Abeir Osman Dabbous

Characteristics of auditory brainstem response latencies in children with autism spectrum disorders

Abstract Background: Hypersensitivity to loud sounds is commonly noticed in children with autism spectrum disorders. Objective and methods: This was a cross-sectional study that included 50 children, ages ranging from 1.5 to 3.33 years, divided into a study group of 25 autistic children with normal hearing and a control group of 25 normal hearing healthy children. The aim of this research was to the assess any abnormality in the loudness growth function objectively using auditory brainstem response (ABR), as well as to detect any ABR abnormalities in normal hearing autistic children with delayed language development. Results: Forty-four percent of normal hearing autistic children showed a lower threshold compared to healthy controls. They also showed significantly delayed wave III, but within-normal wave V, and consequently a longer inter-peak interval (IPI): I–III and shorter IPI: III–V, reflecting retro-cochlear dysfunction that may be related to their difficulty in communication. The mean slope of wave V latency intensity curve did not differ between autism and their controls, reflecting normal loudness growth. Male autistic children showed statistically significant longer latencies of wave V than females except at high intensities, but there was no statistically significant difference between them with regard to the mean slope of wave V latency intensity curve. Conclusion: Autistic children with normal hearing showed a within-normal loudness growth indicating that their abnormal reactions to sounds may either be phonophobia, an efferent system affection or a more central pathology that needs further evaluation. They also showed a retro-cochlear dysfunction that may be related to their difficulty in communication.

Relationship between nailfold capillary abnormalities and vestibular dysfunction in systemic sclerosis

OBJECTIVE To investigate the vestibular dysfunction in a cohort of patients with systemic sclerosis (SSc) and to correlate the findings with disease parameters and microvascular involvement. METHODS Vestibular affection was assessed in 30 female SSc patients and 29 age-matched healthy females subjects by using the computerized dynamic platform posturography (CDP). Assessment of microvasculature was done by nailfold videocapillaroscopy (NVC). The main clinical correlates of disease, such as renal function, skin, articular and lung involvement, were evaluated by clinical and instrumental investigations. RESULTS Subtle vestibular dysfunction was detected in 33% of SSc patients. They exhibited significant decrease in their vestibular ratio values compared to controls (P=0.01). There was a statistical significant association of vestibular affection with both Rodnans skin score and vascular severity score. Moreover a significant association was found between vestibular dysfunction and NVC patterns. On the other hand, no correlation was observed between vestibular impairment with age, disease duration, disease subsets, autoantibodies and the other clinical disease parameters. CONCLUSION Our results showed an evidence of vestibular impairment in patients with SSc. Vestibular dysfunction positively correlates with vascular severity score as assessed by NVC.

Central auditory processing functions in learning disabled children assessed by behavioural tests

Abstract Background: There is a high prevalence of central auditory processing disorders (CAPD) in children diagnosed with learning disability (LD). It is important to identify any deficits early in order to determine appropriate management. Objective: To assess central auditory processing functions in children with LD through behavioural testing. Study design: The present study comprised 60 normal hearing children of both genders. Cases included 30 children with LD, and the controls included 30 healthy children. Each group was further subdivided into three equal number subgroups according to age: 6–8 years, > 8–10 years and > 10–12 years. All subjects were submitted to full history taking, otological examination, basic audiological evaluation and central auditory processing testing which included: low pass filtered speech test, speech-in-noise test, dichotic digit test, pitch pattern sequence test, auditory fusion test and memory tests. Results: This study showed that the prevalence of CAPD in children with LD was 80%, with relatively more than soft CAPD criteria used. There were statistically significant differences between cases and controls regarding the central tests included in this study, except the LPF test and, in the youngest subgroup, the SPIN test. Age significantly affected psychophysical testing, and right ear advantage was found in our subjects. However, gender had no effect on testing. Conclusion: Central auditory processing functions were significantly affected in children with LD compared to controls.

