Feasibility of a Smartphone-Based Hearing Aid App for Mild-to-Moderate Hearing Loss: Prospective Multicenter Randomized Controlled Trial.

Background: Hearing loss is a growing health concern worldwide. Hearing aids (HAs) are the treatment of choice for hearing rehabilitation in most cases of mild-to-moderate hearing loss. However, many patients with hearing loss do not use HAs due to their high cost, stigma, and inaccessibility. Since smartphones are widely used, many apps that mimic the amplification function of HAs have been introduced. Smartphone-based HA apps (SHAAs) are affordable and easy to access. However, the audiological benefit of SHAAs has not been determined. Objective: We compared the audiological performance between an SHAA and a conventional HA in a prospective, multicenter randomized controlled trial. Methods: Patients with mild-to-moderate hearing loss were prospectively enrolled from 2 tertiary hospitals and randomly assigned to either an SHAA (Petralex; IT4YOU Corp LLC) or a conventional HA (Siya 1 miniRITE; Oticon A/S). For the cross-over study design, participants used the alternate device and repeated the same 2-month trial. Audiological measurements were obtained using hearing tests, real-ear measurements, and the hearing-in-noise test (HINT). Subjective satisfaction was evaluated using the Abbreviated Profile of Hearing Aid Benefit (APHAB) and International Outcome Inventory for Hearing Aids (IOI-HA). Results: Overall, 63 participants were screened and 38 completed the study. In sound-field audiometry testing, the SHAA showed a 20- to 60-dB gain in the low-to-high frequencies of the hearing threshold level. The HA provided adequate gain in the middle-to-high frequencies (55, 65, and 75 dB in real-ear measurements), which is the sound level for most speaking volumes. However, the SHAA could not improve word recognition at 50 dB. The HA showed better audiological performance than the SHAA in both quiet and noisy conditions in the HINT. The IOI-HA scores were significantly improved by both the HA and SHAA versus unaided conditions. Among the SHAA users, 37% (14/38), 42% (16/38), 24% (9/38), and 32% (12/38) showed improvement in APHAB scores for ease of communication, reverberation, background noise, and aversiveness of sounds, respectively. There were no differences in adverse events between the 2 study groups. Conclusions: The HA showed better performance than the SHAA in word recognition and the HINT. However, the SHAA was significantly better than unaided hearing in terms of amplification. The SHAA may be a useful hearing assistance device for patients with mild-to-moderate hearing loss when listening to soft sounds in quiet conditions. The SHAA demonstrated poorer performance than the HA in the mid- to high-frequency sounds that are important for word recognition, sound quality, and hearing in noisy conditions. Further development of the signal technology of SHAAs is needed to improve the sound quality of mid- to high-frequency sounds and overcome noisy environments.

Music Perception Abilities of the Hearing Amplification System Users.

BACKGROUND AND OBJECTIVES: Recently, the improvement of music perception abilities for emotional stability and high quality of life has become important for the hearing loss group. This study aimed to examine and compare the music perception abilities of the normal hearing (NH) and hearing amplification system (HAS) groups to find the needs and methods of music rehabilitation. Subjects and. METHODS: The data were collected from 15 NH adults (33.1±11.4 years) and 15 HAS adults (38.7±13.4 years), of whom eight wore cochlear implant [CI] systems and seven wore CI and hearing aid systems depending on pitch, melody, rhythm, timbre, emotional reaction, and harmony perception tests. A mismatch negativity test was also conducted, and attitudes toward and satisfaction with listening to music were measured. RESULTS: The correction percentages for the NH and HAS groups were 94.0%±6.1% and 75.3%±23.2% in the pitch test; 94.0%±7.1% and 30.3%±25.9% in the melody test; 99.3%±1.8% and 94.0%± 7.6% in the rhythm test; 78.9%±41.8% and 64.4%±48.9% in the timbre test; 96.7%±10.4% and 81.7%±16.3% in the emotional reaction test; and 85.7%±14.1% and 58.4%±13.9% in the harmony test, respectively, showing statistical significance (p<0.05). For the mismatch negativity test, the area of the waveform was smaller in the HAS groups than in the NH groups, with 70 dB of stimulation showing no statistical significance. The response rates for satisfaction with listening to music were 80% and 93.3% for the NH and HAS groups, showing no statistical significance. CONCLUSIONS: Although the HAS group showed lower music perception ability than the NH group overall, they showed a strong desire for music listening. Also, the HAS group revealed a higher degree of satisfaction even when listening to unfamiliar music played with unusual instruments. It is suggested that systematic and constant musical rehabilitation based on musical elements and different listening experiences will improve music perception qualities and abilities for HAS users.

