STUTTERING: INITIATING FACTORS, EVOLUTION, HEALING PERSPECTIVES.

Despite high amount of incidents, no scientific paper existed up to now in Georgia dealing with the stuttering. In present essay the views over are collated. It is confirmed that the phenomenon reflects the speech rate and/or the rhythm distortions created by convulsive type involuntary contractions of voice-producing muscles. The disorder is either congenital or acquired. Complicated pregnancy and/or delivery, heavy and/or recurred somatic diseases, speech-formation delay, conflicting social situations appear the main provoking/supporting factors of. The stuttering covers physical and psychological symptoms. The physicals are manifested in speech muscle twitches, while the psychological in phobias. Neurotic and neurotic-like stuttering types are differentiated. The neurotics arise on the background of psychological disorders, the linkage of the neurotic-likes with any concrete factor being mostly difficult or impossible. It is emphasized that the stuttering treatment demands the complex application of pedagogical and medical means and aims the cure of the whole organism, while predominantly of the nervous system, and improvement of mode-of-life conditions of the sufferer. The necessity of the cure of associated diseases is emphasized. It is stated that the stuttering psychotherapy implies the blockage of mental disturbances, while the speech recovery trials intends the establishment of adequate voice, articulation, and respiratory functions. In utilized habilitation/rehabilitation means the particular attention has to draw to initiation of well-balanced logo-rhythms. The regulation of hemisphere speech-center function is a primary target of the vocal exercises applied. Achievements attained in study sessions are regularly spread over the vital situations. The favorable social environment is also regarded as an important item for the pathology defeat. The significance of the systematic cure interventions is emphasized the frequent and/or long-term pauses between being judged as the cause of habit remissions happened. Just compound and customary treatment and active involvement of parents and other family members in applied efforts ensure the better chances for the positive care output.

EFFECT OF SMOKING ON TRASIENTLY EVOKED OTOACOUSTIC EMISSION.

Evoked otoacoustic emissions, EOAEs, are proved to be sounds aroused in response to external acoustic stimulus by the cochlear outer hair cells. Transiently evoked otoacoustic emissions, TEOAEs, are the most clinically utilized EOAEs. TEOAEs are detectable in 98% of people with normal hearing, regardless of age or sex, while two ears of any individual produce similar TEOAEs waveforms. The objective of the presented study was the comparison of TEOAE magnitudes in cigarette smokers and nonsmokers. The TEOAE occurrence and characteristics in individuals of both samples with audiometrically proved hearing losses and in those without were also specifically examined. 30 smokers and and 30 nonsmokers within the age range of 30-59 years were involved in the present study after informed concent. OAEs were performed to each subject by Madsen Capella's-OAE/middle ear analyzer-GN Otometrics, (Danmark). After OAE testing each subject was performed routine pure-tone audiometry and tympanometry. Obtained results were statistically treated by the student's t-distribution. According to our results 76.6% of smokers and 3.33% of nonsmokers had marked different level decrease in TEOAE amplitude. Audiographic measurments showed altered audiogram in 6.7% of smokers and in 3.33% of nonsmokers. Based on the above mentioned results we suppose that smoking has significant influence on hearing function, especially on cochlear apparatus; At the same time, TOEAE, as a sensitive method can be used for very early detection of hearing loss, even when there are neither any subjective complains nor some changies on audiogram.

Cytomegalovirus bearing in children with sensorineural hearing losses.

The rate of bearing of cytomegalovirus, CMV, has been estimated in children suffering from inborn or newborn types of a sensorineural hearing loss of hard-to-severe degrees. The test group comprised 15 hearing-loss children of 3-6 years of age. The control group included accidentally selected 30 healthy children of the same age without any hearing complains. In both groups the CMV-specific IgG antibodies were determined in blood via the enzyme-linked immunosorbent assay, ELISA. The excessive amount of IgG antibodies was found in 14 out of 15 children with sensorineural hearing losses being estimated objectively, via computer registration of auditory brainstem responses, ABRs, and in 14 out of 30 children with normal hearing, being also inspected objectively, via specialized screening procedure. The intergroup difference in CMV bearing rates, 93.3% and 46.7%, respectively, has been confirmed to be statistically significant (p=0.007). CMV bearing happens thus twice as much in sensorineural hearing-loss than in normally-hearing children. Early detection of a hearing loss and early assessment of CMV bearing seem essential for an immediate start and, consequently, for a batter chance of positive outcomes of specific treatment-rehabilitation means.

