Cervical Vestibular-Evoked Myogenic Potentials in Sedated Toddlers

Abstract Introduction Cervical vestibular-evoked myogenic potentials (cVEMPs) are difficult to test in toddlers who cannot follow instructions or stay calm. Objective Due to the growing need for vestibular testing in very young children as a part of a delayed walking assessment battery, this study aimed to provide a solution to this problem by recording the cVEMPs in toddlers during sedation. Method The cVEMPs measures were assessed in 30 toddlers aged 12 to 36 months with normal motormilestones. They were sedated with chloral hydrate. Then, the head was retracted ~ 30° backward with a pillow under the shoulders, and turned 45° contralateral to the side of stimulation to put the sternocleidomastoid (SCM)muscle in a state of tension. Results The P13 and N23 waves of the cVEMPs were recordable in all sedated toddlers. The cVEMPs measures resulted in the following: P13 latency of 17.5 ± 1.41 milliseconds, N23 latency of 25.58 ± 2.02 milliseconds, and peak-topeak amplitude of 15.39 ± 3.45 μV. One-sample t-test revealed statistically significant longer latencies and smaller amplitude of the toddlers' cVEMPs relative to the normative data for adults. Conclusions The difficulty of cVEMPs testing in toddlers can be overcome by sedating them and attaining a position that contracts the SCM muscle. However, the toddlers' recordings revealed delayed latencies and smaller amplitudes than those of adults.

Advanced tubal pregnancy - a case report

A case of advanced tubal pregnancy at 14 weeks is reported. Timely presentation of the patient to the emergency department saved her life although her clinical status was rapidly deteriorating once tubal rupture had started. Discussing this case is needed to shed the light on the basics to prevent life threatening complications

Psychoacoustic Characteristics of Tinnitus versus Temporal Resolution in Subjects with Normal Hearing Sensitivity

Abstract Introduction Cochlear or neural mechanisms of tinnitus generation may affect auditory temporal resolution in tinnitus patients even with normal audiometry. Thus, studying the correlation between tinnitus characteristics and auditory temporal resolution in subjects with tinnitus may help in proper modification of tinnitus management strategy. Objective This study aims to examine the relationship between the psychoacoustic measures of tinnitus and the auditory temporal resolution in subjects with normal audiometry. Methods Two normal hearing groups with ages ranging from 20 to 45 years were involved: control group of 15 adults (30 ears) without tinnitus and study group of 15 adults (24 ears) with tinnitus. Subjective scaling of annoyance and sleep disturbance caused by tinnitus, basic audiological evaluation, tinnitus psychoacoustic measures and Gaps in Noise test were performed. Data from both groups were compared using independent sample t-test. Psychoacoustic measures of tinnitus and Gaps in Noise test parameters of the tinnitus group were correlated with Pearson's correlation coefficient. Results Significantly higher hearing threshold, higher approximate threshold and lower correct Gaps in Noise scores were observed in tinnitus ears. There was no significant correlation between psychoacoustic measures of tinnitus and Gaps in Noise test parameters of the tinnitus group. Conclusion Auditory temporal resolution impairment was found in tinnitus patients, which could be attributed to cochlear impairment or altered neural firing within the auditory pathway. It is recommended to include temporal resolution testing in the tinnitus evaluation battery to provide a proper management planning.

Brainstem Encoding of Aided Speech in Hearing Aid Users with Cochlear Dead Region(s)

Abstract Introduction Neural encoding of speech begins with the analysis of the signal as a whole broken down into its sinusoidal components in the cochlea, which has to be conserved up to the higher auditory centers. Some of these components target the dead regions of the cochlea causing little or no excitation. Measuring aided speechevoked auditory brainstem response elicited by speech stimuli with different spectral maxima can give insight into the brainstem encoding of aided speech with spectral maxima at these dead regions. Objective This research aims to study the impact of dead regions of the cochlea on speech processing at the brainstem level after a long period of hearing aid use. Methods This study comprised 30 ears without dead regions and 46 ears with dead regions at low, mid, or high frequencies. For all ears, we measured the aided speechevoked auditory brainstem response using speech stimuli of low,mid, and high spectral maxima. Results Aided speech-evoked auditory brainstem response was producible in all subjects. Responses evoked by stimuli with spectral maxima at dead regions had longer latencies and smaller amplitudes when compared with the control group or the responses of other stimuli. Conclusion The presence of cochlear dead regions affects brainstem encoding of speech with spectral maxima perpendicular to these regions. Brainstem neuroplasticity and the extrinsic redundancy of speech can minimize the impact of dead regions in chronic hearing aid users.

The Efficacy of Nasal Steroids in Treatment of Otitis Media with Effusion: A Comparative Study

Introduction Otitis media with effusion (OME) continues to be an important pediatric clinical problem, and more studies are needed to decide the proper treatment for it. Objective To assess the efficacy of nasal steroids in the management of OME by comparing its results with that of oral steroid and that of nasal saline spray as placebo. Methods This study was carried on 60 patients with OME who were divided into three groups: in group 1, 20 patients received mometasone furoate spray, one puff in each nostril daily, for 3 months; in group 2, 20 patients received oral prednisolone, 5 mg three times per day for the first 3 weeks; in group 3, 20 patients received nasal saline spray, one puff in each nostril daily for 3 months. Results A highly significant difference between systemic or topical (nasal spray) steroid therapy and saline nasal spray was detected (p < 0.001), and the difference between systemic and topical steroid was nonsignificant (p > 0.05). Conclusion Nasal steroid spray can be used as an effective treatment for OME, giving a significant result similar to systemic steroid. Further studies are needed to investigate its use for longer duration and in recurrent cases.(AU)

Outcomes of premature and very-low-birth-weight infants from 1991 to 2002

Intensive care nursery [ICN] survival rates reflect the efficacy of the perinatal management achieved in each institution. It became of great importance to compare outcome data of individual hospitals to international numbers, taking into consideration the dramatic changes in medical care for very-low-birth weight [VLBW] infants and their mothers that occurred during the past decade worldwide. Evaluate the neonatal outcome [mortality and morbidity] of VLBW and premature infants born at Makassed General Hospital [MGH] and admitted to ICN and compare it to the international rates. Detailed data were collected for all VLBW [<1500 g] and /or premature infants [<30 weeks] born at MGH and admitted to ICN from Jan 1, 1991, through May 31, 2002, retrospectively. Three study periods were defined according to the emergence of new treatment modalities, namely antenatal steroid use and surfactant treatment. Outcome measures were the survival rates at day 28 and on discharge. Secondary outcomes were morbidity rates for patents ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage, bronchopulmonary dysplasia, and nosocomial and maternofetal infections. We studied the effect of antenatal steroids, surfactant, and new respiratory support modes as well as the effect of birth weight, etiology of pre-term labor, mode of delivery, Apgar score, etiology of pre-term labor, mode of delivery, Apgar score, gender, multiple gestation, and intrauterine growth retardation on both survival and morbidity. There were 207 VLBW [