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PubMed2002

Validation of performance of the gen-probe human immunodeficiency virus type 1 viral load assay with genital swabs and breast milk samples.

Human immunodeficiency type 1 (HIV-1) continues to spread at an alarming rate. The virus may be transmitted through blood, genital secretions, and breast milk, and higher levels of systemic virus in the index case, as measured by plasma RNA viral load, have been shown to correlate with increased risk of transmitting HIV-1 both vertically and sexually. Less is known about the correlation between transmission and HIV-1 levels in breast milk or genital secretions, in part because reliable quantitative assays to detect HIV-1 in these fluids are not available. Here we show that the Gen-Probe HIV-1 viral load assay can be used to accurately quantify viral load in expressed breast milk and in cervical and vaginal samples collected on swabs. Virus could be quantified from breast milk and swab samples spiked with known amounts of virus, including HIV-1 subtypes A, C, and D. As few as 10 copies of HIV-1 RNA could be detected above background threshold levels in > or =77% of assays performed with spiked breast milk supernatants and mock swabs. In genital swab samples from HIV-1-infected women, similar levels of HIV-1 RNA were consistently detected in duplicate swabs taken from the same woman on the same clinic visit, suggesting that the RNA values from a single swab sample can be used to measure genital viral load.

Cervix Uteri↗
PubMedDate not supplied

Acute cardiac effects of 'SCUD' missile attacks on a civilian population.

The 'SCUD' raids on Israel during the Gulf War afforded a rare opportunity to examine the effect of mass acute fear on the cardiac health of the general population. Press reports suggested an alarming rise in cardiac deaths during the first missile raids. In order to ascertain this statement, we examined the Emergency Room records of a community hospital in the affected area and all the death certificates in the local region. The periods studied were from 1 January to 28 February 1991, and the equivalent weeks in 1990. The Emergency Room records showed that there was an increased rate of cardiac complaints throughout the war, most marked during the first week. However, this was not accompanied by an increased cardiac mortality, either in the hospital or in the region as a whole, except during the first week. A similar increase in cardiac mortality occurred during the same week the previous year. The increased incidence of acute cardiac events during the first week of the war was probably a coincidence, and not a direct consequence of mass fear. Panic, occasioned by press reports, may have led to a lower threshold of referral which persisted throughout the war.

Acute Disease↗
PubMed1990

A single-interval adjustment-matrix (SIAM) procedure for unbiased adaptive testing.

A new unbiased adaptive procedure is described that requires only half as many presentations in achieving the same precision as the well-known two-interval forced-choice (2IFC) 2-step procedure. The procedure is based on a yes-no task which avoids redundant presentation time. Furthermore, certain psychophysical studies can only be realized with yes-no tasks. Every trial contains randomly presented signals or noises and the answer is either yes or no. The outcome (hit, miss, false alarm, correct rejection) is taken into account by adjusting the signal level in a staircase manner. The adjustment matrix is set up to induce a neutral response criterion. Its convergence point can be adjusted at will. The single-interval adjustment-matrix (SIAM) procedure is compared to von Békésy and 2IFC transformed up-down methods using a Monte-Carlo simulation. The SIAM procedure proves to be the fastest of the unbiased procedures. A test on four subjects verified these results. Implications for optimum track length and the number of reversals to discard are discussed.

Attention↗
PubMed1984

A review of world literature finds iron oxides noncarcinogenic.

