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)".

Declaração de Ética: Os procedimentos foram aprovados pelo Comitê de Ética da Faculdade de Medicina da Universidade de Muenster, o Comitê de Ética do Hospital Universitário Osaka, e pelo Comitê de Rosai Hospital Osaka Ética. 1. Preparação do Equipamento <ol><li> Obter molde do ouvido, leitor de música portátil, do tipo fechado auscultadores, equalizador, amplificador de auscultadores e como mostrado na Figura 2. </li><li> Prepare bibliotecas de diferentes tipos de música (pop, rock, etc. clássica) no leitor de música portátil. <ol><li> Obter CDs de diferentes tipos de música. </li><li> Transferir músicas de CDs para o computador usando um aplicativo de edição de som (por exemplo, o Adobe Audition 3.0 ou similar). <ol><li> Coloque um CD de áudio na unidade de CD-ROM do computador. Escolha Arquivo&gt; extrair o áudio do CD. Escolha a opção de velocidade máxima de todas as velocidades de extração que a unidade selecionada suporta. </li></ol></li><li> Confirme thna música abrange uma ampla faixa de freqüência (ou seja, 125-8,000 Hz ou mais amplo) usando um aplicativo de edição de som (por exemplo, o Adobe Audition 3.0 ou similar). <ol><li> Selecionar tudo de uma forma de onda, escolhendo Editar&gt; Selecionar Todo o Wave. Escolha Janela&gt; Análise de freqüência. Ver frequência ao longo do eixo horizontal e amplitude sobre o eixo vertical no painel de análise de frequências. </li></ol></li><li> Transferir arquivos de música do computador para um leitor de música portátil através de um cabo de conexão. <ol><li> Conecte leitor de música portátil e computador usando o cabo USB. Salvar arquivos de música na pasta [MUSIC] do leitor de música portátil como arquivos .mp3 a uma taxa de 192 kbps. </li></ol></li></ol></li></ol> 2. Os participantes <ol><li> Medir os níveis de limiar de audição de condução de ar (e o osso) em ambas as orelhas utilizando um tamanho de passo de 5 dB em conformidade com o procedimento Hughson-Westlake modificado 24, por meio de um tom puro audiometer. <ol><li> Defina o controle de um audiômetro a 1.000 Hz de frequência e definir a orelha intacta para ser testado para o fone de ouvido. </li><li> Defina o nível de intensidade de 50 dB. </li><li> Pressione o botão de apresentação de som por 1 segundo para dar aos pacientes o tom de 1.000 Hz. Esperar por sua resposta (por exemplo, via botão de imprensa ou angariação de mão). </li><li> Se os pacientes respondem ao tom, apresentar um tom mais suave de 10 dB do modo descrito no passo 2.1.3. Se os pacientes não respondem, vá para o passo 2.1.6. </li><li> Repita o passo 2.1.4 até que os pacientes não podem responder por mais tempo. </li><li> Apresente a 5 dB tom mais alto e esperar que os pacientes para responder. </li><li> Repita o passo 2.1.6, se os pacientes não respondem. </li><li> Note-se a nível de intensidade mais suave que os pacientes respondem ao. </li><li> Repetir passos 2.1.4-2.1.8 até que o mesmo nível de intensidade é de notar duas ou três vezes. Este é o limiar de audição estabelecido em 1000 Hz. </li><li> Repita os passos 2.1.2-2.1.9 para frequências de teste2.000, 4.000 e 8.000 Hz. </li><li> Testar novamente o limiar auditivo para 1000 Hz e confirmar que o primeiro e segundo valores de referência a 1.000 Hz acordo, dentro de 5 dB. </li><li> Repita os passos 2.1.2-2.1.9 para frequências de teste 500, 