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)".

Etica Dichiarazione: procedure sono state approvate dal Comitato Etico della Facoltà di Medicina, Università di Muenster, il Comitato Etico dell&#39;Ospedale Osaka University, e dal Comitato Etico della Rosai Hospital di Osaka. 1. Preparazione di apparecchiature <ol><li> Ottenere chiocciola, lettore di musica portatile, cuffie di tipo chiuso, equalizzatore, e amplificatore per cuffie, come illustrato nella figura 2. </li><li> Preparare biblioteche di diversi tipi di musica (pop, rock, classica, ecc) sul lettore musicale portatile. <ol><li> Ottenere CD di diversi tipi di musica. </li><li> Trasferire la musica dai CD al computer utilizzando un&#39;applicazione di editing audio (ad esempio, Adobe Audition 3.0 o simile). <ol><li> Inserire un CD audio nell&#39;unità CD-ROM del computer. Scegliere File&gt; estrarre l&#39;audio da CD. Scegliere l&#39;opzione massima velocità da tutte le velocità di estrazione che l&#39;unità selezionata supporta. </li></ol></li><li> Conferma thalla musica copre un&#39;ampia gamma di frequenze (cioè, 125-8,000 Hz o più largo) utilizzando un&#39;applicazione di editing audio (ad esempio, Adobe Audition 3.0 o simile). <ol><li> Selezionare tutti una forma d&#39;onda, scegliendo Composizione&gt; Seleziona Tutto il Wave. Scegliete Finestra&gt; Analisi della frequenza. Vista la frequenza lungo l&#39;asse orizzontale e l&#39;ampiezza lungo l&#39;asse verticale nel pannello analisi in frequenza. </li></ol></li><li> Trasferire file musicali dal computer a un lettore musicale portatile tramite un cavo di collegamento. <ol><li> Collegare lettore musicale portatile e il computer utilizzando il cavo USB. Salvare i file musicali nella cartella [Music] del lettore musicale portatile come file .mp3 ad un bit rate di 192 kbps. </li></ol></li></ol></li></ol> 2. I partecipanti <ol><li> Misurare dell&#39;udito livelli di soglia (conduzione aerea e ossea) in entrambe le orecchie con un passo di 5 dB secondo la procedura modificata Hughson Westlake-24, per mezzo di un tono puro audiometer. <ol><li> Impostare il controllo della frequenza di un audiometro a 1.000 Hz ed impostare l&#39;orecchio intatto da testare per l&#39;auricolare. </li><li> Impostare il livello di intensità di 50 dB. </li><li> Premere il pulsante di presentazione del suono per 1 secondo per dare ai pazienti il ​​tono 1.000 Hz. Attendere che la loro risposta (ad esempio, tramite pulsante o sollevare la mano). </li><li> Se i pazienti rispondono al tono, presentare una 10 dB tono più morbido nel modo descritto nel passaggio 2.1.3. Se i pazienti non rispondono, passare al punto 2.1.6. </li><li> Ripetere il punto 2.1.4 fino a quando il paziente non è in grado di rispondere più. </li><li> Presentare un 5 dB tono più alto e attendere per i pazienti di rispondere. </li><li> Ripetere il punto 2.1.6 se i pazienti non rispondono. </li><li> Si noti il ​​livello di intensità più morbido che i pazienti rispondono a. </li><li> Ripetere passaggi 2.1.4-2.1.8 fino allo stesso livello di intensità è notato due o tre volte. Questa è la soglia uditiva stabilita a 1000 Hz. </li><li> Ripetere i passaggi 2.1.2-2.1.9 per frequenze di prova2.000, 4.000 e 8.000 Hz. </li><li> Ritestare la soglia uditiva per 1000 Hz e confermare che il primo e secondo soglie a 1.000 Hz concordano entro 5 dB. </li><li> Ripetere i passaggi 2.1.2-2.1.9 per le frequenze di prova 500, 250 e 125 Hz. </li><li> Impostare l&#39;orecchio colpito da testare per l&#39;auricolare e ripetere i passaggi 2.1.2-2.1.12. Presentare un appropriato rumore a banda stretta mascheratura per l&#39;orecchio non testato tramite l&#39;auricolare utilizzando il metodo plateau 25 se la differenza tra le soglie acustici sinistro e destro è pari o superiore 25 dB nelle frequenze più basse (125, 250, e 500 Hz), o pari o superiore 40 dB pari o superiore a 1.000 Hz. </li><li> Misurare soglie uditive conduzione ossea con nastro rumore in maniera simile a come nei passaggi 2.1.1-2.1.13. Per misurare l&#39;udienza conduzione ossea, utilizzare il vibratore osso-conduzione, invece di cuffie. Applicare un&#39;adeguata rumore a banda stretta mascheratura 25 per l&#39;orecchio non testato per evitare diafonia. </li><li> Tracciare l&#39;udito livelli di soglia su unmodulo audiogramma n. Un audiogramma esemplare di un paziente SSHL è mostrato in Figura 3. </li></ol></li><li> Controllare i criteri per la partecipazione al CIST. <ol><li> Verificare che il numero di giorni dal SSHL esordio è a meno di 5 basato su auto-segnalazione. </li><li> Verificare che la differenza di livello tra le orecchie udito media tra 500, 1.000 e 2.000 Hz è inferiore a 50 dB in base alla audiogramma tono puro aria condotta ottenuto nel passaggio 2.1. Nota: In caso dell&#39;audiogramma mostrato in Figura 3, la differenza di livello acustico è (40 + 40 + 45) / 3 - (5 + 0 + 5) / 3 = 38,3 dB. </li><li> Confermare che i pazienti possono comodamente ascoltare la musica con il loro nell&#39;orecchio interessato. </li><li> Confermare che i pazienti soffrono di perdita dell&#39;udito unilaterale acuta (sulla base di self-reporting) e la condizione idiopatica acuta di ipoacusia neurosensoriale unilaterale di almeno 30 dB a tre o più adiacenti frequenze su un