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At least 217 records · Page 12Linked to original sources
PubMed2003

Chronic varicella-zoster virus ganglionitis--a possible cause of postherpetic neuralgia.

Postherpetic neuralgia (PHN) is dermatomal distribution pain that persists for months to years after the resolution of herpes zoster rash. The cause of PHN is unknown. Herein, we report clinical, molecular virological, and immunological findings over an 11-year period in an immunocompetent elderly woman with PHN. Initially, blood mononuclear cells (MNCs) contained varicella-zoster virus (VZV) DNA on two consecutive occasions. Random testing after treatment with famciclovir to relieve pain did not detect VZV DNA. However, the patient was reluctant to continue famciclovir indefinitely and voluntarily stopped drug treatment five times. Pain always recurred within 1 week, and blood MNCs contained many, but not all, regions of the VZV genome on all five occasions. Immunological analysis revealed increased cell-mediated immunity to VZV. Chronic VZV ganglionitis-induced PHN best explains the recurrence of VZV DNA in MNCs whenever famciclovir was discontinued; the detection of only some regions of the viral genome in MNCs, compared to the detection of all regions of the VZV genome in latently infected ganglia; the increased cell-mediated immunity to VZV; and a gratifying clinical response to famciclovir. The presence of fragments of VZV DNA in MNCs likely represents partial degradation of viral DNA in MNCs that trafficked through ganglia during productive infection.

2-Aminopurine↗
PubMed2006

Long-term assessment of auditory changes resulting from a single noise exposure associated with non-occupational activities.

We examined the long-term sequelae in both ears of 42 patients who reported the occurrence of auditory changes resulting from a single exposure to intense sound levels during non-occupational activities. We divided these patients into two groups, based upon noise exposures of either continuous duration or single high-energy impulse. Audiometric data were available for each of these subjects shortly after their noise-exposure events and follow-up examinations took place more than one year after the noise occurrence (range: 1-16 years). The initial median hearing loss for the continuous-type noise exposure group at 3-8 kHz was found to be 9 dB, relative to the age-appropriate norms, in the more affected ears, and hearing function was found to have returned to normal levels at follow-up. The same initial hearing loss was measured for the impulse-type noise group, but a residual hearing loss of 4 dB was measured at follow-up. Furthermore, the majority of the subjects from both groups reported tinnitus and hypersensitivity to sound at follow-up, but with minimal impact on their lives.

Adolescent↗
PubMedDate not supplied

Loudness and the acoustic reflex.

Fifteen subjects with unilateral sensorineural hypacusis were tested to determine the sound intensity eliciting the acoustic reflex in normal and impaired ears and the sound intensity in the normal ear which is equal in loudness to the intensity eliciting the acoustic reflex in the abnormal ear. Results suggest that loudness is not the mediating factor in the acoustic reflex, justifying the suggestion that low sensation level reflexes observed in hearing-impaired patients should not be considered an unequivocal indicant of recruitment.

Adolescent↗
PubMedDate not supplied

A comparison of reaction times to tinnitus and nontinnitus frequencies.

Reaction time (RT) to auditory stimuli has been suggested as a measure of loudness recruitment in humans and in subhuman primates. In this investigation, RT's were obtained for hearing-impaired subjects with tinnitus (the experimental group) and normal-hearing subjects without tinnitus (the control group) to three sets of frequencies. For the experimental group, these were the tinnitus frequencies (associated with abnormal thresholds), nontinnitus frequencies with thresholds similar to the thresholds of the tinnitus frequencies, and nontinnitus frequencies with thresholds within normal limits. For the control group, these frequencies were all associated with thresholds within normal limits. The only significant difference for RT's for the experimental group versus the control group was to the tinnitus frequencies. There were no significant differences for RT's for the control group among the three sets of frequencies. However, for the experimental group, RT's to each of the three sets of frequencies differed significantly from each other. This study suggests that the measurement of RT's to auditory stimuli provides an objective measure of tinnitus, a means for comparing human and subhuman data on tinnitus, a method for determining recruitment, and a possible technique for mapping areas of tinnitus.

Acoustic Stimulation↗
PubMedDate not supplied

Role of auditory brain stem response in the selection of hearing aids.