Iron oxide appeared in the first list of 154 Threshold Limit Values adopted by the American Conference of Governmental Industrial Hygienists at its April 1949 annual meeting. It was set to control dust and fume at the recommended value of 15 mg/M3, at the time, the limit for an inert or "nuisance" dust, and was based on studies of welders made earlier by the U.S. Dept. of Labor and by Drinker and Nelson. By 1964, the TLV was tentatively reduced to 10 mg/M3 after a considerable body of literature had accumulated not only on the health experience of welders, but of other occupations involving iron oxides as well. As a group, these studies indicated that 15 mg/M3 permitted too great accumulations of iron pigmentation in the lung whose chronic retention effects were not known with certainty. Also, an occasional report of cancer of the lungs appeared particularly among British hematite miners, although these findings were immediately questioned on statistical grounds. In seeming confirmation of these early reports of cancer, an alarming number of reports of cancer of the lung and respiratory tract among welders and foundrymen began to appear by 1970, reaching a crescendo by the end of that decade. As past chairman of the TLV Committee, I decided to examine the bases of these findings. This review is the result of this examination.

Animals↗
PubMed2005

Meditation may predispose to epilepsy: an insight into the alteration in brain environment induced by meditation.

Stress-induced diseases in modern life are on an alarming rise not only in developed countries but also in developing ones. To alleviate stress, one practice that is being commonly and increasingly adapted to is meditation. Limited studies on meditation have reported occurrence of mental calmness along with apparently favorable changes in certain autonomic functional parameters like heart rate, blood pressure, respiration and skin resistance. Recently, meditation is also being practiced and advised for alleviation of epilepsy; however, very little work is available to comprehend effect and utility of meditation on epilepsy. Neuro-imaging and in-depth studies during the course and attainment of meditational state have revealed alteration in neuro-chemistry and neuro-physiology of brain environment that could favor epileptogenesis. The rise in brain glutamate and serotonin along with development of 'hypersynchrony' of EEG activity (which occur during the course and attainment of meditational state) are well documented to form the underlying basis of epilepsy. Each of the above-mentioned factors is individually capable of inducing susceptibility and decreasing threshold to epilepsy. Based on these changes in brain, this paper raises a grave possibility and risk of meditation in developing epilepsy or increasing the severity and frequency of attacks in an already epileptic state, contrary to the popular belief of its remedial role in alleviating epilepsy.

Alpha Rhythm↗
PubMed1985

[Somatosensory evoked potentials and pain discrimination in man].

The relationship between 10 components of somatosensory evoked potentials (EPs) and pain discrimination in man was studied using Signal Detection Theory (SDT) psychophysics. Two painful electrical stimuli were delivered to the right index finger in random order over all trials. EPs were recorded from the scalp at the contralateral primary somatic projection area while subjects performed SDT discrimination. The stimulus-response combination was classified into 4 categories according to SDT response: hits, misses, false alarms (FAs) and correct rejections (CRs). The amplitudes and peak latencies of EPs in 4 categories were compared with each other. EPs associated with hits and FAs had significantly greater amplitude at P 190, N 220 and P 270 than those associated with misses and CRs, while there was no change in the amplitude of other components. The amplitude of these 3 components systematically increased with an increase in the magnitude of subjective response. Peak latencies of all components were not related to the response categories. These results indicate that the amplitude of the 3 last components may be concerned with the pain evaluating system in the brain.

Adult↗
PubMed1983

[Importance of auditory "screening" in the school and preschool environment in relation to language disorders].

Having recalled the acoustics spectrum of the human voice and different types of deafness, the author describes alarm signs of various hearing disorders. Bearing in mind the importance of early detection of deafness for optimal speech development, special emphasis is put on the necessity of mass hearing screening in kindergarten and nursing school. However, the diagnosis may be delayed in less severe deafness; medium hearing loss between 35 to 65 dB being scarcely detected before age 5! In this respect teacher's and school health professional's particular attention should bring the child to a specialised diagnostic and therapeutic center where medical or surgical audioprosthetic treatments could be performed before developmental retardation occurs. Two case records are presented.

Audiometry↗
PubMed2005

Combination of age and sex improves the ability to predict upper gastrointestinal malignancy in patients with uncomplicated dyspepsia: a prospective multicentre database study.

