Name: neuro-rehabilitation approach for sudden sensorineural hearing loss
Uploaded: 2016-01-25T17:00:00.000+00:00
Duration: 9 min 44 s
Description: Watch this Scientific Journal Video about Neuro-rehabilitation Approach for Sudden Sensorineural Hearing Loss at JoVE.com

We thank Yoshimasa Sekiya for demonstrating the protocol technique on film. This work was supported by the ''Japan Society for the Promotion of Science for Young Scientists (26861426)'' and by the "COI STREAM (Center of Innovation Science and Technology based Radical Innovation and Entrepreneurship Program)".

Declaración de Ética: Los procedimientos han sido aprobados por el Comité de Ética de la Facultad de Medicina de la Universidad de Münster, el Comité de Ética del Hospital Universitario de Osaka, y por el Comité de Ética del Hospital Osaka Rosai. 1. Preparación del Equipo <ol><li> Obtener molde auricular, reproductor de música portátil, de tipo cerrado auriculares, ecualizador y amplificador de auriculares como se muestra en la Figura 2. </li><li> Preparar las bibliotecas de los diferentes tipos de música (pop, rock, clásica, etc.) en el reproductor de música portátil. <ol><li> Obtener CDs de diferentes tipos de música. </li><li> Transferir música desde un CD al ordenador utilizando una aplicación de edición de sonido (por ejemplo, Adobe Audition 3.0 o similar). <ol><li> Coloque un CD de audio en la unidad de CD-ROM del ordenador. Elija Archivo&gt; Extraer audio desde CD. Elija la opción de la velocidad máxima de todas las velocidades de extracción que admite la unidad seleccionada. </li></ol></li><li> Confirme ªen la música abarca un amplio rango de frecuencia (es decir, 125-8,000 Hz o más ancho) usando una aplicación de edición de sonido (por ejemplo, Adobe Audition 3.0 o similar). <ol><li> Seleccionar todos una forma de onda, eligiendo Edición&gt; Seleccionar Todo el Wave. Elija Ventana&gt; Análisis de frecuencia. Ver frecuencia a lo largo del eje horizontal, y la amplitud a lo largo del eje vertical en el panel de análisis de frecuencia. </li></ol></li><li> Transferir archivos de música desde el ordenador a un reproductor de música portátil a través de un cable de conexión. <ol><li> Conecte el reproductor de música portátil y el ordenador con el cable USB. Guarde los archivos de música en la carpeta [MUSIC] del reproductor de música portátil como archivos .mp3 a una velocidad de 192 kbps. </li></ol></li></ol></li></ol> 2. Los participantes <ol><li> Medir la audición niveles de umbral (conducción de aire y el hueso) en ambos oídos usando un tamaño de paso de 5 dB de conformidad con el procedimiento Hughson-Westlake modificado 24, por medio de un tono puro audiometer. <ol><li> Ajuste el control de frecuencia de un audiómetro a 1000 Hz y ponga el oído intacto para ser probado al auricular. </li><li> Ajuste el nivel de intensidad de 50 dB. </li><li> Pulse el botón de presentación de sonido durante 1 segundo para dar a los pacientes el tono de 1000 Hz. Espere a que su respuesta (por ejemplo, a través del botón de prensa o levantar la mano). </li><li> Si los pacientes responden al tono, presentar un tono más suave 10 dB de la manera descrita en el paso 2.1.3. Si los pacientes no responden, vaya al paso 2.1.6. </li><li> Repita el paso 2.1.4 hasta que los pacientes no puede responder por más tiempo. </li><li> Presentar un 5 dB tono más alto y esperar a que los pacientes respondan. </li><li> Repita el paso 2.1.6 si los pacientes no responden. </li><li> Tenga en cuenta el nivel de intensidad más suave que los pacientes responden a. </li><li> Repita los pasos 2.1.4-2.1.8 hasta el mismo nivel de intensidad se observó dos o tres veces. Este es el umbral de audición establecido en 1000 Hz. </li><li> Repita los pasos 2.1.2-2.1.9 para frecuencias de prueba2000, 4000 y 8000 Hz. </li><li> Volver a probar el umbral de audición para 1000 Hz y confirman que el primer y segundo umbrales a 1000 Hz de acuerdo dentro de 5 dB. </li><li> Repita los pasos 2.1.2-2.1.9 para frecuencias de prueba 500, 250 y 125 Hz. </li><li> Establecer el oído afectado a ensayar con el auricular y repita los pasos 2.1.2-2.1.12. Presentar un ruido de enmascaramiento de banda estrecha adecuada para el oído no probado a través de los auriculares utilizando el método de meseta 25 si la diferencia entre los umbrales de audición izquierda y derecha es igual o superior 25 dB en las frecuencias más bajas (125, 250, y 500 Hz), o es igual o mayor 40 dB iguales o superiores a 1000 Hz. </li><li> Medir los umbrales de audición de conducción ósea con ruido de enmascaramiento de una manera similar como en los pasos 2.1.1-2.1.13. Para medir la audiencia de conducción ósea, utilice el vibrador de conducción ósea en lugar de auriculares. Aplicar un ruido de enmascaramiento de banda estrecha apropiado 25 para el oído no probado con el fin de evitar la diafonía. </li><li> Trazar escuchar los niveles de umbral en unforma audiograma n. Un audiograma ejemplar de un paciente SSHL se muestra en la Figura 3. </li></ol></li><li> Compruebe los criterios para la participación en CIST. <ol><li> Compruebe que el número de días desde SSHL inicio es de menos de 5 basado en la auto-informes. </li><li> Confirmar que la diferencia de nivel entre las orejas audiencia promedió a través de 500, 1.000, y 2.000 Hz es inferior a 50 dB basado en el audiograma de tono puro llevado a cabo con aire obtenido en la etapa 2.1. Nota: En el caso del audiograma muestra en la Figura 3, la diferencia de nivel de audición es de (40 + 40 + 45) / 3 - (5 + 0 + 5) / 3 = 38,3 dB. </li><li> Confirme que los pacientes cómodamente