audiogramma tono puro 1 ottenuto nella fase 2.1. Ad esempio, nel caso della audiogramma mostrato in figura 3, i livelli acustici e al di sopra di 250 Hz nell&#39;orecchio destro indicano sordità neurosensoriale di almeno 30 dB. </li><li> Verificare che i pazienti non hanno alcun precedente storia di SSHL sulla base di auto-segnalazione e la storia medica. Inoltre confermano che non hanno complicazioni neurologiche o psichiatriche basate su auto-segnalazione e la storia medica. </li><li> Considerate diagnosi differenziali ed escludere i pazienti che hanno ricevuto altre diagnosi come la malattia di Ménière 26, trauma cranico, malattia autoimmune dell&#39;orecchio interno 8,9, la sindrome di Cogan 27,28, malattie genetiche 29, farmaci ototossici 30, disturbi retrococleare legato alla schwannoma vestibolare 31 , neuropatia uditiva 32, 33 o ictus. </li></ol></li></ol> 3. Avvio CIST Nota: si raccomanda l&#39;ospedalizzazione per la psicurezza atients &#39;. Poiché i pazienti sono sigillati da suoni ambientali dovuti tamponamenti ascolto musicale inerente alla procedura CIST, il rischio di incidenti nella loro vita quotidiana dovrebbe aumentare. <ol><li> Inserire il canale esterno dell&#39;orecchio inalterata dei pazienti utilizzando uno stampo orecchio. Strettamente imballare lo stampo nel canale uditivo esterno per garantire che non esiste spazio nel meato uditivo esterno. </li><li> Se i pazienti si sentono dolore o se la tenuta è incompleta, togliere lo stampo orecchio prontamente e quindi reinserire. </li><li> Chiedere ai pazienti di scegliere un tipo piacevole di musica dalle librerie. Nota: sono ammessi anche per ascoltare la propria musica se quest&#39;ultima copre una gamma di frequenza sufficientemente ampio (125-8,000 Hz o più ampio). </li><li> Chiedere ai pazienti di indossare una cuffia di tipo chiuso. Presentare la musica selezionata solo per l&#39;orecchio colpito come mostrato in Figura 1. </li><li> Usare un equalizzatore per aumentare o diminuire il livello sonoro di ogni frefrequenza secondo una &quot;regola mezza guadagno&quot;, in cui si afferma che il livello di guadagno è equiparato alla metà dell&#39;importo di sentire differenza di livello tra le orecchie ad ogni frequenza. <ol><li> Ad esempio, se le differenze di livello acustico fra orecchie sono rispettivamente X 125, X 250, X 500, X 1000, X 2.000, 4.000 X, e X 8.000 a 125, 250. 500, 1.000, 2.000, 4.000, 8.000 Hz e, impostare l&#39;equalizzatore a 1.000 Hz a &quot;X 1000/2 - (X + 125 X 250 + 500 + X + X 1.000 X 2.000 X 4.000 + + X 8000) / 14&quot;. Nota: In caso dell&#39;audiogramma mostrato in Figura 3, l&#39;impostazione di 125, 250, 500, 1000, 2000, 4000, e 8000 Hz è -5, -3, 0, +2, +2, +5 equalizzatore, e 0 dB, rispettivamente. </li></ol></li><li> Chiedere ai pazienti di svolgere regolazioni fini delle impostazioni di livello e equalizzatore audio da loro stessi in modo tale che la musica suona come natural e confortevole possibile. Se l&#39;equalizzatore interno del lettore musicale non è sufficientemente efficace, utilizzare un equalizzatore hardware, come illustrato nella figura 2. </li><li> Chiedi pazienti se essi percepiscono la musica con l&#39;orecchio interessato per confermare che croce udito 34 non si verifica. Escludere i pazienti che ascoltano la musica con l&#39;orecchio inalterato collegato a causa di udito croce. </li></ol> 4. Procedura dopo l&#39;avvio CIST <ol><li> Istruire i pazienti che sono autorizzate a ricevere terapia standard per SSHL come i corticosteroidi, oltre al protocollo CIST. </li><li> Chiedi ai pazienti ascoltare musica per 6 ore al giorno con nell&#39;orecchio interessato utilizzando il tipo chiuso cuffia (Figura 1). Istruire i pazienti che il tempo che trascorrono l&#39;ascolto di musica può essere segmentato. Inoltre, permettono ai pazienti di svolgere altre attività (tra cui la lettura di un libro e navigare in internet) durante il tempo trascorso listening alla musica. </li><li> Indicare ai pazienti di utilizzare la chiocciola continuata fino a quando lasciano l&#39;ospedale. </li><li> Misurare i livelli di soglia di conduzione dell&#39;aria dell&#39;orecchio interessato ogni due giorni nello stesso modo dello step 2.1. Regolare il volume ed equalizzatore impostazioni come indicato nei passaggi 3.5 e 3.6. </li><li> Quando i pazienti vengono dimessi dall&#39;ospedale e quando tornano ambulatorialmente, misurano i livelli di soglia udienza nello stesso modo come al punto 2.1. </li></ol> 5. Cessazione del CIST <ol><li> Togliere lo stampo orecchio se i pazienti riferiscono disagio per quanto riguarda l&#39;orecchio intatto collegato (come tinnito o dolore). </li><li> Misurare livelli di soglia dell&#39;udito nell&#39;orecchio intatto nello stesso modo dello step 2.1. </li><li> Interrompere la procedura CIST se i livelli acustici mediati attraverso 500, 1.000, 2.000 Hz ottenuta nel passo 4.4 e / o 5.2 deteriorarsi più di 5 dB rispetto a quelli ottenuti nel passo 2.1. Ad esempio, nel caso della audiogramma mostrato in figura 3 </strong&gt;, i livelli acustici in media tra 500, 1.000, 2.000 Hz sono (40 + 40 + 45) / 3 = 41,7 dB nell&#39;orecchio interessato e (5 + 0 + 5) / 3 = 3,3 dB nell&#39;orecchio intatto. </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.