Acoustic neuroma diagnosis.

Pure tone audiometry, PTA, has been regarded as an initial step when starting acoustic neuroma, AN, diagnostic service. If observing unilateral/asymmetrical sensorineural hearing loss, electronystagmography, ENG, and registration of auditory brainstem responses, ABRs, are instructed to perform. The measures of the methods are listed appearing particularly effective for AN detecting. Efficacy of ENG and ABR approaches in verification of ANs of even initial stages has been stated to reach the absolute identification score, 100%. In tinnitus and/or vertigo complaints, ENG and ABR examinations are recommended to utilize under normal PTA even. The positive evidence of ANs via ENG and ABR has to validate by contrasting magnetic resonance imaging, MRI, while MRI data are advised to utilize for assessment of concrete strategy of surgical intervention. Under negative ENG and ABR outcomes, on the other hand, MRI is considered as a hardly urgent procedure.

Electrically evoked auditory brainstem response in cochlear implant users.

The waveforms and parameters of electrically evoked auditory brainstem responses, eeABRs, registered in cochlear implant users, were compared with those of acoustically evoked auditory brainstem responses, aeABRs, recorded in normally hearing subjects. The eeABRs, in contrast to the aeABRs, contained dubious Wave IV, while missed Waves VI and VII. The eeABRs possessed also shorter peak-latencies, shorter inter-peak intervals, and greater amplitudes. The revealed differences have been explained by the lack of cochlear mechanisms in cochlear implant recipients. On the other hand, eeABRs and aeABRs exhibited similar stimulus intensity dependence. Both had also lower thresholds, shorter peak-latencies, and greater amplitudes in females than in males.

Does vitamin E prevent gentamicin-induced ototoxicity?

A randomized double-blind study was performed to check the protective efficacy of vitamin E against aminoglycoside ototoxicity. 52 patients scheduled for gentamicin therapy because of acute pulmonary infections have been tested. Volunteers were randomly assigned to receive additionally either vitamin E or placebo. The daily dosage of gentamicin amounted to 240 mg and that of vitamin E to 2800 mg. The treatment lasted 7 days. Hearing function was assessed before the start of medication and at the follow-up visit 6 to 8 weeks afterwards. Elevation of auditory thresholds occurred in similar number of patients in the vitamin-E and placebo groups and no statistically significant differences were found between. Vitamin E has been not confirmed thus to possess any protective action against gentamicin-induced ototoxicity.

Reflection of bounce phenomenon in TEOAE in humans: dependence upon test-stimulus parameters.

The bounce phenomenon signifies an alteration of hearing after presentation of low-frequency loud tones. Generally, it implies an initial improvement and a following reduction in auditory sensitivity that reaching peaks at 1- and 3-min intervals of the post-exposure time, respectively. The dependence of the bounce upon test-stimulus parameters has been investigated in the present study. Normally hearing subjects were tested and transiently evoked otoacoustic emissions, TEOAEs, were utilized for an objective assessment of the event. Clicks and tone-pips served for test-stimuli, i.e. for TEOAE registrations, while a tone of 250-Hz frequency and of 95-dB SPL intensity has been exposed during 3 min for the bounce initiation. Post-exposure TEOAE changes were more prominent at lower than at higher test-stimulus intensity, 15 vs. 35 dB nHL. The differences concerned both phases of the bounce, augmentations and reductions. On the other hand, under different test-stimulus frequencies, 250, 500, and 2000 Hz, the bounce, particularly augmentations, owned similar magnitudes. It has been concluded thus that the mechanism of the bounce, particularly of its augmentation phase, is global and covers all cochlear regions, tuned to different sound frequencies.

The hearing system under thyroid hypofunction.

