Hallucinations in Hearing Impairment: How Informed Are Clinicians?

BACKGROUND AND HYPOTHESIS: Patients with hearing impairment (HI) may experience hearing sounds without external sources, ranging from random meaningless noises (tinnitus) to music and other auditory hallucinations (AHs) with meaningful qualities. To ensure appropriate assessment and management, clinicians need to be aware of these phenomena. However, sensory impairment studies have shown that such clinical awareness is low. STUDY DESIGN: An online survey was conducted investigating awareness of AHs among clinicians and their opinions about these hallucinations. STUDY RESULTS: In total, 125 clinicians (68.8% audiologists; 18.4% Ear-Nose-Throat [ENT] specialists) across 10 countries participated in the survey. The majority (96.8%) was at least slightly aware of AHs in HI. About 69.6% of participants reported encountering patients with AHs less than once every 6 months in their clinic. Awareness was significantly associated with clinicians' belief that patients feel anxious about their hallucinations (ß = .018, t(118) = 2.47, P < .01), their belief that clinicians should be more aware of these hallucinations (ß =.018, t(118) = 2.60, P < .01), and with confidence of clinicians in their skills to assess them (ß = .017, t(118) = 2.63, P < .01). Clinicians felt underequipped to treat AHs (Median = 31; U = 1838; PFDRadj < .01). CONCLUSIONS: Awareness of AHs among the surveyed clinicians was high. Yet, the low frequency of encounters with hallucinating patients and their belief in music as the most commonly perceived sound suggest unreported cases. Clinicians in this study expressed a lack of confidence regarding the assessment and treatment of AHs and welcome more information.

Stimulation Rate and Voice Pitch Perception in Cochlear Implants.

The stimulation rate in cochlear implant (CI) sound coding, or the "carrier" rate in pulses per second (pps), is known to influence pitch perception, as well as loudness perception and sound quality. Our main objective was to investigate the effects of reduced carrier rate on the loudness and pitch of coded speech samples. We describe two experiments with 16 Nucleus® CI users, where we controlled modulation characteristics and carrier rate using Spectral and Temporal Enhanced Processing (STEP), a novel experimental multichannel sound coder. We used a fixed set of threshold and comfortable stimulation levels for each subject, obtained from clinical MAPs. In the first experiment, we determined equivalence for voice pitch ranking and voice gender categorization between the Advanced Combination Encoder (ACE), a widely used clinical strategy in Nucleus® recipients, and STEP for fundamental frequencies (F0) 120-250 Hz. In the second experiment, loudness was determined as a function of the input amplitude of speech samples for carrier rates of 1000, 500, and 250 pps per channel. Then, using equally loud sound coder programs, we evaluated the effect of carrier rate on voice pitch perception. Although nearly all subjects could categorize voice gender significantly above chance, pitch ranking varied across subjects. Overall, carrier rate did not substantially affect voice pitch ranking or voice gender categorization: as long as the carrier rate was at least twice the fundamental frequency, or when stimulation pulses for the lowest, 250 pps carrier were aligned to F0 peaks. These results indicate that carrier rates as low as 250 pps per channel are sufficient to support functional voice pitch perception for those CI users sensitive to temporal pitch cues; at least when temporal modulations and pulse timings in the coder output are well controlled by novel strategies such as STEP.

Implantable, Programmable, and Wireless Device for Electrical Stimulation of the Dorsal Root Ganglion in Freely-Moving Rats: A Proof of Concept Study.