This article describes an electrophysiological taxonomy of patients who are unwilling to continue wearing their hearing aids or are dissatisfied with the performance of the aid. Because the responses on which the taxonomy is based do not depend upon patient cooperation, they can be used in the pediatric population, where alternative procedures are less than optimal. Examples of how this electrophysiological taxonomy relates to patient management decisions are also provided.

Acoustics↗
PubMedDate not supplied

Neural correlates of sensorineural hearing loss.

Sensorineural hearing loss is characterized by a relatively well defined set of audiological signs and symptoms such as elevated thresholds, abnormally rapid loudness growth, subjective tinnitus, poor speech discrimination, and a reduction in temporal summation of acoustic energy. Knowledge of the underlying neural mechanisms responsible for some of these auditory distortions has progressed substantially within the past 10 yrs as a result of physiological studies on hearing-impaired animals. Some of the important neurophysiological changes relevant to sensorineural hearing loss are reviewed. One important effect associated with sensorineural hearing loss is the broadening of the cochlear filtering mechanism which may influence loudness growth and the perception of complex sounds. The neurophysiological results may also provide new insights in interpreting traditional audiological data and help in developing more refined tests for fitting hearing aids or differentiating patients with sensorineural hearing loss.

Animals↗
PubMedDate not supplied

Audiometric earphone discomfort level and hearing aid saturation sound pressure level for a 90 decibel input signal (SSPL90) as measured in the human ear canal.

The acoustical problems involved in matching the saturation sound pressure level for a 90 dB input signal (SSPL90) of a hearing aid to individual discomfort level were investigated. The real ear SPL (RE/SSPL90) produced by a supra-aural earphone used when measuring uncomfortable loudness (UCL), and RE/SSPL90 produced by three different hearing aids at 90 dB SPL input, were measured for nine subjects, using a miniature microphone technique, and compared to the corresponding coupler levels used when matching hearing aid maximum output to UCL. It was found that a hearing aid often gives about 5 dB, and sometimes 10 dB, higher RE/SPLs than the earphone, if the hearing aid output levels, as measured in a 2-cc coupler (IEC126), are equal to the earphone output levels as measured in a 6-cc coupler (NBS9A). It is recommended that a safety margin of at least 5 dB be used in the preliminary fitting when matching hearing aid SSPL90 to the patient's UCL, converted to dB SPL.

Adult↗
PubMed1991

The quantification of pure-tone audiograms and auditory brain stem evoked responses using mathematical modeling procedures.

The relationship between quantified pure-tone audiometric variables (namely, pure-tone audiometric slope and the degree of hearing loss) and the slope of the wave V L-I (latency-intensity) function of the ABR was investigated. The influence of loudness recruitment on the relationship between audiogram slope and the wave V L-I slope was also studied. Fifty-five ears were selected and divided into two groups (a positive Metz group consisting of 35 ears and a negative Metz group comprising 20 ears) for statistical analyses. The results of the study indicated no significant relationship between the audiogram variables and the slope of the wave V L-I function. However, a significant relationship emerged between the degree of hearing loss and the slope of the L-I function. The results also suggested that neither loudness recruitment nor audiometric configuration influenced the slope of the L-I function.

Adolescent↗
PubMed1991

Hearing aid gain for loudness-density normalization in cochlear hearing losses with impaired frequency resolution.

A theoretical criterion for preliminary prescription of hearing aid gain and frequency response was formulated on the basis of Zwicker's loudness model, modified for impaired auditory frequency resolution in cochlear hearing losses. The procedure was designed to restore normal relative loudness contributions from each frequency band of input speech. Prescribed frequency responses had less steep bass cut than recommended by either the Prescription of Gain/Output or the National Acoustic Laboratories' procedures, regardless of various model assumptions. Prescribed overall gain depended on the loudness growth assumed in the model. In cases where auditory filters are wider than normal and loudness recruitment is complete, the procedure yielded a nonlinear relation between hearing aid gain and hearing loss: Required insertion gain (in dB) was 25 to 30% of hearing threshold loss (in dB HL) for mild to moderate losses, but this percentage increased for more severe impairments. For cases with incomplete loudness recruitment, the model prescribed that insertion gain should be 40 to 50% of hearing threshold loss for a wide range of impairments.

Amplifiers, Electronic↗
PubMed1991

Characterization and simulation of impaired hearing: implications for hearing aid design.