The auditory system has been investigated in 50 patients with thyroid hypofunction. Hearing thresholds were estimated by the pure tone audiometry, PTA. The brief tone audiometry, BTA, was carried out, evaluating differences between thresholds of shorter and longer 1-kHz tonal stimuli, 20 and 200 ms, respectively. The objective studies were established by registrations of evoked otoacoustic emissions, EOAEs, and of auditory brainstem responses, ABRs. The thresholds of ipsilateral and contralateral middle-ear muscle acoustic reflexes, ARs, were also compared. By the PTA, sensorineural hearing loss was detected in 74.0% of cases. The BTA revealed disturbances of temporal summation of excitation in cochlear receptors in 26.0% of inspected subjects. The data of the EOAE mostly corresponded to those of the PTA. In some patients, however, the PTA demonstrated normal thresholds, while the EOAEs as well as the BTA indicated abnormalities. The ABR and AR procedures detected the central hearing disorders in 30.0% and 26.0% of the tested patients, respectively. The investigations have shown that the specific hormonal therapy hardly improves either peripheral or central hearing disorders associated with hypothyroidism.

Reflection of bounce phenomenon in DPOAE: a human study.

The behavior of distortion product otoacoustic emission, DPOAE, has been studied in normally hearing subjects after application of a tone of 0.25-kHz frequency and of 80-dB nHL intensity during 3 min. The bounce phenomenon has correspondingly been investigated just in humans and just via the objective approach. The reliable augmentation of DPOAEs was observed at 0.5 min after the cessation of exposures, the amount of increments being statistically equal at different DPOAE frequencies, 0.75, 1, 1.5, and 2 kHz. At 2 and 4 min after the exposure, in contrast, DPOAE magnitudes were shown to be similar to those of pre-exposure recordings. The present DPOAE results were matched with the previous data on transiently evoked otoacoustic emission and no principal differences have been found between.

Reflection of bounce phenomenon in TEOAE in humans: dependence upon exposure parameters.

The bounce phenomenon is an alteration of hearing acuity after presentation of loud tones. Generally, it implies the improvement in hearing acuity that followed by the worsening. The dependence of the bounce upon exposure stimulus parameters has been evaluated in the present study. Normally hearing subjects were investigated, while transiently evoked otoacoustic emission, TEOAE, has been recorded to estimate the event objectively. In the 1st experiment, the bounce indices have been compared under different intensities, 55-100 dB SPL, of exposure-tone of 250-Hz frequency. At lower intensities, 65-75 dB SPL, the augmentation phase in TEOAE bounce reflections exceeded the depression one. At higher intensities, 80-95 dB SPL, both phases of the bounce were of similar magnitudes. The event appeared thus bipolar and symmetric. At the highest intensity, 100 dB SPL, TEOAE drop has hardly been preceded by any augmentation. In the 2nd experiment, the bounce manifestations have been compared under different exposure-tone frequencies, 250, 500, and 2000 Hz. Under 250- and 500-Hz frequencies, the bounce was of similar magnitudes. Under 2000-Hz frequency, a conventional bounce has not been seen, a trend to the overall TEOAE decrement being observed only. The bounce mechanism is discussed and its complex rather than simple nature is considered.

Age-related hearing loss: gender differences.

Hearing thresholds were measured in 224 Tbilisi citizens, 128 females and 96 males, at the frequencies of 0.125-16 kHz. None of the subjects reported any job-related noise exposures or other potentially confounding history. Initial signs of age-related hearing impairments were detected in females and males of 40-49 and 30-39 years of age, respectively. In both genders they involved high frequencies. In the following age decades, 50-59, 60-69, and 70-79 years, the hearing losses increased in magnitudes and extended to lower frequencies. From the age of 30-39 years to that of 40-49 and 50-59 years the dynamics of threshold elevations appeared more rapid in males than in females. The gender differences in hearing acuity increased respectively in this age period. Thereafter, in the ages of 60-69 and 70-79 years, the hearing alterations became steeper in females than in males. As a result, the gender differences in hearing smoothed significantly.

Interaural pitch perception difference: dependence upon internal and external factors.

