Carol A. Silverman

Late‐onset auditory deprivation: Effects of monaural versus binaural hearing aids

Performance on tests of pure-tone thresholds, speech-recognition thresholds, and speech-recognition scores for the two ears of each subject were evaluated in two groups of adults with bilateral hearing losses. One group was composed of individuals fitted with binaural hearing aids, and the other group included persons with monaural hearing aids. Performance prior to the use of hearing aids was compared to performance after 4-5 years of hearing aid use in order to determine whether the unaided ear would show effects of auditory deprivation. There were no differences over time for pure-tone thresholds or speech-recognition thresholds for both ears of both groups. Nevertheless, the results revealed that the speech-recognition difference scores of the binaurally fitted subjects remained stable over time whereas they increased for the monaurally fitted subjects. The findings reveal an auditory deprivation effect for the unfitted ears of the subjects with monaural hearing aids.

Efficacy of the bone‐anchored hearing aid for single‐sided deafness

The aim was to examine short‐ and long‐term efficacy of the bone‐anchored hearing aid (BAHA) on adults with single‐sided deafness.

Eustachian Tube Endoscopy in Patients With Chronic Ear Disease

Objectives/Hypothesis A paucity of research exists on trans–eustachian tube endoscopy to evaluate the status of the eustachian tube. Fuller examination of the role of the eustachian tube in chronic ear disease is needed, particularly because the eustachian tube has been implicated in the chronicity and pathogenesis of chronic ear disease. Therefore the purpose of this study was to evaluate the eustachian tube, based on observations from trans–eustachian tube endoscopy.

Bone Conduction Impairment in Chronic Ear Disease

The preoperative and postoperative bone conduction (BC) thresholds were prospectively investigated in 24 patients with chronic ear disease in the form of cholesteatoma, chronic suppurative otitis media, or adhesive otitis media. All underwent tympanoplasty with mastoidectomy. Ossicular reconstruction was performed in 14, and the remaining 10 were still awaiting second-stage ossicular reconstruction at the time of this investigation. In each group, the postoperative results were compared with the preoperative results by the paired-samples t-test. In the ossicular reconstruction group, the results revealed a significant improvement in the postoperative BC thresholds, as compared with the preoperative BC thresholds, at 250, 1,000, and 2,000 Hz, with the largest mean improvement observed at 2,000 Hz. No significant improvement was observed at any frequency for the group without ossicular reconstruction. Postoperative improvement of at least 10 dB at 2 or more frequencies was observed in 71% of the ossicular reconstruction group, as compared with 0% of the group that did not undergo ossicular reconstruction. The results support the theory that the elevated BC thresholds of patients with chronic ear disease result from the elimination, due to disease, of the middle ear contribution (from the inertial ossicular component and ossicular resonance) to the BC response. The results also suggest that the middle ear contribution to the BC response is restored with ossicular reconstruction.

Objective Computerized versus Subjective Analysis of Facial Synkinesis

Objectives/Hypothesis: To compare the sensitivity of an objective, computerized approach to measurement of facial synkinesis with that for a subjective approach and to examine the test-retest reliability of these approaches. Study Design: Prospective, nonrandomized, and blinded. Methods: Remote facial motion at the upper eyelids and oral commissures during a closed-lip smile and eyelid closure were measured using a commercially available computerized motion analysis system. Thirty healthy adults with normal facial nerve function were enrolled to establish normative data and a threshold value for synkinesis. Thirty consecutive patients were analyzed based on the synkinesis threshold value. Blinded subjective evaluations by two observers were also performed independently on the same patients. Results: Facial synkinesis was detected significantly more frequently with objective than subjective analysis for eyelid closure; no significant differences between approaches were shown for the closed-lip smile. Interestingly, five (17%) patients developed early synkinesis within 3 months from the onset of the facial nerve injury. The test-retest reliability of all objective measures was excellent for both expressions. Close agreement in percent of patients with synkinesis between test and retest subjective evaluations was obtained for both observers for both expressions. Conclusions: The objective, computerized approach to detection of facial synkinesis has excellent reliability and is more sensitive than the subjective approach to assessment to the presence of facial synkinesis associated with eyelid closure. The finding of early synkinesis suggests that central nervous reorganization plays a role in regeneration of the facial nerve.OBJECTIVES/HYPOTHESIS To compare the sensitivity of an objective, computerized approach to measurement of facial synkinesis with that for a subjective approach and to examine the test-retest reliability of these approaches. STUDY DESIGN Prospective, nonrandomized, and blinded. METHODS Remote facial motion at the upper eyelids and oral commissures during a closed-lip smile and eyelid closure were measured using a commercially available computerized motion analysis system. Thirty healthy adults with normal facial nerve function were enrolled to establish normative data and a threshold value for synkinesis. Thirty consecutive patients were analyzed based on the synkinesis threshold value. Blinded subjective evaluations by two observers were also performed independently on the same patients. RESULTS Facial synkinesis was detected significantly more frequently with objective than subjective analysis for eyelid closure; no significant differences between approaches were shown for the closed-lip smile. Interestingly, five (17%) patients developed early synkinesis within 3 months from the onset of the facial nerve injury. The test-retest reliability of all objective measures was excellent for both expressions. Close agreement in percent of patients with synkinesis between test and retest subjective evaluations was obtained for both observers for both expressions. CONCLUSIONS The objective, computerized approach to detection of facial synkinesis has excellent reliability and is more sensitive than the subjective approach to assessment to the presence of facial synkinesis associated with eyelid closure. The finding of early synkinesis suggests that central nervous reorganization plays a role in regeneration of the facial nerve.