Speech evoked auditory brainstem response in learning disabled children

Abstract Background: Children with learning disability (LD) are thought to have deficits of neural origin. Speech evoked auditory brainstem responses (ABR) can objectively assess the biological processes underlying auditory processing of complex signals, not revealed using standard ABR responses to clicks. Objective: To assess central auditory processing functions in children with learning disability through electrophysiological testing. Methods: The present study comprised 60 normal hearing children of both genders. Cases included 30 learning disabled children and the controls included 30 healthy children without a learning disability. Each group was further subdivided into three subgroups according to age: subgroup age ranging from 6 to 8 years, > 8 to 10 years and > 10 to 12 years. All subjects were submitted to full history taking, otological examination, basic audiological evaluation, and Speech ABR testing. Parameters measured were latencies and amplitudes of the onset response and the steady state response waves. Results: This study showed that all subjects demonstrated identifiable and repeatable waves. The reliability of the response peaks was generally very good. All LD children showed statistically significant delayed latencies of waves V, A and F in both ears in all tested subgroups, compared to their controls. There was a statistically significant diminished amplitude of wave F in all tested subgroups in both ears compared to their controls. There was a statistically significant decreased amplitudes of waves D and E in 6–8 years subgroup and waves C and D in 8–10 years subgroup compared to their controls. In addition, compared to the controls, the amplitude of waves D and E were statistically significantly decreased in the 6-8 years subgroup, and waves C and D in the 8-10 years subgroup. Conclusion: Speech evoked ABR response parameters are affected in LD children, reflecting abnormalities in brainstem encoding of speech signals.

Does changes in mismatch negativity after tinnitus retraining therapy using tinnitus pitch as deviant stimulus, reflect subjective improvement in tinnitus handicap?

Abstract Objective: The objective of this research was to study the ability of Mismatch Negativity response parameters to assess the habituation after Tinnitus Retraining Therapy through comparing MMN parameters before and after TRT and comparing MMN in tinnitus patients to non-tinnitus patients, and correlating MMN parameters to subjective measures of tinnitus. Methodology: This research included two groups: a tinnitus group of 30 tinnitus patients who were compared with a control group that consisted of well-matched 10 normal adult subjects. All participants were subjected to full history taking, audiological examination, and MMN test. Tinnitus patients were further assessed for tinnitus severity using the Tinnitus Handicap Inventory (THI), tinnitus analyses including pitch and loudness matching, with the PMF as the deviant stimulus for the MMN test. Results: The MMN latencies were significantly shorter and the MMN amplitudes were significantly greater in the tinnitus group before TRT than the control group. The MMN amplitude after TRT has significantly decreased and the MMN latency has significantly been prolonged in both ears after TRT compared with before TRT. The MMN amplitude improvement matched the subjective improvement measured subjectively by the THI. Conclusion: Tinnitus patients showed abnormality in central auditory processing mechanisms involved in pre-attentive change detection of tinnitus-related neuronal activity. This MMN abnormality showed improvement after habituation using TRT. So, we recommend adding the MMN test in evaluating tinnitus patients objectively before and after TRT for monitoring the treatment progress, together with the usual subjective measures for assessment of the degree of tinnitus severity.

Counselling and amplification with and without fractal music (Zen tones) for management of patients suffering from hearing loss and tinnitus

