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)".

倫理声明：プロシージャは、医学部の倫理委員会、ミュンスター大学、大阪大学医学部附属病院の倫理委員会で、大阪労災病院の倫理委員会によって承認されています。 機器の調製<ol><li> 図2に示すように、耳の金型、携帯型音楽プレーヤ、閉鎖型ヘッドホン、イコライザ、およびヘッドフォンアンプを得ます。 </li><li>携帯音楽プレーヤーで音楽の異なる種類（ポップ、ロック、クラシックなど）のライブラリーを準備します。 <ol><li>音楽のさまざまな種類のCDを入手します。 </li><li> （例えば、アドビオーディション3.0または類似の）サウンド編集アプリケーションを使用してコンピュータにCDから音楽を転送します。 <ol><li>コンピュータのCD-ROMドライブにオーディオCDを入れます。 CDからオーディオを抽出]&gt; [ファイル]を選択します。選択したドライブがサポートしているすべての抽出速度から最高速度オプションを選択します。 </li></ol></li><li>番目の確認音楽の音編集アプリケーション（例えば、アドビオーディション3.0または類似）を使用して、広い周波数範囲（ すなわち、125-8,000ヘルツまたは広い）を覆っています。 <ol><li> [編集]を選択することにより、波形をすべて選択&gt;波形全体を選択します。ウィンドウ&gt;周波数分析を選択してください。周波数分析パネルの縦軸に沿って表示横軸に周波数、振幅。 </li></ol></li><li>接続ケーブルを介して携帯音楽プレーヤーにコンピュータから音楽ファイルを転送します。 <ol><li> USBケーブルを使用して携帯音楽プレーヤーとコンピュータを接続します。 192 kbpsのビットレートでの.mp3ファイルなどの携帯音楽プレーヤーの[MUSIC]フォルダ内の音楽ファイルを保存します。 </li></ol></li></ol></li></ol> 2.参加者<ol><li>純音audiomeによって、修飾さHughson、ウェストレークの手順24に従って、5デシベルのステップサイズを使用して、両耳で閾値レベル（空気及び骨伝導）聴力測定ター。 <ol><li>千Hzにオージオメータの周波数制御を設定し、イヤホンにテストされるべきそのまま耳を設定します。 </li><li> 50デシベルの強度レベルを設定します。 </li><li>患者に千Hzのトーンを与えるために1秒間の音声プレゼンテーションボタンを押します。 （ボタンを押すか、手の調達を経て、 例えば ）の応答を待ちます。 </li><li>患者が音に反応した場合、ステップ2.1.3で説明したように10デシベルよりソフトなトーンを提示。患者が応答しない場合は、2.1.6に進みます。 </li><li>患者を繰り返しステップ2.1.4はもはや対応できません。 </li><li> 5デシベル大声でトーンを提示し、患者が応答するのを待ちます。 </li><li>患者が応答しない場合はステップ2.1.6を繰り返します。 </li><li>患者が応答することを最も軟らかい強度レベルに注意してください。 </li><li>手順を繰り返して、2.1.4-2.1.8同じ強度レベルは2回または3回を指摘されるまで。これは千Hzで確立された聴覚閾値です。 </li><li>テスト周波数のための手順を繰り返し2.1.2-2.1.92000、4000および8000ヘルツ。 </li><li> 1000Hzのための聴覚閾値を再テスト1000 Hzで第一および第二の閾値は5デシベル以内で一致することを確認します。 </li><li>テスト周波数500、250および125 Hzのための手順を2.1.2-2.1.9繰り返します。 </li><li>イヤホンにテストされる影響を受けた耳を設定し、ステップ2.1.2-2.1.12を繰り返します。左と右の聴覚閾値の差が等しいか、低い周波数（125、250、500 Hz）で25デシベルを超える、または等しいか超えた場合にプラトー法25を使用して、イヤホンを経由してテストされていない耳に適切な狭帯域マスキングノイズを提示千ヘルツ以上40デシベル。 </li><li>ステップ2.1.1-2.1.13と同様の方法でノイズをマスキングして骨伝導聴力閾値を測定します。骨伝導聴力を測定するために、代わりにヘッドフォンの骨伝導振動子を使用します。クロストークを回避するためにテストされていない耳に適切な狭帯域マスキングノイズ25を適用します。 </li><li>上のしきい値レベルを聞いプロットn個のオージオグラムの形。 SSHL患者の典型的な聴力図が 、図3に示されています。 </li></ol></li><li> CISTに参加するための基準を確認してください。 <ol><li> SSHL発症からの日数は、自己申告に基づいて、5未満であることを確認してください。 </li><li>ステップ2.1で得られた空気行っ純音聴力図に基づいて、耳の間の聴力レベル差が1000、500にわたって平均し、2,000ヘルツ未満50デシベルであることを確認します。 注： 図3に示したオージオグラムの場合、聴力レベル差が（40 + 40 + 45）/ 3である- （5 + 0 + 5）/ 3 = 38.3デシベル。 </li><li>患者が快適に彼らの影響を受けた耳で音楽を聴くことができることを確認します。 </li><li>患者はステップ2で得られた純音聴力図1上の3つ以上の隣接する周波数で（自己申告に基づいて）急性片側性難聴と少なくとも30デシベルの急性一方的な感音難聴の特発性状態に苦しんでいることを確認してください0.1。 例えば 、図3に示したオージオグラムの場合には、右耳250 Hzで上記聴力レベルは、少なくとも30デシベルの聴力損失を示しています。 </li><li>患者は自己申告と病歴に基づいてSSHLの以前の歴史を持っていないことを確認してください。また、彼らは自己申告と病歴に基づいて、神経学的または精神医学的合併症を持っていないことを確認します。 </li><li>鑑別診断を考えると、このようなメニエール病26、頭部外傷、自己免疫性内耳疾患8,9、コーガン症候群27,28、遺伝病29などの他の診断を受けた患者、耳毒性薬30を除外し 、前庭神経鞘腫31に関連した後迷路障害、聴覚神経障害32、または脳卒中33。 </li></ol></li></ol> 3.起動CIST 注：入院をpのために推奨されますatientsの安全性。患者はCISTの手順に固有のリスニングによる目詰まりや音楽への環境音から密封されているので、彼らの日常生活の中での事故の危険性が増加すると予想されます。 <ol><li>イヤモールドを使用している患者の罹患していない耳の外側の運河を差し込みます。密にスペースが外耳道に存在しないことを確実にするために、外管内にイヤモールドを詰めます。 </li><li>患者が痛みを感じるか、シールが不完全な場合、速やかにイヤモールドを削除してから、再挿入した場合。 </li><li>ライブラリから音楽の楽しいタイプを選択するために患者を確認して下さい。 注意：後者は十分に広い周波数範囲（125-8,000ヘルツ以上の幅）を覆っている場合、彼らはまた、独自の音楽を聴くことが許可されています。 </li><li>密閉型ヘッドホンを着用する患者を確認して下さい。 図1に示すようにのみ影響を受ける耳に選択された楽曲を提示。 </li><li>各FREの音のレベルを増加または減少させるためにイコライザーを使用波数ゲインレベルは、各周波数での耳の間のレベル差を聞くの半分の量と同一視されていることを述べ、「ハーフゲインルール」に記載の方法。 <ol><li>例えば、耳の間の聴力レベル差がそれぞれX 125、X 250、X 500、X 1,000 X 2,000、X 4000、およびX 125で8,000、250 500 1000、2000、4000、および8000 Hzのであれば、 「 - （X + 125 X 250 X 500 + + X 千 + X 2000 + X 4000 + X 8000）/ 14×1000/2」1,000 Hzでイコライザーを設定します。 注： 図3に示したオージオグラムの場合には、125、250、500 1000、2000、4000、およびヘルツで-5 8000、-3、0、2、2、5を設定するイコライザ、および0デシベル、それぞれ。 </li></ol></li><li>音楽はnと聞こえるように自分で音圧​​レベルやイコライザーの設定の微調整を行うために患者を掲載aturalと可能な限り快適。音楽プレーヤの内部イコライザが十分に有効ではない場合 、図2に示すように、ハードウェアのイコライザを使用。 </li><li>彼らはクロス聴覚34が発生していないことを確認するために、罹患耳で音楽を知覚するかどうかを患者に尋ねます。クロス聴覚による差し込ま影響を受けない耳で音楽を聞く人の患者を除外します。 </li></ol> 4.手順CISTを開始した後<ol><li>彼らは、このようなCISTプロトコルに加えて、コルチコステロイドとしてSSHLのための標準的な治療を受けることを許可している患者に指示します。 </li><li>患者は密閉型ヘッドホン（ 図1）を使用して 、影響を受けた耳で1日6時間、音楽を聴いています。彼らは音楽を聴いて過ごす時間をセグメント化することができることを患者に指示します。さらに、患者はLISTE費やした時間の間（本を読み、インターネットサーフィンを含む）他のタスクを実行することができます音楽に寧。 </li><li>彼らは病院を離れるまで、すべての日の耳の型を使用するよう患者に指示します。 </li><li>ステップ2.1と同様に2日ごとに、影響を受けた耳の気導閾値レベルを測定します。ステップ3.5と3.6で述べたように、ボリュームやイコライザ設定を調整します。 </li><li>患者は退院し、それらが外来患者として戻ると、ステップ2.1と同様に聴覚閾値レベルを測定しているとき。 </li></ol> CISTの5停止<ol><li>患者は（そのような耳鳴りや痛みなど）差し込まそのまま耳に関する不快感を報告した場合、耳の型を削除します。 </li><li>ステップ2.1と同様にそのまま耳にしきい値レベルを聞いて測定します。 </li><li>聴力レベルがステップ4.4および/または5.2で得られた2000 Hzのステップ2.1で得られたものに比べて5デシベル以上に悪化、千、500にわたって平均場合CISTの手続きを停止します。たとえば、聴力図の場合には、図3に示され</strongが&gt;、聴力レベルが2,000ヘルツが影響を受けた耳の中（40 + 40 + 45）/ 3 = 41.7デシベルと無傷の耳の中に（5 + 0 + 5）/ 3 = 3.3デシベルであり、500、千にわたって平均。 </li></ol>