Improvvisa perdita dell&#39;udito neurosensoriale (SSHL), o sordità improvvisa, è una condizione idiopatica che è caratterizzata da una rapida perdita di udito 1. Diversi studi epidemiologici hanno riportato 2,3 SSHL tassi di incidenza di 5-30 casi ogni 100.000 persone l&#39;anno nei paesi industrializzati. Anche se le cause della SSHL e dei meccanismi alla base SSHL sono stati esaminati estensivamente, le nostre conoscenze sulla SSHL rimane limitato. Tra le molte potenziali cause di SSHL idiopatica, ipotesi comuni includono un disturbo circolatorio 4, infezione virale 5-7, e 8,9 autoimmune malattia. Sebbene la terapia con corticosteroidi 10 è stato proposto sulla base di queste ipotesi, ed è il trattamento più comunemente applicato, l&#39;efficacia di questa terapia standard è ancora in discussione 3,11-14. Pertanto, strategie di trattamento SSHL innovative, motivati ​​da prospettive diverse, sono fortemente voluti. SSHLcolpisce attività neurale non solo nella coclea, ma anche nella corteccia uditiva. Diversi studi di neuroimaging 15-17 hanno suggerito che la plasticità corticale SSHL indotta nella corteccia uditiva umana nel giro di pochi giorni dalla sua comparsa. Inoltre, il grado di riorganizzazione corticale rappresentato dalla perdita di controlaterale dominanza emisferica del evocati uditivi campi sembravano correlare negativamente con tassi di recupero da perdita dell&#39;udito 18. La plasticità corticale indotta dalla comparsa di SSHL può essere considerato come disadattamento per la capacità dell&#39;udito dell&#39;orecchio interessato. Pertanto, la prevenzione di questa riorganizzazione corticale disadattivi associato con SSHL può rappresentare una nuova strategia di trattamento. Questo articolo propone un approccio neuro-riabilitativo che impedisce &#39;appreso non uso&#39; cambiamenti corticali al fine di prevenire o ridurre disadattivi riorganizzazione corticale. Ad esempio, in caso di disfunzione motoria, il dotto non utilizzo diun limbis un fenomeno in cui il movimento è inizialmente soppresso a causa di reazioni avverse e il fallimento di qualsiasi attività tentato con l&#39;arto interessato, che alla fine si traduce nella soppressione di comportamento e relativa attività neurale 19,20. Imparato non utilizzo non sembra essere limitato a disfunzione motoria, ma può anche riguardare disabilità sensoriali 21. Pazienti SSHL usano principalmente e prestare attenzione per l&#39;orecchio intatto per l&#39;ascolto. Questo comportamento ascolto sembra aumentare attività neurale corrispondente all&#39;orecchio intatto e, allo stesso tempo, ridurre connessioni neurali tra coclea colpita e corteccia uditiva 22. Al fine di evitare che questo cambiamento corticale disadattivi indotto dal &#39;non uso&#39;, sembra essere di beneficio per i pazienti SSHL di eseguire &#39;costrizione indotta terapia del suono (CIST) &#39;23, che motiva i partecipanti di ascoltare la musica intensamente via nell&#39;orecchio interessato e di prestare attenzione uditiva all&#39;orecchio colpito(Figura 1). Rispetto alla terapia farmacologica convenzionale, il CIST presumibilmente è un approccio sicuro, facile, poco costoso ed efficace trattamento per 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