Abstract Background: Counselling, stress reduction and sound stimulation have been effective in the management of tinnitus. Aim of the work: It was to investigate the effectiveness of counselling and amplification and sound stimulation (Zen tones of fractal music) technology for hearing impaired patients suffering from tinnitus. Methods: This study included 40 hearing impaired subjects with tinnitus, divided into two groups: Both received counselling for 2 months then amplification for 4 months. The study group had their hearing aids with Zen program activated. Results: Post-counselling, none of the cases or controls showed improvement >20 points in the total tinnitus handicap inventory (THI) score. Only 20% of the study group and 15% of the controls showed improved tinnitus severity. Only one of the study group showed improvement in the tinnitus functional index (TFI) > 13 points. After hearing aids, 80% of the study group showed improvement in the tinnitus severity degree compared to 60% of the controls. And 20% improved ≥20 points in the total THI score, compared to none of the controls. Half of the study group improved in the TFI >13 points, compared to only 10% of the controls, and this was statistically significant. After 6 months, both groups showed comparable improvement in THI tinnitus severity degree: But 60% of the study group and only 15% of the controls improved ≥20 points in total THI score and this difference was statistically significant. And (85%) of the study group improved >13 points in total TFI score following both counselling and hearing aid fitting, compared to 50% of the controls, and this was statistically significant. Conclusion: Counselling alone had no significant effect on tinnitus improvement in the hearing-impaired patients. The combined approach of counselling and amplification resulted in remarkable improvement. And added music resulted in greater improvements, but was more effective when the loudness of the perceived tinnitus was weaker.

Narrow band CE-Chirp stimulus in auditory steady state response threshold estimation in normal hearers and patients with various degrees of sensorineural hearing loss

Abstract Background: Auditory steady-state responses (ASSRs) are periodic scalp potentials that arise in response to auditory stimuli. Narrow-band (NB) CE-Chirps stimuli have been developed to combine the advantages of compensation for the cochlear traveling wave delay and frequency specificity. Objectives: To measure the hearing threshold objectively using ASSR in adults with normal behavioural hearing thresholds and adult patients with different degrees of sensorineural hearing loss (SNHL) and its comparison to the behavioural thresholds. Methods: In the present study, 35 subjects (70 ears) were enrolled. Ears were grouped according to the level of hearing obtained by pure tone audiometry (PTA) into 7 equal groups. NB-CE-Chirp ASSR was done for all groups by means of auditory-evoked potential device. Results: The estimated ASSR audiograms configuration matched the behavioural curves. ASSR was equally accurate at all frequencies tested except for 1 kHz in the normal-hearing group who showed less accuracy compared to 500 and 4000 Hz in air conduction (AC) and in bone conduction (BC). Although the AC estimation was not equal among the different degrees of hearing compared to the BC estimation, the AC PTA-ASSR thresholds difference range was small. BC PTA-ASSR threshold difference was statistically significantly less than AC at all tested degrees of hearing loss, in most of the frequencies; which reflects that the ASSR was more accurate in estimating BC than the AC thresholds. There was a negative correlation regarding behavioural BC PTA thresholds with PTA-ASSR threshold difference and PTA-estimated audiograms threshold difference at all tested frequencies. Conclusion: ASSR using either AC or BC NB-CE-Chirp is a reliable objective method in estimating the behavioural threshold in normal hearers and patients with various degrees of SNHL, so it can be used in difficult-to-test cases where accurate behavioural thresholds could not be obtained.

Sound therapy for tinnitus patients

Sound therapy, or use of any sound for the purposes of tinnitus management, is widely accepted as a management tool for tinnitus. Sound therapy have varying goals. Reducing the attention drawn to tinnitus, reducing the loudness of tinnitus, substituting a less disruptive noise. Sound therapy can be achieved with many modalities: Environmental Enrichment, tinnitus maskers, hearing aids and combination instruments such as: Danalogic iFIT Tinnitus, ReSound Live TS, Oticon’s Tinnitus “SoundSupport”, Phonak’s Tinnitus Balance and Widex Zen Fractal Tones. There are other sound devices e.g.: Acoustic Co-ordinated Reset, Neuromodulation, Serenade, Neuromonics, Phase-Out, Phase-shift and tinnitus inhibitory pathway activation. The advantages of sound therapy are: being non-invasive, reduce patient frustration and anxiety, some patients experience residual inhibition and it can facilitate patient’s habituation to tinnitus.