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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.

突然の感音難聴（SSHL）、または突発性難聴は、1を聞いての急速な損失によって特徴付けられる特発性状態です。いくつかの疫学的研究2,3は、先進国では年間10万人あたり5〜30例SSHL発生率を報告しました。 SSHLの原因とSSHLの基礎となるメカニズムは広く検討されているにもかかわらず、SSHLに関する我々の知識は限られています。特発性SSHLの多くの潜在的な原因の中で、一般的な仮説は、循環障害4、ウイルス感染5-7、および自己免疫疾患8,9が含まれます 。コルチコステロイド治療10は、これらの仮説に基づいて提案し、最も一般的に適用される治療法であるたが、この標準的治療の有効性はまだ3,11-14に議論されています。そのため、異なる視点が動機革新的なSSHLの治療戦略は、強く望まれています。 SSHL蝸牛ではなく、聴覚皮質だけでなく神経活動に影響を与えます。いくつかの神経画像研究15-17 SSHLはその発症の数日以内に、人間の聴覚皮質における皮質の可塑性を誘導することが示唆されました。また、聴覚誘発フィールドの対側半球優勢の損失によって表される皮質再編の程度が負損失18を聞いてから、回収率と相関するように見えました。 SSHLの発現によって誘導される皮質の可塑性は、影響を受けた耳の聴覚機能のための不適応と考えることができます。したがって、SSHLに関連したこの不適応皮質再編の予防は、新たな治療戦略を表すことができます。 この記事では、不適応皮質再編成を防止または軽減するために皮質の変化 &#39;非使用を学んだ」防止ニューロリハビリテーションのアプローチを提案しています。例えば、運動機能障害の場合には、学習された未使用の最初に起因する副作用を抑制し、すべての活動の障害が最終的行動の抑制とそれに対応する神経活動19,20になり患肢で試行する動き現象をlimbis。学習された不使用は、運動機能障害に限定されるものでは表示されませんが、また、感覚障害21に関するものであってもよいです。 SSHL患者が主に使用し、リスニングのためにそのまま耳に注意を払います。このリスニングの動作はそのまま耳に対応する神経活動を増加させると同時に、影響を受けた蝸牛と聴覚皮質22との間の神経接続を減らすために表示されます。 「不使用」によって誘導され、この不適応皮質の変化を防止するためには、SSHL患者は、影響を受けた耳を介して集中的に音楽を聴くために、参加者の動機「制約によって誘発される音響療法（CIST）&#39;23を実行するために有益であると思われます影響を受けた耳に聴覚注意を払います（ 図1）。従来の薬物療法と比較すると、CISTはたぶんSSHLため、安全で簡単に、安価で、かつ効果的な治療法です。

