Mariola Śliwińska-Kowalska

Acoustic analysis with vocal loading test in occupational voice disorders: outcomes before and after voice therapy.

OBJECTIVE To assess the usefulness of acoustic analysis with vocal loading test for evaluating the treatment outcomes in occupational voice disorders. METHODS Fifty-one female teachers with dysphonia were examined (Voice Handicap Index--VHI, laryngovideostroboscopy and acoustic analysis with vocal loading) before and after treatment. The outcomes of teachers receiving vocal training (group I) were referred to outcomes of group II receiving only voice hygiene instructions. RESULTS The results of subjective assessment (VHI score) and objective evaluation (acoustic analysis) improved more significantly in group I than in group II. The post-treatment examination revealed a decreased percentage of subjects with deteriorated jitter parameters after vocal loading, particularly in group I. CONCLUSIONS Acoustic analysis with vocal loading test can be a helpful tool in the diagnosis and evaluation of treatment efficacy in occupational dysphonia.

Theoretical predictions and actual hearing threshold levels in workers exposed to ultrasonic noise of impulsive character--a pilot study.

Results of standard pure-tone audiom etry (PTA) were collected from 25 workers, mainly females, aged 23–58 years, exposed for 2–13 years to ultrasonic noise emitted by ultrasonic welders. Hearing tests were completed by evaluation of exposure to ultrasonic noise. The subjects’ actual audiometric hearing threshold levels (HTLs) were compared with theoretical predictions calculated according to ISO 1999:1990. In 60% of cases sound pressure levels in the 10–40 kHz 1/3-octave bands at workstands exceeded Polish exposure limits for ultrasonic noise. Our comparison of predicted and measured HTLs suggests that the ISO 1999:1990 method, intended for audible noise, might also make it possible to predict reliably permanent hearing loss (in the 2 000–6 000 Hz frequency range) after exposure to ultrasonic noise. No significant progress of hearing impairment (assessed using PTA) in the operators of ultrasonic welders was noted. Nevertheless, further studies on the hearing status of workers exposed to ultrasonic noise are needed.

Evaluation of Sound Exposure and Risk of Hearing Impairment in Orchestral Musicians

This study aimed to assess exposure to sound and the risk of noise-induced hearing loss (NIHL) in orchestral musicians. Sound pressure level was measured in 1 opera and 3 symphony orchestras; questionnaires were filled in. On the basis of that data, the risk of NIHL was assessed according to Standard No. ISO 1999:1990. Classical orchestral musicians are usually exposed to sound at equivalent continuous A-weighted sound pressure levels of 81–90 dB (10th–90th percentiles), for 20–45 h (10th–90th percentiles) per week. Occupational exposure to such sound levels over 40 years of employment might cause hearing loss (expressed as a mean hearing threshold level at 2, 3, 4 kHz exceeding 35 dB) of up to 26%. Playing the horn, trumpet, tuba and percussion carries the highest risk (over 20%).

Evaluation of individuals with known or suspected noise damage to hearing

The diagnosis of hearing impairment due to noise damage is based on the assessment of the type and level of exposure to noise, the patients medical history, and a clinical and audiometric evaluation. The risk for developing hearing loss increases substantially when the equivalent sound pressure levels of noise exceed 80dB(A). Very high exposures (above 100dB(A)), usually to impulse noise (e.g. fireworks), can result in acoustic trauma. In this case, sensorineural hearing loss develops immediately after exposure and is frequently accompanied by tinnitus. It can be unilateral or asymmetrical, and temporary (temporary threshold shift – TTS) or permanent (permanent threshold shift – PTS). Noise-induced hearing loss (NIHL) that develops after prolonged occupational exposures to relatively moderate levels of noise (85–100dB(A)) is a bilateral, symmetrical, or almost symmetrical, and permanent sensorineural hearing loss progressing slowly over the years of employment. The most dynamic rise in PTS can be seen during the first years of exposure to noise. Audiometric characteristics of NIHL include: hearing threshold shift at high frequencies, with a typical notch at 4–6 kHz; presence of recruitment; amplitude reduction or loss in otoacoustic emission, mostly at frequencies corresponding to hearing loss; and impairment of speech intelligibility. The tinnitus associated with NIHL may be more variable in both prevalence and severity than that associated with acoustic trauma. Nevertheless, it requires thorough investigation. In differential diagnosis, age-related hearing loss, aminoglycoside ototoxicity as well as retrocochlear pathology should be considered. To date, NIHL is an irreversible disease, thus an effective protection against noise is the only way to preserve hearing.

Analysis of inner ear potassium recycling genes as potential factors associated with tinnitus.

