1
|
Adkins D, Rojas-Ramirez MV, Shanker A, Burruss CP, Mirsky B, Westgate P, Shinn JB, Bush ML. Factors Associated with No-Show Rates in a Pediatric Audiology Clinic. Otol Neurotol 2023; 44:e648-e652. [PMID: 37590879 PMCID: PMC10529984 DOI: 10.1097/mao.0000000000003997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE To evaluate factors associated with no-show rates in a pediatric audiology clinic. STUDY DESIGN Retrospective review. SETTING Tertiary referral center. PARTICIPANTS All pediatric patients younger than 18 years whose parents/guardians scheduled an appointment at a tertiary Audiology Clinic between June 1, 2015, and July 1, 2017. MAIN OUTCOME MEASURES Data included whether the patient came to their appointment, patient age, sex, race, insurance type, appointment type, location, season of appointment, and day of the week of the appointment. RESULTS Of the 7,784 pediatric appointments scheduled with audiology, the overall no-show rate was 24.3% (n = 1893). Lower age was significantly associated with no-shows ( p = 0.0003). Black/African American children were more likely to no-show compared with White/Caucasians ( p = 0.0001). Compared with self-pay/military/other insurance, those with Medicaid were more likely to no-show ( p = 0.0001). The highest rate of no-shows occurred during summer (27%). On multivariate analysis, younger age, Black/African American race, and Medicaid insurance were associated with increased no-show rates. CONCLUSION A variety of factors influence no-show rates in a pediatric audiology setting. No-shows can affect treatment quality and affect overall hearing outcomes. Further investigation is necessary to assess barriers to appointment adherence and to develop interventions to improve adherence and care.
Collapse
Affiliation(s)
- David Adkins
- University of Kentucky, Department of Otolaryngology – Head & Neck Surgery, Lexington, KY, USA
| | | | - Anita Shanker
- University of Kentucky, College of Medicine, Lexington KY, USA
| | | | - Becky Mirsky
- University of Kentucky, College of Medicine, Lexington KY, USA
| | - Philip Westgate
- University of Kentucky, University of Kentucky, College of Public Health, Department of Biostatistics, Lexington, KY, USA
| | - Jennifer B Shinn
- University of Kentucky, Department of Otolaryngology – Head & Neck Surgery, Lexington, KY, USA
| | - Matthew L. Bush
- University of Kentucky, Department of Otolaryngology – Head & Neck Surgery, Lexington, KY, USA
| |
Collapse
|
2
|
Abstract
The role of attention in the differentiation of auditory processing disorders from attention deficit disorders is gaining considerable interest in both the clinical and research arenas. It has been well established that when attention is directed to one ear or the other on traditional dichotic tests, performance can be altered. However, preliminary studies in our laboratory have shown that dichotic fusion paradigms are resistant to shifts in ear performance associated with changes in attention. The purpose of this study was to assess the performance of normal listeners on a dichotic consonant-vowel and a dichotic rhyme (fusion) test. Both test procedures were administered to 20 young adults in three different listening conditions (free recall, attention directed to the left ear, and attention directed to the right ear). Results from this study supported the hypothesis that dichotic rhyme tests are resistant to alterations in the laterality of attention and have implications for the development of test paradigms that can be used to segregate attention from pure auditory deficits in the clinical domain.
Collapse
|
3
|
Shinn JB, Musiek FE. The Auditory Steady State Response in Individuals with Neurological Insult of the Central Auditory Nervous System. J Am Acad Audiol 2020; 18:826-45. [DOI: 10.3766/jaaa.18.10.3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The auditory steady state response (ASSR) has recently gained attention with respect to estimates of hearing sensitivity and configuration of hearing loss. The present investigation compared behavioral thresholds to estimated ASSR thresholds in subjects with confirmed CANS lesions to determine if this population can be accurately evaluated with ASSR techniques. Comparisons were made between the experimental group and a normal control group matched for age and hearing sensitivity. ASSR thresholds were obtained for the carrier frequencies of 500 and 2000 Hz with a 46 Hz modulation rate and compared to behavioral thresholds. Within and between group comparisons were made. The control group demonstrated strong correlation between their behavioral and estimated ASSR thresholds which significantly contrasted the neurological group. Additionally, individuals with neurological impairment of the CANS exhibited elevated thresholds that were on average 24 dB greater at 2000 Hz than their behavioral thresholds. These results suggest that individuals with neurological insult may appear as hearing impaired or having greater hearing loss than is actually present. As a result, the ASSR may demonstrate the potential to assist in the detection of CANS dysfunction. Las respuestas auditivas de estado estable (ASSR) han ganado atención recientemente con respecto a la estimación de la sensibilidad auditiva y la configuración de la pérdida auditiva. La presente investigación comparó los umbrales conductuales con umbrales estimados por ASSR en sujetos con lesiones CANS confirmadas para determinar si esta población podía ser evaluada con exactitud por medio de técnicas de ASSR. Las comparaciones se realizaron entre el grupo experimental y un grupo control normal ordenados por edad y sensibilidad auditiva. Los umbrales de los ASSR se obtuvieron por medio de frecuencias portadoras de 500 y 2000 Hz, con una tasa de modulación de 46 Hz y se compararon con los umbrales conductuales. Se realizaron comparaciones entre los grupos y dentro de un mismo grupo. El grupo de control mostró una fuerte correlación entre sus umbrales conductuales y los estimados por ASSR, que contrastó significativamente con el grupo neurológico. Adicionalmente, los individuos con un trastorno neurológico de CANS exhibieron umbrales elevados que fueron en promedio 24 dB más alto en 2000 Hz que sus umbrales conductuales. Estos resultados sugieren que los individuos con alteraciones neurológicas pueden lucir como alterados auditivamente o teniendo una pérdida auditiva mayor de la realidad. Como resultados, los ASSR puede demostrar el potencial para ayudar en la detección de la disfunción por CANS.
Collapse
|
4
|
Abstract
Background: Numerous studies have demonstrated that improving the ability to understand speech in noise can be a difficult task for adults with hearing aids (HAs). If HA users want to improve their speech understanding ability, specific training may be needed. Auditory training (AT) is one type of intervention that may enhance speech recognition abilities for adult HA users.