pueden escuchar la música con su oído afectado. </li><li> Confirme que los pacientes sufren de pérdida aguda unilateral audiencia (basado en la auto-presentación de informes) y la condición idiopática de la pérdida neurosensorial unilateral aguda audiencia de al menos 30 dB a tres o más frecuencias adyacentes en una audiometría de tonos puros 1 obtenido en el paso 20.1. Por ejemplo, en el caso del audiograma muestra en la Figura 3, los niveles de audición en y por encima de 250 Hz en la oreja derecha indican la pérdida auditiva neurosensorial de al menos 30 dB. </li><li> Confirme que los pacientes no tienen antecedentes de SSHL basado en la auto-informes y antecedentes clínicos. También confirmar que no tienen complicaciones neurológicas o psiquiátricas basadas en la auto-informes y antecedentes clínicos. </li><li> Considere la posibilidad de diagnósticos diferenciales y no incluyen los pacientes que han recibido otros diagnósticos como la enfermedad de Ménière 26, traumatismo craneal, enfermedad autoinmune del oído interno 8,9, el síndrome de Cogan 27,28, enfermedades genéticas 29, fármacos ototóxicos 30, trastornos Retrococleares relacionado con schwannoma vestibular 31 , neuropatía auditiva 32, o un derrame cerebral 33. </li></ol></li></ol> 3. A partir CIST Se recomienda la hospitalización para el p: Notaseguridad atients. Dado que los pacientes están sellados de sonidos ambientales debido a la obstrucción y la música que escucha inherente al procedimiento CIST, se espera que el riesgo de accidentes en su vida cotidiana a aumentar. <ol><li> Conecte el conducto externo del oído no afectado de los pacientes que usan un molde de oído. Empacar firmemente el molde en el canal exterior para asegurarse de que no existe espacio en el conducto auditivo externo. </li><li> Si los pacientes sienten dolor o si el sellado es incompleta, quitar el molde auricular con prontitud y vuelva a insertar. </li><li> Pregunte a los pacientes para elegir un tipo agradable de la música de las bibliotecas. Nota: También se les permite escuchar su propia música si este último cubre una gama suficientemente amplia de frecuencias (125-8,000 Hz o más ancho). </li><li> Pregunte a los pacientes a llevar un tipo de auriculares cerrados. Presentar la música seleccionada sólo para el oído afectado como se muestra en la Figura 1. </li><li> Utilice un ecualizador para aumentar o disminuir el nivel de sonido de cada frecuencia de acuerdo con una &quot;regla de un medio de ganancia&quot;, que establece que el nivel de ganancia se iguala a la mitad la cantidad de oír diferencia de nivel entre las orejas en cada frecuencia. <ol><li> Por ejemplo, si las diferencias de nivel de audiencia entre las orejas son X 125, 250 X, X 500, X 1000, X 2000, X 4000, y 8000 en X 125, 250. 500, 1000, 2000, 4000, y 8000 Hz, respectivamente, ajustar el ecualizador a 1.000 Hz a &quot;X 1000/2 - (X 125 X + 250 + 500 + X X 1.000 X + 2,000 + 4,000 X + X 8.000) / 14&quot;. Nota: En el caso del audiograma muestra en la Figura 3, el ajuste de 125, 250, 500, 1000, 2000, 4000, y 8000 Hz es -5, -3, 0, 2, 2, 5 ecualizador, y 0 dB, respectivamente. </li></ol></li><li> Pregunte a los pacientes para realizar ajustes finos de los ajustes de nivel y ecualización de sonido por sí mismos de tal manera que la música suena como natural y cómoda posible. Si el ecualizador interno del reproductor de música no es suficientemente efectivo, utilizar un ecualizador de hardware, como se muestra en la Figura 2. </li><li> Preguntar a los pacientes si ellos perciben la música con el oído afectado, para confirmar que la audiencia transversal 34 no se produce. Excluir los pacientes que escuchan música con el oído afectado enchufado debido a audiencia cruz. </li></ol> 4. Procedimiento después de iniciar CIST <ol><li> Instruir a los pacientes que están autorizadas para recibir la terapia estándar para SSHL como los corticosteroides, además del protocolo CIST. </li><li> Haga que los pacientes escuchan música durante 6 horas por día con el oído afectado el uso de los auriculares de tipo cerrado (Figura 1). Instruir a los pacientes que el tiempo que dedican a escuchar música puede ser segmentado. Además, permiten a los pacientes para llevar a cabo otras tareas (incluyendo la lectura de un libro y navegar por internet) durante el tiempo dedicado listeción a la música. </li><li> Instruir a los pacientes a utilizar el molde durante todo el día hasta su salida del hospital. </li><li> Medir los niveles de umbral de conducción de aire del oído afectado cada dos días de la misma manera como en el paso 2.1. Ajuste el volumen y ecualizador de configuración como se ha mencionado en los pasos 3.5 y 3.6. </li><li> Cuando los pacientes son dados de alta del hospital y cuando regresan como pacientes ambulatorios, miden los niveles de umbral de audición de la misma forma que en el paso 2.1. </li></ol> 5. Cese de CIST <ol><li> Retire el molde del oído si los pacientes reportan molestias sobre la oreja intacta enchufado (como tinnitus o dolor). </li><li> Medir la audición niveles de umbral en el oído intacto de la misma manera como en el paso 2.1. </li><li> Parar el procedimiento CIST si los niveles de audición promedio a través de 500, 1.000, 2.000 Hz obtenido en la etapa 4.4 y / o 5.2 deteriore más de 5 dB en comparación con los obtenidos en el paso 2.1. Por ejemplo, en el caso del audiograma muestra en la Figura 3 </strong&gt;, los niveles de audición promediado en 500, 1.000, 2.000 Hz son (40 + 40 + 45) / 3 = 41,7 dB en el oído afectado y (5 + 0 + 5) / 3 = 3,3 dB en el oído intacto. </li></ol>