Improvvisa perdita dell&#39;udito neurosensoriale (SSHL) è caratterizzata da acuto, perdita dell&#39;udito idiopatica. Il tasso di incidenza stimata è di 5-30 casi ogni 100.000 persone per anno. Le cause di SSHL ei meccanismi alla base SSHL attualmente rimangono sconosciute. Sulla base di varie ipotesi, come un disturbo circolatorio alla coclea, infezione virale, e malattie autoimmuni, approcci farmaco-terapeutico sono stati applicati per il trattamento di pazienti SSHL; Tuttavia, l&#39;efficacia del trattamento standard, la terapia con corticosteroidi, è ancora in discussione. Esposizione a suoni intensi ha dimostrato di causare danni permanenti al sistema uditivo; tuttavia, l&#39;esposizione a un livello moderato arricchito ambiente acustico dopo un trauma rumore può ridurre problemi di udito. Diversi studi neuroimaging recentemente suggerito che l&#39;insorgenza di SSHL indotta disadattamento riorganizzazione corticale nella corteccia uditiva umana, e che il grado di riorganizzazione corticale in fase acuta SSHL negativamente corresaltato con il tasso di recupero di perdita dell&#39;udito. Questo articolo riporta lo sviluppo di un nuovo approccio neuro-riabilitazione per SSHL, &quot;terapia del suono costrizione indotta (CIST)&quot;. Lo scopo del protocollo CIST è prevenire o ridurre maladaptive riorganizzazione corticale utilizzando un ambiente acustico arricchito. Il canale dell&#39;orecchio intatta dei pazienti SSHL sia inserito al fine di motivarli a utilizzare attivamente nell&#39;orecchio interessato e impedire il progresso di disadattamento riorganizzazione corticale in tal modo. Nell&#39;orecchio interessato è inoltre esposto a musica attraverso una cuffia per 6 ore al giorno durante l&#39;ospedalizzazione. Il protocollo CIST sembra essere un trattamento sicuro, semplice, economico ed efficace per SSHL.

