[Impact of CI use and CI fitting on speech production in very early cochlear-implanted infants]. / Bedeutung von CI-Nutzungsverhalten und CI-Anpassung für sprachproduktive Leistungen sehr früh cochleaimplantierter Kinder.

BACKGROUND: Children's age at implantation is an important factor for their outcome in auditory and language skills with a cochlear implant (CI). CI use and frequency of CI fitting may also influence speech performance. Purpose of this study was to evaluate CI use and CI fitting of very early implanted infants and its potential influence on age-related speech production performance. METHODS: Data of 34 bilaterally cochlea-implanted infants (age at CI in months: M = 8,8; SD = 1,7) were included. During the third year of life speech production performance was evaluated and related to datalogging-based CI use and number of CI fitting sessions. RESULTS: About half of the cohort achieved speech production level within the normal range of hearing peers. Daily time of CI use was approximately 8 h. Analysis of listening environment showed that infants were exposed most of the time to quiet environment and least amount of time to speech in noise. Daily time of CI use seems to be a significant predictor of speech production, speech-exposition particularly predicts word production. Number of daily disconnection between CI-processor and implant as well as the monthly number of CI fitting sessions were not correlated with speech production. CONCLUSION: Very early cochlear implanted infants may achieve age-appropriate speech production performance in the third year of life. Time of daily CI use in the study cohort is comparable to results of other studies. Time of daily CI use and exposure to speech seem to be important factors for early speech production. These findings should be integrated in pre- and postoperative parent counselling.

[Cochlear implant fitting strategies]. / Anpassung von Cochleaimplantatsystemen.

Cochlear implant (CI) fitting is the technical adjustment of a CI processor to the individual needs of a subject. Fitting comprises the choice of stimulation strategy and determination of the lower and upper stimulation levels for the individual. This electrical dynamic range defines the stimulation range for the real-time functioning of the CI system. All of the CI manufacturers provide a large set of parameters which have to be optimized for proper hearing and speech comprehension. As a consequence of the widening of indication criteria for CIs and lowering the age of implantation for children, the fitting process has changed dramatically over the years. This includes replacement of behavioral responses by other data from objective electrophysiologic measures and from expert knowledge. Recent developments aim to structure and automatize the CI fitting process. This reduces the time requirement for CI fitting and leads to fast settings which can be tested in the real-time situation. This review provides an overview of state-of-the-art fitting procedures and recent developments for fitting strategies. These will be discussed with respect to practicability and quality assurance.

[Phoneme discrimination training with experienced cochlear implant listeners]. / Training der Phonemdiskrimination mit erfahrenen Cochleaimplantatträgern.

BACKGROUND: Computer-based auditory training programmes seem to be a useful tool in the process of auditory rehabilitation after cochlear implantation (CI). Currently, little is known about the learning mechanism and efficiency of such programs. The aim of the study was to evaluate a specific auditory training programme for phoneme discrimination in experienced CI listeners. MATERIALS AND METHODS: A total of 15 CI adult listeners with more than 2 years' CI experience participated in the auditory training. Over a period of 3 weeks they were instructed to train their phoneme discrimination via computer twice a week. Training material consisted of special syllables for consonants (vCv) and vowels (cVc) discrimination. RESULTS: The discrimination abilities for consonants and vowels improved significantly over the training period for training group participants, whereas the changes for the consonants were higher. In addition, the improvement for voiced and unvoiced consonants was significant. CONCLUSION: Computerised auditory training with phonemes improves CI listeners' discrimination abilities for consonants and vowels.

[Influence of hearing aids on monosyllabic test score and subjective everyday hearing]. / Einfluss einer Hörgeräteversorgung auf das Einsilberverstehen und das subjektiv erlebte Alltagshören.

BACKGROUND: Pure tone and speech audiometry are essential methods for examining the indication for hearing aids, as well as for hearing aid evaluation. Additionally, the subjective benefit of hearing aids has to be evaluated with appropriate questionnaires. The aim of the present study was to investigate the correlation between speech audiometry data and the results of a simple and user-friendly questionnaire, as well as to provide normative data for subjective benefit. MATERIALS AND METHODS: Data from 136 hearing aid users with bilateral sensorineural hearing loss were analyzed retrospectively. Pure tone thresholds and Freiburg monosyllabic speech perception in the binaural situation were measured at 65 dB in quiet and in noise (signal-to-noise ratio, SNR = +5 dB), with and without hearing aids. Additionally, subjective hearing in everyday life was recorded using the 12-item Oldenburg Inventory. RESULTS: Improvement of speech perception with hearing aids for the Freiburg monosyllabic test in quiet was 32.0 percentage points on average; in noise, there was an average improvement of 16.4 percentage points. There was a strong correlation between the results of pure tone and speech audiometry. With hearing aids, patients scored their everyday hearing using the Oldenburg Inventory on average 1.4 scale points better than without hearing aids. Results of the Oldenburg Inventory correlate with both pure tone and speech audiometry. CONCLUSION: Hearing aid evaluation should include both speech audiometry and systematic measurement of the subjective benefit using a suitable questionnaire. In combination, the Freiburg monosyllabic test and the Oldenburg Inventory allow for quick and comprehensive evaluation.