<ol>
	<li>National Institute of Health. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Sudden Deafness. 00-4757, (2000).</li><li>Byl, F. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sudden+hearing+loss:+eight+years'+experience+and+suggested+prognostic+table.">Sudden hearing loss: eight years' experience and suggested prognostic table.</a> Laryngoscope. 94, 647-661 (1984).</li><li>Nosrati-Zarenoe, R., Arlinger, S., Hultcrantz, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Idiopathic+sudden+sensorineural+hearing+loss:+results+drawn+from+the+Swedish+national+database.">Idiopathic sudden sensorineural hearing loss: results drawn from the Swedish national database.</a> Acta Oto-Laryngol. 127, 1168-1175 (2007).</li><li>Rasmussen, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sudden+deafness.">Sudden deafness.</a> Acta Otolaryngol. 37, 65-70 (1949).</li><li>Xenellis, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simultaneous+and+sequential+bilateral+sudden+sensorineural+hearing+loss:+Are+they+different+from+unilateral+sudden+sensorineural+hearing+loss?.">Simultaneous and sequential bilateral sudden sensorineural hearing loss: Are they different from unilateral sudden sensorineural hearing loss?.</a> ORL-J. Oto-Rhino-Laryngol. Relat. Spec. 69, 306-310 (2007).</li><li>Fukuda, S., Chida, E., Kuroda, T., Kashiwamura, M., Inuyama, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+anti-mumps+IgM+antibody+level+in+the+serum+of+idiopathic+sudden+sensorineural+hearing+loss.">An anti-mumps IgM antibody level in the serum of idiopathic sudden sensorineural hearing loss.</a> Auris Nasus Larynx. 28, S3-S5 (2001).</li><li>Wackym, P. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Molecular+temporal+bone+pathology:+II.+Ramsay+Hunt+syndrome+(herpes+zoster+oticus).">Molecular temporal bone pathology: II. Ramsay Hunt syndrome (herpes zoster oticus).</a> Laryngoscope. 107, 1165-1175 (1997).</li><li>Mathews, J., Kumar, B. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Autoimmune+sensorineural+hearing+loss.">Autoimmune sensorineural hearing loss.</a> Clin Otolaryngol. 28, 479-488 (2003).</li><li>Mccabe, B. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Auto-Immune+Sensorineural+Hearing-Loss.">Auto-Immune Sensorineural Hearing-Loss.</a> Ann Oto Rhinol Laryn. 88, 585-589 (1979).</li><li>Wilson, W. R., Byl, F. M., Laird, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+efficacy+of+steroids+in+the+treatment+of+idiopathic+sudden+hearing+loss.+A+double-blind+clinical+study.">The efficacy of steroids in the treatment of idiopathic sudden hearing loss. A double-blind clinical study.</a> Arch Otolaryngol. 106, 772-776 (1980).</li><li>Cinamon, U., Bendet, E., Kronenberg, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Steroids,+carbogen+or+placebo+for+sudden+hearing+loss:+a+prospective+double-blind+study.">Steroids, carbogen or placebo for sudden hearing loss: a prospective double-blind study.</a> Eur Arch Otorhinolaryngol. 258, 477-480 (2001).</li><li>Conlin, A. E., Parnes, L. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+sudden+sensorineural+hearing+loss+II.+A+meta-analysis.">Treatment of sudden sensorineural hearing loss II. A meta-analysis.</a> Arch Otolaryngol Head Neck Surg. 133, 582-586 (2007).</li><li>Conlin, A. E., Parnes, L. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+sudden+sensorineural+hearing+loss+I.+A+systematic+review.">Treatment of sudden sensorineural hearing loss I. A systematic review.</a> Arch Otolaryngol Head Neck Surg. 133, 573-581 (2007).</li><li>Nosrati-Zarenoe, R., Hultcrantz, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Corticosteroid+treatment+of+idiopathic+sudden+sensorineural+hearing+loss:+randomized+triple-blind+placebo-controlled+trial.">Corticosteroid treatment of idiopathic sudden sensorineural hearing loss: randomized triple-blind placebo-controlled trial.</a> Otol Neurotol. 33, 523-531 (2012).</li><li>Li, L. P. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Healthy-side+dominance+of+cortical+neuromagnetic+responses+in+sudden+hearing+loss.">Healthy-side dominance of cortical neuromagnetic responses in sudden hearing loss.</a> Ann. Neurol. 53, 810-815 (2003).</li><li>Morita, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+recovery+from+enhancement+of+activation+in+auditory+cortex+of+patients+with+idiopathic+sudden+sensorineural+hearing+loss.">A recovery from enhancement of activation in auditory cortex of patients with idiopathic sudden sensorineural hearing loss.</a> Neurosci Res. 58, 6-11 (2007).</li><li>Suzuki, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cortical+representation+of+hearing+restoration+in+patients+with+sudden+deafness.">Cortical representation of hearing restoration in patients with sudden deafness.</a> Neuroreport. 13, 1829-1832 (2002).</li><li>Li, L. P. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neuromagnetic+Index+of+Hemispheric+Asymmetry+Prognosticating+the+Outcome+of+Sudden+Hearing+Loss.">Neuromagnetic Index of Hemispheric Asymmetry Prognosticating the Outcome of Sudden Hearing Loss.</a> PLoS ONE. 7, e335055 (2012).</li><li>Blanton, S., Wolf, S. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+application+of+upper-extremity+constraint-induced+movement+therapy+in+a+patient+with+subacute+stroke.">An application of upper-extremity constraint-induced movement therapy in a patient with subacute stroke.</a> Phys Ther. 79, 847-853 (1999).</li><li>Wolf, S. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+constraint-induced+movement+therapy+on+upper+extremity+function+3+to+9+months+after+stroke+-+The+EXCITE+randomized+clinical+trial.">Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke - The EXCITE randomized clinical trial.</a> JAMA. 296, 2095-2104 (2006).</li><li>Taub, E., Mark, V. W., Uswatte, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Implications+of+CI+therapy+for+visual+deficit+training.">Implications of CI therapy for visual deficit training.</a> Front Integr Neurosci. 8, 78 (2014).</li><li>Scheffler, K., Bilecen, D., Schmid, N., Tschopp, K., Seelig, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Auditory+cortical+responses+in+hearing+subjects+and+unilateral+deaf+patients+as+detected+by+functional+magnetic+resonance+imaging.">Auditory cortical responses in hearing subjects and unilateral deaf patients as detected by functional magnetic resonance imaging.</a> Cereb Cortex. 8, 156-163 (1998).</li><li>Okamoto, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Constraint-induced+sound+therapy+for+sudden+sensorineural+hearing+loss--behavioral+and+neurophysiological+outcomes.">Constraint-induced sound therapy for sudden sensorineural hearing loss--behavioral and neurophysiological outcomes.</a> Sci Rep. 4, 3927 (2014).</li><li>Carhart, R., Jerger, J. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Preferred+Method+For+Clinical+Determination+Of+Pure-Tone+Thresholds.">Preferred Method For Clinical Determination Of Pure-Tone Thresholds.</a> J Speech Hear Disord. 24, 330-345 (1959).</li><li>Hood, J. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+principles+and+practice+of+bone+conduction+audiometry:+A+review+of+the+present+position.">The principles and practice of bone conduction audiometry: A review of the present position.</a> Laryngoscope. 70, 1211-1228 (1960).</li><li>Hallpike, C. S., Cairns, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Observations+on+the+Pathology+of+M&#233;ni&#232;re's+Syndrome.">Observations on the Pathology of M&#233;ni&#232;re's Syndrome.</a> J Laryngol Otol. 53, 625-655 (1938).</li><li>Lunardi, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Autoantibodies+to+inner+ear+and+endothelial+antigens+in+Cogan's+syndrome.">Autoantibodies to inner ear and endothelial antigens in Cogan's syndrome.</a> Lancet. 360, 915-921 (2002).</li><li>Greco, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cogan's+syndrome:+An+autoimmune+inner+ear+disease.">Cogan's syndrome: An autoimmune inner ear disease.</a> Autoimmun Rev. 12, 396-400 (2013).</li><li>Janecke, A. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Progressive+hearing+loss,+and+recurrent+sudden+sensorineural+hearing+loss+associated+with+GJB2+mutations+-+phenotypic+spectrum+and+frequencies+of+GJB2+mutations+in+Austria.">Progressive hearing loss, and recurrent sudden sensorineural hearing loss associated with GJB2 mutations - phenotypic spectrum and frequencies of GJB2 mutations in Austria.</a> Hum Genet. 111, 145-153 (2002).</li><li>Guthrie, O. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Aminoglycoside+induced+ototoxicity.">Aminoglycoside induced ototoxicity.</a> Toxicology. 249, 91-96 (2008).</li><li>Matthies, C., Samii, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+1000+vestibular+schwannomas+(acoustic+neuromas):+Clinical+presentation.">Management of 1000 vestibular schwannomas (acoustic neuromas): Clinical presentation.</a> Neurosurgery. 40, 1-9 (1997).</li><li>Starr, A., Picton, T. W., Sininger, Y., Hood, L. J., Berlin, C. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Auditory+neuropathy.">Auditory neuropathy.</a> Brain. 119, 741-753 (1996).</li><li>Shaia, F. T., Sheehy, J. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sudden+Sensori-Neural+Hearing+Impairment+-+Report+of+1,220+Cases.">Sudden Sensori-Neural Hearing Impairment - Report of 1,220 Cases.</a> Laryngoscope. 86, 389-398 (1976).</li><li>Zwislocki, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acoustic+Attenuation+between+the+Ears.">Acoustic Attenuation between the Ears.</a> J Acoust Soc Am. 25, 752-759 (1953).</li><li>H&#228;m&#228;l&#228;inen, M., Hari, R., Ilmoniemi, R. J., Knuutila, J., Lounasmaa, O. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Magnetoencephalography+theory,+instrumentation,+and+applications+to+noninvasive+studies+of+the+working+human+brain.">Magnetoencephalography theory, instrumentation, and applications to noninvasive studies of the working human brain.</a> Rev. Mod. Phys. 65, 413-497 (1993).</li><li>Nilsson, M., Soli, S. D., Sullivan, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+the+hearing+in+noise+test+for+the+measurement+of+speech+reception+thresholds+in+quiet+and+in+noise.">Development of the hearing in noise test for the measurement of speech reception thresholds in quiet and in noise.</a> J Acoust Soc Am. 95, 1085-1099 (1994).</li><li>Henry, J. A., Meikle, M. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Psychoacoustic+measures+of+tinnitus.">Psychoacoustic measures of tinnitus.</a> J. Am. Acad. Audiol. 11, 138-155 (2000).</li></ol>