BACKGROUND AND AIMS: Current guidelines recommend endoscopy for dyspeptic patients >45 yr of age and/or with "alarm" symptoms. The management of younger patients with uncomplicated dyspepsia is controversial. The objective of the study was to identify any risk factors predictive of upper gastrointestinal malignancy in patients with uncomplicated dyspepsia and validate their ability in refining indications for endoscopy. METHODS: Prospective database study of consecutive uninvestigated dyspeptic outpatients undergoing endoscopy was performed. A questionnaire including multiple possible prognostic variables was systematically submitted to patients prior to endoscopic examination. Risk factors for upper gastrointestinal malignancy identified were used to derive a prediction rule subsequently validated on an independent population. RESULTS: A total of 5,224 patients with uncomplicated dyspepsia were considered (training sample). Twenty-two (16 males) had malignancy at endoscopy. These patients were about 20 yr older than patients with no malignancy (p < 0.001). The mean age of females with cancer was almost 10 yr higher compared to males (p= 0.08). Such differences in age were confirmed in a split sample of 3,684 patients (p < 0.001 and p < 0.05, respectively). The age cut-offs identified were 35 yr for males and 56 yr for females. CONCLUSIONS: The age threshold for endoscopy should be lowered in males to decrease the risk of missing cancers, and can be safely increased in females without affecting outcomes. In patients with uncomplicated dyspepsia, the combination of age and gender provides a better discriminant power than age alone.

Adenocarcinoma↗
PubMed2005

Does high organochlorine (OC) exposure impair the resistance to infection in polar bears (Ursus maritimus)? Part II: Possible effect of OCs on mitogen- and antigen-induced lymphocyte proliferation.

Previous studies have reported alarmingly high levels of organochlorines (OCs), particularly polychlorinated biphenyls (PCBs), in free-ranging polar bears (Ursus maritimus). In this study plasma concentration of PCBs ranged from 14.8 to 200 ng/g wet weight. The aim of the study was to investigate associations between OCs and lymphocyte proliferation after in vitro stimulation with different mitogens and antigens. In 1998 and 1999, 26 and 30 free-ranging polar bears from Svalbard and Churchill, Canada, respectively, were recaptured 32-40 d following immunization with inactivated tetanus toxoid and hemocyanin from keyhole limpets (KLH) to sensitize lymphocytes. At recapture, blood was sampled for determination of plasma levels of PCBs and organochlorine pesticides (OCPs) and lymphocyte proliferation after in vitro stimulation with specific mitogens--phytohemagglutinin (PHA), pokeweed mitogen (PWM), concanavalin A (Con A), lipopolysaccharide (LPS), and purified protein derivative of Mycobacterium avium subsp. paratuberculosis (PPD)--and antigens: tetanus toxoid and KLH. The combinations of sum(PCBs) (sum of 12 individual PCB congeners), sum(OCPs) (sum of 6 OCPs), and their interactions contributed up to 15% of the variations in the lymphocyte responses. By using multiple regression analyses, followed by classical mathematic function analyses, thresholds for immunomodulation were estimated. Depending on the lymphocyte proliferation response studied, the estimated thresholds for significant immunomodulation were within the concentration ranges 32-89 ng/g wet weight (ww) and 7.8-14 ng/g ww for sum(PCBs) and sum(OCPs), respectively. Thus, this study demonstrated that OC exposure significantly influences specific lymphocyte proliferation responses and part of the cell-mediated immunity, which also is associated with impaired ability to produce antibodies (Lie et al., 2004).

Animals↗
PubMed1994

Toxic optic neuropathy associated with ethambutol: implications for current therapy.