250 e 125 Hz. </li><li> Defina a orelha afetada a ser testado para o fone de ouvido e repita os passos 2.1.2-2.1.12. Apresentar um ruído de banda estreita uma máscara apropriada para o ouvido não testado através do fone de ouvido usando o método plateau 25 se a diferença entre limiares auditivos esquerdo e direito é igual ou superior a 25 dB nas frequências mais baixas (125, 250, e 500 Hz), ou seja igual ou superior 40 dB iguais ou superiores a 1.000 Hz. </li><li> Medir limiares auditivos de condução óssea com ruído mascarante de forma semelhante como nos passos 2.1.1-2.1.13. Para medir a audiência de condução óssea, use o vibrador de condução óssea em vez de fones de ouvido. Aplicar um ruído de banda estreita 25 uma máscara apropriada para o ouvido não testado, a fim de evitar a interferência. </li><li> Traçar limiar auditivo em umforma audiograma n. Um audiograma exemplar de um paciente SSS é mostrado na Figura 3. </li></ol></li><li> Verifique os critérios para a participação em CIST. <ol><li> Verifique se o número de dias desde o início da surdez súbita é inferior a 5 com base no auto-relato. </li><li> Confirme que a diferença de nível de audição entre as orelhas média entre 500, 1000, e 2000 Hz é inferior a 50 dB com base no audiograma tonal realizada ao ar obtida na etapa 2.1. Nota: No caso do audiograma mostrado na Figura 3, a diferença de nível de audição é (40 + 40 + 45) / 3 - (5 + 0 + 5) / 3 = 38,3 dB. </li><li> Confirme que os pacientes podem confortável para ouvir a música com sua orelha afetada. </li><li> Confirme que os pacientes sofrem de perda auditiva unilateral aguda (com base na auto-relato) e condição idiopática de perda auditiva neurossensorial unilateral aguda de pelo menos 30 dB, em três ou mais freqüências adjacentes em um audiograma tonal 1 obtida na etapa 2.1. Por exemplo, no caso do audiograma mostrado na Figura 3, os níveis de audiência e acima de 250 Hz na orelha direita indicam a perda de audição neurossensorial de pelo menos 30 dB. </li><li> Confirme se os pacientes não têm nenhuma história prévia de SSHL com base no auto-relato e histórico médico. Também confirmam que não têm quaisquer complicações neurológicas ou psiquiátricas baseadas em auto-relatos e histórico médico. </li><li> Considere diagnósticos diferenciais e excluir os pacientes que receberam outros diagnósticos como doença de Ménière 26, traumatismo craniano, doença auto-imune da orelha interna 8,9, síndrome de Cogan 27,28, doenças genéticas 29, drogas ototóxicas 30, distúrbios retrococleares relacionadas com schwannoma vestibular 31 , neuropatia auditiva 32, 33 ou acidente vascular cerebral. </li></ol></li></ol> 3. A partir CIST Nota: A hospitalização é recomendado para o psegurança dos atients. Uma vez que os pacientes são selados de sons ambientais, devido ao entupimento e ouvir música inerente ao procedimento CIST, é esperado o risco de acidentes na sua vida quotidiana a aumentar. <ol><li> Ligue o canal externo do ouvido afetado dos pacientes em uso de um molde auricular. Firmemente embalar o molde auricular no canal externo para garantir que nenhum espaço existe no conduto auditivo externo. </li><li> Se os pacientes sentem dor ou se a vedação é incompleta, remover o molde do ouvido prontamente e, em seguida, recoloque-o. </li><li> Pergunte aos pacientes para escolher um tipo agradável de música a partir das bibliotecas. Nota: Eles também