Ventidue pazienti ricoverati SSHL che ha trovato i criteri descritti nel protocollo e che erano disposti a ricevere CIST sono stati assegnati al gruppo target, che ha subito CIST in aggiunta alla terapia con corticosteroidi standard (gruppo CIST + SCT) 23. Il gruppo di controllo era costituito da 31 pazienti ricoverati SSHL che hanno ricevuto solo la terapia con corticosteroidi standard (gruppo SCT). Tutti i partecipanti sono stati pienamente informati sullo studio e hanno firmato un consenso secondo le procedure approvate dal Comitato Etico della Facoltà di Medicina, Università di Muenster, il Comitato Etico di Osaka University Hospital, e dal Comitato Etico di Osaka Rosai Hospital informati. Questo studio è stato condotto in conformità con la Dichiarazione di Helsinki. I partecipanti a ciascuno dei due gruppi (SCT + Cist vs SCT) avevano età simili e ritardi di tempo tra il verificarsi di SSHL e audiogramma iniziale. (1 ° esame), (ii) al momento della dimissione dall&#39;ospedale (2 ° esame: intervallo di tempo tra il 1 ° e 2 misure nd (media ± deviazione standard (SCT + CIST: 9.41 ± 3.14 giorni, SCT: 10,42 ± 3,18 giorni), e di nuovo (iii) un paio di mesi più tardi (3 esame rd: media ± deviazione standard (SCT + CIST: 63,45 ± 28,56 giorni , SCT: 84.64 ± 38,68 giorni)) con un audiometro tono puro. Come mostrato in Figura 4, prima del trattamento (1 misura st), nessuna differenza significativa è stata osservata in soglie uditive tra i gruppi a tutte le frequenze misurate (125, 250, 500, 1.000, 2.000, 4.000 e 8.000 Hz) nell&#39;orecchio interessato . Dopo il trattamento (2 ° e 3 esami Rd), l&#39;udito nell&#39;orecchio interessato era migliorata affatto Frequenza diper proiezione sia nel cista e SCT gruppi (Figura 4) SCT +. I livelli di soglia dell&#39;udito attraverso tutte le frequenze sono stati mediati per ciascun orecchio separatamente e poi acustici differenze di livello fra le orecchie sono stati calcolati (Figura 5). Le differenze di livello dell&#39;udito tra le orecchie colpite e intatti sono stati attribuiti a SSHL. Le differenze di livello dell&#39;udito calcolate tra le orecchie erano simili tra i gruppi prima del trattamento al 1 ° esame (Figura 5). Tuttavia, state osservate differenze significative tra i due gruppi al momento della dimissione dall&#39;ospedale (esame ° 2: P &lt;0,05 (Bonferroni-corretto)), e in un paio di mesi più tardi (esame 3 °: P &lt;0.001 (Bonferroni-corretto)). Per quanto riguarda i livelli di udito all&#39;orecchio intatto, le soglie medie non differivano significativamente tra i due gruppi in una qualsiasi delle frequenze in nessuno dei tre esami. Questo risultato indica che collegare °canale uditivo e non sembra avere un effetto negativo su un orecchio intatto. Nei 22 partecipanti che hanno subito CIST, effetti collaterali apparenti non sono state rispettate. <img alt="Figura 1" src="/files/ftp_upload/53264/53264fig1.jpg" /> Figura 1. Schema di terapia del suono costrizione indotta (CIST). Il canale dell&#39;orecchio intatto sia collegato al fine di motivare l&#39;utilizzo di nell&#39;orecchio interessato. La musica è in mono presentato nell&#39;orecchio interessato tramite una cuffia di tipo chiuso; l&#39;altro canale corrispondente per l&#39;orecchio intatto è mantenuta silente (questa cifra è stata adattata da Okamoto et al. 23:. Disegno per gentile concessione di Lothar Lagemann). <img alt="Figura 2" src="/files/ftp_upload/53264/53264fig2.jpg" /> Figura 2. Collegamenti e dispositivi da utilizzare in CIST. Un lettore musicale portatile, equalizzatore, amplificatore per cuffie, e di tipo chiuso<html> cuffie sono collegati in sequenza. Equalizzatore e amplificatore per cuffie vengono utilizzate solo quando l&#39;equalizzatore digitale del lettore musicale portatile non è sufficientemente efficace. <a href="https://www.jove.com/files/ftp_upload/53264/53264fig2large.jpg" target="_blank">Cliccate qui per vedere una versione più grande di questa figura.</a> <img alt="Figura 3" src="/files/ftp_upload/53264/53264fig3.jpg" /> . Figura 3. Un audiogramma esemplare di un paziente SSHL Questa cifra rappresenta i livelli acustici (range: da 125 a 8.000 Hz; gradini un&#39;ottava) nell&#39;orecchio interessato (di conduzione dell&#39;aria: cerchi aperti; Bone conduzione: a sinistra parentesi quadre) e l&#39;intatto orecchio (conduzione dell&#39;aria: croci; Osso di conduzione: parentesi quadre a destra) di un paziente SSHL prima del trattamento. <a href="https://www.jove.com/files/ftp_upload/53264/53264fig3large.jpg" target="_blank">Cliccate qui per vedere una versione più grande di questa 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 corso 4. Tempo di livello del volume medio della nell&#39;orecchio interessato Questa figura mostra i audiogrammi media (range: da 125 a 8.000 Hz; gradini un&#39;ottava) nelle orecchie interessate dei partecipanti che hanno subito la terapia del suono costrizione indotta oltre a ricevere norma terapia con corticosteroidi (CIST + SCT: piazze) o in coloro che hanno ricevuto solo la terapia con corticosteroidi di serie (SCT: piazze piene). Il 1 °, 2 °, e 3 ° esami audiometrici sono stati eseguiti (i) prima del trattamento, (ii) al momento della dimissione dall&#39;ospedale, e (iii) un paio di mesi più tardi, rispettivamente. Le barre di errore indicano intervalli di confidenza al 95% (questo dato è stato modificato da Okamoto et al., 23). <a href="https://www.jove.com/files/ftp_upload/53264/53264fig4large.jpg" target="_blank">Cliccate qui per vedere una versione più grande di questo fico</a>Ure. <img alt="Figura 5" src="/files/ftp_upload/53264/53264fig5.jpg" /> Figura 5. Significa udito differenza di livello tra le orecchie udito differenze soglia tra le orecchie colpite e intatti sono stati in media su tutte le frequenze misurate al 1 ° (a sinistra: prima del trattamento)., 2 ° (al centro: al momento della dimissione dall&#39;ospedale), e 3 ° (a destra: qualche mese più tardi) di tono puro esami audiometrici. Le piazze aperte e piene indicano la terapia del suono costrizione indotta + Standart gruppo terapia con corticosteroidi (CIST + SCT) e la terapia con corticosteroidi solo gruppo standard (SCT), rispettivamente. Le barre di errore indicano gli intervalli di confidenza al 95% (questa cifra è stata modificata da Okamoto et al., 23). <a href="https://www.jove.com/files/ftp_upload/53264/53264fig5large.jpg" target="_blank">Cliccate qui per vedere una versione più grande di questa 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.

