Jen-Fang Yu

Diffusion tensor imaging of the auditory pathway in sensorineural hearing loss: Changes in radial diffusivity and diffusion anisotropy

To prospectively compare diffusion tensor imaging (DTI) measures of axial diffusivity (λ∥), radial diffusivity (λ⟂), mean diffusivity (MD), and fractional anisotropy (FA) along the auditory pathway of patients with sensorineural hearing loss (SNHL) and normal controls.

A novel opto-electromagnetic actuator coupled to the tympanic membrane

A new type of electromagnetic vibration transducer designed to be placed onto the tympanic membrane was developed. The actuator consisted of two photodiodes, two permanent magnets, an aluminum ring, two opposing wound coils, a latex membrane and a Provil Novo membrane. An optic probe was designed to allow sound and light signals to enter the ear canal, thereby preventing the acoustic occlusion effect of traditional ear molds. Two light-emitting diodes were used for carrying the input signals. The corresponding photodiodes were used for receiving the light signals and generating currents in the actuator. The opto-electromagnetic vibration actuator was fabricated and tested using a Laser Doppler vibrometer. The actuator showed displacements of vibration between 30 and 1 nm from 300 to 6500Hz and reduced in amplitude at higher frequencies. The average gain of the actuator with 140microA on the umbo displacement was about 20 dB relative to 87 dBA at the distance of 6cm from the tympanic membrane and 0microA in actuator.

The cortical modulation from the external cues during gait observation and imagination.

The cortical involvement of gait observation and imagination under the modulation of external cues was studied in human using fMRI. Fourteen healthy volunteers were scanned using visual stimuli, which showed an actor walking in different background. The defined relevant cue was a background of evenly spaced stripes orthogonal to the walking direction, which was rhythmic presented as the actor proceeded. The irrelevant cue was two parallel lines within which the actor was confined. When viewing the relevant cue, the subject showed activation, noticeably in dorsal premotor areas, posterior parietal lobes, bilateral parahippocampal lobes, and visual related areas. The relevant external cue leads to the modulation of cortical activation related to gait, which could initialize the processing of the input information and lead to a different motor strategy from the native automatic gait. The understanding of the cortical involvement of gait under different cues might lead to a new clinical impact on the therapeutic intervention of patients with Parkinsons disease.

Energy types of snoring sounds in patients with obstructive sleep apnea syndrome: a preliminary observation.

Background Annoying snore is the principle symptom and problem in obstructive sleep apnea syndrome (OSAS). However, investigation has been hampered by the complex snoring sound analyses. Objective This study was aimed to investigate the energy types of the full-night snoring sounds in patients with OSAS. Patients and Method Twenty male OSAS patients underwent snoring sound recording throughout 6 hours of in-lab overnight polysomnogragphy. Snoring sounds were processed and analyzed by a new sound analytic program, named as Snore Map®. We transformed the 6-hour snoring sound power spectra into the energy spectrum and classified it as snore map type 1 (monosyllabic low-frequency snore), type 2 (duplex low-&mid-frequency snore), type 3 (duplex low- & high-frequency snore), and type 4 (triplex low-, mid-, & high-frequency snore). The interrator and test-retest reliabilities of snore map typing were assessed. The snore map types and their associations among demographic data, subjective snoring questionnaires, and polysomnographic parameters were explored. Results The interrator reliability of snore map typing were almost perfect (κ = 0.87) and the test-retest reliability was high (r = 0.71). The snore map type was proportional to the body mass index (r = 0.63, P = 0.003) and neck circumference (r = 0.52, P = 0.018). Snore map types were unrelated to subjective snoring questionnaire scores (All P>0.05). After adjustment for body mass index and neck circumference, snore map type 3–4 was significantly associated with severity of OSAS (r = 0.52, P = 0.026). Conclusions Snore map typing of a full-night energy spectrum is feasible and reliable. The presence of a higher snore map type is a warning sign of severe OSAS and indicated priority OSAS management. Future studies are warranted to evaluate whether snore map type can be used to discriminate OSAS from primary snoring and whether it is affected by OSAS management.

Comparative Effects of Snoring Sound between Two Minimally Invasive Surgeries in the Treatment of Snoring: A Randomized Controlled Trial

Background Minimally invasive surgeries of the soft palate have emerged as a less-invasive treatment for habitual snoring. To date, there is only limited information available comparing the effects of snoring sound between different minimally invasive surgeries in the treatment of habitual snoring. Objective To compare the efficacy of palatal implant and radiofrequency surgery, in the reduction of snoring through subjective evaluation of snoring and objective snoring sound analysis. Patients and Method Thirty patients with habitual snoring due to palatal obstruction (apnea-hypopnea index ≤15, body max index ≤30) were prospectively enrolled and randomized to undergo a single session of palatal implant or temperature-controlled radiofrequency surgery of the soft palate under local anesthesia. Snoring was primarily evaluated by the patient with a 10 cm visual analogue scale (VAS) at baseline and at a 3-month follow-up visit and the change in VAS was the primary outcome. Moreover, life qualities, measured by snore outcomes survey, and full-night snoring sounds, analyzed by a sound analytic program (Snore Map), were also investigated at the same time. Results Twenty-eight patients completed the study; 14 received palatal implant surgery and 14 underwent radiofrequency surgery. The VAS and snore outcomes survey scores were significantly improved in both groups. However, the good response (postoperative VAS ≤3 or postoperative VAS ≤5 plus snore outcomes survey score ≥60) rate of the palatal implant group was significantly higher than that of the radiofrequency group (79% vs. 29%, P = 0.021). The maximal loudness of low-frequency (40–300 Hz) snores was reduced significantly in the palatal implant group. In addition, the snoring index was significantly reduced in the radiofrequency group. Conclusions Both palatal implants and a single-stage radiofrequency surgery improve subjective snoring outcomes, but palatal implants have a greater effect on most measures of subjective and objective snoring. Multi-stage radiofrequency surgery was not tested. Trial Registration ClinicalTrials.gov NCT01955083

Changes of snoring sound after relocation pharyngoplasty for obstructive sleep apnoea: the surgery reduces mean intensity in snoring which correlates well with apnoea-hypopnoea index

To investigate objective changes of snoring after surgery in patients with obstructive sleep apnoea (OSA) and correlate these with changes in the apnoea–hypopnoea index (AHI).