Purpose: The purpose of this study was to examine the behavioral effects of an AT program called Listening and Communication Enhancement (LACE) in the DVD format in new and experienced HA users. While some research has been conducted using the computer version of this program, no research to date has been conducted on the efficacy of the DVD version of the LACE training program in both new and experienced HA users.
Research Design: An experimental, prospective repeated measures group design, with random assignment.
Study Sample: Twenty-nine adults with hearing loss were assigned to one of three groups: new HA plus training, experienced HA plus training, or control (new HA users with no training during the study but provided with training afterward). New HA aid users were randomly assigned to either the training or control group.
Intervention: Participants in the training groups completed twenty 30 min training lessons from the LACE DVD program at home over a period of 4 wk.
Data Collection: Participants in both training groups were evaluated at baseline, after 2 wk of training and again after 4 wk of training. Participants in the control group were evaluated at baseline and after 4 wk of HA use. Several objective listening measures were administered including speech in noise, rapid speech, and competing sentences tasks. Subjective measures included evaluating the participants' perception of the intervention as well as their perceptions of functional listening abilities.
Results: Findings indicate that both new and experienced users improved their understanding of speech in noise, understanding of competing sentences, and communication function after training in comparison to a control group. Effect size calculations suggested that a larger training effect was observed for new HA users compared to experienced HA users. New HA users also reported greater benefit from training compared to experienced users. AT with the LACE DVD format should be encouraged, particularly among new HA users, to improve understanding in difficult listening conditions.
Collapse
|
5
|
Bush ML, McNulty B, Shinn JB. Does Adherence to Early Infant Hearing Detection and Intervention Guidelines Positively Impact Pediatric Speech Outcomes? Laryngoscope 2020; 131:1693-1694. [PMID: 32750169 DOI: 10.1002/lary.28994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/24/2020] [Accepted: 07/14/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Matthew L Bush
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, U.S.A
| | - Beth McNulty
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, U.S.A
| | - Jennifer B Shinn
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, U.S.A
| |
Collapse
|
6
|
Fletcher KT, Dicken FW, Adkins MM, Cline TA, McNulty BN, Shinn JB, Bush ML. Audiology Telemedicine Evaluations: Potential Expanded Applications. Otolaryngol Head Neck Surg 2019; 161:63-66. [PMID: 30832542 DOI: 10.1177/0194599819835541] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is underutilization of cochlear implants with delays in implantation linked to distance from implant centers. Telemedicine could connect cochlear implant specialists with patients in rural locations. We piloted telemedicine cochlear implant testing in a small study, largely composed of normal-hearing volunteers to trial this new application of teleaudiology technology. Thirteen subjects (8 with normal hearing and 5 with hearing loss ranging from mild to profound) underwent a traditional cochlear implant evaluation in person and then via telemedicine technology. Routine audiometry, word recognition testing, and Arizona Biological Test (AzBio) and consonant-nucleus-consonant (CNC) testing were performed. Mean (SD) percent difference in AzBio between in-person and remote testing was 1.7% (2.06%). Pure tone average (PTA), speech reception threshold (SRT), and word recognition were similar between methods. CNC testing showed a mean (SD) difference of 6.8% (10.2%) between methods. Testing conditions were acceptable to audiologists and subjects. Further study to validate this method in cochlear implant candidates and a larger population is warranted.
Collapse
Affiliation(s)
- Kyle T Fletcher
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Frank W Dicken
- 2 University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Margaret M Adkins
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Trey A Cline
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Beth N McNulty
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Jennifer B Shinn
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Matthew L Bush
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
| |
Collapse
|
7
|
Abstract
BACKGROUND Older adults often report difficulty hearing in background noise which is not completely attributable to peripheral hearing loss. Although age-related declines in cognition and hearing in background noise occur, the underlying age-related changes in processing of auditory stimuli in background noise has yet to be fully understood. The auditory P300 has the potential to elucidate the effects of age on auditory and cognitive processing of stimuli in background noise, but additional research is warranted. PURPOSE The purpose of this study was to investigate age-related differences in cognitive processing of auditory stimuli by evoking the auditory P300 at multiple signal-to-noise ratios (SNRs). RESEARCH DESIGN A two-group, repeated measures study design was used. STUDY SAMPLE A convenience sample of 35 participants, 15 older adults (mean age of 66.4 yr) and 20 younger adults (mean age of 21.1 yr), participated in the study. All participants had negative otologic and neurological histories. DATA COLLECTION AND ANALYSIS The auditory P300 was evoked using an oddball paradigm with 500 (frequent) and 1000 Hz (target) tonal stimuli in quiet and in the presence of background noise at +20, +10, and 0 SNRs. P300 amplitudes and latencies were measured in each condition for every participant. Repeated measures analyses of variance were conducted for the amplitude and latency measures of the P300 for each group. RESULTS Results from this study demonstrated P300 latencies were significantly longer in older adults in noise at the most challenging condition (0 SNR) compared with the quiet condition and between the +10 SNR and 0 SNR conditions. Although older adults had significantly longer P300 latencies compared with younger adults, no significant group by listening condition interaction existed. No significant P300 amplitude differences were found for group, noise, or group × listening condition interactions. CONCLUSIONS Results provide evidence that auditory cortical processing, regardless of age, is poorer at more difficult SNRs. However, results also demonstrate that older adults perform significantly poorer than younger adults. This supports the notion that some degree of age-related decline in synchronous firing and rate of transmission of the auditory cortical neurons contributing to the auditory P300 exists. Studies are needed to further understand the impact of noise on auditory cortical processing across populations.