Approccio Neuro-riabilitazione per improvvisa neurosensoriale Hearing Loss

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 Views.  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 metodo per studiare l'adattamento a sinistra-destra invertita 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 ...

Ricerca

Comportamento

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.

Test di localizzazione della sorgente sonora nella sordità monolaterale a seguito di intervento di conduzione ossea

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.

L&#39;approccio del mouse Round-finestra per ototossico Delivery Agent: Una rapida e tecnica affidabile per indurre la degenerazione delle cellule Cochlear

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.

Semplice induzione chirurgica della perdita dell'udito conduttiva con verifica utilizzando la visualizzazione dell'otoscopio e la risposta di clap di clap di comportamento in ratto

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

Neuroscienze

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.

Riabilitazione motoria strutturata dopo trasferimenti nervosi selettivi

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.

Valutazione della formazione di sostituzione sensoriale audio-tattile in partecipanti con sordità profonda utilizzando la tecnica del potenziale correlato all'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.

Analisi semi-automatica dell'ampiezza e della latenza di picco per le forme d'onda di risposta uditiva del tronco encefalico utilizzando 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.

Processo sistematico di valutazione delle prestazioni uditive per adolescenti con impianto cocleare in tenera età

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>Preservazione dell'udito con elettrodi lunghi nella stimolazione elettroacustica

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>Autore in primo piano: Ottimizzazione dell'EAS con elettrodi lunghi per una migliore copertura cocleare e la conservazione dell'udito

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.

Migliore copertura cocleare e preservazione dell'udito nell'ipoacusia ad alta frequenza grazie alla stimolazione elettroacustica con elettrodo più lungo

Approccio Neuro-riabilitazione per improvvisa neurosensoriale Hearing Loss

Riepilogo

Esplora Altri Video

PLAYLIST