Exact Dynamic Analysis of Space Structures Using Timoshenko Beam Theory

A method employing an exact transfer dynamic stiffness matrix (TDSM) based on Timoshenko beam theory for dynamic analysis of three-dimensional frame structures was developed, where TDSM was a frequency-dependent basis function. In this method, the TDSM of each member was assembled to get the system matrix. All free-vibration solutions, including repeated roots for the characteristic equation, could be obtained to any desired accuracy using an equation developed by Wittrick and Williams. The exact mode shape of the structures can then be computed using the dynamic shape function and the eigenvector. The accuracy of the present method is demonstrated by two examples. The results show good agreement with those computed by the finite element method.

Human amygdala activation by the sound produced during dental treatment: A fMRI study

During dental treatments, patients may experience negative emotions associated with the procedure. This study was conducted with the aim of using functional magnetic resonance imaging (fMRI) to visualize cerebral cortical stimulation among dental patients in response to auditory stimuli produced by ultrasonic scaling and power suction equipment. Subjects (n = 7) aged 23-35 years were recruited for this study. All were right-handed and underwent clinical pure-tone audiometry testing to reveal a normal hearing threshold below 20 dB hearing level (HL). As part of the study, subjects initially underwent a dental calculus removal treatment. During the treatment, subjects were exposed to ultrasonic auditory stimuli originating from the scaling handpiece and salivary suction instruments. After dental treatment, subjects were imaged with fMRI while being exposed to recordings of the noise from the same dental instrument so that cerebral cortical stimulation in response to aversive auditory stimulation could be observed. The independent sample confirmatory t-test was used. Subjects also showed stimulation in the amygdala and prefrontal cortex, indicating that the ultrasonic auditory stimuli elicited an unpleasant response in the subjects. Patients experienced unpleasant sensations caused by contact stimuli in the treatment procedure. In addition, this study has demonstrated that aversive auditory stimuli such as sounds from the ultrasonic scaling handpiece also cause aversive emotions. This study was indicated by observed stimulation of the auditory cortex as well as the amygdala, indicating that noise from the ultrasonic scaling handpiece was perceived as an aversive auditory stimulus by the subjects. Subjects can experience unpleasant sensations caused by the sounds from the ultrasonic scaling handpiece based on their auditory stimuli.

Snoring Sounds Predict Obstruction Sites and Surgical Response in Patients with Obstructive Sleep Apnea Hypopnea Syndrome.

Snoring sounds generated by different vibrators of the upper airway may be useful indicators of obstruction sites in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). This study aimed to investigate associations between snoring sounds, obstruction sites, and surgical responses (≥50% reduction in the apnea-hypopnea index [AHI] and <10 events/hour) in patients with OSAHS. This prospective cohort study recruited 36 OSAHS patients for 6-hour snoring sound recordings during in-lab full-night polysomnography, drug-induced sleep endoscopy (DISE), and relocation pharyngoplasty. All patients received follow-up polysomnography after 6 months. Fifteen (42%) patients with at least two complete obstruction sites defined by DISE were significantly, positively associated with maximal snoring sound intensity (40–300 Hz; odds ratio [OR], 1.25, 95% confidence interval [CI] 1.05–1.49) and body mass index (OR, 1.48, 95% CI 1.02–2.15) after logistic regression analysis. Tonsil obstruction was significantly, inversely correlated with mean snoring sound intensity (301–850 Hz; OR, 0.84, 95% CI 0.74–0.96). Moreover, baseline tonsil obstruction detected by either DISE or mean snoring sound intensity (301–850 Hz), and AHI could significantly predict the surgical response. Our findings suggest that snoring sound detection may be helpful in determining obstruction sites and predict surgical responses.

Gain affected by the interior shape of the ear canal.

Objective. This study investigated the correlation of gain distribution and the interior shape of the human external ear canal. Study Design. Cross-sectional study of gain measurement at the first bend and second bend. Setting. Chang Gung Memorial Hospital and Chang Gung University. Subjects and Methods. There were 15 ears in patients aged between 20 and 30 years (8 men/7 women) with normal hearing and middle ears. Stimulus frequencies of 500, 1000, 2000, 3000, and 4000 Hz were based on the standard clinical hearing test. Measurements closer to the tympanic membrane and the positions at the first and second bends were confirmed by using otoscope. Real ear measurement to analyze the canal resonance in human external ears was adopted. Results. This study found that gain at stimulus frequencies of 4000 Hz was affected by the interior shape of the ear canal (P < .005), particularly at the first and second bends, whereas gain was only affected by the length of the ear canal for stimulus frequencies of 2000 Hz (P < .005). Conclusion. This study found that gain was affected not only by the length of the external auditory canal (EAC) but also by the interior shape of the EAC significantly. The findings of this study may have potential clinical applications in canalplasty and congenital aural atresia surgery and may be used to guide surgeries that attempt to reshape the ear canal to achieve more desirable hearing outcomes.