Biomechanical analysis analyzing association between bone mineral density and lag screw migration.

A proximal femoral nail using a helical blade (HB) is commonly utilized to treat proximal femoral fracture but cut through failure of the lag screws is one of the devastating complications following the surgery. While controversial, one of the potential risk factors for cut through failure is poor bone strength which can be predicted by measuring bone mineral density (BMD). In this study, we performed a biomechanical test on the fractured femoral head to validate whether the indirectly measured BMD from the contralateral hip or that measured directly from the retrieved femoral head can elucidate the structural strength of the fractured femoral head and thereby can be used to predict migration of lag screws. Our result showed that directly measured BMD has a significant correlation with the HB migration on the osteoporotic femoral head. However, while the BMDs measured from the contralateral femoral neck or total hip is the most widely used parameter to predict the bone strength of the fractured femur, this may have limited usability to predict HB migration.

Impact of Capsulotomy on Hip Biomechanics during Arthroscopy.

Background and Objectives: Anterior capsulotomy is routinely performed in hip arthroscopy to improve joint visualization; however, this can partly or completely disrupt the stabilizing ligaments of the hip. This study aimed to report the effects of conventional and extensive arthroscopic capsulotomies on hip stability. Materials and Methods: Eight freshly frozen cadaveric pelvises were used in this study. The range of motion and translation were measured and compared among different capsular conditions utilized in hip arthroscopy, with a special interest in the iliofemoral ligament (IFL) and zona orbicularis (ZO). The conditions included intact capsule, interportal capsulotomy, T-capsulotomy, complete IFL disruption, and complete IFL and ZO disruption. Internal rotation at three flexion planes (-10°, 0°, and 30°) and external rotation at six flexion planes (-10°, 0°, 30°, 60°, 90°, and 110°) were measured with corresponding femoral head translation distance at the application of 2.5 Nm torque. Results: As compared to an intact capsule, a significant increase in external rotation was observed after interportal capsulotomy from -10° to 60° and after T-capsulotomy from -10° to 110° flexion. A significant translation was observed only with a T-capsulotomy, which ranged from 1.9 to 2.3 mm across the flexion angles. Compared with conventional interportal capsulotomy, disruption of the entire IFL resulted in a significant increase in external rotation in all flexion planes, and significant translation was accompanied by disruption of the ZO. Conclusions: Interportal capsulotomy can result in an increase in range of motion, and T-capsulotomy can lead to significant translation. Partial or complete tears of the IFL and ZO can result in further external rotation and translation.

Renal oncocytoma in a cat with chronic renal failure.

CASE SUMMARY: A 9-year-old male neutered domestic shorthair cat presented with anorexia. Ultrasonography showed an irregularly shaped hypoechoic mass in the cranial pole of the right kidney. Ultrasound-guided fine-needle aspiration of the renal mass was performed. Cytology revealed moderate cellularity smears composed of epithelial cell clusters, which consisted of an exclusive population of oncocytic cells seen in sheets and papillary clusters along with abundant single cells. A moderate-to-abundant amount of densely stained granular cytoplasm with round nuclei and indistinct nucleoli was seen. The cytological diagnosis was renal oncocytic neoplasm. CT and surgical resection revealed a firm tan mass in the right kidney. A final diagnosis of renal oncocytoma was made on the basis of histology, immunohistochemical staining profile (positive for cytokeratin, and negative for chromogranin A, neuron-specific enolase and vimentin) of neoplastic cells, together with the electronic microscopy results. RELEVANCE AND NOVEL INFORMATION: We believe that this is the first report of the cytological features of feline renal oncocytoma.

