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1.
Respir Physiol ; 108(1): 11-22, 1997 Apr.
Article in English | MEDLINE | ID: mdl-9178373

ABSTRACT

We studied five adult male patients with central sleep apnea syndrome (> 75% of the monitored events being central) during sleep using a fiberoptic scope and EMG monitoring of the superior and middle constrictors of the pharynx and the genioglossus and geniohyoid muscles. The fiberoptic investigation revealed a spontaneous decrease in the size of the airway during central apneas, without negative intrathoracic pressure or activation of the superior and middle pharyngeal constrictor muscles. We found a mean maximum decrease of 71 +/- 7% in the cross-sectional area of the airway and an absence of superior-middle pharyngeal constrictor EMG discharge. We did not observe any complete collapses of the airway.


Subject(s)
Airway Obstruction/physiopathology , Pharynx/physiopathology , Sleep Apnea Syndromes/physiopathology , Adult , Aged , Electromyography/methods , Fiber Optic Technology/methods , Humans , Male , Middle Aged , Pharynx/innervation , Video Recording
3.
Otolaryngol Head Neck Surg ; 109(1): 108-10, 1993 Jul.
Article in English | MEDLINE | ID: mdl-8336955

ABSTRACT

We measured the owner-adjusted acoustic outputs of 10 automobile stereo systems, with power ratings ranging between 150 and 600 watts. The sound levels ranged from 107 to 138 dB SPL and 84 to 108 dBA. Most of the high-intensity sound was in the 31, 62, and 125 Hz center-frequency octave bands. The mean computed noise dose, based on the vehicle owners' reported daily duration of exposure, was 108.5%. While there is clearly a risk of hearing damage in the extreme cases according to OSHA standards, the typical listening durations claimed by the stereo owners would seem to lower the risk for the majority to acceptable margins for the automobiles measured.


Subject(s)
Automobiles , Music , Noise/adverse effects , Evaluation Studies as Topic , Hearing Loss, Noise-Induced/epidemiology , Hearing Loss, Noise-Induced/etiology , Humans , Maximum Allowable Concentration , Risk Factors , Sound Spectrography , Time Factors , United States , United States Occupational Safety and Health Administration
6.
Otolaryngol Head Neck Surg ; 103(4): 625-7, 1990 Oct.
Article in English | MEDLINE | ID: mdl-2123323

ABSTRACT

A four-level severity scale for obstructive sleep apnea is offered using four criteria: maximum oxygen desaturation, apnea/hyponea index, symptoms of excessive day-time sleepiness, and symptoms of related cardiac disease. Oxygen desaturation and the apnea/hyponea index for 175 patients, all having had uvulopalatopharyngoplasty surgery, showed 19% mild, 33% moderate, 17% moderately severe, and 31% severe obstructive sleep apnea. There was a very poor correlation between oxygen desaturations and number of obstructive events, which demands that both be used in any estimation of disease severity.


Subject(s)
Sleep Apnea Syndromes/classification , Humans , Oxygen/blood , Sleep Apnea Syndromes/physiopathology
7.
West J Med ; 148(4): 470, 1988 Apr.
Article in English | MEDLINE | ID: mdl-3388857
8.
Ann Otol Rhinol Laryngol ; 97(2 Pt 1): 105-8, 1988.
Article in English | MEDLINE | ID: mdl-3258485

ABSTRACT

Seventy-eight tympanotomies were performed to determine the presence of perilymph fistulas (PLFs); of these, 51% were found. The oval and round windows of all patients were grafted, whether PLFs were present or not. Of those patients with PLFs, 64% had resolution of their major symptom; when no PLF was found, 44% had a similar outcome. We concluded that 1) PLFs often behave as if they are epiphenomena in relation to hearing and balance, 2) PLFs can be intermittent, 3) PLF surgery is disappointing for restoration of hearing in sudden hearing loss when compared to the rate of spontaneous recovery, 4) stabilizing a fluctuating or progressive loss is a more realistic goal, and 5) establishing preoperative criteria for exploration is still a problem.


