Terese Finitzo

Tympanometry and otoscopy prior to myringotomy: issues in diagnosis of otitis media

Tympanometry and pneumatic otoscopy were compared to findings at myringotomy in 86 children (163 ears). Seventy percent of the ears (115) had effusion, as revealed by myringotomy. Sensitivity and specificity for tympanometry were 90% and 86%, respectively. Sensitivity and specificity for pneumatic otoscopy were 93% and 58%, respectively. A chi-square was performed to compare the sensitivity and specificity to tympanometry to otoscopy, revealing tympanometry significantly better at determining non-effusion states. Additionally, a combined otoscopy and tympanometry sensitivity and specificity were calculated for those otoscopy and tympanometry determinations in agreement, revealing both sensitivity and specificity above 90%. A Fishers exact probability test revealed no significant differences for the accuracy of tympanometry over otoscopy when the determinations of each were not in agreement. Implications of these results are discussed.

Infarction of the superior temporal gyrus: a description of auditory evoked potential latency and amplitude topology.

P1 and N1 of the cortical auditory evoked potential (AEP) were studied with multiple electrodes in 10 normal subjects and 6 patients with left middle cerebral artery infarction. Patients were selected based on neurological examination and on CT scans showing both (1) infarction limited to the vascular territory and (2) involvement of posterior portion of superior temporal gyrus. Waveforms recorded from C3, Cz, and C4 were examined for peak latency and amplitude of P1 and N1 on all subjects. Topographic displays of amplitude over P1 and N1 latency ranges were also examined. In normals, P1 was identified in 9 of the 10 subjects at all three electrode sites. In patients, P1 was identified at C3 in only 1 of the 6. N1 was present at all three electrodes in the 10 normal subjects and in 5 of the 6 patients. The remaining patient had N1 at C4 and Cz only. Examination of amplitude topology showed as asymmetric evolution of P1 and N1 in the patients. This asymmetry was not present in normals. The results of this study are consistent with theory that P1 arises from primary auditory cortex. Results further suggest multiple generators for N1. Additional study correlating topographic display from multichannel recordings with CT or MRI in brain-injured patients may bring more insight into N1 generators.

Linguistic performance deficits in stutterers : relation to laryngeal reaction time profiles

Abstract Converging evidence suggests that stuttering is associated with deficits in the planning and execution of speech. Evidence also suggests that the onset, development, and loci of stuttering are related to demands language places on speech motor planning and execution. We combined linguistic and vocal motor assessments to address two questions: 1) Can we identify a subgroup of adult stutterers who demonstrate linguistic deficits? and 2) Do linguistically normal and impaired stutterers show different patterns of laryngeal reaction time (LRT) as a function of response complexity? Linguistic performance was evaluated using tasks that assess relatively high-level production and comprehension processes. Responses used to record LRT differed in linguistic and motoric complexity. Only linguistically impaired stutterers showed significant increases in LRT for complex responses. Findings suggest that linguistic and motor processes affect the efficiency and fluency of speech motor control and that both processes be made explicit in models of stuttering.

Magnetic resonance imaging findings and correlations in spasmodic dysphonia patients

A sample of 19 spasmodic dysphonia (SD) patients was selected from a larger population of such patients to undergo magnetic resonance imaging (MRI), auditory brain stem response (ABR) testing, speech analysis, and extensive physical examination. Six patients had abnormal spin-echo MRI findings, ranging from infarcts within the basal ganglia to demyelinating lesions within the supralateral angles of the lateral ventricles. A weakly positive correlation was noted between the abnormal MRI findings and an abnormal ABR. The lack of a significant correlation between the MRI findings and other predictors of brain stem and midbrain disease, and the current spatial resolution limitations of MRI, suggest that we are visualizing the associated lesions rather than the actual foci of SD. The range of MRI findings is consistent with the concept that SD is a voice disorder in a heterogeneous patient population.

Texas Hospitals’ Quality Control Approach to Universal Infant Hearing Detection

To paraphrase Stein (1995), designing, implementing, and maintaining a cost-effective process for UIHD may be the most challenging responsibility we face as audiologists because those activities af...