Collapse
|
8
|
Bush ML, Taylor ZR, Noblitt B, Shackleford T, Gal TJ, Shinn JB, Creel LM, Lester C, Westgate PM, Jacobs JA, Studts CR. Promotion of early pediatric hearing detection through patient navigation: A randomized controlled clinical trial. Laryngoscope 2017; 127 Suppl 7:S1-S13. [PMID: 28940335 DOI: 10.1002/lary.26822] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/26/2017] [Accepted: 06/30/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess the efficacy of a patient navigator intervention to decrease nonadherence to obtain audiological testing following failed screening, compared to those receiving the standard of care. METHODS Using a randomized controlled design, guardian-infant dyads, in which the infants had abnormal newborn hearing screening, were recruited within the first week after birth. All participants were referred for definitive audiological diagnostic testing. Dyads were randomized into a patient navigator study arm or standard of care arm. The primary outcome was the percentage of patients with follow-up nonadherence to obtain diagnostic testing. Secondary outcomes were parental knowledge of infant hearing testing recommendations and barriers in obtaining follow-up testing. RESULTS Sixty-one dyads were enrolled in the study (patient navigator arm = 27, standard of care arm = 34). The percentage of participants nonadherent to diagnostic follow-up during the first 6 months after birth was significantly lower in the patient navigator arm compared with the standard of care arm (7.4% vs. 38.2%) (P = .005). The timing of initial follow-up was significantly lower in the navigator arm compared with the standard of care arm (67.9 days after birth vs. 105.9 days, P = .010). Patient navigation increased baseline knowledge regarding infant hearing loss diagnosis recommendations compared with the standard of care (P = .004). CONCLUSIONS Patient navigation decreases nonadherence rates following abnormal infant hearing screening and improves knowledge of follow-up recommendations. This intervention has the potential to improve the timeliness of delivery of infant hearing healthcare; future research is needed to assess the cost and feasibility of larger scale implementation. LEVEL OF EVIDENCE 1b. Laryngoscope, 127:S1-S13, 2017.
Collapse
Affiliation(s)
- Matthew L Bush
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky
| | - Zachary R Taylor
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky
| | - Bryce Noblitt
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky
| | | | - Thomas J Gal
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky
| | - Jennifer B Shinn
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky
| | - Liza M Creel
- Department of Health Management and Systems Sciences, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky
| | - Cathy Lester
- Cabinet for Health and Family Services, Commission for Children with Special Health Care Needs, Louisville, Kentucky
| | - Philip M Westgate
- Department of Biostatistics, University of Kentucky College of Public Health, Lexington, Kentucky
| | - Julie A Jacobs
- Department of Health, Behavior and Society, University of Kentucky College of Public Health, Lexington, Kentucky, U.S.A
| | - Christina R Studts
- Department of Health, Behavior and Society, University of Kentucky College of Public Health, Lexington, Kentucky, U.S.A
| |
Collapse
|
9
|
Chan S, Hixon B, Adkins M, Shinn JB, Bush ML. Rurality and determinants of hearing healthcare in adult hearing aid recipients. Laryngoscope 2017; 127:2362-2367. [PMID: 28144961 DOI: 10.1002/lary.26490] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study was to compare the timing of hearing aid (HA) acquisition between adults in rural and urban communities. We hypothesized that time of acquisition of HA after onset of hearing loss is greater in rural adults compared with urban adults. Secondary objectives included assessment of socioeconomic/educational status and impact of hearing loss and hearing rehabilitation of urban and rural HA recipients. STUDY DESIGN Cross-sectional questionnaire survey. METHODS We assessed demographics, timing of HA fitting from onset of hearing loss, and impact of hearing impairment in 336 adult HA recipients (273 urban, 63 rural) from a tertiary referral center. Amplification benefit was assessed using the International Outcome Inventory for Hearing Aids (IOI). RESULTS The time to HA acquisition was greater for rural participants compared to urban participants (19.1 vs. 25.7 years, P = 0.024) for those with untreated hearing loss for at least 8 years. Age at hearing loss onset was correlated with time to HA acquisition (P = -0.54, P < 0.001). Rural HA participants experienced longer commutes to hearing specialists (68 vs. 32 minutes, P < 0.001), were less likely to achieve a degree beyond high school (P < 0.001), and were more likely to possess Medicaid coverage (P = 0.012) compared to urban participants. Hearing impairment caused job performance difficulty in 60% of all participants. CONCLUSION Rural adults are at risk for delayed HA acquisition, which may be related to distance to hearing specialists. Further research is indicated to investigate barriers to care and expand access for vulnerable populations. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2362-2367, 2017.
Collapse
Affiliation(s)
- Stephen Chan
- University of Kentucky College of Medicine, Lexington, Kentucky, U.S.A
| | - Brian Hixon
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Margaret Adkins
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Jennifer B Shinn
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Matthew L Bush
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A
| |
Collapse
|
10
|
Barnett M, Hixon B, Okwiri N, Irungu C, Ayugi J, Thompson R, Shinn JB, Bush ML. Factors involved in access and utilization of adult hearing healthcare: A systematic review. Laryngoscope 2016; 127:1187-1194. [PMID: 27545324 DOI: 10.1002/lary.26234] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/14/2016] [Accepted: 07/13/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE/HYPOTHESIS Hearing loss is a public health concern, yet hearing healthcare disparities exist and influence utilization of rehabilitation services. The objective of this review was to systematically analyze the published literature on motivators, barriers, and compliance factors affecting adult patient access and utilization of hearing rehabilitation healthcare. DATA SOURCES Pubmed, PsychINFO, CINAHL, and Web of Science were searched for relevant articles. Eligible studies were those containing original, peer-reviewed research in English pertaining to factors affecting adult hearing healthcare access and utilization of hearing aids and cochlear implantation. The search encompassed 1990 to 2015. METHODS Two investigators independently reviewed all articles and extracted data. Specific variables regarding access to care and compliance to recommended care were extracted from each study. RESULTS Thirty articles were reviewed. The factors affecting access and utilization of hearing rehabilitation could be classified into motivators, barriers, and compliance in treatment or device use. The key motivators to seek care include degree of hearing loss, self-efficacy, family support, and self-recognition of hearing loss. The primary barriers to care were financial limitations, stigma of hearing devices, inconvenience, competing chronic health problems, and unrealistic expectations. Compliance is most affected by self-efficacy, education level, and engagement in the rehabilitation process. CONCLUSION Accessing hearing healthcare is complicated by multiple factors. Considering the current climate in healthcare policy and legislation toward improved access of care, a deeper understanding of motivators, barriers, and compliance factors can aid in delivery of effective and efficient hearing healthcare. Laryngoscope, 127:1187-1194, 2017.