OBJECTIVE: This was a proof of concept study, based on systematic reviews of the efficacy and safety of the dorsal root ganglion (DRG) stimulation. The main objective was to develop an implantable, programmable, and wireless device for electrical stimulation of DRG and a methodology that can be used in translational research, especially to understand the mechanism of neuromodulation and to test new treatment modalities in animal models of pain. METHODS: We developed and tested a stimulator that uses a battery-powered microelectronic circuit, to generate constant current square biphasic or monophasic pulsed waveform of variable amplitudes and duration. It is controlled by software and an external controller that allows radio frequency communication with the stimulator. The stimulator was implanted in Sprague-Dawley (SD) rats. The lead was positioned at the L5 DRG level, while the stimulator was placed in the skin pocket at the ipsilateral side. Forty-five animals were used and divided into six groups: spinal nerve ligation (SNL), chronic compression injury of the DRG (CCD), SNL + active DRG stimulation, intact control group, group with the implanted sham stimulator, and sham lead. Behavioral testing was performed on the day preceding surgery and three times postoperatively (1st, 3rd, and 7th day). RESULTS: In animals with SNL, neurostimulation reduced pain-related behavior, tested with pinprick hyperalgesia, pinprick withdrawal test, and cold test, while the leads per se did not cause DRG compression. The rats well tolerated the stimulator. It did not hinder animal movement, and it enabled the animals to be housed under regular conditions. CONCLUSION: A proof-of-concept experiment with our stimulator verified the usability of the device. The stimulator enables a wide range of research applications from adjusting stimulation parameters for different pain conditions, studying new stimulation methods with different frequencies and waveforms to obtain knowledge about analgesic mechanisms of DRG stimulation.

Supporting Equity and Inclusion of Deaf and Hard-of-Hearing Individuals in Professional Organizations.

Disability is an important and often overlooked component of diversity. Individuals with disabilities bring a rare perspective to science, technology, engineering, mathematics, and medicine (STEMM) because of their unique experiences approaching complex issues related to health and disability, navigating the healthcare system, creatively solving problems unfamiliar to many individuals without disabilities, managing time and resources that are limited by physical or mental constraints, and advocating for themselves and others in the disabled community. Yet, individuals with disabilities are underrepresented in STEMM. Professional organizations can address this underrepresentation by recruiting individuals with disabilities for leadership opportunities, easing financial burdens, providing equal access, fostering peer-mentor groups, and establishing a culture of equity and inclusion spanning all facets of diversity. We are a group of deaf and hard-of-hearing (D/HH) engineers, scientists, and clinicians, most of whom are active in clinical practice and/or auditory research. We have worked within our professional societies to improve access and inclusion for D/HH individuals and others with disabilities. We describe how different models of disability inform our understanding of disability as a form of diversity. We address heterogeneity within disabled communities, including intersectionality between disability and other forms of diversity. We highlight how the Association for Research in Otolaryngology has supported our efforts to reduce ableism and promote access and inclusion for D/HH individuals. We also discuss future directions and challenges. The tools and approaches discussed here can be applied by other professional organizations to include individuals with all forms of diversity in STEMM.

The influence of consumer ethnocentrism on purchase of domestic wine: Application of the extended theory of planned behaviour.

With the globalization of markets, consumers are increasingly confronted with a wide range of domestic and foreign products. One of the elements influencing purchase choice of domestic over foreign products are consumer ethnocentric tendencies. There are few studies that have focused on the impact of consumer ethnocentrism on domestic products purchase in developing nations. The goal of this study was to determine drivers of regular purchase of domestic wine using an consumer ethnocentrism extended model of the Theory of Planned Behaviour. The face to face survey was conducted on a sample of 315 Croatian wine buyers using the mall-intercept method. Data were analysed using Structural Equation Modeling by Partial Least Square. The investigation found that consumer ethnocentrism has strong and positive impact on attitudes about domestic wine purchase, while attitudes have partial mediating effect on the relationship between consumer ethnocentrism and intention to buy domestic wine. Attitudes have the strongest effect on the intention to buy domestic wine, while the intention is the strongest predictor of regular purchase of domestic wine. The results of this research can serve as an informative basis for creating marketing strategies in order to increase purchase of domestic food products, namely wine.

Guided growth with aligned neurites in adult spiral ganglion neurons cultured in vitro on silicon micro-pillar substrates.