The authors declare that they have no competing interests.

This article describes a behavioral treatment approach for SSHL. The CIST protocol merely requires the use of easily available devices. A comparison of the treatment effects of CIST + SCT with those of SCT alone revealed significantly better hearing improvements with the CIST + SCT treatment. No apparent side effects were associated with the CIST protocol. The cost of CIST is markedly lower than other newly suggested treatments (including a stellate ganglion block and hyperbaric oxygen therapy). The CIST protocol represents an effective, inexpensive, easy, and safe treatment for SSHL; however, several important points must be considered. One point is the prevention of acoustic trauma. Although the maximal volume settings of recent commercial portable music players are limited to remain below the harmful levels, the sound level needs to be observed when a large adjustment is made to the equalizer settings or when a headphone amplifier is used. The second point is 'cross hearing'. The purpose of the CIST procedure is to enable SSHL patients to actively use their affected ear for listening. When patients develop severe hearing loss, they may still hear sounds with the intact ear despite plugging. The third point is 'accidents'. In the case of traditional pharmacotherapy, the intact ear is not plugged, and thus SSHL patients can pick up environmental sounds via this intact ear. On the other hand, plugging and music listening inherent to the CIST protocol seal patients from environmental sounds, and thus the accident hazard is likely increased. Therefore, the CIST protocol should be conducted in a safe environment. 
Unlike pharmacotherapy, the CIST protocol has no limitations concerning medications, allergies, or other diseases such as diabetes, hypertension, and hyperlipidemia. However, the limitation of this protocol is that it is intended for patients who are able to listen to sounds with their affected ear. As such, the CIST protocol is not suited for SSHL patients with severe hearing loss. This protocol is applied to acute stage SSHL (days since SSHL onset &#8804; 5) because previous studies reported that a shorter time delay between the onset of SSHL and the start of treatment led to better hearing recovery2. It remains elusive whether there is a time restriction for starting the CIST protocol. Moreover, the optimum duration of the CIST protocol and the total music listening time require further investigation.
This protocol utilizes the corticosteroid therapy in addition to CIST. At present, corticosteroids are the most commonly used treatment for SSHL, and therefore it is ethically not feasible to stop this treatment. However, recent triple-blinded SSHL treatment studies14 revealed that the recovery of non-treated patients was similar to that of patients who had received corticosteroids. Even though one cannot exclude the possibility that the combination of CIST + SCT led to the results obtained, it appears reasonable to assume that CIST alone will be beneficial, especially for patients with diseases that are worsened by corticosteroids such as infections, diabetes, and glaucoma.
In this protocol, patients are hospitalized in order to avoid accidents. However, SSHL patients often cannot be hospitalized because of work, family, and financial reasons. The utilization of a hearing aid may allow these outpatients to perform the CIST protocol. SSHL patients who wear a hearing aid in their affected ear are 'functionally' exposed to an enriched acoustic environment, are not in danger to be exposed to harmful sound levels, and are able to detect warning sound signals. However, the daily monitoring of hearing threshold levels and appropriate adjustments to the hearing aid settings would be necessary since hearing capability of SSHL patients can improve rapidly. Generally, the CIST protocol will not disturb other treatment approaches and may actually manifest a synergic effect when used in combination with other SSHL treatment strategies.
In the present study, a limited number of SSHL patients underwent the CIST protocol, and the participants were not randomized to the different treatment conditions. Thus, a randomized controlled study including a larger number of patients should be executed in the future. Moreover, the effectiveness of the CIST protocol should be investigated in patients with different types of hearing loss. Further, in the present study, all participants who performed the CIST protocol also received the corticosteroid therapy. Therefore, it remains unresolved whether the CIST protocol alone can improve the hearing ability of SSHL patients. It would be valuable to perform a randomized controlled study in which SSHL patients, for whom corticosteroids may cause severe side effects (such asinfectious diseases or diabetes mellitus), would either merely receive the CIST protocol or merely a standard corticosteroid therapy. Notably, in our previous report23, the effects of the CIST protocol within the human auditory cortex were examined by means of magnetoencephalography35. The results showed that the CIST protocol could have prevented maladaptive cortical reorganization in the human primary and non-primary auditory cortices. Of course, it is difficult to conduct neuroimaging studies in practices and hospitals; however, speech test, hearing in noise test36, and tinnitus related examinations37 may contribute to reveal the functional plasticity in the central auditory system induced by the CIST protocol. Eventually, even though the CIST protocol is in a very early stage in development, and although further investigations are needed, the CIST protocol as an effective, inexpensive, and safe treatment option can complement the corticosteroid therapy, which may induce severe and potentially lethal side effects.

Pérdida repentina de audición neurosensorial (SSHL), o sordera súbita, es una condición idiopática que se caracteriza por una rápida pérdida de la audición 1. Varios estudios epidemiológicos 2,3 informaron tasas de incidencia SSHL de 5-30 casos por cada 100.000 personas por año en los países industrializados. A pesar de que las causas de SSHL y los mecanismos subyacentes SSHL han examinado extensivamente, nuestro conocimiento sobre SSHL sigue siendo limitada. Entre las muchas causas potenciales de SSHL idiopática, hipótesis comunes incluyen una perturbación circulatoria 4, infección viral 5-7, y 8,9 enfermedad autoinmune. Aunque la terapia con corticosteroides 10 fue propuesta en base a estas hipótesis, y es el tratamiento más comúnmente aplicado, la eficacia de esta terapia estándar todavía se está debatiendo 3,11-14. Por lo tanto, las estrategias de tratamiento SSHL innovadoras, motivadas por diferentes perspectivas, están fuertemente deseados. SSHLafecta a la actividad neural no sólo en la cóclea, sino también en la corteza auditiva. Varios estudios de neuroimagen 15-17 sugirieron que SSHL indujo la plasticidad cortical en la corteza auditiva humana dentro de unos pocos días de su aparición. Por otra parte, el grado de reorganización cortical representado por la pérdida de contralateral dominancia hemisférica de la evocados auditivos campos parecen correlacionar negativamente con las tasas de recuperación de la pérdida de audición 18. La plasticidad cortical inducida por el inicio de SSHL puede ser considerada como mala adaptación para la capacidad de audición del oído afectado. Por lo tanto, la prevención de esta reorganización cortical desadaptativa asociado con SSHL puede representar una nueva estrategia de tratamiento. En este artículo se propone un enfoque neuro-rehabilitación que impide &#39;aprendido no utilización&#39; cambios corticales con el fin de prevenir o reducir la reorganización cortical mala adaptación. Por ejemplo, en casos de disfunción motora, el aprendido no utilización deun limbis un fenómeno en el que el movimiento se suprime inicialmente debido a las reacciones adversas y la falta de cualquier actividad intentó con la extremidad afectada, lo que finalmente se traduce en la supresión de la conducta y la correspondiente actividad neuronal 19,20. No uso aprendido no parece estar limitada a la disfunción motora, pero también puede referirse a discapacidades sensoriales 21. Pacientes con SSHL utilizan principalmente y prestar atención a la oreja intacta para escuchar. Este comportamiento de escucha parece aumentar la actividad neuronal correspondiente a la oreja intacta y, al mismo tiempo, reducir las conexiones neuronales entre la cóclea afectada y corteza auditiva 22. Con el fin de evitar que este cambio cortical mala adaptación inducida por el &#39;no utilización&#39;, que parece ser beneficioso para los pacientes con SSHL para llevar a cabo la &quot;terapia de sonido restricción inducida (CIST) &#39;23, lo que motiva a los participantes a escuchar música intensamente a través del oído afectado y para pagar la atención auditiva en el oído afectado(Figura 1). En comparación con la farmacoterapia convencional, el CIST supuestamente es un enfoque de tratamiento seguro, fácil, barato y eficaz para SSHL.