<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

突然の感音難聴（SSHL）は、急性、突発性難聴によって特徴付けられます。推定発症率は年間10万人あたり5〜30例です。 SSHLの原因と現在SSHLの根底にあるメカニズムは不明のままです。このような蝸牛への循環障害、ウイルス感染、および自己免疫疾患などのいくつかの仮定に基づいて、薬理学的治療法はSSHL患者を治療するために適用されています。しかし、標準的な治療、コルチコステロイド療法の有効性は、議​​論中です。激しい音への暴露は、聴覚系に永久的な損傷を引き起こすことが示されています。しかし、適度なレベルへの暴露は、聴覚障害を減らすことができるノイズ外傷後の音響環境を豊かに。いくつかの神経画像研究は、最近SSHLの発症は、人間の聴覚皮質で不適応皮質再編を誘導することを示唆し、急性SSHL段階負CORRにおける皮質再編の度合いこと難聴からの回復率と大喜び。この記事ではSSHL、「制約によって誘発される音響療法（CIST）」のための新たなニューロリハビリテーション手法の開発を報告します。 CISTプロトコルの目的は、予防または濃縮された音響環境を使用して、不適応皮質の再編成を低減することです。 SSHL患者の無傷の耳の外耳道を積極的に影響を受けた耳を使用することにより、不適応皮質再編の進行を防ぐためにそれらをやる気にさせるために接続されています。影響を受けた耳も入院中の1日6時間、ヘッドホンで音楽にさらされています。 CISTプロトコルはSSHLため、安全で簡単に、安価で、かつ効果的な治療であるように思われます。