This article reviews several aspects of auditory perception that are affected by hearing loss of cochlear origin. It is argued that most of the observed effects can be understood in terms of damage to a physiologically vulnerable active process in the cochlea. In a normal ear, this process enhances sensitivity and frequency selectivity and reduces the slope of the input-output function on the basilar membrane. Damage to the active process in impaired ears leads to reduced sensitivity and frequency selectivity, an abnormally rapid rate of growth of loudness with intensity, reduced temporal integration and, for certain types of stimuli, reduced temporal resolution. The implications and relevance of each of these effects to the design and fitting of hearing aids are discussed.

Acoustics↗
PubMed2006

Hearing in nonprofessional pop/rock musicians.

OBJECTIVE: The purpose of this study was to evaluate the hearing and subjective auditory symptoms in a group of nonprofessional pop/rock musicians who had experienced repeated exposures to intense sound levels during at least 5 yr of musical activity. DESIGN: An evaluation of both ears in 42 nonprofessional pop/rock musicians included pure-tone audiometry in the conventional and extended high-frequency range, the measurement of uncomfortable loudness levels, and an assessment of tinnitus and hypersensitivity to sound. Exclusion criteria were (a) the occurrence of acoustic trauma, (b) excessive noise exposure during occupational activities, (c) a history of recurrent otitis media, (d) previous ear surgery, (e) a fracture of the cranium, (f) ingestion of potentially ototoxic drugs, and (g) reported hearing difficulties within the immediate family. These audiometric results were then compared with a control group of 20 otologically normal young adults with no history of long-term noise exposure. RESULTS: After adjusting for age and gender, relative to ISO 7029, the mean hearing threshold in the frequency range of 3 to 8 kHz was 6 dB in the musicians and 1.5 dB in the control group. This difference was statistically significant (Mann-Whitney rank sum test, p < 0.001). A significant difference was also observed between musicians using regular hearing protection during their activities (average 3 to 8 kHz thresholds = 2.4 dB) and musicians who never used such hearing protection (average 3 to 8 kHz thresholds = 8.2 dB), after adjusting for age and gender (Mann-Whitney rank sum test, p = 0.006). Eleven of the musicians (26%) were found to be hypersensitive to sound, and seven (17%) presented with tinnitus. Tinnitus assessment, however, did not reveal any clinically significant psychological distress in these individuals. CONCLUSIONS: Tinnitus and hypersensitivity to sound were observed in a significant minority within a group of nonprofessional pop/rock musicians who had experienced repeated exposure to intense sound levels over at least 5 yr but with minimal impact on their lives. Moreover, hearing loss was minimal in the subjects who always used ear protection, being only 0.9 dB higher than the control group. In contrast, hearing loss was significantly more pronounced, at 6.7 dB higher than the control group, in those musicians who never used ear protection. Continued education about the risk to hearing and the benefits of the persistent use of ear protection is warranted for musicians who are exposed frequently to intense sound levels.

Adolescent↗
PubMed2006

The relationship between migraine pain and other associated symptoms.

This study explores the relationship of the pain of the migraine headache and the associated features of migraine. Migraineurs (n=1025) (ICHD-2, 1.1-1.2 and 1.5.1) were evaluated retrospectively using a detailed database (daily unremitting excluded). Variables studied included headache intensity and duration, associated symptoms and pain characteristics. Non-parametric correlations were used to evaluate relationships among variables. Headache intensity correlated with nausea, vomiting, photophobia, phonophobia, dizziness (all P=0.000), running of the nose/tearing of the eyes (P=0.007), and osmophobia (P=0.044), but not with diarrhoea or taste abnormality. Headache duration correlated only with osmophobia (P=0.002) and taste abnormality (P=0.005). Throbbing, pressure and stabbing pain correlated with most of the associated symptoms. Aching correlated only with taste abnormality. This correlational study demonstrates that migraine pain is clearly related to nausea, but is also correlated with other associated migraine symptoms. Taste abnormality and osmophobia are better correlated with headache duration rather than headache intensity.

Adult↗
PubMed2006

The natural course of migraine attacks. A prospective analysis of untreated attacks compared with attacks treated with a triptan.

