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Biomedical subjects

R Chmiel

Publications and source records attributed to R Chmiel.

17 recordsLinked to original sources
PubMed1996

Hearing aid use, central auditory disorder, and hearing handicap in elderly persons.

We compared self-reported handicap (Hearing Handicap Inventory for the Elderly, HHIE) scores before and after a 6-week period of hearing aid use in subjects drawn from a pool of 115 elderly persons with hearing impairment. Study patients (PTs) were divided into two categories according to whether scores on a dichotic listening test (Dichotic Sentence Identification Test, DSI) were normal or abnormal. In a subgroup of 63 persons who had not previously used amplification, subjects in the two DSI categories showed equivalent average HHIE scores. After 6 weeks of first-time hearing aid use, there was a significant improvement in average HHIE scores, but only in the DSI-normal category. In the subgroup with dichotic deficits (DSI-abnormal group), average HHIE scores did not change significantly after hearing aid use. In a subgroup of 89 PTs, we compared the self-assessed HHIE scores of the PTs with the HHIE scores rated by their significant others (SOs). In both DSI categories, the average handicap, as judged by the subject's SO, was significantly greater than the handicap as judged by the PT. In addition, both ratings reflected significant improvement after hearing aid use. It was the case, however, that improvement consequent on amplification was significantly smaller for subjects in the DSI-abnormal category. Finally, we show, in the entire pool of 115 PTs, that the effect of practice on the HHIE score is not sufficient to explain the improvement after amplification. Results affirm both the positive value of amplification and the negative impact of central auditory deficit as they affect the HHIE scores of the elderly hearing-impaired person.

Aged↗
PubMed1995

Quantifying improvement with amplification.

We employed a nonparametric measure, the randomization test, to evaluate, statistically, a variety of speech understanding measures used to quantify the efficacy of different intervention strategies in five clinical patients. The flexibility of the approach was demonstrated by comparing monaural with binaural amplification, a conventional aid with an assistive listening device, and a cochlear implant alone versus a cochlear implant supplemented by visual cues. The randomization test allows statistical analysis of differences in performance at the level of the individual subject. This approach may be useful in addressing accountability when recommending a specific intervention strategy for a particular hearing-impaired individual.

Adolescent↗
PubMed1995

Dichotic listening, event-related potentials, and interhemispheric transfer in the elderly.

OBJECTIVE: To determine the basis for the large, age-related asymmetries in dichotic listening performance scores reported by Jerger et al. (1994). DESIGN: Behavioral and electrophysiologic responses to dichotic listening tasks in both verbal and nonverbal paradigms were obtain in four groups of subjects: young adults with normal hearing, elderly persons with presbyacusis, elderly persons with presbyacusis and marked dichotic deficits, and patients with lesions of the corpus callosum. RESULTS: In comparison with the young group the two elderly groups showed an increasing left-ear deficit on the verbal task, and an increasing right-ear deficit on the nonverbal paradigm. The pattern of results obtained in the elderly persons with marked dichotic deficits was similar to the pattern of results in the group with callosal lesions. CONCLUSIONS: With age, there may be a significant loss of efficiency of interhemispheric transfer of auditory information through the corpus callosum. Such age-related deficit might have important implications for the effective use of binaural information by elderly person.

Adolescent↗
PubMed1995

Hearing impairment in older adults: new concepts.

OBJECTIVE: To review present information about the epidemiology, etiologies, pathogenesis, evaluation, and quality of life aspects of hearing loss and to present an approach to rehabilitation for hearing loss in older adults. DESIGN: A survey of recent findings on the problem of hearing loss in older adults, efficacy of intervention with amplification, and new developments in intervention strategies. CONCLUSIONS: The complex nature of hearing problems in older adults involves changes in the auditory periphery as well as in the central mechanisms for processing sound input. These changes affect the social and emotional impact of the hearing disorder. The importance of understanding the many implications of hearing loss on quality of life is emphasized. Both older adults and immediate family members need information and advice about the consequences of age-related hearing loss. The physician has a key role in helping them to overcome negative attitudes toward a hearing handicap. For most older persons, hearing aids alleviate many of the handicaps of hearing impairment. For some older persons who do not benefit adequately from conventional hearing aids, assistive listening devices may be helpful. Many old persons and their relatives are reluctant to confront the reality of hearing handicap and try to hide the fact that they need sound amplification. One important future direction is to foster acceptance of hearing loss and to support the more open use of amplification systems.