Collapse
Affiliation(s)
- Margaret Barnett
- Division of Audiology and Communication Disorders, Department of Otolaryngology-Head and Neck Surgery, University of Louisville College of Medicine, Louisville, Kentucky, U.S.A
| | - Brian Hixon
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Neville Okwiri
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Catherine Irungu
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - John Ayugi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Robin Thompson
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Jennifer B Shinn
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Matthew L Bush
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A
| |
Collapse
|
11
|
Abstract
OBJECTIVES AND METHODS It has been our clinical observation that active middle ear disease (MED) temporally corresponds to a transient decrease in cochlear implant (CI) function, specifically at the apical electrodes. This is non-intuitive as CI function is thought to be independent of middle ear aeration and inflammation. The purpose of this case study is to demonstrate how active MED negatively affects both subjective hearing complaints and objective impedance measures in a CI patient. RESULTS Subjective hearing decreased and impedances levels increased significantly when the patient was experiencing active MED. No significant changes in these measures occurred when there was no active MED. CONCLUSIONS MED may affect CI function in some patients requiring adjustments in programing at times of involvement.
Collapse
Affiliation(s)
- Joshua F Dixon
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, KY USA
| | - Jennifer B Shinn
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, KY USA
| | - Meg Adkins
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, KY USA
| | - Bryan D Hardin
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, KY USA
| | - Matthew L Bush
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, KY USA
| |
Collapse
|
12
|
Bush ML, Osetinsky M, Shinn JB, Gal TJ, Ding X, Fardo DW, Schoenberg N. Assessment of Appalachian region pediatric hearing healthcare disparities and delays. Laryngoscope 2014; 124:1713-7. [PMID: 24402802 DOI: 10.1002/lary.24588] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 12/04/2013] [Accepted: 01/06/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study was to examine the timing of diagnostic and therapeutic services in cochlear implant recipients from a rural Appalachian region with healthcare disparity. STUDY DESIGN Retrospective analysis. METHODS Cochlear implant recipients from a tertiary referral center born with severe congenital sensorineural hearing loss were examined. Rural status and Appalachian status of their county of origin were recorded. A log-rank test was used to examine differences in the distributions of time to definitive diagnosis of hearing loss, initial amplification fitting, and cochlear implantation in these children. Correlation analysis of the rural status of each county and the timing of services was assessed. RESULTS A total of 53 children born with congenital hearing loss were included in the study (36 from rural counties and 17 from urban/suburban counties). The distribution of weeks after birth to diagnosis (P=.006), amplification (P=.030), and cochlear implantation (P=.002) was delayed in rural children compared with urban children. An analysis factoring in the effect of implementation of mandatory infant hearing screening in 2000 demonstrated a similar delay in rural children for weeks to diagnosis (P=.028), amplification (P=.087), and cochlear implantation (P<.0001). CONCLUSIONS Children with severe hearing loss in very rural areas, such as Appalachia, may have significant delays in diagnostic and rehabilitative services. Further investigation is warranted to assess causative factors in delays of cochlear implantation and to develop interventions to promote timely diagnosis and care. LEVEL OF EVIDENCE 3b.
Collapse
Affiliation(s)
- Matthew L Bush
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A
| | | | | | | | | | | | | |
Collapse
|
13
|
Bush ML, Bianchi K, Lester C, Shinn JB, Gal TJ, Fardo DW, Schoenberg N. Delays in diagnosis of congenital hearing loss in rural children. J Pediatr 2014; 164:393-7. [PMID: 24183213 PMCID: PMC3946850 DOI: 10.1016/j.jpeds.2013.09.047] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 08/30/2013] [Accepted: 09/19/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the incidence of pediatric congenital hearing loss and the timing of diagnosis in a rural region of hearing healthcare disparity. STUDY DESIGN Data from the Kentucky newborn hearing-screening program was accessed to determine the incidence of congenital hearing loss in Kentucky, both in the extremely rural region of Appalachia and non-Appalachian region of Kentucky. We also performed a retrospective review of records of children with congenital hearing loss at our institution to determine the timing of diagnostic testing. RESULTS In Kentucky, during 2009-2011, there were 6970 newborns who failed hearing screening; the incidence of newborn hearing loss was 1.71 per 1000 births (1.28/1000 in Appalachia and 1.87/1000 in non-Appalachia); 23.8% of Appalachian newborns compared with 17.3% of non-Appalachian children failed to obtain follow-up diagnostic testing. Children from Appalachia were significantly delayed in obtaining a final diagnosis of hearing loss compared with children from non-Appalachian regions (P = .04). CONCLUSION Congenital hearing loss in children from rural regions with hearing healthcare disparities is a common problem, and these children are at risk for a delay in the timing of diagnosis, which has the potential to limit language and social development. It is important to further assess the causative factors and develop interventions that can address this hearing healthcare disparity issue.
Collapse
Affiliation(s)
- Matthew L Bush
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Louisville, KY.
| | | | - Cathy Lester
- Cabinet for Health and Family Services Commission for Children with Special Health Care Needs, Louisville, KY
| | - Jennifer B Shinn
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Louisville, KY
| | - Thomas J Gal
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Louisville, KY
| | - David W Fardo
- Department of Biostatistics, University of Kentucky, Lexington, KY
| | - Nancy Schoenberg
- Department of Behavioral Science, University of Kentucky, Lexington, KY
| |
Collapse
|
14
|
|
15
|
Way TJ, Long A, Weihing J, Ritchie R, Jones R, Bush M, Shinn JB. Reply: To PMID 23518255. J Am Coll Surg 2013; 217:1154-5. [PMID: 24246627 DOI: 10.1016/j.jamcollsurg.2013.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 08/14/2013] [Indexed: 11/29/2022]
|
16
|
Bush ML, Bingcang CM, Chang ET, Fornwalt B, Rayle C, Gal TJ, Jones RO, Shinn JB. Hot or cold? Is monothermal caloric testing useful and cost-effective? Ann Otol Rhinol Laryngol 2013; 122:412-6. [PMID: 23837395 DOI: 10.1177/000348941312200611] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Videonystagmography (VNG) is used widely in the assessment of balance dysfunction. The full test battery can be time-consuming and can induce patient discomfort. The purpose of this study was to examine the value of monothermal caloric testing in predicting unilateral caloric weakness, as well as abnormal VNG vestibular and nonvestibular eye movement, while considering the time and reimbursement associated with these tests. METHODS In a retrospective review of 645 patients who completed a comprehensive VNG test battery with bithermal caloric testing, we calculated the specificity, sensitivity, and predictive values of monothermal caloric testing in relation to bithermal caloric results and noncaloric VNG results. RESULTS With unilateral vestibular weakness (UVW) defined as a 25% interear difference, warm-air monothermal caloric testing yielded a sensitivity of 87% and a negative predictive value of 90% for predicting UVW. With a 10% UVW definition, the warm-air caloric testing sensitivity increased to 95% and the negative predictive value to 92%. Warm-air monothermal caloric testing had a positive predictive value of 85% and a negative predictive value of 18% for predicting noncaloric VNG findings; cold-air monothermal and bithermal testing displayed similar results. CONCLUSIONS Isolated monothermal testing is a sensitive screening tool for detecting UVW, but is not adequate for predicting noncaloric VNG results.
