omnidirectional response for the given environment approximately 90% of the time. 5 Academically, children with UHL have been found to perform more poorly than their normal-hearing counterparts. Even if the microphone is in the a€?wronga€? mode 10% of the use time, it is still likely that the child will experience significant overall benefit. In a study of 60 children with UHL, Bess and Tharpe 6 found that 35% of the children had repeated at least one grade in school, and an additional 13.3% required resource assistance, such as academic tutoring.


Such hearing aids can receive an audio signal from a remote location to improve signal-to-noise ratio (SNR) and can be of particular benefit when listening in noisy environments. We do not yet know which children are at greatest risk for educational problems nor do we know which interventions are most effective at ameliorating these problems. An example of a wireless accessory that could be used for this purpose is a companion microphone that can be held or worn by a conversational partner or speaker-of-interest.
The speakera€™s voice will be picked up by the microphone and transmitted wirelessly to the hearing aid.
Only one additional child had tried using a frequency modulation (FM) system and conventional hearing aid over the course of the study, even though the majority of these children had severe-to-profound UHL. 8 With the introduction of universal newborn hearing screening, UHL can be diagnosed within the first 3 months of life. It has been shown that fitting of aids soon after identification can minimize language delay; however, there can be a delay of up to 7 months in provision of amplification for children with mild and UHL. The time of arrival of the streamed wireless signal to the impaired ear should not be delayed too much relative to the good ear receiving the signal acoustically to avoid disturbing perceptual effects. It has been demonstrated that speech intelligibility benefits will be affected if the transmission delay is greater than 40 ms and the coupling is vented.
15 Considering this, the proprietary 2.4 GHz digital wireless technology used by ReSound is advantageous for UHL since the delay associated with streaming is short and there is no relay device needed.
Auditory deprivation has been described as more marked if it has an early onset (1-2 years) in individuals with UHL.
9 The treatment of UHL can include sound field systems, FM systems, traditional hearing aids, CROS hearing aids, bone-anchored hearing aids (BAHA), and even a cochlear implant depending on the type, configuration, and degree of hearing loss. In this article, we will only discuss the fitting of conventional hearing aid amplification.
Noise reduction has not been found to improve or degrade speech understanding in adults or school-aged children, but it can improve comfort and ease-of-listening in realistic listening situations. For younger children, further research is needed and it is therefore not generally recommended. Percentage of monaural fitting in all hearing aid users from 1984 to 2008 (data from MarkeTrak VIII).1 (click to enlarge image) Benefits of Hearing Aids The benefits of hearing aids include increased audibility, minimizing of auditory deprivation, as well as ease of listening in both quiet and noisy listening conditions. Their results showed that a hearing aid can provide bilateral localization benefit to some children with UHL.
Since the good ear will receive undistorted normal sound, the frequency lowered sound may interfere with binaural processing.
Localization acuity in younger children with UHL was significantly improved, but not in the group of older children; time of intervention is also a main factor affecting the localization benefit.
Children who were fit earlier showed bilateral benefit, whereas children who were fit later showed bilateral interference. And, without hearing aid amplification, localization performance in children with UHL rarely equals that of peers.
For patients with UHL, the good ear serves as the reference for the sound, so it is important to keep distortion at a minimum.A  Compression output limiting provides superior sound quality as compared to hearing aids that limit maximum output through peak clipping. 17 It is better that a hearing aid with compression output limiting is selected in order to get better sound quality to match the good ear. The decision to fit a patient with unilateral hearing loss should be made on an individual basis, taking into consideration the persona€™s or familya€™s preferences, as well as audiologic, developmental, educational, and communication needs.
Those with moderately severe or better UHL are likely to accept the use of a hearing aid, whereas those with a severe or profound UHL may not comply with hearing aid usage at all. The role of aided ear is to provide more useful information to help understand speech and for binaural processing. When the poor ear has a severe hearing loss, the aided sound can reach the brain, but it may not be helpful.
For infants, there is still debate whether they should be fit before or after 18 months of age.
11 UHL is common, and without intervention it can lead to academic, speech-language, and social-emotional difficulties.
On the one hand, it is unknown what degree of UHL may result in auditory deprivation and what is the critical time to provide amplification thereby avoiding these effects. But there is only limited literature about hearing aid fitting for patients with UHL; some of the ideas have to borrow from asymmetry hearing loss fitting. On the other hand, more reliable hearing test results can be obtained from children over 18 months of age.
9 Fitting Considerations & Rationale Should hearing aids be fit differently for patients with UHL than for those with bilateral hearing losses? Fitting of a hearing aid should be individually based and using your own expertise, taking consideration of patient age, degree of hearing loss, speech development, communication needs, and other morbidities, etc. The relevance of other treatment options than conventional hearing aids, such as FM, CROS, BAHA, and a cochlear implant, also should be considered and communicated to the patient. Although the prescription may provide targets for a monaural versus binaural fitting, it might not specifically address the needs of people with UHL. That is, we do not yet know if people with UHL prefer the gain generated by a prescriptive method designed for monaural fitting of a bilateral hearing loss.
NAL-NL2 is an example of a prescription that provides binaural correction for both pediatric and adult patients, while DSL 5.0 only has a binaural correction for adults. Thus, any binaural correction should be used even though only one hearing aid is being fit to compensate for binaural summation effects. The goal of fitting asymmetric losses is to provide amplification that results in the perception of a fused auditory image rather than the patient hearing two different sounds from each ear. 11 One technique 12 to achieve the goal of binaural fusion or balance for fitting an asymmetric hearing loss can easily be applied to fitting UHL. Then, ask the patient about where they perceive your voice to be coming from when you are sitting in front of him or her.
Increase or decrease gain accordingly until the patient reports hearing your voice at the front and center of the head.
Unilateral hearing loss is associated with worse speech-language scores in children: a case-control study.
Amplification considerations for children with minimal or mild bilateral hearing loss and unilateral hearing loss. Sound localization acuity in children with unilateral hearing loss who wear a hearing aid in the impaired ear. An evidence-based systematic review of amplitude compression in hearing aids for school-age children with hearing loss. An evidence-based systematic review of directional microphones and digital noise reduction hearing aids in school-age children with hearing loss. Fewer wires, less complexity, and more connections: The new challenge for wireless hearing instruments. Monaural hearing aid fitting considerations for Patients with unilateral hearing loss: Who should receive unilateral fittings, and how should you fit them?A Hearing Review.



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