Cochlear microphonics recording during ABR threshold testing in children

Abstract Objective: It is agreed that the cochlear microphonic (CM) arises mainly from the normal outer hair cells (OHCs) in cochlea. The aim of this research is to study the CM characteristics in different hearing profiles and reflect the usefulness of recording CM simultaneously during Auditory Brainstem Response (ABR) threshold testing in children. Methods: This is a retrospective study that included 33 cases comprised of children with autism spectral disorders (ASD), children with cochlear sensorineural hearing loss (SNHL), children with auditory neuropathy spectrum disorder (ANSD) and 41 normal hearing healthy children as controls. The children’s ages ranged from 0.5 to 96 months. Both the CM and ABR waves were simultaneously recorded using alternating split polarity ABR. Results: CM amplitudes and thresholds in normal hearing children with ASD did not significantly differ from normal hearing healthy children. CM were preserved in children with ANSD despite the absence of distortion product OAE responses, but in a significantly lower amplitude than those with DPOAE. There was no statistically significant correlation between the children’s ages and CM amplitude at any intensity level and in any of the different child groups, except in the controls where there was a statistically significant negative correlation between the children’s ages and CM amplitude at 70dBnHL, while there was a statistically significant positive correlation between the children’s ages and CM threshold. There were no differences in the CM amplitude between the two ears at any intensity level in all of the different groups of children. Conclusion: Children with ASD showed comparable outer hair cell function to normal hearing healthy children, reflecting absence of any peripheral hyperacusis due to loudness recruitment. CM should always be searched for when testing young children when there is absence of ABR response with absence or presence of otoacoustic emissions, to avoid any false negative results for ANSD. CM can be preserved in children with SNHL with loudness recruitment. This finding could be confused with ANSD, so CM should be traced down to its threshold for an appropriate diagnosis.AbstractObjective: It is agreed that the cochlear microphonic (CM) arises mainly from the normal outer hair cells (OHCs) in cochlea. The aim of this research is to study the CM characteristics in different hearing profiles and reflect the usefulness of recording CM simultaneously during Auditory Brainstem Response (ABR) threshold testing in children.Methods: This is a retrospective study that included 33 cases comprised of children with autism spectral disorders (ASD), children with cochlear sensorineural hearing loss (SNHL), children with auditory neuropathy spectrum disorder (ANSD) and 41 normal hearing healthy children as controls. The children’s ages ranged from 0.5 to 96 months. Both the CM and ABR waves were simultaneously recorded using alternating split polarity ABR.Results: CM amplitudes and thresholds in normal hearing children with ASD did not significantly differ from normal hearing healthy children. CM were preserved in children with ANSD despite the absence of distortion product OAE response...

Comparison of three fitting rationales in adults in an artificial intelligence parallel processing hearing aid

Introduction Hearing rehabilitation using nonlinear hearing aid (HA) fitting formulae provides hearing-impaired individuals with the audibility, comfort, and speech intelligibility for a better life. Objective To compare three nonlinear HA fitting formulae in adults in a Channel Free artificial intelligence parallel processing HA. Materials and methods The study included 19 adults with bilateral moderate to severe sensorineural hearing loss, monaurally fitted with nonlinear HA. Comparisons were made on the basis of aided speech intelligibility in quiet and in noise, aided sound field thresholds, and functional performance in real life using APHAB, COSI, and GHABP questionnaires. Results The three formulae have significantly improved speech discrimination in adults, with no significant difference among the formulae for speech intelligibility in quiet or in noise, with no sex or HA experience differences. The three formulae have significantly improved functional performance in real-life speech communication, with the NAL-NL1-based formula showing the greatest degree of benefit and improvement in listening needs, followed by NAL-NL1 and then DSL [I/O]. However, amplification with the three formulae increased aversiveness to environmental sounds. Participants reported significant benefits using NAL and NAL-NL1-based formulae. Experienced HA users, using the NAL-NL1-based formula, showed significantly less difficulty in listening quality in large spaces and greater capacity to recognize speech within competitive noise and better tolerance to environmental sounds than nonexperienced users. The SPIN test correlated well with real-life speech communication. Conclusion The three fitting rationales have equally improved intelligibility, with variable degrees of improvement in real-life speech communication with preferences for NAL-NL1 and the manufacture-specific NAL-NL1-based formula.