Collapse
Affiliation(s)
- Matthew L Bush
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Liang C, Hong Q, Jiang TT, Gao Y, Yao XF, Luo XX, Zhuo XH, Shinn JB, Jones RO, Zhao HB, Lu GJ. The effects and outcomes of electrolyte disturbances and asphyxia on newborns hearing. Int J Pediatr Otorhinolaryngol 2013; 77:1072-6. [PMID: 23648318 PMCID: PMC3738180 DOI: 10.1016/j.ijporl.2013.03.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 03/25/2013] [Accepted: 03/28/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the effect of electrolyte disturbances (ED) and asphyxia on infant hearing and hearing outcomes. STUDY DESIGN We conducted newborn hearing screening with transient evoked otoacoustic emission (TEOAE) test on a large scale (>5000 infants). The effects of ED and asphyxia on infant hearing and hearing outcomes were evaluated. RESULT The pass rate of TEOAE test was significantly reduced in preterm infants with ED (83.1%, multiple logistic regression analysis: P<0.01) but not in full-term infants with ED (93.6%, P=0.41). However, there was no significant reduction in the pass rate in infants with asphyxia (P=0.85). We further found that hypocalcaemia significantly reduced the pass rate of TEOAE test (86.8%, P<0.01). In the follow-up recheck at 3 months of age, the pass rate remained low (44.4%, P<0.01). CONCLUSION ED is a high-risk factor for preterm infant hearing. Hypocalcaemia can produce more significant impairment with a low recovery rate.
Collapse
Affiliation(s)
- Chun Liang
- Maternal and Child Health Care Hospital of Baoan, Shenzhen, P.R. of China, 518133,Dept. of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA 40536
| | - Qi Hong
- Maternal and Child Health Care Hospital of Baoan, Shenzhen, P.R. of China, 518133
| | - Tao-Tao Jiang
- Maternal and Child Health Care Hospital of Baoan, Shenzhen, P.R. of China, 518133
| | - Yan Gao
- Maternal and Child Health Care Hospital of Baoan, Shenzhen, P.R. of China, 518133
| | - Xiao-Fang Yao
- Maternal and Child Health Care Hospital of Baoan, Shenzhen, P.R. of China, 518133
| | - Xiao-Xing Luo
- Maternal and Child Health Care Hospital of Baoan, Shenzhen, P.R. of China, 518133
| | - Xiu-Hui Zhuo
- Maternal and Child Health Care Hospital of Baoan, Shenzhen, P.R. of China, 518133
| | - Jennifer B. Shinn
- Dept. of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA 40536
| | - Raleigh O. Jones
- Dept. of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA 40536
| | - Hong-Bo Zhao
- Dept. of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA 40536
| | - Guang-Jin Lu
- Maternal and Child Health Care Hospital of Baoan, Shenzhen, P.R. of China, 518133
| |
Collapse
|
18
|
|
19
|
Bush ML, Jones RO, Shinn JB. The clinical reliability of vestibular evoked myogenic potentials. Ear Nose Throat J 2010; 89:170-176. [PMID: 20397145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
Vestibular evoked myogenic potential (VEMP) testing has gained popularity as a diagnostic modality in otolaryngology and audiology. To maximize the utility of this test, examiners need the availability of ideal test settings and reliable norms. We conducted a prospective study of 8 subjects with no history of neurotologic symptoms to examine the test-retest consistency of VEMP testing and to analyze the impact of stimulus type and muscle tension monitoring. All subjects underwent VEMP testing with two stimuli: a 500-Hz tone and a click. With each stimulus, testing was completed with and without monitoring of sternocleidomastoid muscle tension. All subjects participated in an initial testing session and then returned for a repeat testing session 2 to 4 weeks later. We measured the amplitude of primary waveforms P13 (first positive peak) and N23 (first negative peak) and analyzed the reliability and reproducibility of the mean amplitude asymmetry of these VEMP peaks. The P13 component of the VEMP (specificity: 86.25%) demonstrated a more stable amplitude than did the N23 component (specificity: 70.50%). Therefore, our statistical analysis of the effect of stimulus type and muscle tension monitoring on test-retest reliability was limited to the P13 waveform. We found that neither the type of stimulus nor the presence or absence of muscle tension monitoring had any statistically significant effect on amplitude asymmetry. We concluded that in VEMP testing, the P13 component was more specific than the N23 component in identifying normal subjects and that the P13 component provided consistent results across test sessions, regardless of the type of stimulus or the presence or absence of muscle tension monitoring.