têm permissão para ouvir a sua própria música se este último abrange uma faixa de freqüência suficientemente larga (125-8,000 Hz ou mais amplo). </li><li> Pergunte aos pacientes a usar um tipo de fone de ouvido fechado. Apresentar a música seleccionada apenas para o ouvido afectado, como mostrado na Figura 1. </li><li> Utilize um equalizador, para aumentar ou diminuir o nível de som de cada frequência de acordo com uma &quot;regra de meia-ganho&quot;, que afirma que o nível de ganho é equiparado a metade do montante de ouvir diferença de nível entre as orelhas em cada frequência. <ol><li> Por exemplo, se as diferenças de nível de audiência entre as orelhas são X 125 X 250 X 500 X 1000, 2000 X, 4000 X, e X 8.000 a 125, 250. 500, 1.000, 2.000, 4.000, e 8.000 Hz, respectivamente, definir o equalizador a 1.000 Hz para &quot;X 1000/2 - (X 125 X + 250 + 500 + X X X 1000 + 2000 + 4000 + X X 8000) / 14&quot;. Nota: No caso do audiograma mostrado na Figura 3, a configuração em 125, 250, 500, 1.000, 2.000, 4.000, e 8.000 Hz é -5, -3, 0, 2, 2, 5 equalizador, e 0 dB, respectivamente. </li></ol></li><li> Pergunte aos pacientes para realizar ajustes finos das definições de nível e equalização de som por si de tal modo que a música soa como natural e confortável possível. Se o equalizador interna do leitor de música não é suficientemente eficaz, utilizar um equalizador de hardware, como mostrado na Figura 2. </li><li> Pergunte aos pacientes se eles percebem a música com o ouvido afetado, a fim de confirmar que a audição cruzada 34 não ocorre. Excluir os pacientes que ouvem música com o ouvido afetado conectado devido a audição cruz. </li></ol> 4. Procedimento após iniciar CIST <ol><li> Instrua os pacientes que eles estão autorizados a receber a terapia padrão para SSHL tais como corticosteróides, além do protocolo CIST. </li><li> Ter os pacientes ouvir música durante 6 horas por dia, com o ouvido afetado usando o fone de ouvido do tipo fechado (Figura 1). Instrua os pacientes que o tempo que passam ouvindo música pode ser segmentados. Além disso, permitir que os pacientes para executar outras tarefas (incluindo a leitura de um livro e navegar na internet) durante o tempo gasto listening a música. </li><li> Instrua os pacientes a usar o molde do ouvido durante todo o dia, até deixarem o hospital. </li><li> Medir os níveis de limiar de condução do ar do ouvido afectado a cada dois dias, do mesmo modo como no passo 2.1. Ajustar o volume e equalizador configurações conforme mencionado nas etapas 3.5 e 3.6. </li><li> Quando os pacientes recebem alta hospitalar e quando eles retornam em ambulatório, medir os níveis de limiar auditivo, da mesma forma como no passo 2.1. </li></ol> 5. Cessação do CIST <ol><li> Retire o molde auricular se os pacientes relatam desconforto em relação à orelha intacta ligado (tal como o zumbido ou dor). </li><li> Medir os níveis de limiar de audição no ouvido intacto do mesmo modo como no passo 2.1. </li><li> Pare o procedimento CIST se os níveis de audiência na média de 500, 1.000, 2.000 Hz obtido na etapa 4.4 e / ou 5.2 se deteriorar mais de 5 dB em comparação com os obtidos no passo 2.1. Por exemplo, no caso do audiograma mostrado na Figura 3 </strong&gt;, os níveis de audiência média entre 500, 1.000, 2.000 Hz são (40 + 40 + 45) / 3 = 41,7 dB na orelha afetada e (5 + 0 + 5) / 3 = 3,3 dB na orelha intacta. </li></ol>