OBJECTIVE: Assessment of the relationship between the topographical organization of silicon micro-pillar surfaces (MPS) on guidance and neural alignment of adult spiral ganglion neurons (SGN) and use of the otosurgical approach as an alternative for the extraction and isolation of SGNs from adult guinea pigs. APPROACH: SGNs from adult guinea pigs were isolated using conventional and otosurgical approach for in vitro cell culturing on MPS of various micro-pillar widths (1-5.6 µm) and spacing (0.6-15 µm). Cell cultures were compared morphologically with neuronal cultures on control glass coverslips. MAIN RESULTS: We found enhanced SGN in vitro cultures in MPS areas with small and intermediate inter-pillar spacing (from 0.6 µm to 3.2 µm) as well as in MPS areas with wider pillars (from 1.8 µm to 4 µm) compared to MPS flat zones and control glass coverslips. Scanning electron microscopy (SEM) images highlighted how neurites of SGNs follow straight lines by growing on top and between micro-pillars. Only micro-pillars with small and intermediate pillar spacings favor neurite alignment along preferred angles (30°, 90°, and 150°), while pillars with wider spacing produced less aligned neurites. We found propensity of adult SGNs grown on MPSs to attain more bipolar and multipolar morphologies. Additionally, we observed reduced interaction between neuronal and glial cells compared to control glass coverslips. Finally, we found that the otosurgical approach was more beneficial for SGN survival on glass coverslips and MPS flat surfaces than the conventional method. SIGNIFICANCE: MPS with specific architecture supports the guided growth of adult SGNs in vitro and controls adult SGN development and behavior.

Advantageous environment of micro-patterned, high-density complementary metal-oxide-semiconductor electrode array for spiral ganglion neurons cultured in vitro.

This study investigated micro-patterned, high-density complementary metal-oxide-semiconductor (CMOS) electrode array to be used as biologically permissive environment for organization, guidance and electrical stimulation of spiral ganglion neurons (SGN). SGNs extracted and isolated from cochleae of P5-P7 rat pups and adult guinea pigs were cultured 1, 4 and 7 days in vitro on glass coverslips (control) and CMOS electrode array. The cultures were analyzed visually and immunohistochemically for SGN presence, outgrowth, neurite alignment, neurite length, neurite asymmetry as well as the contact of a neuronal soma and neurites with the micro-electrodes. Our findings indicate that topographical environment of CMOS chip with micro-patterned pillars enhanced growth, survival, morphology, neural orientation and alignment of SGNs in vitro compared to control. Smaller spacing (0.8-1.6 µm) between protruding pillars on CMOS led SGNs to develop structured and guided neurites oriented along three topographical axes separated by 60°. We found morphological basis for positioning of the micro-electrodes on the chip that was appropriate for direct contact of SGNs with them. This configuration allowed CMOS electrode array to electrically stimulate the SGN whose responses were observed with live Fluo 4 calcium imaging.

Microelectrode array-induced neuronal alignment directs neurite outgrowth: analysis using a fast Fourier transform (FFT).

Many studies have shown that the topography of the substrate on which neurons are cultured can promote neuronal adhesion and guide neurite outgrowth in the same direction as the underlying topography. To investigate this effect, isotropic substrate-complementary metal-oxide-semiconductor (CMOS) chips were used as one example of microelectrode arrays (MEAs) for directing neurite growth of spiral ganglion neurons. Neurons were isolated from 5 to 7-day-old rat pups, cultured 1 day in vitro (DIV) and 4 DIV, and then fixed with 4% paraformaldehyde. For analysis of neurite alignment and orientation, fast Fourier transformation (FFT) was used. Results revealed that on the micro-patterned surface of a CMOS chip, neurons orient their neurites along three directional axes at 30, 90, and 150° and that neurites aligned in straight lines between adjacent pillars and mostly followed a single direction while occasionally branching perpendicularly. We conclude that the CMOS substrate guides neurites towards electrodes by means of their structured pillar organization and can produce electrical stimulation of aligned neurons as well as monitoring their neural activities once neurites are in the vicinity of electrodes. These findings are of particular interest for neural tissue engineering with the ultimate goal of developing a new generation of MEA essential for improved electrical stimulation of auditory neurons.