Collapse
Affiliation(s)
- Matthew L Bush
- Division of Otolaryngology, Department of Surgery, University of Kentucky College of Medicine, 800 Rose St., Suite C-236, Lexington, KY 40536-0293, USA.
| | | | | |
Collapse
|
20
|
Abstract
Vestibular evoked myogenic potential (VEMP) testing has gained popularity as a diagnostic modality in otolaryngology and audiology. To maximize the utility of this test, examiners need the availability of ideal test settings and reliable norms. We conducted a prospective study of 8 subjects with no history of neurotologic symptoms to examine the test-retest consistency of VEMP testing and to analyze the impact of stimulus type and muscle tension monitoring. All subjects underwent VEMP testing with two stimuli: a 500-Hz tone and a click. With each stimulus, testing was completed with and without monitoring of sternocleidomastoid muscle tension. All subjects participated in an initial testing session and then returned for a repeat testing session 2 to 4 weeks later. We measured the amplitude of primary waveforms P13 (first positive peak) and N23 (first negative peak) and analyzed the reliability and reproducibility of the mean amplitude asymmetry of these VEMP peaks. The P13 component of the VEMP (specificity: 86.25%) demonstrated a more stable amplitude than did the N23 component (specificity: 70.50%). Therefore, our statistical analysis of the effect of stimulus type and muscle tension monitoring on test-retest reliability was limited to the P13 waveform. We found that neither the type of stimulus nor the presence or absence of muscle tension monitoring had any statistically significant effect on amplitude asymmetry. We concluded that in VEMP testing, the P13 component was more specific than the N23 component in identifying normal subjects and that the P13 component provided consistent results across test sessions, regardless of the type of stimulus or the presence or absence of muscle tension monitoring.
Collapse
Affiliation(s)
- Matthew L. Bush
- Division of Otolaryngology, Department of Surgery,
University of Kentucky College of Medicine, Lexington
| | - Raleigh O. Jones
- Division of Otolaryngology, Department of Surgery,
University of Kentucky College of Medicine, Lexington
| | - Jennifer B. Shinn
- Division of Otolaryngology, Department of Surgery,
University of Kentucky College of Medicine, Lexington
| |
Collapse
|
21
|
Abstract
BACKGROUND The recently developed Gaps-In-Noise (GIN) test has provided a new diagnostic tool for the detection of temporal resolution deficits. Previous reports indicate that the GIN is a relatively sensitive tool for the diagnosis of central auditory processing disorder ([C]APD) in adult populations. PURPOSE The purpose of the present study was to determine the feasibility of the GIN test in the pediatric population. RESEARCH DESIGN This was a prospective pseudorandomized investigation. STUDY SAMPLE This investigation involved administration of the GIN to 72 participants divided into six groups of normal children ranging from 7 through 18 years of age. DATA COLLECTION AND ANALYSIS The approximate GIN threshold (the shortest gap duration for which at least four of six gaps were correctly identified) served as the dependent variable. Results were analyzed using an ANOVA to examine between- and within-group differences. RESULTS No statistically significant differences were seen in GIN thresholds among age groups. In addition, within group analysis yielded no statistically significant differences between ears within each age group. No developmental effect was seen in GIN thresholds between the ages of 7 and 18 years. Children as young as age 7 are able to complete the GIN with no significant difficulty and perform at levels commensurate with normal adults. The absence of ear differences suggests that temporal resolution as measured by the GIN is an auditory process that develops relatively early and symmetrically (i.e., no laterality or ear dominance effects). CONCLUSIONS The GIN procedure appears to be a feasible measure of temporal resolution in both pediatric and adult populations.
Collapse
Affiliation(s)
- Jennifer B Shinn
- Division of Otolaryngology, Department of Surgery, University of Kentucky College of Medicine, Chandler Medical Center, B317 Kentucky Clinic, Lexington, KY, 40536-0284, USA
| | | | | |
Collapse
|
22
|
Shinn JB, Bush ML, Jones RO. Correlation of central auditory processing deficits and vascular loop syndrome. Ear Nose Throat J 2009; 88:E34-E37. [PMID: 19826989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
We report a case involving a 49-year-old woman with vascular loop syndrome. The patient was evaluated because of complaints of decreased hearing sensitivity in her right ear. Central auditory tests were performed. The patient was found to have an asymmetry on pure-tone audiometry and an auditory processing deficit, suggesting central pathology. Magnetic resonance imaging confirmed central involvement, revealing a vascular loop extending into the right internal auditory canal. This case report demonstrates that auditory deficits may result from vascular loop compression and that these deficits may benefit from a battery of tests to help identify and localize the pathology.
Collapse
Affiliation(s)
- Jennifer B Shinn
- Department of Surgery (Otolaryngology), University of Kentucky College of Medicine, Lexington, Ky, USA
| | | | | |
Collapse
|
23
|
Abstract
Cases of central deafness are rare but they can be most informative about the function and dysfunction of the central auditory nervous system. Previous information on the anatomy, physiology, and terminology related to central deafness is reviewed and a patient with central deafness is profiled. The patient suffered bilateral cerebrovascular accidents (CVAs) compromising Heschl's gyrus and some adjacent neural tissue on both sides of the brain. At 18 months post CVAs, this patient could not understand speech presented solely through the auditory modality. Environmental sounds were perceived, but rarely recognized. Pure-tone testing revealed a severe-to-profound hearing loss bilaterally, but otoacoustic emissions, acoustic reflexes, and the auditory brainstem response were essentially within normal ranges for both ears. Middle late and late auditory potentials were compromised, yielding complex modifications of the waveforms. These findings and the compromised vascular anatomy in this case are detailed in this article.
Collapse
Affiliation(s)
- Frank E Musiek
- Department of Communication Disorders, University of Connecticut, Storrs, Connecticut, USA
| | | | | | | | | | | |
Collapse
|
24
|
Olson AD, Shinn JB. A systematic review to determine the effectiveness of using amplification in conjunction with cochlear implantation. J Am Acad Audiol 2009; 19:657-71; quiz 735. [PMID: 19418706 DOI: 10.3766/jaaa.19.9.2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The question regarding the use of amplification with implantation is timely and relevant in today's clinical settings where an increased number of adults with measurable hearing are receiving cochlear implants due to the expanding implant criteria, especially among individuals seeking bilateral implantation. PURPOSE To review the evidence available to answer the clinical question: "Does amplification in the ear opposite of a cochlear implant provide improved communication function for adult users?" RESEARCH DESIGN A systematic review of the evidence that met the search criteria related to the use of amplification in adult implant users. All types of experiments were included with the exception of expert opinion. This systematic review ranked the levels of evidence related to these studies and distinguished the levels of evidence from judgments about the grade and strength of recommendations for the stated clinical question. STUDY SAMPLE Fifty-two articles were initially reviewed with a final 11 articles meeting the search criteria and identified for in-depth analysis. DATA COLLECTION AND ANALYSIS Several electronic databases and textbooks were searched to locate the evidence related to bimodal stimulation. Each article was reviewed using a check sheet and assigned a ranking for level of evidence (Levels 1-6) based on the type of research design that was used and a grade of evidence (A-D) based on the quality, relevance, and extensiveness of the study. Finally the level and grade were collapsed into only three categories to indicating the strength of the recommendations coming from each study and were classified as either strong (I), moderate (II), or weak (III). RESULTS Several trends about bimodal stimulation were observed, which include (1) significantly better speech understanding in the bimodal condition for many participants; (2) in noise, the largest bimodal benefits in speech recognition; (3) variable findings on localization tasks; and (4) overall significant improvement in functional ability based on self-assessments. The preponderance of evidence received grades of B or C. CONCLUSIONS The evidence available indicates "moderate" (II) strength in support of bimodal stimulation for adult implant users. Clinicians should encourage their clients to consider bimodal fittings. Additional research is needed about optimal time frame for introducing bimodal fittings as well as establishing a clinical profile of patients who may benefit most from this intervention compared to bilateral implantation.