Aged↗
PubMed1994

Effects of age and gender on dichotic sentence identification.

There is converging evidence that aging causes a progressive decline in the central processing of speech and that this decline is greater for left-ear than for right-ear input. In the present paper we investigated, by means of a dichotic sentence identification paradigm, some parameters of the "left-ear effect." We analyzed the clinical records of 356 individuals, 203 males and 153 females, to whom the Dichotic Sentence Identification (DSI) Test had been administered as part of routine audiometric assessment. Subjects ranged in age from 9 to 91 yr. The DSI test was always carried out in two modes: free report (FR) and directed report (DR). In the FR mode the subject reported what was heard in both ears. In the DR mode the subject reported only what was heard in one precued ear. In half of the trials the right ear was precued, in the other half the left ear was precued. Findings confirm a progressively larger right-ear advantage, or left-ear deficit, with increasing age. We document this effect in both the FR and DR modes, then demonstrate that the effects cannot be attributed to interaural asymmetries in threshold sensitivity. Comparison of male and female data suggest a gender difference in the effect of age on the left-ear deficit. Males show a larger effect then females in both modes of test administration. Finally, we propose a model of dichotic listening performance that attempts to explain ear asymmetry as the linear combination of an auditory/structural component and a task-related/cognitive component. We then show how these hypothetical components change with age in the present sample.

Adolescent↗
PubMed1993

Some factors affecting assessment of hearing handicap in the elderly.

In 42 elderly hearing-impaired persons we compared the patient's self-assessment of hearing handicap with the assessment made by the patient's significant other. In general, patients tended to rate themselves as less handicapped than did their significant others. The difference was not affected by degree of loss but was affected by slope of loss and by the presence of central auditory processing deficit. Results support the value of the handicap assessment by the significant other in understanding the communication problems of the elderly patient.

Adult↗
PubMed1993

Gender affects audiometric shape in presbyacusis.

A review of large-scale surveys of hearing over the past 50 years reveals a "gender-reversal" phenomenon in the average audiograms of the elderly. Above 1 kHz males show greater average loss than females, but below 1 kHz females show greater average loss than males. The effect increases with both age and degree of hearing loss. The difference is present whether or not the elderly persons complain of a hearing problem and remains after persons with a history of noise exposure are excluded from the analysis. A possible explanation, based on the greater likelihood of cardiovascular disease in the elderly female, is considered.

Aged↗
PubMed1993

Case studies in binaural interference: converging evidence from behavioral and electrophysiologic measures.

We present four case reports of elderly hearing-impaired persons demonstrating a binaural interference effect. Performance measures were poorer when stimulation was binaural than when it was monaural. In the first case the effect is shown for aided speech recognition scores. In the second case it is shown in topographic brain maps of the middle-latency auditory evoked potential. In the third and fourth cases it is shown for both aided speech recognition and the middle-latency response. The effect may be analogous to the phenomenon of binocular rivalry in the visual domain.

Acoustic Stimulation↗
PubMed1992

Non-dilated urinary tract obstruction.

OBJECTIVE: To describe the occurrence of obstructive uropathy in the absence of dilatation of the urinary tract. CLINICAL FEATURES: Five cases of non-dilated obstructive nephropathy are described. All patients were uraemic on presentation. Obstruction was caused by retroperitoneal malignancy in two patients and uric acid lithiasis in the remaining three. All patients had at least one ultrasound examination. Isotope renography and computed tomography were performed in three and four patients respectively. None of these imaging techniques suggested obstruction in any of the cases. Radionuclide scans were characterised by unusually poor perfusion and parenchymal phase images. INTERVENTION AND OUTCOME: An immediate diuresis and a rapid return of normal renal function occurred after relief of the obstruction in all cases. CONCLUSION: The absence of dilatation in obstructive nephropathy is uncommon but may be responsible for delayed diagnosis and management of a readily treatable cause of acute renal failure.