Subject(s)
Fistula/diagnosis , Labyrinth Diseases/diagnosis , Labyrinthine Fluids , Perilymph , Adolescent , Adult , Aged , Child , Child, Preschool , Connective Tissue/transplantation , Diagnostic Errors , Female , Fistula/etiology , Fistula/surgery , Follow-Up Studies , Hearing Disorders/etiology , Humans , Labyrinth Diseases/etiology , Labyrinth Diseases/surgery , Male , Meniere Disease/diagnosis , Middle Aged , Oval Window, Ear/injuries , Oval Window, Ear/surgery , Round Window, Ear/injuries , Round Window, Ear/surgery , Vestibule, Labyrinth/physiopathology
9.
J Acoust Soc Am ; 83(2): 657-61, 1988 Feb.
Article in English | MEDLINE | ID: mdl-3351123

ABSTRACT

Electrophonic and auditory-nerve electroneural responses were recorded from the inferior colliculus of the cat. The electrophonic response appeared at a latency 1.0-1.5 ms later than the electroneural response, due to the time requirements for cochlear transduction. The electrophonic response also demonstrated very slow growth of response amplitude with increasing stimulus current as compared to the electroneural response. Aminoglycoside perfusion of the cochlea eliminated the electrophonic component from the evoked response record and left the electroneural component relatively unchanged, indicating that the electrophonic is an acoustic stimulus that requires an intact auditory end organ for transduction.


Subject(s)
Inferior Colliculi/physiology , Neurons/physiology , Vestibulocochlear Nerve/physiology , Animals , Cats , Cochlea/physiology , Electric Stimulation , Neural Conduction
10.
J Speech Hear Res ; 30(4): 480-93, 1987 Dec.
Article in English | MEDLINE | ID: mdl-3695442

ABSTRACT

Four profoundly deaf adults, each a recent recipient of a scala tympani implant, underwent auditory and auditory-visual speech comprehension evaluations. Two subjects had multiple-electrode auditory prostheses, and 2 had single-electrode implants. All subjects were tested preoperatively with a high-power hearing aid, and postoperatively with a single-channel wearable sound processor. Reported here are the results of the first formal speech recognition tests which were conducted during the 8 months after the sound processor fitting. Three subjects had used the single-channel processor on a daily basis for up to 8 months at the time of postoperative testing. The 4th subject was a nonuser. On listening tests, a comparison between pre- and post-implant scores revealed little difference for any subject. On postoperative speechreading tasks, all subjects identified medial consonant phonemes and 2-digit numerals better with stimulation than without. The 3 frequent users of the device experienced significant improvement on connected-discourse tracking, and their speechreading of videotaped and live voice CID Everyday Sentences (Davis & Silverman, 1978) was enhanced with the addition of stimulation. The nonuser was a very proficient speechreader at the outset and exhibited no significant difference on connected-discourse tracking with and without stimulation. Moreover her ability to speechread Everyday Sentences was hampered slightly by the addition of stimulation. This single-channel sound processor functioned as a sensory supplement for the 3 frequent users, but no subject was able to use the processor as a sensory substitute.


Subject(s)
Cochlear Implants , Deafness/therapy , Speech Perception , Adult , Aged , Audiometry, Speech , Female , Follow-Up Studies , Humans , Lipreading , Male , Middle Aged , Prosthesis Design , Speech Discrimination Tests
11.
Ear Hear ; 8(1): 12-20, 1987 Feb.
Article in English | MEDLINE | ID: mdl-3549402

ABSTRACT

Congenital and early-onset hearing losses were discovered in 6.1% of 975 Intensive Care Nursery (ICN) graduates. The methods used were neonatal screening by Crib-O-Gram (COG) and high risk register, in combination with repeated behavioral hearing tests at 1 to 3 years. This 7-year longitudinal study had follow-up hearing evaluations for a remarkably high 84% of all subjects. Significant losses that interfered with speech and language development (1000 to 8000 Hz average loss greater than 45 dB HL bilaterally) were found in 4.3% of infants. COG in combination with subsequent behavioral hearing screening was a sensitive strategy for detecting significant hearing loss: only one child was missed with this combination. Alone, COG sensitivity to significant hearing losses was 79.3%, but would have been higher had a stricter passing criterion been adopted. Behavioral hearing screenings detected bilateral hearing losses of even mild (greater than 20 dB HL) degree. Sensitivity to significant hearing losses was 82.6% and would have been improved if test frequencies greater than 3000 Hz were included in the screen. Even if screening failure occurred at 1 year of age, the age of actual confirmation of hearing loss depended on severity of the loss and ear involvement. Significant hearing losses were confirmed earlier than less severe or unilateral losses. Although behavioral screenings could be done during the first year of life, continued follow-up was required to detect progressive hearing losses.