Collapse
Affiliation(s)
- Anne D Olson
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, KY 40536, USA.
| | | |
Collapse
|
25
|
Bush ML, Jones RO, Shinn JB. Auditory brainstem response threshold differences in patients with vestibular schwannoma: a new diagnostic index. Ear Nose Throat J 2008; 87:458-462. [PMID: 18712694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Auditory brainstem response (ABR) testing is less sensitive in detecting small vestibular schwannomas than medium-size tumors. Magnetic resonance imaging (MRI) is more sensitive than ABR alone for small and large tumors, but it carries with it increased cost and issues of unavailability and patient discomfort. We conducted a prospective pilot study of 7 patients with untreated MRI-proven, unilateral vestibular schwannoma to determine if we could increase the sensitivity of ABR testing in detecting small tumors. Our method involved the use of a new ABR index that is based on threshold differences. All patients underwent pure-tone audiometry followed by a determination of behavioral threshold and neurodiagnostic threshold ABR in the normal ear, which was used as a control, and in the diseased ear. Analysis of results revealed that all 7 patients had an abnormal ABR threshold difference, and 5 patients displayed abnormal traditional ABR indices. The mean difference between the ABR and behavioral click thresholds was 41.4 dB in the diseased ears (with the ABR threshold being higher than the click threshold) and 15.8 dB in the normal ears. None of the control ears had a threshold difference > 30 dB.
Collapse
Affiliation(s)
- Matthew L Bush
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery,University of Kentucky College of Medicine, 800 Rose St., Suite C-236, Lexington, KY 40536-0293, USA.
| | | | | |
Collapse
|
26
|
Bush ML, Jones RO, Shinn JB. Auditory Brainstem Response Threshold Differences in Patients with Vestibular Schwannoma: A New Diagnostic Index. Ear Nose Throat J 2008. [DOI: 10.1177/014556130808700811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Auditory brainstem response (ABR) testing is less sensitive in detecting small vestibular schwannomas than medium-size tumors. Magnetic resonance imaging (MRI) is more sensitive than ABR alone for small and large tumors, but it carries with it increased cost and issues of unavailability and patient discomfort. We conducted a prospective pilot study of 7 patients with untreated MRI-proven, unilateral vestibular schwannoma to determine if we could increase the sensitivity of ABR testing in detecting small tumors. Our method involved the use of a new ABR index that is based on threshold differences. All patients underwent pure-tone audiometry followed by a determination of behavioral threshold and neurodiagnostic threshold ABR in the normal ear, which was used as a control, and in the diseased ear. Analysis of results revealed that all 7 patients had an abnormal ABR threshold difference, and 5 patients displayed abnormal traditional ABR indices. The mean difference between the ABR and behavioral click thresholds was 41.4 dB in the diseased ears (with the ABR threshold being higher than the click threshold) and 15.8 dB in the normal ears. None of the control ears had a threshold difference >30 dB.
Collapse
Affiliation(s)
- Matthew L. Bush
- From the Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington
| | - Raleigh O. Jones
- From the Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington
| | - Jennifer B. Shinn
- From the Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington
| |
Collapse
|
27
|
|
28
|
Musiek FE, Shinn JB, Jirsa R, Bamiou DE, Baran JA, Zaida E. GIN (Gaps-In-Noise) Test Performance in Subjects with Confirmed Central Auditory Nervous System Involvement. Ear Hear 2005; 26:608-18. [PMID: 16377996 DOI: 10.1097/01.aud.0000188069.80699.41] [Citation(s) in RCA: 217] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of the present study was to investigate the value of a new gap detection procedure called Gaps-In-Noise (GIN) for assessment of temporal resolution in a clinical population. DESIGN The test consists of 0 to 3 silent intervals ranging from 2 to 20 msec embedded in 6-sec segments of white noise. The location, number, and duration of the gaps per noise segment vary throughout the test for a total of 60 gaps presented in each of four lists. The GIN procedure was administered to 50 normal-hearing listeners (group I) and 18 subjects with confirmed neurological involvement of the central auditory nervous system (group II). RESULTS Results showed mean approximated gap detection thresholds of 4.8 msec for the left ear and 4.9 msec for the right ear for group I. In comparison, results for group II demonstrated a statistically significant increase in gap detection thresholds, with approximated thresholds of 7.8 msec and 8.5 msec being noted for the left and right ears, respectively. Significant mean differences were also observed in the overall performance scores (i.e., the identification of the presence of the gaps within the noise segments) of the two groups of subjects. Finally, psychometric functions, although similar for short and long duration gaps, were highly different for gaps in the 4- to 10-msec range for the two groups. CONCLUSIONS A variety of psychoacoustic procedures are available to assess temporal resolution; however, the clinical use of these procedures is minimal at best. Results of the present study show that the GIN test holds promise as a clinically useful tool in the assessment of temporal resolution in the clinical arena.
