The use of averaged electroencephalic response techniques in the study of auditory processing related to speech and language.
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Adult↗
Biomedical subjects
J T Jacobson
Publications and source records attributed to J T Jacobson.
Clinical considerations in the interpretation of auditory brainstem response audiometry.
Auditory brainstem response (ABR) audiometry which monitors the electrical activity of the auditory nerve and brainstem nuclei, has provided a new technique in the diagnosis of neurological dysfunction and peripheral hearing deficits. Brainstem potentials consist of seven waves, each separated in latency by approximately one millisecond and each representing successively higher order neuron activity of the auditory pathway. The criteria used for ABR interpretation are based primarily on the latency of individual were peaks and their interpeak latencies. Due to its consistency and stability, the fifth wave has been considered prominent in the interpretation of auditory threshold sensitivity. Unfortunately, Wave V latency-intensity function may be affected by extrinsic and intrinsic variables. Consequently, in order to establish diagnostic criteria that are comparable, the elimination and/or control of these variables must be examined. Therefore, the purpose of this paper is to report the effects of various pathological and nonpathological conditions which contribute to difference in ABR audiometry interpretation.
Acoustic Stimulation↗
Identifying deafness in the newborn.
The necessity of early identification of hearing loss has long been urged by otolaryngologists, pediatricians, audiologists, and others working with the deaf. Yet there have been difficulties in implementing accurate and cost-effective newborn hearing screening programs. This article reviews some of the history of infant screening programs, discusses various areas of research related to stimulus and response parameters, and outlines a screening program, designed to fit new recommended procedures, currently under way in Halifax.
Acoustic Stimulation↗
Clinical application of the Grason-Stadler otoadmittance meter.
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Audiometry↗
Ordering patterns, collection, transport, and screening of sputum cultures in a community hospital: evaluation of methods to improve results.
The clinical usefulness of sputum cultures depends on the quality of specimens submitted to the laboratory. In a community hospital, during two separate surveillance periods, we evaluated ordering practices and circumstances under which sputum specimens were obtained and techniques to improve the quality of the specimens. Physicians themselves rarely participated in obtaining specimens of sputum, and members of the nursing staff directly instructed patients or supervised specimen collection in only one third of cases. The mean elapsed time from collection at the bedside to processing in the laboratory was two hours, with a range from several minutes to 13 hours. One fifth of all the specimens in this study were obtained from patients with no discernible evidence of lower respiratory tract infection. Microscopic screening revealed that one half of the specimens were of poor or uncertain quality. After the first survey, inservice education of nursing personnel in the proper techniques of sputum collection, along with regular use of the screening procedure in the clinical laboratory, failed to effect any long-term change in ordering patterns or collection practices. However, the screening procedure did improve the quality of the sputum cultured, through rejection of unsatisfactory specimens.
Hospitals, Community↗
Injuries of hospital employees from needles and sharp objects.
During a 30-month period in our 570-bed private community hospital, employees reported 218 injuries from needles and other sharp objects. Five of these injuries were from needles used on patients known to be hepatitis B surface antigens (HBsAg) positive. Four were from blades or scalpels used on HBsAg positive patients. Another needle injury resulted in serious Staphylococcus aureus infection. Thirty-three percent of the injuries were from improperly disposed objects, generally in trash baskets in patient rooms. Housekeeping employees were the "innocent victims" of more than one-half of the injuries from such improperly disposed objects. A survey of reporting practices revealed housekeepers reported all their injuries. Underreporting was identified as a problem with laboratory personnel and nurses who tended to make their own judgment concerning the extent of the injury. An effective innovation resulting from our survey was the use of plastic irrigation bottles as an inexpensive and readily available container for disposal of sharps.
Accidents, Occupational↗
Strategies for infant auditory brain stem response assessment.
The use of auditory brain stem response (ABR) represents a new dimension in auditory and neurological pediatric assessment. Because the ABR may be altered by stimulus and procedural variables, the lack of an established standard has reduced its clinical efficiency. This paper describes a suggested ABR protocol for infants. Included are stimulus and electrode considerations, measurement criteria, and procedures. In addition, ABR results are presented from 125 newborns ranging between 40 and 49 weeks gestational age. The effects of age and intensity on latency and amplitude are discussed.
Audiometry↗
Dichotic paradigms in multiple sclerosis.
A total of 20 "definite" multiple sclerosis patients were administered three commonly used dichotic speech paradigms. The tests included the Consonant-Vowel (CV) Nonsense Syllable test, the Synthetic Sentence Identification (SSI) test, and the Staggered Spondaic Word (SSW) test. Results of the test procedures were variable, with the higher percentage of abnormalities obtained with the CV test, followed by the SSI, and finally, the SSW. These findings suggest that brain stem lesions may influence higher order auditory processing as measured by certain dichotic test procedures.