Hearing loss in children with congenital heart disease: a preliminary report*

Life expectancy for children with serious congenital heart defects has dramatically increased in recent years due to advances in medical and surgical care. Anatomic studies of temporal bones in patients with non-syndromic congenital heart disease have demonstrated a high incidence of middle and inner ear anomalies. Systematic study of auditory function in these patients has not been reported. Fifty children with serious congenital heart disease have been evaluated with otologic examination and auditory brainstem-evoked response (ABR) testing. The patients ranged in age from 3 days to 17 years-8 months. Eight patients had hearing loss and normal otologic examinations, 14 patients had hearing loss and associated otitis media with effusion, and 28 patients had normal hearing by ABR testing. These results show a high incidence (16%) of hearing loss not associated with otitis media with effusion in the study population. We suggest that children with serious congenital heart disease are at high risk for hearing loss. This patient group will benefit from early identification, and appropriate medical and audiologic management.

Quantitative topographic electrophysiology and functional neurologic status in right middle cerebral artery infarction

SummaryThirteen patients with clinically and radiographically defined right middle cerebral artery infarction were studied using EEG, quantitative electroencephalographic (QEEG) spectra, and multi-channel evoked potentials. The purpose of this effort was to develop QEEG rules that related to the patients neurologic status. Three QEEG relative delta spectral patterns were identified in the right hemisphere which related to neurologic residua. These include limited perisylvian involvement, mixed involvement of perisylvian and extrasylvian regions, and extrasylvian involvement only. While there were parallels between QEEG spectral patterns and auditory, visual and somatosensory evoked potentials, there were modality specific features consistent with functional differences.

Quantitative electroencephalography and anatomoclinical principles of aphasia. A validation study.

No single technology in isolation can provide a full view of the anatomoclinical principles evident in the clinical populations we study. The dynamic nature of quantitative electrophysiology makes it an ideal complement to anatomic and metabolic imaging. The statistical conundrum it has presented may be resolved by the approach incorporated in CART. The intent of this study was to examine QEEG and CART in the evaluation of the neurologic bases of a well-defined behavioral disorder like aphasia. The combined power of QEEG and CART yielded objective electrophysiologic methods to predict aphasia that rival the reliability of the language examination. Such success is unprecedented. This success allows us to incorporate QEEG and CART into our technological armamentarium and to return to the evaluation of less well-understood disorders with confidence in both our findings and anatomoclinical principles we derive from them.

Brain electrical activity mapping in adductor spasmodic dysphonia

Brain electrical activity mapping (BEAM) was employed to study ten patients exhibiting adductor spasmodic dysphonia. BEAM is a recent neural imaging technique which utilizes digital signal processing and color graphics capabilities to generate mappings of the scalp distribution of ongoing cortical EEG activity, as well as cortical evoked response amplitudes to sensory stimulation. The technique provides data for EEG eyes open, EEG eyes closed, and auditory, visual and somatosensory evoked potentials. Patient responses were compared with normative data previously established for the BEAM technique, and significance probability mappings of patient‐to‐normal deviations generated. Results suggest diverse neurophysiologic abnormalities among the spasmodic dysphonic patients. Specific findings varied from patient to patient but included abnormal EEG activity and abnormal evoked responses in a significant proportion of patients tested. Regions of frequent “lesion” overlap were also present. Relationships of BEAM...

Effects of fluctuating conductive hearing loss in infancy on auditory brain‐stem responses and binaural interaction measured at age 5

The purpose of this research was to examine long‐term auditory electrophysiologic effects of early conductive hearing loss. Animal deprivation studies suggest brain‐stem anatomic and physiologic alteration during critical periods. Comparable human research is limited. The research questioned whether auditory brain‐stem responses (ABR) and binaural interaction (BI) at ages 5–7 differed depending on documented patterns of early hearing. Stimuli were rarefaction clicks at 21.1/s, presented binaurally at 60 dB and monaurally at 30, 60, and 80 dB HL. The BI was derived by subtracting summed ipsilateral and contralateral monaural responses from binaural responses, and defined as deflections whose amplitude exceeded 3 s.d. from derived prestimulus amplitudes. Results indicated that waves III and V, and I–III and I–V interpeak latencies (IPL) differed when controls were compared to experimental subjects. Wave I, the latency/intensity functions at 30–60 and 30–80 dB, and III–V IPLs were unchanged. The BI was prese...