Facial motion analysis with a video and computer system after treatment of acoustic neuroma.

Objective To objectively evaluate facial function with a computer and video system in a group of normal adults and a group of adults who have been treated for acoustic neuroma. Study Design A prospective descriptive study was performed in which the experimenter performing the objective facial motion analysis was blinded to the subjective rating of facial function. Patients The normal subjects comprised 18 women and 16 men. The subjects who had been treated for acoustic neuroma included 12 patients (seven women and five men) who underwent treatment for acoustic neuroma. Methods Light-reflective markers were placed at selected facial sites. A video and computer-assisted system was used to measure displacement that was unconfounded by head motion at these sites during two expressions. Proximal and remote displacement were measured for the x and y coordinates. Percentage of asymmetry relative to the total displacement was determined. Results Significant asymmetry in displacement for the y coordinate during the eyes-closed expression occurred in 100% of the subjects who had been treated for acoustic neuroma with apparent facial dysfunction and 0% of the subjects who had been treated for acoustic neuroma with no apparent facial dysfunction. Synkinesis was severe (>0.2 cm) in 17%, moderate (0.1–0.2 cm) in 25%, mild (>95th percentile for normal subjects but <0.1 cm) in 42%, and absent in 16% of the subjects who had been treated for acoustic neuroma. Conclusion This method of objective assessment of facial function is useful in the evaluation of the asymmetry in facial motion and in the detection and quantification of synkinesis. The findings suggest that those subjective rating systems of facial function that compare the abnormal to the normal side may be confounded by compensatory motion on the presumed normal side.

The acoustic reflex threshold in aging ears

This study investigates the controversy regarding the influence of age on the acoustic reflex threshold for broadband noise, 500-, 1000-, 2000-, and 4000-Hz activators between Jerger et al. [Mono. Contemp. Audiol. 1 (1978)] and Jerger [J. Acoust. Soc. Am. 66 (1979)] on the one hand and Silman [J. Acoust. Soc. Am. 66 (1979)] and others on the other. The acoustic reflex thresholds for broadband noise, 500-, 1000-, 2000-, and 4000-Hz activators were evaluated under two measurement conditions. Seventy-two normal-hearing ears were drawn from 72 subjects ranging in age from 20-69 years. The results revealed that age was correlated with the acoustic reflex threshold for BBN activator but not for any of the tonal activators; the correlation was stronger under the 1-dB than under the 5-dB measurement condition. Also, the mean acoustic reflex thresholds for broadband noise activator were essentially similar to those reported by Jerger et al. (1978) but differed from those obtained in this study under the 1-dB measurement condition.

How to measure cerebrospinal fluid pressure invasively and noninvasively.

We describe tympanic membrane displacement (TMD) testing for non-invasive estimation of intracranial pressure (ICP). With the TMD test, displacement of the tympanic membrane of the middle ear is recorded during elicitation of the acoustic middle-ear reflex (AR). Increased intracranial/perilymphatic pressure displaces the resting stapes footplate laterally so that TMD during the acoustic reflex is medial. Decreased intracranial/perilymphatic pressure displaces the baseline stapes footplate position medially (inward) so that TMD during the AR is lateral. The TMD typically is bidirectional when intracranial/perilymphatic pressure is normal. Discrepant findings have been reported for the sensitivity of the TMD test to ICP as the regression of TMD on invasive measurement of the ICP reveals substantial intersubject variability and overlap among patient and control groups. Large-sample research on TMD test performance in healthy persons and patients with various disorders affecting the ICP is needed using direct, invasive measures of the ICP as the gold standard. Research also is needed to examine whether non-invasive TMD testing can be used to investigate the trans-lamina cribrosa pressure difference in glaucoma.

Repair issues associated with cochlear implants in children.

Objective: To examine the number and type of repair issues associated with the use of cochlear implants in children who have worn either the body-level or ear-level style for 4 to 5 years. Study Design: Retrospective review. Setting: Specialty eye and ear institute. Methods: Charts for all children who received cochlear implants from one of the authors between 1994 and 2002 and who received 4 to 5 years of follow-up for either the body or the ear-level style were examined. Based on the return merchandise authorizations and chart notes, implant problems were classified as external or internal. External problems were further subclassified as affecting the batteries, case, earhook, cords/cables, microphone, speech processor, coil, and/or external magnet; internal problems were subclassified as affecting the internal magnet, electrode(s), or other. Main Outcome Measures: Type and number of internal and external cochlear implant component breakdowns over time (including external component repair rates per year) and number of associated hospital visits. Results: Of the 22 children, 4 (18.2%) had internal component problems. For the external components, the repair rate per year was 4.1 and 2.7 for the body style and ear-level style, respectively. For the group of children who was seen for each of 4 years, the mean number of repair problems declined 32% and 43% over that period for the body-worn and ear-level implants, respectively. The mean repair cost per year, based on Years 4 and 5 of use, was

Temporal integration of the contralateral acoustic-reflex threshold and its age-related changes

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