Small-molecule-induced Rho-inhibition: NSAIDs after spinal cord injury.

Limited axonal plasticity within the central nervous system (CNS) is a major restriction for functional recovery after CNS injury. The small GTPase RhoA is a key molecule of the converging downstream cascade that leads to the inhibition of axonal re-growth. The Rho-pathway integrates growth inhibitory signals derived from extracellular cues, such as chondroitin sulfate proteoglycans, Nogo-A, myelin-associated glycoprotein, oligodendrocyte-myelin glycoprotein, Ephrins and repulsive guidance molecule-A, into the damaged axon. Consequently, the activation of RhoA results in growth cone collapse and finally outgrowth failure. In turn, the inhibition of RhoA-activation blinds the injured axon to its growth inhibitory environment resulting in enhanced axonal sprouting and plasticity. This has been demonstrated in various CNS-injury models for direct RhoA-inhibition and for downstream/upstream blockade of the RhoA-associated pathway. In addition, RhoA-inhibition reduces apoptotic cell death and secondary damage and improves locomotor recovery in clinically relevant models after experimental spinal cord injury (SCI). Unexpectedly, a subset of "small molecules" from the group of non-steroid anti-inflammatory drugs, particularly the FDA-approved ibuprofen, has recently been identified as (1) inhibiting RhoA-activation, (2) enhancing axonal sprouting/regeneration, (3) protecting "tissue at risk" (neuroprotection) and (4) improving motor recovery confined to realistic therapeutical time-frames in clinically relevant SCI models. Here, we survey the effect of small-molecule-induced RhoA-inhibition on axonal plasticity and neurofunctional outcome in CNS injury paradigms. Furthermore, we discuss the body of preclinical evidence for a possible clinical translation with a focus on ibuprofen and illustrate putative risks and benefits for the treatment of acute SCI.

Triptolide exhibits anti-inflammatory, anti-catabolic as well as anabolic effects and suppresses TLR expression and MAPK activity in IL-1ß treated human intervertebral disc cells.

INTRODUCTION: Increased levels of proinflammatory cytokines seem to play a pivotal role in the development of back pain in a subpopulation of patients with degenerative intervertebral disc (IVD) disease. As current treatment options are mostly limited to surgical interventions or conservative treatment, anti-inflammatory substances might offer a novel, more target-orientated therapeutic approach. Triptolide (TPL), a natural substance found in the Chinese medicinal herb Tripterygium wilfordii Hook, has been demonstrated to possess anti-inflammatory effects in various cells, but no studies exist so far for the IVD. Therefore, the aim of this study was to determine the effects of TPL on human IVD cells by analyzing changes in gene expression and underlying molecular mechanisms. MATERIALS AND METHODS: In order to investigate the anti-inflammatory, anabolic and anti-catabolic effect of TPL, dose-dependency experiments (n = 5) and time course experiments (n = 5) were performed on IL-1ß prestimulated human IVD cells and changes in gene expression of IL-6/-8, TNF-α, PGE2S, MMP1/2/3/13, aggrecan and collagen-I/-II were analyzed by real-time RT-PCR. The molecular mechanisms underlying the effects observed upon TPL treatment were investigated by analyzing involvement of Toll-like receptors TLR2/4 (real-time RT-PCR, n = 5), NF-κB, MAP kinases p38, ERK and JNK (immunoblotting and immunocytochemistry, n = 4) as well as RNA polymerase II (immunoblotting, n = 3). RESULTS: Results showed that 50 nM TPL exhibited an anti-inflammatory, anti-catabolic and anabolic effect on the mRNA level for IL-6/-8, PGE2S, MMP1/2/3/13, aggrecan, collagen-II and TLR2/4, with most pronounced changes after 18 h for proinflammatory cytokines and MMPs or 30 h for TLRs and matrix proteins. However, we also observed an up-regulation of TNF-α at higher concentrations. The effects of TPL did not seem to be mediated via an inhibition of NF-κB or a decrease of RNA polymerase II levels, but TPL influenced activity of MAP kinases p38 and ERK (but not JNK) and expression of TLR2/4. CONCLUSIONS: In conclusion, TPL may possess promising potential for the treatment of inflammation-related discogenic back pain in vitro, but its analgetic effect will need to be confirmed in an appropriate in vivo animal model.