BACKGROUND: Aside from the direct ocular manifestations of tuberculosis, significant vision loss can occur during treatment with agents that have potential ocular toxicities. Many thoracic specialists and eye care physicians consider these effects rare and readily reversible. With the alarming increase in incidence of tuberculosis in the United States over the past several years a review of anti-tuberculosis medications and their potential side effects is warranted. METHODS: A patient who developed dramatic, permanent vision loss after a 9-month course of treatment with ethambutol and isoniazid for pulmonary tuberculosis is presented. The medical and ophthalmic literature was reviewed for current use of these medications as well as for the reported incidence of visual side effects. RESULTS: Ethambutol, and to a lesser extent isoniazid, are both implicated in the development of visually related side effects. There is documentation of ocular toxicity with ethambutol when administered at dosages generally pronounced as being safe. Controversy as to what constitutes a safe and effective dose of these medications still exists. CONCLUSIONS: Any patient undergoing medical treatment for tuberculosis requires proper education concerning potential drug side effects. Routine ophthalmic observation for the development of optic neuropathy is strongly recommended for patients with significant risk factors that could increase the chance of side effects and those on longer treatment courses. Baseline and follow-up examinations should include: Snellen acuity, Farnsworth D-15 color testing, automated threshold perimetry and optic nerve head photography.

Blindness↗
PubMed1998

Multicenter study of the incidence of and predictive risk factors for diabetic neuropathic foot ulceration.

OBJECTIVE: To investigate longitudinally prognostic factors for foot ulceration in a large population of diabetic patients with established neuropathy. RESEARCH DESIGN AND METHODS: A double-blind multicenter study of a potential new agent for diabetic neuropathy provided the opportunity for this 1-year investigation since intervention demonstrated no efficacy in the condition. A total of 1,035 patients with NIDDM and IDDM were included. Inclusion criteria were vibration perception threshold (VPT) at the great toe > or = 25 V in at least one foot and < or = 50 V in both feet, normal peripheral circulation, and no previous foot ulceration. VPT and clinical components of the Michigan diabetic polyneuropathy (DPN) score were assessed at baseline and subsequent visits. RESULTS: After 1 year, the incidence of first foot ulcers for the total population was 7.2%. Neuropathy parameters were the same between the treatment and placebo groups at baseline and were unchanged at 1 year; therefore, baseline data were combined for multiple regression analysis. VPT, age, and Michigan DPN scores for muscle strength and reflexes were significant independent predictors for first foot ulceration (P < 0.01). For each 1-U increase in VPT values at baseline, the hazard of the first foot ulcer increased by 5.6%. Similarly, for each 1-U increase in muscle strength and reflex components of the Michigan DPN scores, the hazard of the first foot ulcer increased by 5.0%. CONCLUSIONS: Tests of VPT and Michigan DPN scores for muscle strength and reflexes are useful clinical predictors for foot ulceration in diabetic patients with established neuropathy. The rate of subsequent ulceration in the following year was alarmingly high, however, despite standardized foot care education at baseline and regular follow-up visits.

Adult↗
PubMed2006

Improvement in glycemic excursions with a transcutaneous, real-time continuous glucose sensor: a randomized controlled trial.