Pre- and Post-Angioplasty Perfusion CT with Acetazolamide Challenge in Patients with Unilateral Cerebrovascular Stenotic Disease.

OBJECTIVE: Perfusion computed tomography (PCT) has the ability to measure quantitative value and produce maps of mean transit time (MTT), cerebral blood flow (CBF), and cerebral blood volume (CBV). We assessed cerebral hemodynamics by using these parameters and acetazolamide (ACZ) challenge for pre- and post-procedural evaluation in patients with unilateral cerebrovascular stenotic disease. METHODS: Thirty patients underwent pre-procedural PCT with ACZ challenge, and 24 patients (80%) was conducted follow up PCT after angioplasty with same protocol. The mean MTT, CBF, and CBV were measured and compared in both middle cerebral arterial (MCA) territories before and after ACZ challenge. Hemispheric ratio and percent change after ACZ challenge were calculated before and after angioplasty. RESULTS: The mean stenosis rate was 76.6%. Significant increases in MTT (32.6%, p=0.000) and significant decreases in CBF (-14.2%, p=0.000) were found in stenotic side MCA territories. After ACZ challenge, there were significant changes in MTT (37.4%, p=0.000), CBF (-13.1%, p=0.000), and CBV (-10.5%, p=0.001) in pre-procedural perfusion study. However, no significant increases were found in MTT, or decreases in CBF and CBV in post-procedural study. There were no significant changes after ACZ challenge also. In addition, the degrees of these changes (before and after ACZ challenge) were highly correlated with the stenotic degrees in pre-procedural perfusion study. CONCLUSION: PCT with ACZ challenge appears to be a useful tool to assess the cerebral perfusion status especially in patients with unilateral symptomatic stenotic disease.

Comparison of Drug-eluting Coronary Stents, Bare Coronary Stents and Self-expanding Stents in Angioplasty of Middle Cerebral Artery Stenoses.

OBJECTIVE: The purpose of this study is to investigate the results of treatment using stent-angioplasty for symptomatic middle cerebral arterial (MCA) stenosis and comparison of in-stent restenosis between drug-eluting stents (DES), bare metal coronary stents (BMS) and self-expanding stents (SES). MATERIALS AND METHODS: From Jan. 2007 to June. 2012, 34 patients (mean age ± standard deviation: 62.9 ± 13.6 years) with MCA stenosis were treated. Inclusion criteria were acute infarction or transient ischemic attacks (TIAs) and angiographically proven symptom related severe stenosis. Stents used for treatment were DES (n = 8), BMS (n = 13) and SES (n = 13). National Institutes of Health Stroke Scale (NIHSS) at admission was 2.5 ± 3.1 and mean stenosis rate was 79.0 ± 8.2%. Assessment of clinical and angiographic results was performed retrospectively. RESULTS: Among 34 patients, periprocedural complications occurred in four cases (11.8%), however, only two cases (6.0%) were symptomatic. All patients were followed clinically (mean follow-up period; 40.7 ± 17.7 months) and 31 were followed angiographically (91.2%. 13.4 ± 8.5 months). There was no occurrence of repeat stroke in all patients; however, mild TIAs related to restenosis occurred in three of 34 patients (8.8%). The mean NIHSS after stent-angioplasty was 1.7 ± 2.9 and 0.8 ± 1.1 at discharge. The modified Rankin score (mRS) at discharge was 0.5 ± 0.9 and 0.3 ± 0.8 at the last clinical follow-up. In-stent restenosis over 50% occurred in five of 31 angiographically followed cases (16.1%), however, all of these events occurred only in patients who were treated with BMS or SES. Restenosis rate was 0.0% in the DES group and 20.8% in the other group (p = 0.562); it did not differ between BMS and SES (2/11 18.2%, 3/13 23.1%, p = 1.000). CONCLUSION: Stent-angioplasty appears to be effective for symptomatic MCA stenosis. As for restenosis, in our study, DES was presumed to be more effective than BMS and SES; meanwhile, the results did not differ between the BMS and SES groups.