Tinnitus is defined as a perception of sound in the absence of an external acoustic stimulus. Several factors are known to influence tinnitus, e.g. hearing loss, noise exposure, age, and hypertension. As only certain individuals develop tinnitus in the presence of the above risks and in approximately 50% of cases tinnitus is not attributed to any particular cause, the question arose whether this inter-individual susceptibility to tinnitus could be explained by the influence of genetic factors.ObjectivesTo test the hypothesis that genetic variability in genes of the potassium recycling pathway is associated with increased susceptibility to tinnitus.Materials and MethodsThe study group consisted of 626 subjects exposed to occupational noise (128 with tinnitus and 498 without tinnitus). 99 single nucleotide polymorphisms were investigated in 10 genes involved in the potassium recycling pathway in the inner ear, previously selected as putative noise-induced hearing loss (NIHL) candidate genes.ResultsNominally significant associations were obtained for 2 variants in KCNE1 (potassium voltage-gated channel, Isk-related family, member 1) and SLC12A2 (solute carrier family 12, member 2) genes. The first gene contributed to tinnitus that developed independently of hearing loss, while the second one was associated with increased susceptibility to noise-induced hearing loss.ConclusionsPresent findings lend support to the notion of potassium recycling pathway genes as possible risk modifiers of tinnitus in individuals with and without hearing loss. Due to the lack of replication in other independent populations these results should be seen as suggestive.

Assessment of the influence of osteopathic myofascial techniques on normalization of the vocal tract functions in patients with occupational dysphonia.

ObjectivesOccupational voice disorders are accompanied by increased tension of the external laryngeal muscle which changes the position of the larynx and consequently disturbs the conditions of functioning of the vocal tract. The aim of the study is to assess the use of osteopathic procedures in the diagnosis and treatment of occupational dysphonia.Material and MethodsStudy subjects included 40 teachers with chronic diseases of the voice organ (38 women and 2 men) aged from 39 to 59 (mean age: 48.25). Before and after the voice therapy the osteopathic examination according to Libermann’s protocol was performed as well as phoniatric examination including laryngovideostroboscopy (LVSS), assessment of the maximum phonation time (MPT) and the Voice Handicap Index (VHI) score. The voice therapy, scheduled and supervised by a laryngologist-phoniatrician and conducted by a speech-language pathologist, was supplemented with osteopathic myofascial rehabilitation of the larynx. The chi-square McNemar test and non-parametric Wilcoxon matched pairs test were applied in the statistical assessment.ResultsThe applied interdisciplinary treatment including osteopathic and vocal therapy resulted in a statistically significant decrease in tenderness of muscles raising the larynx (cricothyroid ligament, sternocleidomastoid muscles, and pharyngeal constrictor muscles) and in lowering the tonus (geniohyoid muscles, pharyngeal constrictor muscles and sternocleidomastoid muscles). A significant improvement was also observed in the case of dysfunction of the cricothyroid joint examined during glissando and yawning, as well as in asymmetry of the thyrohyoid apparatus. Moreover, the therapy resulted in significantly better normalization of the head position and better control of the centre of gravity of the body. Statistically significant post-therapy improvement was observed in the phoniatric examination, including VHI scores, MPT results and parameters of videostroboscopic examination.ConclusionsThe use of osteopathic therapy helps significantly improve the functions of the vocal tract in patients with occupational dysphonia.

Applicability of the Polish Vocal Tract Discomfort (VTD) scale in the diagnostics of occupational dysphonia

Abstract Occupational dysphonia is mainly of hyperfunctional origin, expressed by complaints experienced in the vocal tract. The aim of the paper was to evaluate the applicability of the Polish Vocal Tract Discomfort (VTD) scale in the diagnostics of occupational dysphonia. Patients with occupational dysphonia (n = 218) and controls (n = 140) were subjected to the VTD scale, VHI evaluation, and maximum phonation time (MPT) measurement. The patients also underwent videostroboscopy. The comparison of the frequency and severity of VTD symptoms showed that the results of the study group were significantly higher (P = 0.000). The VTD scale is characterized by high values of Cronbachs alpha. This study results indicatethat the VTD scale can be a valuable tool, useful in the diagnostics of occupational dysphonia.

