One-year sustainability of brow-lifting procedures.

BACKGROUND: Unlike blepharoplasty or facelifting procedures, there is little evidence of the sustainability of brow-lifting techniques. OBJECTIVES: This study aimed to investigate the one-year sustainability of three brow-lifting techniques performed at our department. METHODS: Thirty-six patients received an upper blepharoplasty and simultaneously one of three brow-lifting procedures: the direct (excisional) browpexy, the transpalpebral brow lift, and the EndotineⓇ forehead fixation. analogue and digital measurements of 3 vertical distances, from fixed anatomical points at pupil, lateral canthal, and lateral orbital rim level, were performed preoperatively and 12 months postoperatively. Patients' and surgeons' satisfaction considering functional and aesthetic outcomes were investigated by carrying out paper-pencil surveys. RESULTS: Direct browpexy was performed in 8, transpalpebral eyebrow lift in 10, and the EndotineⓇ fixation in 18 of the cases. In the first year, direct browpexy showed a general descent of 1.2 mm at the pupil level, 2.1 mm at the lateral canthal, and 0.6 mm at the orbital rim level. In the transpalpebral eyebrow lift group, a descent of 0.7 mm at the pupil level and 0.3 mm at the lateral canthal level was found; the orbital rim level showed a slight but nonsignificant ascent of 0.7 mm. In the EndotineⓇ group, a descent of 1.1 mm at the pupil level, 1.2 mm at the lateral canthal level, and 0.7 mm at the orbital rim level was shown. Subjective surgeon opinions and overall patient satisfaction underline an aesthetic improvement despite objective results falsifying the hypothesis of a raised eyebrow position after one year. CONCLUSION: Patients showed minor eyebrow decrement after 12 months postoperatively; therefore, sustainability is questioned and must be reevaluated. The extent of dissection, the downward pull of upper blepharoplasty resection, and the decrease in frontalis muscle activity are discussed as the possible causes.

Effectiveness of Dietary Interventions in the Treatment of Endometriosis: a Systematic Review.

A patients' increasing interest in dietary modifications as a possible complementary or alternative treatment of endometriosis is observed. Unfortunately, the therapeutic potential of dietary interventions is unclear and to date no guidelines to assist physicians on this topic exist. The aim of this study, therefore, was to systematically review the existing studies on the effect of dietary interventions on endometriosis. An electronic-based search was performed in MEDLINE and COCHRANE. We included human and animal studies that evaluated a dietary intervention on endometriosis-associated symptoms or other health outcomes. Studies were identified and coded using standard criteria, and the risk of bias was assessed with established tools relevant to the study design. We identified nine human and 12 animal studies. Out of the nine human studies, two were randomized controlled trials, two controlled studies, four uncontrolled before-after studies, and one qualitative study. All of them assessed a different dietary intervention, which could be classified in one of the following principle models: supplementation with selected dietary components, exclusion of selected dietary components, and complete diet modification. Most of the studies reported a positive effect on endometriosis; they were however characterized by moderate or high-risk bias possibly due to the challenges of conducting dietary intervention trials. According to the available level of evidence, we suggest an evidence-based clinical approach for physicians to use during consultations with their patients. Further well-designed randomized controlled trials are needed to accurately determine the short-term and long-term effectiveness and safety of different dietary interventions.

Supra-threshold perception and neural representation of tones presented in noise in conditions of masking release.

The neural representation and perceptual salience of tonal signals presented in different noise maskers were investigated. The properties of the maskers and signals were varied such that they produced different amounts of either monaural masking release, binaural masking release, or a combination of both. The signals were then presented at different levels above their corresponding masked thresholds and auditory evoked potentials (AEPs) were measured. It was found that, independent of the masking condition, the amplitude of the P2 component of the AEP was similar for the same stimulus levels above masked threshold, suggesting that both monaural and binaural effects of masking release were represented at the level of the auditory pathway where P2 is generated. The perceptual salience of the signal was evaluated at equal levels above masked threshold using a rating task. In contrast to the electrophysiological findings, the subjective ratings of the perceptual signal salience were less consistent with the signal level above masked threshold and varied strongly across listeners and masking conditions. Overall, the results from the present study suggest that the P2 amplitude of the AEP represents an objective indicator of the audibility of a target signal in the presence of complex acoustic maskers.

