Biomedical subjects
D N Brooks
Publications and source records attributed to D N Brooks.
The chief scientist reports ... head injury and the rehabilitation professions in the West of Scotland.
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Hysterical deafness: an unusual presentation of stress in an air traffic control officer.
A case is described of an air traffic control officer who presented with paradoxical hearing loss, the aetiology of which is thought to have been functional. A review of the literature reveals no comparable case.
Fenestration: a twenty-five-year evaluation.
A review was made at least 25 years after surgery on a series of patients who had been fenestrated for otosclerosis. Adequate follow-up information was obtained on 28 of the original 58 subjects. Of these three still had hearing above the social adequacy level of 30 db. HL. One half of the subjects had hearing that was still significantly better than it had been prior to surgery. Twenty-five years post-operatively more than half the patients were using hearing aids, generally with a high degree of satisfaction. Four out of five patients indicated that with hindsight they would still have gone ahead and had the operation. The small residual conductive impairment in a fenestrated ear appears to act as a protection against the effects of acoustic insult, in that the rate of decline of hearing with age in male subjects is less than the average for a normal population of adult males. The rate of decline approximates more closely with the assumed non-noise exposed female population.
Three months after severe head injury: psychiatric and social impact on relatives.
Female relatives of defined groups of consecutive male minor and severe head injury victims were seen at home 3 months after the injury. The relatives of the severely injured suffered significant psychiatric morbidity compared to the minor head injury relatives. They also showed poorer functioning in social roles associated with the home. There was no difference in the vulnerability of either wives or mothers of the head injury victims. It is argued that there is a need for support for the relatives of those who have suffered severe brain injury.
Patient outcome in the year following severe head injury and relatives' psychiatric and social functioning.
Fifty-seven consecutive severe male head injury patients together with a defined female relative were assessed at home 3, 6 and 12 months after injury in order to measure the psychiatric and social impact of the injury on the relative. Relatives were found to have significant and persistent psychiatric and social dysfunction and they considered themselves to have a high burden in caring for the relative throughout the year. No particular relationship was found to be the more vulnerable. The most frequent predictor of the relatives' psychiatric and social status was the level of symptomatic complaints voiced by the patients. The findings suggest the need for comprehensive rehabilitation of head injury patients and their relatives.
Acoustic impedance measurement as screening procedure in children: discussion paper.
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Life stress, medical lethality, and suicidal intent.
Eighty parasuicide patients were studied. The importance of life stress, age, and General Health Questionnaire score as predictors of the suicidal intent and medical lethality which they exhibited was examined. Medical lethality and suicidal intent were closely related: those whose parasuicide resulted in high lethality differed from those showing low lethality in their degree of suicidal intent, but did not differ in life stress, age, or GHQ score. Although both life stress and GHQ score were significantly correlated with suicidal intent, the GHQ score accounted for a greater proportion of the variance. These results suggest a more complex relationship between life stress, GHQ score, and suicidal intent than is often assumed.
A comparison of two hearing-aid selection methods.
The target hearing-aid frequency response for 30 new candidates for NHS aids was derived on a theoretical basis and realised within +/- 5 dB by appropriate aid and earmould selection and modification. After a period of six months the listening comfort was assessed using a TR60 noise pulse audiometer (Siemens AG). Good agreement was obtained between the prescription derived on a theoretical basis and utilised in determining the frequency/gain characteristics of the aid and the users judgement of 'best response' made in a simulated real-life listening situation. This finding gives encouragement to the use of this theoretical method for hearing-aid selection for first-time users.
Resource allocation in audiology.
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Factors relating to the under-use of postaural hearing aids.