Auditory nerve frequency tuning measured with forward-masked compound action potentials.

Frequency selectivity is a fundamental cochlear property. Recent studies using otoacoustic emissions and psychophysical forward masking suggest that frequency selectivity is sharper in human than in common laboratory species. This has been disputed based on reports using compound action potentials (CAPs), which reflect activity in the auditory nerve and can be measured in humans. Comparative data of CAPs, obtained with a variety of simultaneous masking protocols, have been interpreted to indicate similarity of frequency tuning across mammals and even birds. Unfortunately, there are several issues with the available CAP measurements which hamper a straightforward comparison across species. We investigate sharpness of CAP tuning in cat and chinchilla using a forward masking notched-noise paradigm--which is less confounded by cochlear nonlinearities than simultaneous masking paradigms and similar to what was used in the psychophysical study reporting sharper tuning in humans. Our parametric study, using different probe frequencies and notch widths, shows relationships consistent with those of auditory nerve fibers (ANFs). The sharpness of tuning, quantified by Q(10) factors, is negatively correlated with probe level and increases with probe frequency, but the Q(10) values are generally lower than the average trend for ANFs. Like the single fiber data, tuning for CAPs is sharper in cat than in chinchilla, but the two species are similar in the dependence of tuning on probe frequency and in the relationship between tuning in ANFs and CAP. Growth-of-maskability functions show slopes <1 indicating that with increasing probe level the probe is more susceptible to cochlear compression than the masker. The results support the use of forward-masked CAPs as an alternative measure to estimate ANF tuning and to compare frequency tuning across species.

Ongoing temporal coding of a stochastic stimulus as a function of intensity: time-intensity trading.

Stimulus-locked temporal codes are increasingly seen as relevant to perception. The timing of action potentials typically varies with stimulus intensity, and the invariance of temporal representations with intensity is therefore an issue. We examine the timing of action potentials in cat auditory nerve to broadband noise presented at different intensities, using an analysis inspired by coincidence detection and by the binaural "latency hypothesis." It is known that the two cues for azimuthal sound localization, interaural intensity or level differences and interaural time differences (ITDs), interact perceptually. According to the latency hypothesis, the increase in intensity for the ear nearest to a sound source off the midline causes a decrease in response latency in that ear relative to the other ear. We found that changes in intensity cause small but systematic shifts in the ongoing timing of responses in the auditory nerve, generally but not always resulting in shorter delays between stimulus onset and neural response for increasing intensity. The size of the temporal shifts depends on characteristic frequency with a pattern indicating a fine-structure and an envelope response regime. Overall, the results show that ongoing timing is remarkably stable with intensity at the most peripheral neural level. The results are not consistent in a simple way with the latency hypothesis, but because of the acute sensitivity to ITDs, the subtle effects of intensity on timing may nevertheless have perceptual consequences.

Integrity of gut mucosa during anaesthesia in major abdominal surgery.