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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.

Súbita perda auditiva neurossensorial (SSS), ou surdez súbita, é uma condição idiopática que se caracteriza por uma rápida perda de audição 1. Vários estudos epidemiológicos 2,3 relatado taxas de incidência de SS de 5-30 casos por 100.000 pessoas por ano nos países industrializados. Mesmo que as causas de surdez neurossensorial súbita e os mecanismos subjacentes SSHL foram examinados extensivamente, o nosso conhecimento sobre SSS permanece limitado. Entre as muitas causas potenciais de surdez neurossensorial súbita idiopática, hipóteses comuns incluem um distúrbio circulatório 4, infecção viral 5-7, e 8,9 doença auto-imune. Embora a terapia de corticosteróides 10 foi proposta com base em tais hipóteses, e é o tratamento mais comumente aplicado, a eficácia desta terapia padrão ainda está sendo debatido 3,11-14. Portanto, as estratégias de tratamento da surdez súbita inovadoras, motivadas por diferentes perspectivas, são fortemente desejado. SSHLafecta a actividade neural, não só na cóclea, mas também no córtex auditivo. Vários estudos de neuroimagem 15-17 sugeriu que SSHL induzida plasticidade cortical no córtex auditivo humano dentro de poucos dias de seu início. Além disso, o grau de reorganização cortical representado pela perda de dominância hemisférica contralateral da evocados auditivos campos apareceu correlacionar negativamente com as taxas de recuperação da perda auditiva 18. A plasticidade cortical induzida pelo início da surdez súbita pode ser considerada como má adaptação para a capacidade auditiva do ouvido afetado. Portanto, a prevenção dessa reorganização cortical mal-adaptativo associado à surdez súbita pode representar uma nova estratégia de tratamento. Este artigo propõe uma abordagem neuro-reabilitação que impede &#39;aprendi a não utilização &quot;alterações corticais, a fim de prevenir ou reduzir a reorganização cortical maladaptive. Por exemplo, em casos de disfunções motoras, aprendeu a não-utilização deum limbis um fenômeno em que o movimento é inicialmente suprimidos, devido a reações adversas eo fracasso de qualquer atividade tentada com o membro afetado, o que, eventualmente, resulta na supressão do comportamento e da correspondente actividade neural 19,20. Não-uso aprendido não parece ser limitado a disfunção motora, mas poderão incidir também sobre deficiências sensoriais 21. Pacientes de SS utilizam principalmente e preste atenção à orelha intacta para ouvir. Este comportamento de audição parece aumentar a actividade neural correspondente à orelha intacta e, ao mesmo tempo, reduzir as conexões neurais entre a cóclea afectada e córtex auditivo 22. A fim de evitar esta mudança cortical maladaptive induzida por «não utilização», que parece ser benéfico para pacientes de SS para executar &quot;terapia de som induzido por restrição (CIST) &#39;23, o que motiva os participantes a ouvir música intensivamente através do ouvido afetado e prestar atenção auditivo para o ouvido afetado(Figura 1). Em comparação com a farmacoterapia convencional, o CIST supostamente é uma abordagem de tratamento seguro, fácil, barata e eficaz para SSHL.

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

neuro-rehabilitation approach for sudden sensorineural hearing loss

Perda auditiva neurossensorial súbita (SS) é caracterizada por perda auditiva aguda, idiopática. A taxa de incidência estimada é de 5-30 casos por 100.000 pessoas por ano. As causas da surdez súbita e os mecanismos subjacentes SSHL atualmente permanecem desconhecidos. Com base em diversas hipóteses, como uma perturbação circulatória para a cóclea, infecção virai, e doenças auto-imunes, as abordagens fármaco-terapêutico têm sido aplicados para o tratamento de pacientes de SS; No entanto, a eficácia do tratamento padrão, a terapia corticosteróide, está ainda sob debate. A exposição a sons intensos foi mostrado para causar danos permanentes ao sistema auditivo; no entanto, a exposição a um nível moderado enriquecido ambiente acústico após o trauma ruído pode reduzir deficiências auditivas. Vários estudos de neuroimagiologia sugeriu recentemente que o início da SSS reorganização cortical induzida maladaptativa no córtex auditivo humano, e que o grau de reorganização cortical na fase aguda negativa SSS correxultante com a taxa de recuperação de perda auditiva. Este artigo relata o desenvolvimento de uma abordagem neuro-reabilitação romance para SSHL, &quot;terapia de som induzido por restrição (CIST)&quot;. O objectivo do protocolo CIST é para prevenir ou reduzir a reorganização cortical maladaptativa usando um ambiente acústico enriquecido. O canal do ouvido intacto de pacientes de SS está ligado a fim de motivá-los a usar ativamente o ouvido afetado e, assim, impedir o progresso da reorganização cortical maladaptive. O ouvido afetado também está exposta a música através de um fone de ouvido durante 6 horas por dia durante a hospitalização. O protocolo CIST parece ser um tratamento seguro, fácil, barato e eficaz para o SS.