Tone pulses were presented consecutively to one and the other ear in normally hearing musicians. The frequency of pulses in one, reference ear was fixed. That in the other, test ear varied to achieve the same pitch of tones in both ears. The frequency deviation of the test tone from the reference one was judged as the interaural pitch perception difference, IPPD. No dissimilarities in IPPDs were found between females and males. On the other hand, in both genders the IPPD scores were greater at higher than at medium and, especially, at lower tone frequencies, 2000, 1000, and 500 Hz, respectively. Also, the IPPDs displayed greater values when the reference tone was administered to the left ear, while the right ear served for the application of the test tone, LrRt, than when the reference tone was delivered to the right ear, while the test tone was applied to the left ear, RrLt. The IPPD differences under LrRt and RrLt stimulus presentations modes were prominent just at higher than at medium and, especially, at lower tone frequencies. The results are interpreted proceeding from the peculiar coding of low- and high-frequency acoustic information into brain auditory structures. Correspondingly, the IPPD is considered to be a consequence of central neural rather than of peripheral receptor events.

The proper time for hearing screening in newborns.

The proper time for hearing screening in newborns via recordings of transiently evoked otoacoustic emission, TEOAE, has been estimated. 269 healthy neonates were investigated during five consecutive days after birth. On the first day, the results of screening were positive in 51 newborns only, 19.0%. In the following days, the number of the positive results systematically grew. In all inspected newborns, 100.0%, the TEOAE procedure was positive on the fifth day only. The fifth and following postnatal days are considered thus to be an appropriate time for hearing assessments in neonates.

Auditory brainstem, middle-latency, and slow cortical responses in multiple sclerosis.

The efficacy of auditory brainstem responses (ABRs), middle-latency responses (MLRs), and slow cortical potentials (SCPs) has been evaluated in 40 patients with multiple sclerosis (MS). ABRs and MLRs were averaged to clicks and SCPs to 1-kHz tone bursts of 70-dB nHL intensity. ABR, MLR, and SCP abnormalities were detected in 65.0, 42.5, and 30.0% of the sample, respectively. The combined sensitivity of ABRs and MLRs amounted to 80.0%, of ABRs and SCPs to 75.0%, and of MLRs and SCPs to 60.0%. The joint aptitude of all three responses equalled 87.5%. All three responses were capable to detect MS in seven of nine patients, failing to display neurological signs of brainstem lesion. The responses were also abnormal in three of five subjects with negative magnetic resonance imaging. It is concluded that the combined application of ABRs, MLRs, and SCPs promotes both detecting and confirming MS loci.

[Effect of stimulus rise time and high-pass masking on early auditory evoked potentials]. / Der Einfluss der Reizanstiegszeit und der Hochpassmaskierung auf die frühen auditorisch evozierten Potentiale.

BACKGROUND: Problems of frequency-specific objective assessment of hearing threshold by means of auditory brainstem response (ABR) have been discussed recently. While a number of workers have recommended methods of selective masking to improve the frequency specificity, others believe that frequency-specific potentials can also be obtained without masking. In this context, the effects of rise-decay time and high-pass masking on ABRs were investigated. METHOD: ABRs were recorded in normal-hearing subjects and patients with high and low frequency hearing loss by means of surface electrodes between the vertex and the ipsilateral mastoid. The frequency of the stimulus was 1 kHz, and the rise-decay time 1 ms (1-0-1) or 2 ms (2-0-2). High-pass filtered noise (cutoff frequency 1.5 kHz; filter slope 250 dB/octave) was employed for masking. Particular attention was paid to the problem of efficient masking. RESULTS: In normal-hearing subjects under the influence of high-pass masking compared to non-masked ABRs, longer mean latencies and diminished means of the amplitudes of wave V were found, with differences in the near-threshold domain being less pronounced. Similar results were observed in patients with high frequency hearing loss. In patients with low frequency hearing loss, the influence of high-pass masking was especially marked distinctly near to threshold. Furthermore, latency and amplitude differences of wave V of the 1-0-1 and the 2-0-2 stimuli were determined from the ABRs obtained with and without high-pass masking. The differences between the latency differences of both stimuli in the suprathreshold range (70 dB nHL) only were statistically significant. CONCLUSIONS: The results are suggestive of an inadequate frequency specificity of unmasked stimuli in the suprathreshold range. Evaluation of the latencies revealed for both rise-decay times a similar frequency specificity near the threshold and a higher frequency specificity of the longer stimulus in the suprathreshold range.