All adult patients issued at Withington Hospital with NHS postaural hearing aids in 1980 (n = 731) were reviewed. Efforts were made to determine the reasons for under-use and dissatisfaction among those who were not using the aid at all or using it minimally and with low satisfaction. The major presenting reason for non-use, accounting for over a quarter of all non-users, was inability to insert the earmould. The next most common reason for non-use and the major reason for poor satisfaction in low level users was related to difficulty in coping with signals in noise. Other significant factors contributing to poor or non-use were (1) lack of recognition of hearing impairment, (2) advanced age and poor health, (3) less than ideal matching of the aid to the loss of hearing. The percentage of under-users was significantly reduced by hearing aid orientation and counselling. Further reduction might be achieved if attitudes to hearing loss among those affected and concerned professionals could be improved so that early referral and treatment became the norm rather than the exception.
Problems in measuring cognitive recovery after acute brain injury.
The measurement of cognitive recovery after traumatic brain damage raises a number of methodological and practical problems. The precise schedule of testing, the specification of functions to be measured, the separation of practice from recovery, and the specification of appropriate control or comparison groups must all be considered by the researcher. In addition, strenuous efforts must be made to achieve as high a follow-up rate as possible.
Methodological problems in assessing psychosocial recovery following severe head injury.
A number of specific methodological issues have arisen in studies of the social, emotional, and behavioural sequelae of head injury. The accounts given by patients and relatives may differ: Patients may lack insight, and relatives--who are often under considerable stress--may themselves give distorted accounts. Moreover, the sequelae of head injury may not all be specific to brain injury but may include effects common to other forms of traumatic injury: The use of control groups may help disentangle specific and non-specific effects.
Hearing loss--hearing aids, and some aspects of NHS provision.
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Binaural benefit--when and how much?
Subjective ratings of aided hearing ability on a five point scale in ten hypothetical listening situations were obtained from 150 binaural hearing aid users, and from 296 monaural hearing aid users. Ratings of unaided hearing ability in nine of the same situations were obtained from 125 persons with self-defined normal hearing. The results indicated that in situations where signal-to-noise ratio was low, hearing aid users rated their listening much below the performance of normal hearing persons, binaural users indicating no advantage over monaural users. In the other hypothetical situations the binaural users rated their ability higher than did the monaural aid users. In some situations, where the sound was presented from a single source, binaural aid users rated their ability on a par with the normal hearing individuals. Age and hearing loss had small effects on the ratings, but the magnitudes of these effects were considerably less than that attributable to the type of aid provision, that is, whether monaural or binaural. These findings lend support to the benefits of binaural amplification in many listening situations.
Four years of British audiology.
The last four years have, as envisaged by Dr Watson, seen a rapid growth in 'Audiology in the Community'. The high prevalence of hearing loss in the community, especially in the elderly, has been indicated by the pilot epidemiological study of the Institute of Hearing Research. This and other studies suggest that in the over-seventies as many as three out of five have a hearing loss sufficient to impair ordinary communication. However, the numbers having and using hearing aids falls far short of this. The range of hearing aids available through the National Health Service has increased substantially, and support services have improved with more and better qualified technical, scientific and therapeutical staff, and with the growth of rehabilitation schemes involving both professional and voluntary workers. Much still remains to be done in educating the community and the profession of the need for earlier referral and treatment of hearing loss. Assistance for the profoundly deaf will, it is hoped, come through the research studies on electrical stimulation of the cochlea. In the meantime Vistel , television captioning and similar exercises in exploiting advances in technology enhance the quality of life of those with profound loss. Help for those suffering from tinnitus has improved greatly in the last four years, partly through recognition that the difficulties are real, and partly through the increasing use of hearing aids and maskers to overcome the debilitating consequences of this condition. Preventative measures progress steadily, as do efforts towards the earlier detection of hearing loss in infants and children.
Factors relating to under-use of hearing aids.
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Tritan pedigree without optic-nerve atrophy.
Results of several previous reports have questioned the occurrence of the tritan color deficiency independently of dominantly inherited optic atrophy. This report describes the results of testing 34 members of a pedigree (including four tritans) for whom optic atrophy can be ruled out according to criteria previously described by Krill et al.