The aim of the study was to examine a perfusion and integrity of small bowel in 60 subsequent patients during the major open abdominal surgery which lasted from 2 to 7 hours. Two samples of the intestinal mucosa were removed: at the beginning, and at the end of the surgical procedure in general anaesthesia. A mucosal injury was classified into 4 grades. pH, PCO2 and lactate level were measured in the blood samples from the arterial and mesenteric vein in one hour time intervals. The changes of intestinal mucosa were found in 31 patients (51.7%): in 19 patients (31.7%) grade 1 changes were recorded, in 10 patients (16.7%) grade 2, and in 2 patients (3.3%) grade 3. Grade 4 lesions were not recorded. There was a statistically significant correlation between grades of the mucosal damage and the surgery duration (p = 0.001). Analysis during the one hour intervals showed that there was no exact time point when the significant aggravation of the pathohistological changes in intestinal mucosa occurred. However, when patients were allocated into two subgroups with surgical procedures lasting less than 4 hours and more than 4 hours, there was a statistically significant difference in the grades of mucosal damage between subgroups (p < 0.05). More biopsies without pathohistological changes were observed in the patients whose procedure duration was < 4 hours. A significantly higher lactate concentrations in arterial and mesenteric venous blood were observed in the patients with pathohistological changes at 6 hours time point as compared to 2 hour time point in the patients without pathohistological changes (p < 0.05). During the open abdominal surgery in general anaesthesia, the length of the procedure influences the grade of the intestinal mucosa injury. Deterioration of the pathohistological findings in the intestinal mucosa correlates with high lactate blood level, suggesting that the cause of these changes may result from tissue hypoxia.

Hearing history influences voice gender perceptual performance in cochlear implant users.

OBJECTIVES: The study was carried out to assess the role that five hearing history variables (chronological age, age at onset of deafness, age of first cochlear implant [CI] activation, duration of CI use, and duration of known deafness) play in the ability of CI users to identify speaker gender. DESIGN: Forty-one juvenile CI users participated in two voice gender identification tasks. In a fixed, single-interval task, subjects listened to a single speech item from one of 20 adult male or 20 adult female speakers and had to identify speaker gender. In an adaptive speech-based voice gender discrimination task with the fundamental frequency difference between the voices as the adaptive parameter, subjects listened to a pair of speech items presented in sequential order, one of which was always spoken by an adult female and the other by an adult male. Subjects had to identify the speech item spoken by the female voice. Correlation and regression analyses between perceptual scores in the two tasks and the hearing history variables were performed. RESULTS: Subjects fell into three performance groups: (1) those who could distinguish voice gender in both tasks, (2) those who could distinguish voice gender in the adaptive but not the fixed task, and (3) those who could not distinguish voice gender in either task. Gender identification performance for single voices in the fixed task was significantly and negatively related to the duration of deafness before cochlear implantation (shorter deafness yielded better performance), whereas performance in the adaptive task was weakly but significantly related to age at first activation of the CI device, with earlier activations yielding better scores. CONCLUSIONS: The existence of a group of subjects able to perform adaptive discrimination but unable to identify the gender of singly presented voices demonstrates the potential dissociability of the skills required for these two tasks, suggesting that duration of deafness and age of cochlear implantation could have dissociable effects on the development of different skills required by CI users to identify speaker gender.

Voice gender perception by cochlear implantees.

Gender identification of human voices was studied in a juvenile population of cochlear implant (CI) users exposed to naturalistic speech stimuli from 20 male and 20 female speakers using two different voice gender perception tasks. Stimulus output patterns were recorded from each individual CI for each stimulus, and features related to voice fundamental frequency and spectral envelope were extracted from these electrical output signals to evaluate the relationship between implant output and behavioral performance. In spite of the fact that temporal and place cues of similar quality were produced by all CI devices, only about half of the subjects were able to label male and female voices correctly. Participants showed evidence of using available temporal cues, but showed no evidence of using place cues. The implants produced a consistent and novel cue to voice gender that participants did not appear to utilize. A subgroup of participants could discriminate male and female voices when two contrasting voices were presented in succession, but were unable to identify gender when voices were singly presented. It is suggested that the nature of long-term auditory categorical memories needs to be studied in more detail in these individuals.

Mutations that modulate receptor-hormone congruency as a cause of the primate GH receptor species specificity.