Adult↗
A comparison of auditory brain stem response and behavioral screening in high risk and normal newborn infants.
A total of 345 newborn infants received a behavioral screening consistent with protocol adopted by the Joint Committee on Infant Hearing. Infants were divided into three groups consisting of 108 at-risk for hearing loss, 80 intensive care nursery graduates, and 157 normal control infants. Of the total, 315 newborns received auditory brain stem response (ABR) assessment. The results suggest that 4% of the high risk population had irreversible hearing loss to such a degree that amplification was warranted. Discussion focuses on the questionable use of behavioral screening in the newborn nursery and the application of ABR in a high risk population.
Arousal↗
A database to select and inventory services, measure value, and assist redesign.
The services of a three-hospital quality resource department (QRD) were redesigned over a 5-year period. The intention was to provide high-level database management services to improve hospital operations and ensure accountability for performance. There were three key components to the redesign efforts: planning, learning, and measuring performance. This article focuses on planning and measuring the QRD's service using a project registry database.
Health Care Rationing↗
Influence of amplification on the discrimination of dichotic consonant-vowel syllables in a population with sensorineural hearing loss.
This study was designed to investigate the premise that the long-term use of monaural amplification influences dichotic listening conditions in a population with sensorineural hearing losses. 30 subjects with moderate, bilateral sensorineural hearing losses and 10 normally-hearing adults were chosen for this study. 20 of the subjects with sensorineural hearing loss had worn amplification successfully for at least 1 year prior to testing. 10 of these subjects had worn amplification only on the right ear while the remaining 10 had worn amplification only on the left ear. All subjects received 60 monaural and dichotic consonant-vowel (CV) nonsense syllables presented at equal loudness levels using the most comfortable level (MCL) as the loudness criteria. While monaural scores revealed nonsignificant differences between ears for all subjects, using percentage of error, dichotic results produced a right-ear advantage for the right-ear-aided, unaided and normally-hearing subjects. A significant left-ear advantage was seen for the left-ear-aided subjects. Results of this study suggest that amplification introduces selective listening effects which alter reported dichotic test scores.
Audiometry, Pure-Tone↗
Computer surveillance of hospital-acquired infections and antibiotic use.
Surveillance of hospital-acquired infections and antibiotic use is required of US hospitals. The time and cost needed to actively perform this surveillance can be extensive. We developed a computerized infectious disease monitor that automatically generates four types of surveillance "alerts" for patients with hospital-acquired infections, not receiving antibiotics to which their pathogens are susceptible, who could be receiving less expensive antibiotics, or who are receiving prophylactic antibiotics too long. Surveillance personnel using computer screening for two months found more hospital-acquired infections when compared with our traditional surveillance methods, while requiring only 35% of the time. In addition, alerts from the computer identified 37 patients not receiving appropriate antibiotics, 31 patients who could have been receiving less expensive antibiotics, and 142 patients, during one month, receiving prolonged cephalosporin prophylaxis. Computer screening can help focus the activities and improve the efficiency of hospital surveillance personnel.
Anti-Bacterial Agents↗
Brainstem electrical responses from selected tone pip stimuli.
Brainstem-electrical responses were obtained from 10 normal hearing adult subjects using frequency specific tone pips as stimuli. The four frequency specific tone pips (500, 1000, 2000, and 4000 Hz) were diamond shaped with a 2.5-msec rise/fall time. Each tone pip was presented at four intensity levels (70, 50, 30, and 10 dB hearing threshold level), and graphic recordings were made for each frequency at the specific intensity levels. Frequency specific Wave V intensity-latency functions were plotted, and these results were compared to tone pip data obtained in previous studies. In addition, suggested test procedures for obtaining tone pip brainstem-evoked responses under diagnostic conditions are discussed.
Acoustic Stimulation↗
The hearing practitioner and hearing impairment.
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Child Health Services↗
Admittance tympanometry in otosclerotic ears.
Twenty-eight surgically confirmed otosclerotic ears were evaluated to determine whether tympanometric admittance measurements could differentiate otosclerosis from a normal population. Subjects were tympanometrically measured at test conditions B220, B660, G220 and G660 Hz. When comparing mean curve peak amplitude to normative standards, 20 ears showed significantly low admittance tympanograms. Further investigation revealed no significant differences in curve width or pressure of the curve peak. Of the remaining eight otosclerotic ears, all produced diphasic "W"-notched tympanometric configurations. Diagnostic implications and physiological hypothesis are discussed.
Acoustic Impedance Tests↗