Binaural timing information in electric hearing at low rates: Effects of inaccurate encoding and loudness.

Stimulation strategies for cochlear implants potentially impose timing limitations that may hinder the correct encoding and representation of interaural time differences (ITDs) in realistic bilateral signals. This study aimed to specify the tolerable room for inaccurate encoding of ITDs at low rates by investigating the perceptual degradation due to the removal of individual pulses at various levels of loudness. Unmodulated, 100-pulses-per-second pulse trains were presented at a single, interaurally pitch-matched electrode pair. In experiment I, ITD thresholds were measured applying different degrees of bilateral, interaurally-uncorrelated pulse removal. The ITD sensitivity deteriorated with increasing degree of pulse removal, with significant deterioration for degrees of 16% or greater. In experiment II, the interaction between loudness and pulse removal was investigated. Louder stimuli yielded better ITD sensitivity, however, no further improvement was found for stimuli louder than "medium." When removing 8% of the pulses, the ITD sensitivity deteriorated significantly across the entire loudness range tested. A loudness-induced compensation for the deterioration of ITD sensitivity due to pulse removal seems to be feasible for soft stimuli but not for medium or loud stimuli. Overall, our findings suggest that the degree of pulse removal employed in low-rate channels within coding strategies should not exceed 8%.

Channel Interaction and Current Level Affect Across-Electrode Integration of Interaural Time Differences in Bilateral Cochlear-Implant Listeners.

Sensitivity to interaural time differences (ITDs) is important for sound localization. Normal-hearing listeners benefit from across-frequency processing, as seen with improved ITD thresholds when consistent ITD cues are presented over a range of frequency channels compared with when ITD information is only presented in a single frequency channel. This study aimed to clarify whether cochlear-implant (CI) listeners can make use of similar processing when being stimulated with multiple interaural electrode pairs transmitting consistent ITD information. ITD thresholds for unmodulated, 100-pulse-per-second pulse trains were measured in seven bilateral CI listeners using research interfaces. Consistent ITDs were presented at either one or two electrode pairs at different current levels, allowing for comparisons at either constant level per component electrode or equal overall loudness. Different tonotopic distances between the pairs were tested in order to clarify the potential influence of channel interaction. Comparison of ITD thresholds between double pairs and the respective single pairs revealed systematic effects of tonotopic separation and current level. At constant levels, performance with double-pair stimulation improved compared with single-pair stimulation but only for large tonotopic separation. Comparisons at equal overall loudness revealed no benefit from presenting ITD information at two electrode pairs for any tonotopic spacing. Irrespective of electrode-pair configuration, ITD sensitivity improved with increasing current level. Hence, the improved ITD sensitivity for double pairs found for a large tonotopic separation and constant current levels seems to be due to increased loudness. The overall data suggest that CI listeners can benefit from combining consistent ITD information across multiple electrodes, provided sufficient stimulus levels and that stimulating electrode pairs are widely spaced.

Perception and coding of interaural time differences with bilateral cochlear implants.

Bilateral cochlear implantation is increasingly becoming the standard in the clinical treatment of bilateral deafness. The main motivation is to provide users of bilateral cochlear implants (CIs) access to binaural cues essential for localizing sound sources and understanding speech in environments of interfering sounds. One of those cues, interaural level differences, can be perceived well by CI users to allow some basic left versus right localization. However, interaural time differences (ITDs) which are important for localization of low-frequency sounds and spatial release from masking are not adequately represented by clinical envelope-based CI systems. Here, we first review the basic ITD sensitivity of CI users, particularly their dependence on stimulation parameters like stimulation rate and place, modulation rate, and envelope shape in single-electrode stimulation, as well as stimulation level, electrode spacing, and monaural across-electrode timing in multiple-electrode stimulation. Then, we discuss factors involved in ITD perception in electric hearing including the match between highly phase-locked electric auditory nerve response properties and binaural cell properties, the restricted stimulation of apical tonotopic pathways, channel interactions in multiple-electrode stimulation, and the onset age of binaural auditory input. Finally, we present clinically available CI stimulation strategies and experimental strategies aiming at improving listeners' access to ITD cues. This article is part of a Special Issue entitled .