<table><tbody><tr><td>Ear mold</td><td>RION Co.Ltd, Tokyo, Japan</td><td>EM-59</td><td></td></tr><tr><td>portable music player</td><td>Sony Corporation, Tokyo, Japan</td><td>NW-S775</td><td></td></tr><tr><td>headphone</td><td>SENNHEISER Electronic GmbH &amp;amp; Co. KG, Hannover, Germany</td><td>HD280pro</td><td></td></tr><tr><td>equalizer</td><td>Roland Corporation, Hamamatsu, Japan</td><td>GE-7</td><td></td></tr><tr><td>headphone amplifier</td><td>FiiO Electronics Technology Co. Ltd, Guangzhou, China</td><td>E11</td><td></td></tr><tr><td>sound editing application</td><td>Adobe Systems Inc., CA, USA</td><td>Audition 3.0</td><td></td></tr></tbody></table>

neuro-rehabilitation approach for sudden sensorineural hearing loss

Pérdida de audición neurosensorial súbita (SSHL) se caracteriza por la pérdida de audición aguda idiopática. La tasa de incidencia estimada es de 5-30 casos por cada 100.000 personas por año. Las causas de SSHL y los mecanismos subyacentes SSHL actualmente siguen siendo desconocidos. Sobre la base de varias hipótesis, tales como una perturbación circulatoria a la cóclea, infección viral, y la enfermedad autoinmune, los enfoques farmacoterapéutica se han aplicado para tratar a pacientes con SSHL; Sin embargo, la eficacia del tratamiento estándar, el tratamiento con corticosteroides, sigue siendo objeto de debate. La exposición a sonidos intensos se ha demostrado que causar daños permanentes en el sistema auditivo; Sin embargo, la exposición a un nivel moderado enriquecido entorno acústico después de un traumatismo de ruido puede reducir problemas de audición. Varios estudios de neuroimagen sugerido recientemente que la aparición de SSHL inducida reorganización cortical de mala adaptación en la corteza auditiva humana, y que el grado de reorganización cortical en la fase aguda SSHL negativamente correufórico con la tasa de recuperación de la pérdida de audición. Este artículo presenta el desarrollo de un enfoque neuro-rehabilitación novedoso para SSHL, &quot;terapia de sonido restricción inducida (CIST)&quot;. El objetivo del protocolo CIST es para prevenir o reducir la reorganización cortical de mala adaptación mediante el uso de un ambiente acústico enriquecido. El canal de la oreja intacta de los pacientes con SSHL está conectado con el fin de motivarlos a utilizar activamente el oído afectado y con ello evitar que el progreso de la reorganización cortical mala adaptación. El oído afectado también está expuesta a la música a través de auriculares durante 6 horas por día durante la hospitalización. El protocolo CIST parece ser un tratamiento seguro, fácil, barato, y eficaz para SSHL.

Veintidós pacientes hospitalizados SSHL que coincidan con los criterios descritos en el protocolo y que estaban dispuestos a recibir CIST fueron asignados al grupo objetivo, que se sometió a CIST además de la terapia con corticosteroides estándar (grupo CIST + SCT) 23. El grupo control consistió de 31 SSHL pacientes que sólo recibieron la terapia con corticosteroides estándar (grupo SCT). Todos los participantes fueron plenamente informados sobre el estudio y dieron su consentimiento informado por escrito de conformidad con los procedimientos aprobados por el Comité de Ética de la Facultad de Medicina de la Universidad de Münster, el Comité de Ética del Hospital de la Universidad de Osaka, y por el Comité de Ética del Hospital Osaka Rosai. Este estudio se realizó de conformidad con la Declaración de Helsinki. Los participantes en cada uno de los dos grupos (SCT + cista vs. SCT) tenían edades similares y retrasos de tiempo entre la aparición de SSHL y el audiograma inicial. st examen), (ii) al momento del alta del hospital (2º examen: intervalo de tiempo entre la 1 ª y 2 ª mediciones (media ± desviación estándar (SCT + CIST: 9.41 ± 3.14 días, SCT: 10,42 ± 3,18 días), y otra vez (iii) un par de meses más tarde (3 examen rd: media ± desviación estándar (SCT + CIST: 63.45 ± 28,56 días , SCT: 84.64 ± 38,68 días)) con un audiómetro de tono puro. Como se muestra en la Figura 4, antes del tratamiento (1 medición st), no se observaron diferencias significativas en los umbrales entre los grupos de audición en todas las frecuencias de medición (125, 250, 500, 1.000, 2.000, 4.000, y 8.000 Hz) en el oído afectado . Después del tratamiento (2 ª y 3 ª exámenes), la audición en el oído afectado habían mejorado en absoluto Frecucias, tanto en el SCT + grupos cista y SCT (Figura 4). Los niveles umbral de audición en todas las frecuencias se promediaron para cada oído por separado y luego audición diferencias de nivel entre las orejas se calcularon (Figura 5). Las diferencias de nivel de audiencia entre los oídos afectados y intactas fueron atribuidos a SSHL. Las diferencias de nivel de audiencia calculados entre las orejas fueron similares entre los grupos antes del tratamiento en el 1er examen (Figura 5). Sin embargo, no se observaron diferencias significativas entre los dos grupos en el alta del hospital (examen nd 2: P &lt;0,05 (corregido de Bonferroni-)) y en un par de meses más tarde (3 de examen: P &lt;0,001 (corregida-Bonferroni)). En cuanto a los niveles de audición en el oído intacto, los umbrales medios no difirieron significativamente entre los grupos en cualquiera de las frecuencias en cualquiera de los tres exámenes. Este resultado indicó que enchufar THCanal e oído no parecen tener un efecto negativo en el oído intacto. En los 22 participantes que se sometieron a CIST, no se observaron efectos secundarios aparentes. <img alt="Figura 1" src="/files/ftp_upload/53264/53264fig1.jpg" /> Figura 1. Esquema de la terapia de sonido restricción inducida (CIST). El canal del oído intacto está conectado con el fin de motivar el uso del oído afectado. La música es monoaural presentado al oído afectado a través de unos auriculares de tipo cerrado; el otro canal correspondiente a la oreja intacta se mantiene en silencio (Esta figura se ha adaptado de Okamoto et al 23:.. Dibujo cortesía de Lothar Lagemann). <img alt="Figura 2" src="/files/ftp_upload/53264/53264fig2.jpg" /> Figura 2. Conexiones y dispositivos para su uso en CIST. Un reproductor de música portátil, ecualizador, amplificador de auriculares, y de tipo cerrado<html> auriculares están conectados secuencialmente. Ecualizador y amplificador de auriculares sólo se utilizan cuando el ecualizador digital del reproductor de música portátil no es suficientemente eficaz. <a href="https://www.jove.com/files/ftp_upload/53264/53264fig2large.jpg" target="_blank">Por favor haga clic aquí para ver una versión más grande de esta figura.</a> <img alt="figura 3" src="/files/ftp_upload/53264/53264fig3.jpg" /> . Figura 3. Un audiograma ejemplar de un paciente SSHL Esta figura representa los niveles de audición (rango: 125 a 8000 Hz; pasos una octava) en el oído afectado (conducción del aire: círculos abiertos; Conducción ósea: dejó entre corchetes) y la intacta oído (conducción de aire: cruces, la conducción ósea: soportes derecho cuadrados) de un paciente SSHL antes del tratamiento. <a href="https://www.jove.com/files/ftp_upload/53264/53264fig3large.jpg" target="_blank">Haga clic aquí para ver una versión más grande de esta figura.</a> e_content &quot;fo: keep-together.within-page =&quot; 1 &quot;&gt; <img alt="Figura 4" src="/files/ftp_upload/53264/53264fig4.jpg" /> . Figura 4. Tiempo curso de nivel de audiencia media en el oído afectado Esta figura muestra los audiogramas media (rango: 125 a 8000 Hz; pasos una octava) en los oídos afectados de los participantes que se sometieron a la terapia de sonido inducida por restricción además de recibir norma la terapia con corticosteroides (CIST + SCT: cuadrados abiertos) o en aquellos que sólo recibieron la terapia con corticosteroides estándar (SCT: cuadrados rellenos). El 1 °, 2 ° y 3 exámenes audiométricos rd se realizaron (i) antes del tratamiento, (ii) al momento del alta del hospital, y (iii) un par de meses más tarde, respectivamente. Las barras de error indican los intervalos de confianza del 95% (esta cifra se ha modificado de Okamoto et al. 23). <a href="https://www.jove.com/files/ftp_upload/53264/53264fig4large.jpg" target="_blank">Haga clic aquí para ver una versión más grande de esta figura</a>Ure. <img alt="Figura 5" src="/files/ftp_upload/53264/53264fig5.jpg" /> Figura 5. La media de la audición diferencia de nivel entre las orejas audición diferencias de umbral entre los oídos afectados y intactas se promediaron en todas las frecuencias medidas en la primera (izquierda: antes del tratamiento)., Segundo (centro: al alta hospitalaria), y la tercera (a la derecha: unos meses más tarde) exámenes audiométricos tono puro. Las plazas abiertas y llenas denotan la terapia de sonido restricción inducida + grupo de terapia con corticosteroides estándar (CIST + SCT) y el grupo que sólo el tratamiento con corticosteroides estándar (SCT), respectivamente. Las barras de error indican los intervalos de confianza del 95% (esta cifra se ha modificado desde Okamoto et al. 23). <a href="https://www.jove.com/files/ftp_upload/53264/53264fig5large.jpg" target="_blank">Por favor, haga clic aquí para ver una versión más grande de esta figura.</a>