Vinte e dois pacientes internados de SS que se encaixaram nos critérios descritos no protocolo e que estavam dispostos a receber CIST foram designados para o grupo-alvo, que sofreu CIST, além de corticoterapia padrão (grupo CIST + SCT) 23. O grupo controle foi composto por 31 pacientes internados SSHL que receberam apenas a terapia de corticosteróides padrão (grupo SCT). Todos os participantes foram devidamente informados sobre o estudo e deram consentimento por escrito de acordo com os procedimentos aprovados pelo Comitê de Ética da Faculdade de Medicina da Universidade de Muenster, o Comitê de Ética do Hospital Universitário de Osaka, e pelo Comitê de Osaka Rosai Ética do Hospital informado. Este estudo foi realizado em conformidade com a Declaração de Helsinki. Os participantes em cada um dos dois grupos (SCT + Cist vs. SCT) tinham idades semelhantes e atrasos de tempo entre a ocorrência de surdez súbita e audiograma inicial. (1º exame), (ii) no momento da alta hospitalar (2º exame: intervalo de tempo entre a 1ª e 2 ª medições (média ± desvio padrão (SCT + CIST: 9,41 ± 3,14 dias, SCT: 10,42 ± 3,18 dias) e, novamente, (iii) alguns meses mais tarde (3 exame rd: média ± desvio padrão (SCT + CIST: 63,45 ± 28,56 dias , SCT: 84.64 ± 38,68 dias)), utilizando um audiômetro tom puro. Como mostrado na Figura 4, antes do tratamento (1 medição st), não foram observadas diferenças significativas nos limiares entre os grupos audição em todas as freqüências medidos (125, 250, 500, 1.000, 2.000, 4.000 e 8.000 Hz) no ouvido afetado . Após o tratamento (2º e 3 exames rd), a audição no ouvido afetado tinha melhorado em tudo frequacetatos, tanto a cist e SCT grupos (Figura 4) de SCT +. Os níveis limite de audição em todas as frequências foram calculadas para cada orelha separadamente e depois auditivos diferenças de nível entre as orelhas foram calculados (figura 5). As diferenças de nível de audição entre as orelhas comprometida e intactos foram atribuídos a SSS. As diferenças de nível de audição calculados entre as orelhas foram semelhantes entre os grupos antes do tratamento no exame st 1 (Figura 5). No entanto, não foram observadas diferenças significativas entre os dois grupos na alta do hospital (exame nd 2: P &lt;0,05 (Bonferroni-corrigida)) e, alguns meses mais tarde (3º exame: P &lt;0,001 (Bonferroni-corrigida)). Em relação aos níveis de audição no ouvido intacto, a média dos limiares não diferiram significativamente entre os grupos em nenhuma das freqüências em qualquer um dos três exames. Este resultado indicou que o ligando thdo canal auditivo e não pareceu ter um efeito negativo sobre a orelha intacta. Nos 22 participantes que se submeteram CIST, efeitos colaterais aparentes não foram observados. <img alt="figura 1" src="/files/ftp_upload/53264/53264fig1.jpg" /> Figura 1. Ilustração esquemática da terapia de som induzido por restrição (CIST). O canal do ouvido intacto está ligado a fim de motivar o uso do ouvido afetado. A música é monoauralmente apresentado ao ouvido afetado por meio de um fone de ouvido do tipo fechado; o outro canal correspondente à orelha intacta é mantido em silêncio (Esta figura foi adaptado a partir Okamoto et al. 23:. Desenho cortesia de Lothar Lagemann). <img alt="Figura 2" src="/files/ftp_upload/53264/53264fig2.jpg" /> Figura 2. Conexões e dispositivos para usar em CIST. Um leitor de música portátil, equalizador, amplificador de auscultadores, e de tipo fechado<html> auscultadores são sequencialmente ligado. Equalizador e amplificador de auscultadores são usados ​​apenas quando o equalizador digital do leitor de música portátil não é suficientemente eficaz. <a href="https://www.jove.com/files/ftp_upload/53264/53264fig2large.jpg" target="_blank">Por favor clique aqui para ver uma versão maior desta figura.</a> <img alt="Figura 3" src="/files/ftp_upload/53264/53264fig3.jpg" /> . Figura 3. Um audiograma exemplar de um paciente SSHL Esta figura representa os níveis de audiência (variação: de 125 a 8.000 Hz; passos uma oitava) no ouvido afetado (condução Air: círculos abertos; condução óssea: deixou colchetes) eo intacta orelha (Air condução: cruzes; condução óssea: suportes direito quadrados) de um paciente SSHL antes do tratamento. <a href="https://www.jove.com/files/ftp_upload/53264/53264fig3large.jpg" target="_blank">Por favor clique aqui para ver uma versão maior desta figura.</a> e_content &quot;fo: manter-together.within-page =&quot; 1 &quot;&gt; <img alt="Figura 4" src="/files/ftp_upload/53264/53264fig4.jpg" /> . Figura 4. Tempo de curso de nível médio audição no ouvido afetado Esta figura mostra os audiogramas médios (variação: de 125 a 8.000 Hz; passos uma oitava) nas orelhas comprometida dos participantes que se submeteram à terapia de som restrição induzida além de receber padrão corticoterapia (CIST + SCT: quadrados abertos) ou em aqueles que só receberam corticosteróide padrão (SCT: quadrados preenchidos). O 1º, 2º, e 3º exames audiométricos foram realizados (i) antes do tratamento (ii), no momento da alta hospitalar, e (iii) alguns meses mais tarde, respectivamente. As barras de erro representam os intervalos de confiança de 95% (este valor tenha sido modificado a partir Okamoto et al 23.). <a href="https://www.jove.com/files/ftp_upload/53264/53264fig4large.jpg" target="_blank">Por favor clique aqui para ver uma versão maior desta fig</a>ure. <img alt="Figura 5" src="/files/ftp_upload/53264/53264fig5.jpg" /> Figura 5. A média de ouvir diferença de nível entre as orelhas Ouvindo diferença dos limiares entre orelhas comprometida e intactas foram na média entre todas as freqüências medidos no primeiro (à esquerda: antes do tratamento)., 2 (centro: no momento da alta hospitalar) e 3 (à direita: alguns meses mais tarde) exames audiométricos de tom puro. Os quadrados abertos e cheios denotar a terapia de som induzido por restrição + padrão grupo corticoterapia (CIST + SCT) ea corticoterapia sozinho grupo padrão (SCT), respectivamente. As barras de erro representam os intervalos de confiança de 95% (este valor foi modificado de Okamoto et al. 23). <a href="https://www.jove.com/files/ftp_upload/53264/53264fig5large.jpg" target="_blank">Por favor clique aqui para ver uma versão maior desta 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.