This study was designed to document prospectively and explore scientifically the natural course of untreated migraine attacks in detail. A new, integrated, time-intensity method for self-assessment of the intensity of symptoms was tested on 18 adult International Headache Society migraineurs who volunteered to refrain from treatment during one attack. The area under the curves (AUC) during 72 h of untreated attacks was compared with attacks treated with a triptan. Migraine attacks are heterogeneous both inter- and intra-individually. In untreated attacks, the pain can stabilize and fluctuate around a plateau with a wavelength of hours. In general, the symptoms of each separate migraine attack follow a similar temporal course, with only moderate deviations. In some cases photo- and/or phonophobia (hyperexcitability) were not experienced at all, despite severe pain and nausea. Moreover, there was sometimes no nausea despite severe pain and hyperexcitability. Vomiting does not always correlate to the intensity of nausea and is not always followed by decreased headache intensity. Treatment with a triptan usually only temporarily distorts the basic pattern of attacks. Hyperexcitability can respond before pain to treatment. These genuine findings of the classic symptoms of migraine attacks support the notion of a mutual underlying pathophysiological mechanism.

Adult↗
PubMed2006

The prevalence of premonitory symptoms in migraine: a questionnaire study in 461 patients.

Migraine attacks are often preceded by premonitory symptoms. Prevalence rates of migraine patients reporting one or more premonitory symptoms show considerable variability and rates range between 12% and 79%. Sources of variability might be differences in study population or research design. Using a questionnaire, we retrospectively studied the prevalence of 12 predefined premonitory symptoms in a clinic-based population. Of 461 migraine patients, 374 (81%) responded. At least one premonitory symptom was reported by 86.9% and 71.1% reported two or more. The most frequently reported premonitory symptoms were fatigue (46.5%), phonophobia (36.4%) and yawning (35.8%). The mean number of premonitory symptoms per person was 3.2 (+/- 2.5). Women reported 3.3 premonitory symptoms compared with 2.5 symptoms in men (P = 0.01). Age, education, migraine subtype (with or without aura) and mean attack frequency had no effect on the mean number of symptoms per individual. In conclusion, premonitory symptoms are frequently reported by migraine patients. Sensitivity and specificity of premonitory symptoms for migraine need to be assessed using prospective methods.

Adult↗
PubMed2003

Speech perception, localization, and lateralization with bilateral cochlear implants.

Five bilateral cochlear implant users were tested for their localization abilities and speech understanding in noise, for both monaural and binaural listening conditions. They also participated in lateralization tasks to assess the impact of variations in interaural time delays (ITDs) and interaural level differences (ILDs) for electrical pulse trains under direct computer control. The localization task used pink noise bursts presented from an eight-loudspeaker array spanning an arc of approximately 108 degrees in front of the listeners at ear level (0-degree elevation). Subjects showed large benefits from bilateral device use compared to either side alone. Typical root-mean-square (rms) averaged errors across all eight loudspeakers in the array were about 10 degrees for bilateral device use and ranged from 20 degrees to 60 degrees using either ear alone. Speech reception thresholds (SRTs) were measured for sentences presented from directly in front of the listeners (0 degrees) in spectrally matching speech-weighted noise at either 0 degrees, +90 degrees or -90 degrees for four subjects out of five tested who could perform the task. For noise to either side, bilateral device use showed a substantial benefit over unilateral device use when noise was ipsilateral to the unilateral device. This was primarily because of monaural head-shadow effects, which resulted in robust SRT improvements (P<0.001) of about 4 to 5 dB when ipsilateral and contralateral noise positions were compared. The additional benefit of using both ears compared to the shadowed ear (i.e., binaural unmasking) was only 1 or 2 dB and less robust (P = 0.04). Results from the lateralization studies showed consistently good sensitivity to ILDs; better than the smallest level adjustment available in the implants (0.17 dB) for some subjects. Sensitivity to ITDs was moderate on the other hand, typically of the order of 100 micros. ITD sensitivity deteriorated rapidly when stimulation rates for unmodulated pulse-trains increased above a few hundred Hz but at 800 pps showed sensitivity comparable to 50-pps pulse-trains when a 50-Hz modulation was applied. In our opinion, these results clearly demonstrate important benefits are available from bilateral implantation, both for localizing sounds (in quiet) and for listening in noise when signal and noise sources are spatially separated. The data do indicate, however, that effects of interaural timing cues are weaker than those from interaural level cues and according to our psychophysical findings rely on the availability of low-rate information below a few hundred Hz.

Adult↗