Watch this Scientific Journal Video about Neuro-rehabilitation Approach for Sudden Sensorineural Hearing Loss at JoVE.com

Neuro-rehabilitation Approach for Sudden Sensorineural Hearing Loss

This article reports the development of a neuro-rehabilitation approach, "constraint-induced sound therapy (CIST)" for sudden sensorineural hearing loss. The aim of CIST is to prevent maladaptive cortical reorganization by using an enriched acoustic environment. CIST represents a safe, easy, inexpensive, and effective approach to treat sudden sensorineural hearing loss.

Enfoque Neuro-rehabilitación de hipoacusia neurosensorial súbita

Sudden sensorineural hearing loss (SSHL) is characterized by acute, idiopathic hearing loss. The estimated incidence rate is 5-30 cases per 100,000 people ...

neuro-rehabilitation-approach-for-sudden-sensorineural-hearing-loss

Research

JoVE Journal

Behavior

19.1K vistas.  National Institute for Physiological Sciences. This article reports the development of a neuro-rehabilitation approach, "constraint-induced sound therapy (CIST)" for sudden sensorineural hearing loss. The aim of CIST is to prevent maladaptive cortical reorganization by using an enriched acoustic environment. CIST represents a safe, easy, inexpensive, and effective approach to treat sudden sensorineural hearing loss.

Video: Neuro-rehabilitation Approach for Sudden Sensorineural Hearing Loss

A Method to Study Adaptation to Left-Right Reversed Audition

An unusual sensory space is one of the effective tools to uncover the mechanism of adaptability of humans to a novel environment. Although most of the previous studies have used special spectacles with prisms to achieve unusual spaces in the visual domain, a methodology for studying the adaptation to unusual auditory spaces has yet to be fully established. This study proposes a new protocol to set-up, validate, and use a left-right reversed stereophonic system using only wearable devices, and to study the adaptation to left-right reversed audition with the help of neuroimaging. Although individual acoustic characteristics are not yet implemented, and slight spillover of unreversed sounds is relatively uncontrollable, the constructed apparatus shows high performance in a 360&#176; sound source localization coupled with hearing characteristics with little delay. Moreover, it looks like a mobile music player and enables a participant to focus on daily life without arousing curiosity or drawing attention of other individuals. Since the effects of adaptation were successfully detected at the perceptual, behavioral, and neural levels, it is concluded that this protocol provides a promising methodology for studying adaptation to left-right reversed audition, and is an effective tool for uncovering the adaptability of humans to a novel environments in the auditory domain.

The present study proposes a protocol to investigate the adaptation to left-right reversed audition achieved only by wearable devices, using neuroimaging, which can be an effective tool for uncovering the adaptability of humans to a novel environment in the auditory domain.

Un método para estudiar la adaptación a izquierda y derecha invertida Audition

An unusual sensory space is one of the effective tools to uncover the mechanism of adaptability of humans to a novel environment. Although most of the ...

Investigación

Comportamiento

Sound Source Localization Testing in Single-sided Deafness Following Bone Conduction Intervention

Single-sided deafness (SSD), where there is severe to profound hearing loss in one ear and normal hearing in the other, is a prevalent auditory condition that significantly impacts the quality of life for those affected. The ability to accurately localize sound sources is crucial for various everyday activities, including speech communication and environmental awareness. In recent years, bone conduction intervention has emerged as a promising solution for patients with SSD, offering a non-invasive alternative to traditional air conduction hearing aids. However, the effectiveness of bone conduction devices (BCDs), especially in terms of improving sound localization abilities, remains a topic of considerable interest.
Here, we present a protocol to assess the impact of bone conduction intervention on sound localization ability in patients with SSD. The protocol includes the experimental setup (a sound-treated room and a semicircular array of loudspeakers), stimuli, and data analysis methods. Participants indicate the perceived direction of noise bursts, and their responses are analyzed using root mean square error (RMSE) and bias. The results of sound localization testing before and after bone conduction intervention are reported and compared. Despite no significant differences, most patients (71%) had a localization bias clearly toward the intervention side after bone conduction intervention. The study concludes that bone conduction intervention can promptly enhance certain sound localization skills in patients with SSD, offering evidence to support the efficacy of BCDs as a treatment for SSD.