プロトコールに記載された基準に一致すると二十二SSHL入院患者は、標準的なコルチコステロイド療法（CIST + SCTグループ）23に加えて、CISTを受けたターゲットグループに割り当てられたCISTを受け取るために喜んでいました。対照群には、標準的なコルチコステロイド療法（SCT群）を受信し31 SSHL入院患者から成りました。すべての参加者は、研究について十分知らされたと倫理医療学部の委員会、ミュンスター大学、大阪大学医学部附属病院の倫理委員会、大阪労災病院の倫理委員会によって承認された手順に従って書面によるインフォームドコンセントを与えました。この研究は、ヘルシンキ宣言に従って行われました。二つのグループ（SCT対SCT + CIST）のそれぞれの参加者はSSHLの発生と初期オージオグラムの間で同様の年齢や時間遅延を持っていました。 回目の検査）、（ii）の病院（2 回目の検査から退院時：1 回目と2 回目の測定値の間の時間間隔9.41±3.14日、SCT：10.42±3.18日）、そして再び（iii）の数ヶ月後（3 回目の検査：平均値±標準偏差（SCT + CIST：63.45±28.56日（標準偏差（SCT + CIST平均± 、SCT：84.64±38.68日））純音オージオメータを使用して。 図4に示すように、処理（1 回目の測定）の前に、有意な差は、影響を受けた耳内のすべての測定された周波数（125、250、500 1000、2000、4000、及び8000ヘルツ）での群間の閾値を聴覚で観察されませんでした。処理後（2 回目と3 回目の検査）、影響を受けた耳で聞いて、すべてのfrequで改善しましたSCT + CISTとSCTグループ（ 図4）の両方でencies。すべての周波数にわたって聴覚閾値レベルは、別々に各耳について平均したと耳との間のその後聴力レベル差（図5）を算出しました。影響を受けるとそのまま耳の間の聴力レベル差がSSHLに起因するものでした。耳の間の計算された聴力レベル差が1の検査（ 図5）での処理の前に群間で同様でした。数ヶ月で、後（3 回目の検査：P &lt;0.001（ボンフェローニ補正後））：しかし、有意差は病院（P &lt;0.05（ボンフェローニ補正後）2 回目の検査）からの放電で両群間で観察されました。そのまま耳で聴力レ​​ベルについては、平均値のしきい値を大幅に3試験のいずれかの周波数のいずれかで群間で差はなかったです。この結果は、目を塞ぐことが示されEの外耳道は、無傷の耳に悪影響を与えるようには見えませんでした。 CISTを受けた22の参加者では、見かけ上の副作用は観察されませんでした。 <img alt="図1" src="/files/ftp_upload/53264/53264fig1.jpg" /> 制約によって誘発される音響療法（CIST）の図1模式図。そのまま耳の外耳道は、影響を受ける耳の使用をやる気にさせるために接続されています。音楽はモノラル密閉型ヘッドホンを経由して、影響を受けた耳に提示されます。そのまま耳に対応する他のチャンネルが（この図は、岡本ら 23から適応されています。：ローターLagemannの礼儀を描く）黙っています。 <img alt="図2" src="/files/ftp_upload/53264/53264fig2.jpg" /> 図CISTで使用する2.接続とデバイス。携帯音楽プレーヤー、イコライザー、ヘッドフォンアンプ、および閉鎖型<html>ヘッドフォンが順次接続されています。イコライザーとヘッドフォンアンプは、携帯音楽プレーヤーのデジタルイコライザが十分に効果的ではない場合にのみ使用されている。 <a href="https://www.jove.com/files/ftp_upload/53264/53264fig2large.jpg" target="_blank">この図の拡大版をご覧になるにはこちらをクリックしてください。</a> <img alt="図3" src="/files/ftp_upload/53264/53264fig3.jpg" /> 。図3. SSHL患者の典型的な聴力図この図は、聴力レベルを表します（範囲：125〜8000ヘルツ、1オクターブステップ）影響を受けた耳（空気伝導：白丸;骨伝導は：角括弧を左）と、そのまま治療前SSHL患者の：;：耳（右の角括弧空気伝導骨伝導十字）。 <a href="https://www.jove.com/files/ftp_upload/53264/53264fig3large.jpg" target="_blank">この図の拡大版をご覧になるにはこちらをクリックしてください。</a> 1 &quot;&gt;：&quot; =キープtogether.withinページFO」e_content <img alt="図4" src="/files/ftp_upload/53264/53264fig4.jpg" /> 影響を受けた耳の平均聴力レベルの図4時間経過この図は、平均オージオグラムを示す（範囲：125〜8000ヘルツ、1オクターブステップ）標準を受信することに加えて、制約によって誘発される音の治療を受けた参加者の影響を受けた耳にします。コルチコステロイド療法（CIST + SCT：白四角）または唯一の標準的なコルチコステロイド療法受けた患者における（SCT：黒四角）を。 第 1、 第 2、 および第3 の聴力検査が行われた病院からの退院時の処理前（I）、（II）、および（iii）数ヵ月後、それぞれ。エラーバーは、（この図は、岡本らから変更されている。23）95％信頼区間を示す。 <a href="https://www.jove.com/files/ftp_upload/53264/53264fig4large.jpg" target="_blank">この図の拡大版を表示するには、こちらをクリックしてください</a>URE。 <img alt="図5" src="/files/ftp_upload/53264/53264fig5.jpg" /> 図5は、耳の間のレベル差を聞い平均 （左：処理前）第一に、影響を受けるとそのまま耳の間のしきい値の差が、すべての測定周波数にわたって平均したヒアリング 。、第二（センター：病院から退院時）、および第三（右：数ヶ月後）純音聴力検査。オープンと黒四角は、それぞれの制約によって誘発される音療法+標準コルチコステロイド療法群（CIST + SCT）と標準的なコルチコステロイド療法単独群（SCT）を意味します。エラーバーは95％信頼区間（この図は、岡本ら 23から変更されている）を示す。 <a href="https://www.jove.com/files/ftp_upload/53264/53264fig5large.jpg" target="_blank">この図の拡大版をご覧になるにはこちらをクリックしてください。</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.

突然の感音難聴のためのニューロリハビリテーションアプローチ

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 ビュー.  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.

ビデオ: 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.

左から右への適応を研究する方法を逆にオーディション

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 ...

行動学

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.

骨伝導介入後の片側難聴における音源定位試験

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.

蝸牛細胞の変性を誘導するための迅速かつ信頼性の高いテクニック：耳毒性剤送達のためのマウスラウンドウィンドウアプローチ

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

医学

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.

ラットにおける耳鏡可視化と行動拍手驚き応答を用いた検証による導電性難聴の単純な外科的誘導

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

神経科学

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.

選択的神経移動後の構造化運動リハビリテーション

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.

イベント関連電位技術を用いた重度難聴参加者における音声触覚代替訓練の評価

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.

Rを用いた聴覚脳幹応答波形のピーク振幅と潜時の半自動解析

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.

早期に人工内耳を留置した青年のための系統的聴力評価プロセス

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>電気音響刺激における長電極による聴力保存

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>著者スポットライト:蝸牛のカバー範囲と聴力保存を強化するための長い電極によるEASの最適化

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.

突然の感音難聴のためのニューロリハビリテーションアプローチ

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