Peptide hormones depend on reliable recognition by their receptors. Any mutation that compromises recognition of hormone and receptor molecules is dangerous, the carrier animal would not procreate and the mutation would be lost. Although, most of the hormones from one mammalian species are active when injected into another, the incompatibility of human GH receptor toward nonprimate GHs is a notable exception. It is reported that the coevolution of GH and GHR in primates includes two crucial steps (Mol. Biol. Evol. 18 (2001) 945). The first was mutation of GH His-->Asp at position 171 that happened before the split of Old world and New world monkeys. The second event was Leu-->Arg change at position 43 in the GH receptor molecule that happened in the ancestor of Old world monkeys. The proposed model is based on the possibility that certain mutations can modify the surface of one of interacting molecules to form a confined empty space, a niche in the otherwise congruent hormone/receptor interface. Altoough affinity between molecules is probably slightly reduced, recognition and function are not compromised in this special case. Further mutations of hormone and receptor molecules are allowed under the condition that they remain confined to the niche space. Mutations that do not compromise hormone function can be passed to offsprings. If the consequent mutation of one molecule change its shape to fill the niche space, further mutations without function loss will become less probable. Without the niche space, the phase of fast evolution is closed and both genes become conserved. In this setting, accumulated mutations before the niche closing mutation are the cause of species specificity. To become a dominant variety, carrier animals must possess survival advantage in comparison to the carriers of other less advantageous mutations.

The gender congruency effect and the selection of freestanding and bound morphemes: evidence from croatian.

The authors report 3 picture-word interference experiments in which they explore some properties of the agreement process in speech production. In Experiment 1, Croatian speakers were asked to produce utterances in which the noun's gender value had an impact on the selection of gender-marked freestanding morphemes (pronouns) while ignoring the presentation of same- or different-gender distractor words. In Experiments 2 and 3, Croatian speakers were asked to name the same pictures using noun phrases in which the noun's gender value surfaced as an inflectional suffix. Different-gender distractors interfered more than same-gender distractors (the gender congruency effect) in Experiment 1, but not in Experiments 2 and 3. These contrasting results show that the cause of the gender congruency effect is not at the level where lexical-grammatical information is selected but at the level of selection of freestanding morphemes.

Sounds and silence: an optical topography study of language recognition at birth.

Does the neonate's brain have left hemisphere (LH) dominance for speech? Twelve full-term neonates participated in an optical topography study designed to assess whether the neonate brain responds specifically to linguistic stimuli. Participants were tested with normal infant-directed speech, with the same utterances played in reverse and without auditory stimulation. We used a 24-channel optical topography device to assess changes in the concentration of total hemoglobin in response to auditory stimulation in 12 areas of the right hemisphere and 12 areas of the LH. We found that LH temporal areas showed significantly more activation when infants were exposed to normal speech than to backward speech or silence. We conclude that neonates are born with an LH superiority to process specific properties of speech.

[Catheter placement for peritoneal dialysis using videoendoscopy]. / Postavljanje katetera za peritonejsku dijalizu videoendoskopskim nacinom.

From December 1993 to December 2000 at the Department of Surgery, General Hospital "Sveti Duh", and University, Hospitals Split and Osijek the catheter for peritoneal dialysis was placed in 128 patients, in 137 cases. Videoendoscopic procedure, with the trocar made precisely for that purpose, was used. All surgical procedures, performed in the completely equipped operation room and in general anesthesia, were done without any intraoperative or postoperative complications. The procedure showed to have all advantages of endoscopic or minimally invasive surgery. The patients recovered quickly with low consumption of analgesics, got out of the bed and started with feeding sooner. There were no wound complications. It was possible to start with the dialysis 2-3 days after the procedure. Most important, the results showed that using this approach in comparison to others, there were no more dialysis solution leakages, catheter drainage problems, or more tunnel, exit site or peritoneal infections. Along with placing the catheter, other surgical procedures could be also done without increasing the complication rate. Therefore, laparoscopic cholecystectomy was done in 12 cases, adhesiolysis in 25 cases, and right adnexectomy, open hernioplasty and umbilical hernioplasty in one case. Videoendoscopic approach of placing the catheter is a simple, short and patient convenient procedure, with quick recovery and without any increase in complication rate.