We present a protocol to evaluate the impact of bone conduction intervention on sound localization ability in patients with single-sided deafness (SSD). This protocol can be applied to assess the efficacy of bone conduction devices in restoring sound localization abilities and improving the overall quality of life for individuals with SSD.

Pruebas de localización de la fuente sonora en la sordera unilateral tras una intervención de conducción ósea

Single-sided deafness (SSD), where there is severe to profound hearing loss in one ear and normal hearing in the other, is a prevalent auditory condition ...

The Mouse Round-window Approach for Ototoxic Agent Delivery: A Rapid and Reliable Technique for Inducing Cochlear Cell Degeneration

Investigators have utilized a wide array of animal models and investigative techniques to study the mammalian auditory system. Much of the basic research involving the cochlea and its associated neural pathways entails exposure of model cochleae to a variety of ototoxic agents. This allows investigators to study the effects of targeted damage to cochlear structures, and in some cases, the self-repair or regeneration of those structures. Various techniques exist for delivery of ototoxic agents to the cochlea. When selecting a particular technique, investigators must consider a number of factors, including the induction of inadvertent systemic toxicity, the amount of cochlear damage produced by the surgical procedure itself, the type of lesion desired, animal survivability, and reproducibility/reliability of results. Currently established techniques include parenteral injection, intra-peritoneal injection, trans-tympanic injection, endolymphatic sac injection, and cochleostomy with perilymphatic perfusion. Each of these methods has been successfully utilized and is well described in the literature; yet, each has various shortcomings. Here, we present a technique for topical application of ototoxic agents directly to the round window niche. This technique is non-invasive to inner ear structures, produces rapid onset of reliably targeted lesions, avoids systemic toxicity, and allows for an intra-animal control (the contra-lateral ear). Results stemming from this approach have helped deeper understanding of auditory pathophysiology, cochlear cell degeneration, and regenerative capacity in response to an acute injury. Future investigations may use this method to conduct interventional studies involving gene therapy and stem cell transplantation to combat hearing loss.

Various methods exist for introducing ototoxic agents to the cochleae of animal models. Presented is a surgical protocol for delivery of ototoxic agents to the round window niche. The procedure is reliable, creates targeted intra-cochlear lesions, and avoids mechanical damage to the microarchitecture. Examination of cochlear self-repair/regeneration is possible.

El Enfoque del ratón Ronda-ventana para ototóxicos Agente de entrega: Una rápida y técnica fiable para la inducción de degeneración de las células cocleares

Investigators have utilized a wide array of animal models and investigative techniques to study the mammalian auditory system. Much of the basic research ...

Medicina

Simple Surgical Induction of Conductive Hearing Loss with Verification Using Otoscope Visualization and Behavioral Clap Startle Response in Rat

Conductive hearing loss (CHL) is a prevalent hearing impairment in humans. The goal of the protocol is to describe a simple surgical procedure for inducing CHL in rodents. The protocol demonstrates CHL by tympanic membrane puncture. Verification of CHL surgery was by otoscope examination and behavioral assessment by clap startle response, both replicable and reliable, and are simple methods to demonstrate hearing loss has occurred. The simple CHL procedure is advantageous due to its reproducibility and flexibility to different pursuits in hearing loss research. The limitations of inducing CHL by a surgical approach are associated with the learning curve to perform the surgical procedure and confidence in audiological examination. Inducing a hearing impairment by CHL allows one to readily study the neural manifestations and behavioral outcomes of hearing loss.

Here, we present a protocol to establish a replicable conductive hearing loss induction via surgical tympanic membrane puncture and verification by otoscope visualization and behavioral assessment by clap startle.

Inducción quirúrgica simple de pérdida auditiva conductiva con verificación mediante la visualización del otoscopio y la respuesta de golpe de golpe conductual en Rata

Conductive hearing loss (CHL) is a prevalent hearing impairment in humans. The goal of the protocol is to describe a simple surgical procedure for ...

Neurociencias

Structured Motor Rehabilitation After Selective Nerve Transfers

After severe nerve injuries, selective nerve transfers provide an opportunity to restore motor and sensory function. Functional recovery depends both on the successful re-innervation of the targets in the periphery and on the motor re-learning process entailing cortical plasticity. While there is an increasing number of methods to improve rehabilitation, their routine implementation in a clinical setting remains a challenge due to their complexity and long duration. Therefore, recommendations for rehabilitation strategies are presented with the aim of guiding medical doctors and therapists through the long-lasting rehabilitation process and providing step-by-step instructions for supporting motor re-learning.
Directly after nerve transfer surgery, no motor function is present, and therapy should focus on promoting activity in the sensory-motor cortex areas of the paralyzed body part. After about two to six months (depending on the severity and modality of injury, the distance of nerve regeneration and many other factors), the first motor activity can be detected via electromyography (EMG). Within this phase of rehabilitation, multimodal feedback is used to re-learn the motor function. This is especially critical after nerve transfers, as muscle activation patterns change due to the altered neural connection. Finally, muscle strength should be sufficient to overcome gravity/resistance of antagonistic muscles and joint stiffness, and more functional tasks can be implemented in rehabilitation.

Here, we present a protocol for the motor rehabilitation of patients with severe nerve injuries and selective nerve transfer surgery. It aims at restoring the motor function proposing several stages in patient education, early-stage therapy after surgery and interventions for rehabilitation after successful re-innervation of the nerve&#8217;s target.

Rehabilitación del Motor Estructurado Después de Transferencias Selectivas de Nerve

After severe nerve injuries, selective nerve transfers provide an opportunity to restore motor and sensory function. Functional recovery depends both on ...

Assessment of Audio-Tactile Sensory Substitution Training in Participants with Profound Deafness Using the Event-Related Potential Technique

This paper examines the application of electroencephalogram-based methods to assess the effects of audio-tactile substitution training in young, profoundly deaf (PD) participants, with the aim of analyzing the neural mechanisms associated with vibrotactile complex sound discrimination. Electrical brain activity reflects dynamic neural changes, and the temporal precision of event-related potentials (ERPs) has proven to be key in studying time-locked processes while performing behavioral tasks that involve attention and working memory. 
The current protocol was designed to study electrophysiological activity in PD subjects while they performed a continuous performance task (CPT) using complex-sound stimuli, consisting of five different animal sounds delivered through a portable stimulator system worn on the right index finger. As a repeated-measures design, electroencephalogram (EEG) recordings in standard conditions were performed before and after a brief training program (five 1 h sessions over 15 days), followed by offline artifact correction and epoch averaging, to obtain individual and grand-mean waveforms. Behavioral results show a significant improvement in discrimination and a more robust P3-like centroparietal positive waveform for the target stimuli after training. In this protocol, ERPs contribute to the further understanding of learning-related neural changes in PD subjects associated with audio-tactile discrimination of complex sounds.

This protocol is designed to explore underlying learning-related electrophysiological changes in subjects with profound deafness after a short training period in audio-tactile sensory substitution by applying the event-related potential technique.

Evaluación del entrenamiento de sustitución sensorial audiotáctil en participantes con sordera profunda utilizando la técnica de potencial relacionado con el evento

This paper examines the application of electroencephalogram-based methods to assess the effects of audio-tactile substitution training in young, ...