Aged↗
PubMed1992

Identification of the site of severe colon bleeding by technetium-labeled red-cell scan.

In cases of severe colon bleeding, it is more important to know the site than the cause, in case surgery is required. Technetium-labeled red-cell scan (TLRCS) is known to identify the site of bleeding at the rate of 0.1 ml per minute or more. The aim of this retrospective study was to see whether TLRCS was a reliable indicator of the site of severe colon bleeding. A retrospective study was made of patients investigated in this way for acute, severe colon bleeding at St. Vincent's Hospital, Melbourne, from 1984 to 1988 (five years). TLRCS identified the site of bleeding in less than half of the cases but correctly identified the site in all nine patients in whom bleeding was so severe as to require emergency surgery, avoiding total colectomy in eight cases.

Aged↗
PubMed1989

Speech tracking in the evaluation of a multichannel cochlear prosthesis.

Individual speech tracking data were analyzed in relation to other variables in 11 adult users of the Nucleus multichannel cochlear implant. Patients were categorized according to postoperative speech tracking results. The resultant groups could also be differentiated on the basis of postoperative MAC scores, surgeon's rating of overall success, and duration of deafness before implantation. The speech tracking paradigm appears to be a useful technique for the evaluation of performance with a cochlear prosthesis.

Adult↗
PubMed1987

Rate and filter dependence of the middle-latency response in infants.

Auditory evoked-potential activity in the 0 to 100-ms latency range was explored using wide-band filtering and a range of stimulus rates, in 8 babies ranging in age from 2 to 6 months. We observed both a stable early positive peak, in the 10 to 15-ms region, and a rate-dependent, positive peak at about 50 ms in all 8 babies. The latter response was best observed at rates of 1-2.5 stimuli/s and seldom observed at rates above 4/s. This peak may represent a developmentally early version of the Pa peak of the adult middle-latency response.

Auditory Perception↗
PubMed1986

Effect of sleep on the auditory steady state evoked potential.

The effects of both natural and sedated sleep on the auditory steady state evoked potential (SSEP) were evaluated in nine normal-hearing subjects. Both absolute amplitude and phase variability measures were obtained by Fourier analysis of successive samples of the averaged SSEP waveform. Amplitude decreased significantly in the sleeping state but phase variability was not substantially altered. Because it does not seem to be affected by sleep, phase variability of the SSEP is suggested as a potentially useful technique for predicting threshold sensitivity.

Adolescent↗
PubMed1980

Renal impairment and its reversibility following variable periods of complete ureteric obstruction.

There is debate concerning the time course and degree of recovery possible after relief of complete unilateral ureteric obstruction. This study in dogs investigates these features. One ureter was occluded for varying periods, and then reimplanted into the bladder. Recovery was monitored by Tc-Sn-labelled diethylene triamine penta acetic acid (D.T.P.A.) scans and renograms together with creatinine clearance studies. The morphological changes were also studied. There was found to be a progressive loss of functional recovery with increasing periods of obstruction, though this was dramatically improved by contralateral nephrectomy once recovery had stabilized. Increased radial scarring developed in the kidney following increasing periods of obstruction.

Animals↗
PubMed1979

Detection of deep venous thrombosis by scanning of 99mtechnetium-labelled red-cell venous pool.

A comparative study of 32 patients with suspected deep venous thrombosis was carried out using blood-pool radionuclide scanning and conventional x-ray phlebography. Results of the two methods showed close agreement, the sensitivity (positive correlation) of the scan being 100% and its specificity 89%. We conclude that a patient's red cells labelled with 99mtechnetium (99mTc) provide an excellent medium for this type of scanning. The technique has particular advantages in visualising the whole venous system, giving a persisting image, and obviating the need to inject into a vein of the affected limb. In view of the inherent disadvantages of contrast phlebography, 99mTc-red-cell scanning is clearly an acceptable alternative.

Erythrocytes↗