OBJECTIVE: Hypoglycemia and wide glucose excursions continue to be major obstacles to achieving target HbA(1c) values and the associated reductions in long-term complications (and economic costs) in people with insulin-treated diabetes. In this study we evaluated the accuracy, safety, and clinical effectiveness of a continuous glucose-sensing device. RESEARCH DESIGN AND METHODS: A total of 91 insulin-requiring patients with type 1 (n = 75) and type 2 (n = 16) diabetes were enrolled in this multicenter randomized study. Subjects wore a transcutaneous, 3-day, continuous glucose-sensing system for three consecutive 72-h periods. Subjects were randomly assigned (1:1 ratio) to either a control group (continuous glucose data not provided) or a display group (continuous glucose data not provided during period 1 but displayed during periods 2 and 3). During periods 2 and 3, patients in the display group had real-time access to sensor glucose values, could review glucose trends over the preceding 1, 3, and 9 h, and were provided with high (> or = 200 mg/dl) and low (< or = 80 mg/dl) alerts and a low (< or = 55 mg/dl) alarm. Sensors were inserted by patients, and both groups used (or wore) the system during daily activities. Device accuracy was assessed by comparing continuous glucose values to paired self-monitoring of blood glucose (SMBG) meter readings. Clinical effectiveness was evaluated by analyzing between-group (control vs. display, periods 2 and 3) and within-group (display, period 1 vs. period 3) differences in time spent in high, low, and target (81-140 mg/dl) glucose zones. RESULTS: When prospective, real-time sensor values were compared with SMBG values, 95.4% of 6,767 paired glucose values fell within Clarke error grid A and B zones. Pearson's correlation coefficient was 0.88, and mean and median absolute relative differences were 21.2 and 15.9%, respectively. No systematic bias was detected at any of the prespecified glucose levels (50, 80, 100, 150, and 200 mg/dl). When compared with control subjects, the display group spent 21% less time as hypoglycemic (<55 mg/dl), 23% less time as hyperglycemic (> or = 240 mg/dl), and 26% more time in the target (81-140 mg/dl) glucose range (P < 0.001 for each comparison). Nocturnal (10:00 p.m. to 6:00 a.m.) hypoglycemia, as assessed at two thresholds, was also reduced by 38% (<55 mg/dl; P < 0.001) and 33% (55-80 mg/dl; P < 0.001) in the display group compared with control subjects. CONCLUSIONS: We conclude that real-time continuous glucose monitoring for periods up to 72 h is accurate and safe in insulin-requiring subjects with type 1 and type 2 diabetes. This study demonstrates that availability of real-time, continuously measured glucose levels can significantly improve glycemic excursions by reducing exposure to hyperglycemia without increasing the risk of hypoglycemia, which may reduce long-term diabetes complications and their associated economic costs.

Adult↗
PubMed1993

A comparison of speech discrimination with cochlear implants and tactile aids.

This study investigates patterns of speech discrimination in profoundly hearing-impaired children who have received cochlear implants or tactile aids. The change/no change procedure was used to assess speech discrimination in these children. Three groups of subjects were tested: the first group used 3M/House single-channel cochlear implants; the second group used Nucleus 22-channel cochlear implants; and the third group used two-channel Tactaid II+ vibrotactile aids. Nine contrasts were constructed that assessed discrimination of suprasegmental and segmental speech features. Subjects were presented with stimulus trials in which stimuli changed during the trial or in which stimuli remained the same. Hits, misses, false alarms, and correct rejections were tallied and d' values were calculated for individual subjects for each contrast. Results indicated that different patterns of speech discrimination are provided by the three sensory prosthetic devices. For all contrasts, mean discrimination performance with the Nucleus device was better than that observed for the other two devices, despite the shorter duration of subject experience with this cochlear implant. In addition, interactions between device and speech contrast were not observed. Examination of individual subject performance revealed that each device group had a distribution of good to poor performers. The results suggest that the change/no change procedure is able to provide information regarding speech perception through sensory prosthetic devices despite existing differences in vocabulary and language skills of subjects.

Acoustic Stimulation↗
PubMed2002

Automatic detection of distorted plethysmogram pulses in neonates and paediatric patients using an adaptive-network-based fuzzy inference system.