[Contralateral modification of transitory evoked otoacoustic emissions]. / Kontralaterale Beeinflussung transitorisch evozierter otoakustischer Emissionen.

BACKGROUND: In recent publications the influence of contralateral white noise on transient evoked otoacoustic emissions (TEOAE) is discussed with regard on contributions of the efferent auditory system. METHODS: In the present study the effects have been investigated with regards to middle-ear muscles, efferents and cross hearing. TEOAE to monaural 40-80 dB SPL clicks were recorded in normal-hearing adults under simultaneous presentation of 20-60 dB SPL broadband noise to the contralateral ear. Control runs were performed before, during a short break of, and after contralateral stimulation. The control run before contralateral stimulation was used as a reference. RESULTS: Decrease in TEOAE, and increase in accompanying noise floor, were found to follow the contralateral stimulation. In particular a 1-3 dB decrease was found for contralateral noise levels of 40 and 60 dB SPL, even though the readings at 60 dB only were statistically significant (paired-samples t test, p = 0.05). For both TEOAE and noise floor no systematic dependence on click intensity was seen. The control runs during temporary break and after contralateral noise revealed an increase in both TEOAE and noise floor. As a rule, the TEOAE adapted to the reference within 2-3 min following the cessation of contralateral stimulation, whereas the increased noise floor level was still noted after 10 min. CONCLUSIONS: Traditionally, suppressing effects of contralateral stimulation on TEOAE have been attributed to cochlear efferents (CEs). Occasionally, the middle-ear muscle and cross hearing involvement have been considered as well. Substantially, the present results and findings of other workers are inconsistent with the basic knowledge of CE functioning: (I) The decrease in TEOAE under contralateral stimulation is in conflict with an increase in cochlear microphonics and summating potentials observed during activation of CEs: (II) contralateral suppression of TEOAE exhibited no significant dependence on the test-stimulus level while the CEs are known to be efficient in the range of the low signal intensities only, and (III) acoustic activation of the CEs can hardly be expected to reach levels sufficient to influence the TEOAE mechanism. The present findings, i.e. decrease in TEOAE and increase in noise floor level, can more reasonably be explained as being mainly attributable to activation of the middle-ear muscles.

Auditory brainstem response, middle-latency response, and slow cortical potential in patients with partial epilepsy.

Auditory brainstem responses (ABRs), middle-latency responses (MLRs), and slow cortical potentials (SCPs) have been recorded in patients with partial epilepsy previously untreated by anticonvulsants. Peak latencies, interpeak intervals, and amplitudes were estimated and the mean group values were compared with the respective data in age- and gender-matched healthy individuals. Neither ABRs nor MLRs in the patients differed significantly from those in the control group. Conversely, the SCP characteristics demonstrated regular differences: the P2 peak latency in the patients was prolonged and both the P1N1 and N1P2 amplitudes were increased. Considering the mechanisms of the ABR and MLR, it has been suggested that the specific structures of central auditory pathway up to the primary cortex do not play any essential role in the pathogenesis of partial epilepsy. Furthermore, it is speculated that the SCP-generating cortical areas, being primarily of non-specific qualities, are intimately involved in the mechanisms of epilepsy.

Effects of the conditioning click on click-evoked otoacoustic emission.

The effects of the preceding (conditioning) click on the evoked otoacoustic emission (EOAE) to the following (test) click were investigated in normally hearing adults. To overcome distortions due to superimposition of the test EOAE on the EOAE to the conditioning click, a special stimulation and response subtraction procedure was utilized. The conditioning stimulus was found to suppress the test EOAE. The suppression lessened with a decrease in the conditioning stimulus level and an increase in the time interval between the conditioning and the test stimuli. Nevertheless, the influence was traced even with the level of the conditioning stimulus as low as 5 dB SL, and lasted for the interval between the conditioning and the test stimuli, as long as 7.5 ms. An attempt at theoretical comprehension of the obtained results is made and their usefulness in differentiation of EOAEs from acoustic reflections is proposed.