Subject(s)
Hearing Tests , Acoustic Stimulation , Child Behavior , Child, Preschool , Hearing Disorders/diagnosis , Hearing Loss, Conductive/diagnosis , Humans , Infant , Infant, Newborn , Longitudinal Studies , Risk , Sensitivity and Specificity
12.
Ann Otol Rhinol Laryngol Suppl ; 96(1 Pt 2): 106-8, 1987.
Article in English | MEDLINE | ID: mdl-11542645

ABSTRACT

Vestibular function in cochlear implant candidates varies from normal to total absence of function. In patients with intact vestibular function preoperatively, invasion of the otic capsule places residual vestibular function at risk. Speech-processing strategies that result in large amplitude electrical transients or strategies that employ high amplitude broad frequency carrier signals have the potential for disrupting vestibular function. Five patients were tested with and without electrical stimulation via cochlear electrodes. Two patients experienced subjective vestibular effects that were quickly resolved. No long-term vestibular effects were noted for the two types of second generation cochlear implants evaluated. Histopathological findings from another patient, who had electrically generated vestibular reflex responses to intramodiolar electrodes, indicated that responses elicited were a function of several variables including electrode location, stimulus intensity, stimulus amplitude, and stimulus frequency. Differential auditory, vestibulocolic, and vestibulospinal reflexes were demonstrated from the same electrode as a function of stimulus amplitude, frequency, and duration.


Subject(s)
Cochlear Implants/adverse effects , Postoperative Complications/etiology , Reflex, Vestibulo-Ocular/physiology , Vestibular Nerve/physiology , Vestibule, Labyrinth/physiology , Aged , Caloric Tests , Deafness/rehabilitation , Deafness/surgery , Electric Stimulation , Electrodes, Implanted/adverse effects , Female , Humans , Male , Middle Aged , Temporal Bone/pathology , Vertigo/etiology , Vestibular Function Tests
13.
Laryngoscope ; 96(5): 498-501, 1986 May.
Article in English | MEDLINE | ID: mdl-3486336

ABSTRACT

This paper proposes two relatively common "syndromes" seen in children with perilymph fistulas using illustrative case reports. One, a 2 1/2-year-old child with bilaterally symmetric progressive sensorineural hearing loss, was found to have bilateral oval and round window fistulas. The other was a child who presented originally with an unexplained unilateral sensorineural loss. It was only when hearing deteriorated in the opposite ear several years later that a perilymph fistula was suspected and confirmed by tympanotomy. The clinical presentations and other details of these cases diverge widely, but may represent two emerging syndromes of perilymph fistulas in children: 1. a congenital or hereditary predisposition, and the other, 2. sudden hearing loss in the "good" ear of children with an unexplained sensorineural hearing loss in the opposite ear.


Subject(s)
Cochlea , Fistula/complications , Hearing Loss, Sensorineural/etiology , Labyrinthine Fluids , Oval Window, Ear , Perilymph , Round Window, Ear , Vestibule, Labyrinth , Audiometry , Auditory Threshold , Child, Preschool , Dizziness/etiology , Female , Fistula/diagnosis , Fistula/surgery , Humans , Labyrinth Diseases/complications , Labyrinth Diseases/diagnosis , Labyrinth Diseases/surgery , Syndrome
14.
Ear Hear ; 7(2): 78-82, 1986 Apr.
Article in English | MEDLINE | ID: mdl-3699263

ABSTRACT

This paper describes a delayed onset sensorineural hearing loss in a baby known to have normal hearing until at least 13 months. A mild high-frequency loss was discovered quite by accident at 25 months. The bilaterally symmetrical loss progressed over the next 6 months to no measurable high-frequency hearing and a 70 dB threshold at 500 Hz. To our knowledge this is the youngest completely documented case of what has been called hereditary delayed onset hearing loss. However, in this instance, and perhaps unsuspected in others, this child had bilateral oval and round window fistulas whose repair may have not only arrested the progression of her loss, but even improved her residual hearing sensitivity.