Abordagem Neuro-reabilitação para Perda auditiva neurossensorial súbita

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

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

Research

JoVE Journal

Behavior

19.1K visualizações.  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.

Vídeo: 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.

Um método para estudar a adaptação para a esquerda-direita invertida audição

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 ...

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.

Teste de localização da fonte sonora na surdez unilateral após intervenção de condução óssea

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.

A abordagem do rato Round-janela para ototóxicos Delivery Agent: A rápida e técnica confiável para induzir a degeneração das células da cóclea

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.

Indução cirúrgica simples da perda auditiva condutora com verificação usando a visualização do otoscópio e a resposta comportável do startle do clap no rato

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

Neurociência

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.

Reabilitação motora estruturada após transferências de nervos seletivos

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.

Avaliação do Treinamento de Substituição Sensorial Áudio-Tátil em Participantes com Surdez Profunda Utilizando a Técnica de Potencial Relacionado a Eventos

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.

Análise Semi-Automatizada de Amplitude de Pico e Latência para Formas de Onda de Resposta Auditiva de Tronco Encefálico Usando 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 Sistemático de Avaliação do Desempenho Auditivo para Adolescentes com Implante Coclear em Idades Precoces

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>Preservação da Audição com Eletrodos Longos na Estimulação Eletroacústica

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

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

<meta charset="utf8"></head><body>Autor em destaque: Otimizando EAS com eletrodos longos para maior cobertura coclear e preservação auditiva

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

Cobertura coclear aprimorada e preservação auditiva na perda auditiva de alta frequência por meio de estimulação eletroacústica com eletrodo mais longo

Abordagem Neuro-reabilitação para Perda auditiva neurossensorial súbita

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