A European Perspective on Auditory Processing Disorder-Current Knowledge and Future Research Focus

Current notions of “hearing impairment,” as reflected in clinical audiological practice, do not acknowledge the needs of individuals who have normal hearing pure tone sensitivity but who experience auditory processing difficulties in everyday life that are indexed by reduced performance in other more sophisticated audiometric tests such as speech audiometry in noise or complex non-speech sound perception. This disorder, defined as “Auditory Processing Disorder” (APD) or “Central Auditory Processing Disorder” is classified in the current tenth version of the International Classification of diseases as H93.25 and in the forthcoming beta eleventh version. APDs may have detrimental effects on the affected individual, with low esteem, anxiety, and depression, and symptoms may remain into adulthood. These disorders may interfere with learning per se and with communication, social, emotional, and academic-work aspects of life. The objective of the present paper is to define a baseline European APD consensus formulated by experienced clinicians and researchers in this specific field of human auditory science. A secondary aim is to identify issues that future research needs to address in order to further clarify the nature of APD and thus assist in optimum diagnosis and evidence-based management. This European consensus presents the main symptoms, conditions, and specific medical history elements that should lead to auditory processing evaluation. Consensus on definition of the disorder, optimum diagnostic pathway, and appropriate management are highlighted alongside a perspective on future research focus.

EFFECTS OF GSM SIGNALS DURING EXPOSURE TO EVENT RELATED POTENTIALS (ERPs)

OBJECTIVES The primary aim of this work was to assess the effect of electromagnetic field (EMF) from the GSM mobile phone system on human brain function. The assessment was based on the assay of event related potentials (ERPs). MATERIAL AND METHODS The study group consisted of 15 volunteers, including 7 men and 8 women. The test protocol comprised determination of P300 wave in each volunteer during exposure to the EMF. To eliminate possible effects of the applied test procedure on the final result, the test was repeated without EMF exposure. P300 latency, amplitude, and latency of the N1, N2, P2 waves were analysed. RESULTS The statistical analysis revealed an effect of EMF on P300 amplitude. In the experiment with EMF exposure, lower P300 amplitudes were observed only at the time in which the volunteers were exposed to EMF; when the exposure was discontinued, the values of the amplitude were the same as those observed before EMF application. No such change was observed when the experiment was repeated with sham exposure, which may be considered as an indirect proof that lower P300 amplitude values were due to EMF exposure. No statistically significant changes were noted in the latencies of the N1, N2, P2 waves that precede the P300 wave, nor in the latency of the P300 itself. CONCLUSIONS The results suggest that exposure to GSM EMF exerts some effects on CNS, including effects on long latency ERPs.

WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Permanent Hearing Loss and Tinnitus

Background: Hearing loss is defined as worsening of hearing acuity and is usually expressed as an increase in the hearing threshold. Tinnitus, defined as “ringing in the ear”, is a common and often disturbing accompaniment of hearing loss. Hearing loss and environmental exposures to noise are increasingly recognized health problems. Objectives: The objective was to assess whether the exposure-response relationship can be established between exposures to non-occupational noise and permanent hearing outcomes such as permanent hearing loss and tinnitus. Methods: Information sources: Computer searches of all accessible medical and other databases (PubMed, Web of Science, Scopus) were performed and complemented with manual searches. The search was not limited to a particular time span, except for the effects of personal listening devices (PLDs). The latter was limited to the years 2008–June 2015, since previous knowledge was summarized by SCENIHR descriptive systematic review published in 2008. Study eligibility criteria: The inclusion criteria were as follows: the exposure to noise was measured in sound pressure levels (SPLs) and expressed in individual equivalent decibel values (LEX,8h), the studies included both exposed and reference groups, the outcome was a permanent health effect, i.e., permanent hearing loss assessed with pure-tone audiometry and/or permanent tinnitus assessed with a questionnaire. The eligibility criteria were evaluated by two independent reviewers. Study appraisal and synthesis methods: The risk of bias was assessed for all of the papers using a template for assessment of quality and the risk of bias. The GRADE (grading of recommendations assessment, development, and evaluation) approach was used to assess the overall quality of evidence. Meta-analysis was not possible due to methodological heterogeneity of included studies and the inadequacy of data. Results: Out of 220 references identified, five studies fulfilled the inclusion criteria. All of them were related to the use of PLDs and comprised in total of 1551 teenagers and young adults. Three studies used hearing loss as the outcome and three tinnitus. There was a positive correlation between noise level and hearing loss either at standard or extended high frequencies in all three of the studies on hearing loss. In one study, there was also a positive correlation between the duration of PLD use and hearing loss. There was no association between prolonged listening to loud music through PLDs and tinnitus or the results were contradictory. All of the evidence was of low quality. Limitations: The studies are cross-sectional. No study provides odds ratios of hearing loss by the level of exposure to noise. Conclusions: While using very strict inclusion criteria, there is low quality GRADE evidence that prolonged listening to loud music through PLDs increases the risk of hearing loss and results in worsening standard frequency audiometric thresholds. However, specific threshold analyses focused on stratifying risk according to clearly defined levels of exposure are missing. Future studies are needed to provide actionable guidance for PLDs users. No studies fulfilling the inclusion criteria related to other isolated or combined exposures to environmental noise were identified.