Subject(s)
Hearing Loss, Sensorineural/etiology , Audiometry , Audiometry, Evoked Response , Child, Preschool , Female , Fistula/complications , Fistula/diagnosis , Hearing Loss, High-Frequency/diagnosis , Hearing Loss, High-Frequency/etiology , Hearing Loss, Sensorineural/diagnosis , Humans , Labyrinth Diseases/complications , Labyrinth Diseases/diagnosis , Oval Window, Ear , Round Window, Ear
15.
Ann Otol Rhinol Laryngol ; 95(2 Pt 1): 132-6, 1986.
Article in English | MEDLINE | ID: mdl-3754409

ABSTRACT

Four electrodes were placed in the cochlea and eighth nerve of a 57-year-old man, deafened earlier by neomycin. One electrode received over 4,000 known hours of electrical stimulation and the others fewer, but still substantial hours during extensive psychometric and speech-related testing. While tissue examination showed nerve damage in the basal turn secondary to the implant surgery, there were 18,450 surviving neurons (25,000 are normal for age). There was little or no local tissue reaction and no erosion of the electrode tips caused by electrical stimulation.


Subject(s)
Cochlear Implants/adverse effects , Deafness/rehabilitation , Ear/pathology , Cochlea/pathology , Cochlear Nerve/pathology , Deafness/pathology , Ear, Inner/pathology , Ear, Middle/pathology , Electrodes, Implanted/adverse effects , Humans , Male , Middle Aged , Neurons/pathology , Patient Compliance , Time Factors
16.
Ann Otol Rhinol Laryngol ; 95(1 Pt 1): 71-5, 1986.
Article in English | MEDLINE | ID: mdl-3753836

ABSTRACT

Two subjects with transcutaneously connected 8-electrode scala tympani implants were given subsets of the Minimal Auditory Capabilities test during stimulation with five speech processing strategies--two single channel and three multichannel. While there were significant (p = 0.05%) scores on some items with all types of stimulation, one subject did as well with single channel analog as with multichannel stimulation. She is an enthusiastic full-time user of single channel stimulation. The other, a nonuser of the same device, preferred (and performed better with) one of multichannel stimulation. This is an interim report because neither subject has yet had the opportunity of nonlaboratory use of the multichannel schemes.


Subject(s)
Cochlear Implants , Speech Discrimination Tests , Speech Reception Threshold Test , Adult , Aged , Correction of Hearing Impairment , Female , Hearing Disorders/surgery , Humans , Lipreading , Scala Tympani/physiology , Speech Perception
18.
Otolaryngol Head Neck Surg ; 93(2): 240-4, 1985 Apr.
Article in English | MEDLINE | ID: mdl-3921918

ABSTRACT

Nine patients with obstructive sleep apnea who underwent unsuccessful palatopharyngoplasty (PPP) as documented by polygraphic monitoring had abnormal cephalometric roentgenogram measurements. Findings indicated a small posterior airway space and inferiorly placed hyoid bone. Cephalometry performed with appropriate techniques to investigate soft tissue location should be obtained systematically in obstructive sleep apneic patients before any surgery is performed. The roentgenogram finding is a helpful guide in deciding whether PPP alone or PPP in combination with other surgical procedures would be more efficacious.


Subject(s)
Cephalometry , Palate/surgery , Pharynx/surgery , Sleep Apnea Syndromes/surgery , Adult , Endoscopy , Humans , Male , Methods , Middle Aged , Palate/diagnostic imaging , Pharynx/diagnostic imaging , Pharynx/pathology , Radiography , Sleep Apnea Syndromes/diagnostic imaging , Sleep Apnea Syndromes/pathology
20.
J Acoust Soc Am ; 76(2): 449-55, 1984 Aug.
Article in English | MEDLINE | ID: mdl-6090518

ABSTRACT

Evoked potentials to a dichotic stimulus composed of either (1) two binaurally presented tone pips or (2) one tone pip and an electrical pulse to the auditory nerve are recorded from the primary auditory cortex of barbiturate anesthetized cats. The composite stimulus is delivered as a time delayed pair where the interstimulus interval (25 ms) is within the relative refractory period of the evoked potential to either stimulus alone. The amplitude of the cortical potential to the trailing stimulus is compared with its single amplitude as the frequency of the trailing tone pip is changed from 250 Hz through 40 kHz. There is an optimal frequency range over which the trailing stimulus is suppressed and this range appears directly related to the current of a preceding electrical pulse. The frequency of maximum suppression shifts according to the position of the electrode in the nerve. In some experiments secondary maxima develop, suggesting stimulus current spread from fibers of one cochlear turn into fibers from another turn.


Subject(s)
Auditory Cortex/physiology , Evoked Potentials, Auditory , Inferior Colliculi/physiology , Pitch Perception/physiology , Vestibulocochlear Nerve/physiology , Animals , Auditory Pathways/physiology , Cats , Electric Stimulation , Synaptic Transmission
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