Despite the fact that pulse oximetry has become an essential technology in respiratory monitoring of neonates and paediatric patients, it is still fraught with artefacts causing false alarms resulting from patient or probe movement. As the shape of the plethysmogram has always been considered as a useful visual indicator for determining the reliability of SaO(2) numerical readings, automation of this observation might benefit health care providers at the bedside. We observed that the systolic upstroke time (t(1)), the diastolic time (t(2)) and heart rate (HR) extracted from the plethysmogram pulse constitute features, which can be used for detecting normal and distorted plethysmogram pulses. We developed a technique for classifying plethysmogram pulses into two categories: valid and artefact via implementations of fuzzy inference systems (FIS), which were tuned using an adaptive-network-based fuzzy inference system (ANFIS) and receiver operating characteristics (ROC) curves analysis. Features extracted from a total of 22,497 pulse waveforms obtained from 13 patients were used to systematically optimise the FIS. A further 2843 waveforms obtained from another eight patients were used for testing the system, and visually classified into 1635 (58%) valid and 1208 (42%) distorted segments. For the optimum system, the area under the ROC curve was 0.92. The system was able to classify 1418 (87%) valid segments and 897 (74%) distorted segments correctly. The calculations of the system's performance showed 87% sensitivity, 81% accuracy and 74% specificity. In comparison with the 95% confidence interval (CI) thresholding method, the fuzzy system showed higher specificity (P=0.008,P<0.01), and no significant difference was found between the two methods in terms of sensitivity (P=0.720,P>0.05) and accuracy (P=0.053,P>0.05). We therefore conclude that the algorithm used in this system has some potential in detecting valid and distorted plethysmogram pulse. However, further evaluation is needed using larger patient groups.

Adolescent↗
PubMed1996

Biological challenge manipulation of PCO2 levels: a test of Klein's (1993) suffocation alarm theory of panic.

D.F. Klein (1993) proposed that patients with panic disorder (PD) have a hypersensitive suffocation monitor that predisposes them to experience panic attacks under certain conditions. The suffocation alarm theory predicts differential emotional responding to biological challenges that affect arterial partial pressure of carbon dioxide (PCO2). These PD patients should exhibit (a) lower fear and less likelihood of panic in response to biological challenges that lower PCO2 levels (e.g., hyperventilation), and (b) increased fear and greater likelihood of panic in response to biological challenges that raise PCO2 levels (e.g., inhalation of 35% CO2 gas). The following indicators of the suffocation monitor were assessed: (a) severity of dyspnea symptoms, (b) frequency of dyspnea symptoms, (c) heightened respiration rate, and (d) lowered PCO2 levels. Ratings of physiological and subjective responding, as well as panic, were obtained during both a hyperventilation and a 35% CO2 challenge. None of the classification methods predicted differential emotional responding to hyperventilation versus 35% CO2 challenge.

Adult↗
PubMed2005

Evidence for the Stepwise Stress Model: Gambusia holbrooki and Daphnia magna under acid mine drainage and acidified reference water stress.

The Stepwise Stress Model (SSM) states that a cascade of regulative behavioral responses with different intrinsic sensitivities and threshold values offers increased behavioral plasticity and thus a wider range of tolerance for environmental changes or pollutant exposures. We tested the SSM with a widely introduced fish Gambusia holbrooki (Girard) (Pisces, Poeciliidae) and the standard laboratory test species Daphnia magna Straus (Crustacea, Daphniidae). The stress was simulated by short-term exposure to acid mine drainage (AMD) and to acidified reference water (ACID). Recording of behavioral responses with the multispecies freshwater biomonitor (MFB) generated continuous time-dependent dose-response data that were modeled in three-dimensional (3D) surface plots. Both the pH-dependent mortalities and the strong linear correlations between pH and aqueous metals confirmed the toxicity of the AMD and ACID gradients, respectively, for fish and Daphnia, the latter being more sensitive. AMD stress at pH < or = 5.5 amplified circadian rhythmicity in both species, while ACID stress did so only in G. holbrooki. A behavioral stepwise stress response was found in both species: D. magna decreased locomotion and ventilation (first step) (AMD, ACID), followed by increased ventilation (second step) (AMD). G. holbrooki decreased locomotion (first step) (AMD, ACID) and increased ventilation at intermediate pH levels (second step) (AMD). Both species, although from different taxonomic groups and feeding habits, followed the SSM, which might be expanded to a general concept for describing the behavioral responses of aquatic organims to pollution. Stepwise stress responses might be applied in online biomonitors to provide more sensitive and graduated alarm settings, hence optimizing the "early warning" detection of pollution waves.

Acids↗
PubMedDate not supplied

Diagnosis of acute myeloid leukemia and system Coulter VCS.