Semi-Automated Analysis of Peak Amplitude and Latency for Auditory Brainstem Response Waveforms Using R

Many reports in the last 15 years have assessed changes in the auditory brainstem response (ABR) waveform after insults such as noise exposure. Common changes include reductions in the peak 1 amplitude and the relative latencies of the later peaks, as well as increased central gain, which is reflected by a relative increase in the amplitudes of the later peaks compared to the amplitude of peak 1. Many experimenters identify the peaks and troughs visually to assess their relative heights and latencies, which is a laborious process when the waveforms are collected in 5 dB increments throughout the hearing range for each frequency and condition. This paper describes free routines that may be executed in the open-source platform R with the RStudio interface to semi-automate the measurements of the peaks and troughs of auditory brainstem response (ABR) waveforms. The routines identify the amplitudes and latencies of peaks and troughs, display these on a generated waveform for inspection, collate and annotate the results into a spreadsheet for statistical analysis, and generate averaged waveforms for figures. In cases when the automated process misidentifies the ABR waveform, there is an additional tool to assist in correction. The goal is to reduce the time and effort needed to analyze the ABR waveform so that more researchers will include these analyses in the future.

This article describes the semi-automated measurement of the amplitudes and latencies of the first five peaks and troughs in the auditory brainstem response waveform. An additional routine compiles and annotates the data into a spreadsheet for experimenter analysis. These free computer routines are executed using the open-source statistical package R.

Análisis semiautomatizado de la amplitud y latencia máximas para formas de onda de respuesta auditiva del tronco encefálico utilizando R

Many reports in the last 15 years have assessed changes in the auditory brainstem response (ABR) waveform after insults such as noise exposure. Common ...

Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages

Cochlear implant (CI) provision is the most effective clinical treatment to restore hearing performance in individuals with profound sensorineural hearing loss (SNHL). It has been successful in providing improved speech perception outcomes, especially in quiet environments. However, speech perception performance within complex environments, lexical tone recognition, and music perception have been shown to only improve with newer fine structure coding strategies or related techniques. Therefore, the methods used to assess hearing performance in noisy environments, lexical tone recognition, and music perception are of vital importance. These assessments must reflect the postoperative outcomes and also provide guidance for the programming, rehabilitation, and application of new coding strategies. In this study, hearing performance in simple and complex situations was evaluated before and after upgrading to a fine structure strategy. The participants were a cohort of Mandarin-speaking adolescents, who were experienced CI users. The comprehensive clinical workflow involved assessments of speech in quiet conditions, speech in noisy conditions, lexical tone recognition, and music perception. This battery of tests is explained in detail, from the coding strategy to the test methods, including the test process, environment, device, material, and order. The details that require special attention are discussed, such as the position of the participants, the angle of the loudspeaker, the intensity of the sound, the noise type, the practice test, and the way of answering questions. Each test step, method, and material for speech, lexical tone, and music perception is presented in detail. Finally, the clinical results are discussed.

This paper describes a battery of tests used to clinically assess the hearing performance of adolescent, Mandarin-speaking, experienced cochlear implant users upgraded to a new fine structure coding strategy. The battery of tests include speech in quiet conditions, speech in noisy conditions, lexical tone, and music perception.

Proceso de Evaluación Sistemática del Desempeño Auditivo para Adolescentes con Implante Coclear en Edades Tempranas

Cochlear implant (CI) provision is the most effective clinical treatment to restore hearing performance in individuals with profound sensorineural hearing ...

A State-of-the-Art Method for Preserving Residual Hearing During Cochlear Implant Surgery

The developments in surgical techniques and cochlear implant (CI) electrode design have expanded the indications for CI treatment. Currently, patients with high-frequency hearing loss may benefit from CIs when low-frequency residual hearing can be preserved, as this enables combined electric-acoustic stimulation (EAS). The possible benefits of EAS include, for example, improved sound quality, music perception, and speech intelligibility in noise.
The risks of inner ear trauma and a deterioration or even complete loss of residual hearing vary according to the surgical technique and the type of electrode array used. Short, lateral-wall electrodes with shallower angular insertion depths have demonstrated higher rates of hearing preservation than longer electrodes. The very slow insertion of the electrode array through the round window of the cochlea contributes to insertion atraumaticity and, thus, may lead to favorable hearing preservation results. However, residual hearing can be lost even after an atraumatic insertion. 
Electrocochleography (ECochG) can be used to monitor inner ear hair cell function during the insertion of the electrode. Several investigators have demonstrated that the ECochG responses during surgery may predict postoperative hearing preservation results. 
In a recent study, we correlated the patients' subjective hearing perception with simultaneously recorded intracochlear ECochG responses during the insertion. This is the first report evaluating the association between intraoperative ECochG responses and hearing perception in a subject undergoing cochlear implantation under local anesthesia without sedation. The combination of intraoperative ECochG responses with the patient's real-time feedback to sound stimuli has excellent sensitivity for the intraoperative monitoring of cochlear function. This paper presents a state-of-the-art method for the preservation of residual hearing during CI surgery. We describe this treatment procedure with the special consideration of performing the surgery under local anesthesia, which makes it feasible for monitoring the patient's hearing during the insertion of the electrode array.

The preservation of cochlear structures and possible residual hearing is one important factor to consider during cochlear implant surgery. Here, we present a state-of-the-art method for preserving residual hearing during cochlear implant surgery under local anesthesia.

The developments in surgical techniques and cochlear implant (CI) electrode design have expanded the indications for CI treatment. Currently, patients ...

<meta charset="utf8"></head><body>Preservación de la audición con electrodos largos en la estimulación electroacústica

Enhanced Cochlear Coverage and Hearing Preservation in High-Frequency Hearing Loss via Electric Acoustic Stimulation with Longer Electrode

Electric-acoustic stimulation (EAS) is a promising treatment to improve hearing ability in patients with high-frequency hearing loss (HL). In EAS surgeries, shorter electrodes have been preferred to avoid the presence of an electrode covering the residual hearing region. However, our earlier studies showed that EAS with longer electrodes (28 mm) could preserve acoustic hearing. Additionally, we reported that the hearing preservation (HP) scores were independent of the length of the inserted electrodes, consistent with the systematic review. As most EAS patients gradually lose residual hearing over time due to the natural course of HL, in these cases, providing broader cochlear coverage using longer electrodes was beneficial toward better place-pitch matching. In addition to preparing for the deterioration in&#160;hearing in&#160;the future, EAS with longer electrodes could offer various types of map strategies. Herein, we show the pre-, intra-, and post-procedures for EAS surgery. Appropriate preoperative evaluation, less invasive surgery, flexible lateral-wall electrodes, and steroid administration resulted in good HP following EAS with longer electrodes.

<meta charset="utf8"></head><body>Autor destacado: Optimización de EAS con electrodos largos para mejorar la cobertura coclear y la preservación de la audición

Electric acoustic stimulation (EAS) with longer electrodes can offer broader cochlear coverage and various types of maps in cases of high-frequency hearing loss. Combining less invasive surgery, flexible lateral-wall electrodes, and steroid administration permits deeper insertion with little or no surgical trauma, resulting in good preservation of hearing.

Cobertura coclear mejorada y preservación de la audición en la pérdida auditiva de alta frecuencia mediante estimulación electroacústica con electrodo más largo

Enfoque Neuro-rehabilitación de hipoacusia neurosensorial súbita

Resumen

Explorar más videos

PLAYLIST