Collapse
Affiliation(s)
- Frank E Musiek
- University of Connecticut, Storrs, Connecticut 06269-1085, USA.
| | | | | | | | | | | |
Collapse
|
29
|
Walker MM, Shinn JB, Cranford JL, Givens GD, Holbert D. Auditory temporal processing performance of young adults with reading disorders. J Speech Lang Hear Res 2002; 45:598-605. [PMID: 12069011 DOI: 10.1044/1092-4388(2002/048)] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The present study investigated the temporal processing abilities of college students with diagnosed reading disorders. A behavioral test battery was used that involved discrimination of the pattern of presentation of tone triads in which individual components differed in either frequency or duration. An additional test involving measurement of frequency difference limens for long- and short-duration tones was also administered. The college students with reading disorders exhibited significantly higher error rates in discriminating duration patterns than the normal reading group. No group differences were found for the frequency pattern discrimination task. Both groups exhibited larger frequency difference limens with the shorter 20- and 50-ms tones than with the 200-ms tones. Significant correlations were found between reading ability measures and temporal processing abilities, specifically in word recognition and duration pattern processing, suggesting a relationship between lower level auditory temporal processing skills and decoding efficiency.
Collapse
Affiliation(s)
- Marianna M Walker
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC 27858, USA.
| | | | | | | | | |
Collapse
|
30
|
Pickett BP, Shinn JB, Smith MF. Ear drop ototoxicity: reality or myth? Am J Otol 1997; 18:782-9; discussion 789-91. [PMID: 9391678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- B P Pickett
- Department of Otolaryngology/Head and Neck Surgery, University of New Mexico Health Sciences Center, Albuquerque 87131-5341, USA
| | | | | |
Collapse
|
31
|
Affiliation(s)
- J P Newman
- Stanford University, Division of Otolaryngology-Head and Neck Surgery, Santa Clara Valley Medical Center, San Jose, California, USA
| | | |
Collapse
|
32
|
Abstract
Mandible fracture repair is commonly undertaken by otolaryngologists. Although the essential principles of reduction and immobilization are undisputed, the approach used to obtain these goals varies considerably. We performed a critical evaluation of all mandible fractures treated at the Santa Clara Valley Medical Center by the otolaryngology service between January 1988 and February 1992, with the purpose of better defining the indications for plate fixation and for the use of more traditional techniques. One hundred eighty-three fractures in 112 patients were evaluable. Thirty-six (32.1%) of these patients had at least one plate placed (group A); 39 (34.8%) underwent an open procedure, with interosseous wire fixation (group B); and 37 (33.0%) were treated with closed techniques (group C). The severity of fracture (indexed by comminution, presence of infection, teeth in the fracture line, interval to repair, and whether the fracture was open or closed) was similar in plated and nonplated mandibles. Mean (+/- standard deviation) operative times for the three groups were 3.2 +/- 1.6 hours for group A, 3.0 +/- 0.9 hours for group B, and 1.4 +/- 0.5 hours for group C. The number of follow-up visits required was not statistically different (group A, 5.6 +/- 3.8 visits; group B, 5.2 +/- 2.5 visits; and group C, 5.3 +/- 2.0 visits). The overall incidence of major complications was 14.3% (16 of 112), including 11 of 36 (30.6%) in group A, 4 of 39 (10.3%) in group B, and 1 of 37 (2.7%) in group C.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- D J Terris
- Division of Otolaryngology/Head and Neck Surgery, Stanford University Medical Center, CA 94305
| | | | | | | |
Collapse
|
33
|
Smith MF, Lagger RL, Shinn JB. Otolaryngology/Head and neck surgery-important advances in clinical medicine: carbon dioxide lasers in managing Basal skull tumors. West J Med 1982; 137:229. [PMID: 18749191 PMCID: PMC1274071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
34
|
Pont A, Spratt D, Shinn JB. T3 toxicosis due to nonmetastatic follicular carcinoma of the thyroid. West J Med 1982; 136:255-8. [PMID: 7090374 PMCID: PMC1273666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
35
|
Abstract
Traumatic facial paralysis can be improved with surgical techniques but alone will not restore full function. EMG sensory (bio) feedback can, however, facilitate rehabilitation. Four cases are described using a combined treatment technique of EMG, behavioural modification and specific action exercises. Retraining of eyelid control was also accomplished. Standardized evaluation methods are described. All four patients showed improvement, despite the failure of traditional retraining methods.
Collapse
|
36
|
Cochran JH, Shinn JB. A method for temporary reconstitution of the cervical esophagus. J Surg Oncol 1980; 13:107-9. [PMID: 7359916 DOI: 10.1002/jso.2930130204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A simple method of temporary reconstitution of the cervical esophagus in major head and neck surgery is detailed in a case report. Accompanying diagrams illustrate the mechanics of inserting a number 26 nasopharyngeal airway from the hypopharynx to the esophagus. This arrangement simplifies the management of oral secretions until permanent reconstruction of the cervical esophagus can be accomplished.
Collapse
|
37
|
Cochran JH, Shinn JB. The postauricular flap in helical injuries. Laryngoscope 1979; 89:1347-50. [PMID: 379482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
38
|
Abstract
Long-term stenting (3 to 12 months) with silicone rubber stents was found successful in 12 of 14 cases (86%) with severe subglottic stenosis. A new silicone rubber stent is described that is suitable for long-term stenting in infants or adults.
Collapse
|
39
|
Abstract
Wide surgical exposure, total tumor removal and anatomic and functional reconstruction are the goals of tumor management. These goals are met by radical mastoidectomy exposure for the removal of glomus tympanicum tumors and reconstruction by autograft replacement of the posterior osseous canal, and if the tympanic membrane, malleus and incus are removed for tumor exposure, autograft replacement may also be accomplished. The history, physical findings, X-rays and details of surgical management of two patients with glomus tympanicum are reviewed. Wide removal of the posterior osseous canal, just lateral to the VIIth nerve with total replacement of this segment gives excellent exposure of the middle ear space and affords total reconstruction of the posterior osseous canal.
Collapse
|
40
|
Aldous EW, Shinn JB. Far advanced malignant external otitis: report of a survival. Laryngoscope 1973; 83:1810-5. [PMID: 4357104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
41
|
Smith MF, Proffitt SD, Shinn JB. An otologic tissue bank. Trans Am Acad Ophthalmol Otolaryngol 1972; 76:134-41. [PMID: 5024596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|