BACKGROUND: The aim of this study was to evaluate the possible contribution VCS could make in a hematological laboratory for the diagnosis of acute myeloid leukemia (AML). MATERIALS AND METHODS: Peripheral blood samples from 42 AML patients and 58 normal donors were analyzed by flow cytometry with the VCS. Normal and leukemic peripheral blood samples were tested to establish a correlation between VCS data and the reference manual method. We evaluated the sensitivity threshold of the VCS for blast cell detection in progressively diluted samples. We looked at a correlation between different scatterplots and flags and the FAB classification of acute myeloid leukemia in order to identify a characteristic VCS image for each subtype. Thirty-four bone marrow samples (18 normal donors and 16 leukemic patients) were analyzed by the VCS system to demonstrate a characteristic scattergram distribution. Further, we tried to compare scatterplots to the flags of leukemic bone marrow samples and, finally, we compared VCS scatterplots with aberrant antigen expression in AML cases. RESULTS AND CONCLUSIONS: Overall VCS specificity was 93.1% (54/58) in peripheral blood samples; sensitivity was 100% (42/42) and VCS efficiency was 96%. In AML the characteristic X6 flag was observed in 95.23% of the cases (40/42). In peripheral samples discrimination was made between AML M1 with agranular blasts > 50% of the non erythroid cells (NEC), M4, M5 on the one hand, and AML M1 with granular blasts > 50% of NEC, M2, M3 on the other: the X5 flag was often present in the second group because of the different localization of the cells (p = 0.001). In all normal bone marrow samples we observed granuloblasts in different maturation stages in the neutrophil region of the DF1 VCS scatterplot corresponding to the X5X6 flags or, rarely, to the X5X6X1, because of the presence of immature erythroid cells. This association X5X6 was never observed alone in patients affected by AML. In our study, it was difficult to identify peculiar scatterplots and alarms for each FAB class of AML. Nevertheless, we observed that in all M4 and M5 FAB cases the blastic cells both in the peripheral blood and in the bone marrow samples were located in the monocyte region, with the frequent presence of the X3 flag often associated with the X6 flag. Eight out of the 16 AML bone marrow samples (1 FAB M0, 1 M2, 1 M3, 2 M4, 3 M5) showed the X2 flag and partial localization of blasts in the lymphoid region. In all these cases the presence of some small blastic cells with agranular cytoplasm was confirmed by morphological observation and cytochemical stainings.

Acute Disease↗
PubMedDate not supplied

Distortion product otoacoustic emissions in children at school entry: a comparison with pure-tone screening and tympanometry results.

This study examined the test performance of distortion product otoacoustic emissions (DPOAEs) when used as a screening tool in the school setting. A total of 1003 children (mean age 6.2 years, SD = 0.4) were tested with pure-tone screening, tympanometry, and DPOAE assessment. Optimal DPOAE test performance was determined in comparison with pure-tone screening results using clinical decision analysis. The results showed hit rates of 0.86, 0.89, and 0.90, and false alarm rates of 0.52, 0.19, and 0.22 for criterion signal-to-noise ratio (SNR) values of 4, 5, and 11 dB at 1.1, 1.9, and 3.8 kHz respectively. DPOAE test performance was compromised at 1.1 kHz. In view of the different test performance characteristics across the frequencies, the use of a fixed SNR as a pass criterion for all frequencies in DPOAE assessments is not recommended. When compared to pure tone plus tympanometry results, the DPOAEs showed deterioration in test performance, suggesting that the use of DPOAEs alone might miss children with subtle middle ear dysfunction. However, when the results of a test protocol, which incorporates both DPOAEs and tympanometry, were used in comparison with the gold standard of pure-tone screening plus tympanometry, test performance was enhanced. In view of its high performance, the use of a protocol that includes both DPOAEs and tympanometry holds promise as a useful tool in the hearing screening of schoolchildren, including difficult-to-test children.

Acoustic Impedance Tests↗