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Acoustic rhinometry in the practice of allergy.

OBJECTIVE: To provide a comprehensive practical overview of the use of acoustic rhinometry in the practice of allergy. DATA SOURCES: An all-inclusive PubMed search was conducted for articles on acoustic rhinometry that were published in peer-reviewed journals, between 1989 and 2006, using the keywords acoustic rhinometry, allergic rhinitis, and nasal provocation testing. STUDY SELECTION: The expert opinion of the authors was used to select studies for inclusion in this review. RESULTS: Acoustic rhinometry is a sound-based technique used to measure nasal cavity area and volume. It has been validated by comparison to measurements with computed tomography and magnetic resonance imaging. Acoustic rhinometry requires minimal patient cooperation and may be used in adults, children, and infants. It is used by medical practitioners to diagnose and evaluate therapeutic responses in conditions such as rhinitis and to measure nasal dimensions during allergen provocation testing. Acoustic rhinometry also provides a visual reflection of the nasal response to therapy, which may be useful in increasing compliance to prescribed medications. CONCLUSIONS: Acoustic rhinometry is a safe, noninvasive, objective, and validated measure of nasal obstruction that appears to be of practical use in the diagnosis and management of inflammatory diseases of the upper airways.

Hypersensitivity↗

Thoracic epidural puncture guided by an acoustic signal: clinical results.

BACKGROUND AND OBJECTIVE: In previous studies we have demonstrated that it is possible and safe to identify the lumbar epidural space by an acoustic and visible signal. The use of an experimental set-up constructed for this purpose, the acoustic puncture assist device, the lumbar epidural puncture procedure became both audible and visible. In the present study we have extended the use of the device to localize the thoracic epidural space. We have also evaluated whether the device can be used as a practical tool to confirm correct catheter placement. METHODS: In 100 consecutive patients a prototype of the acoustic puncture assist device was connected to the epidural needle in order to localize the epidural space. The device translates the pressure encountered by the needle tip into a corresponding acoustic and visible signal and enables the anaesthesiologist to detect the epidural space by means of the acoustic signal. After catheter insertion, local anaesthetic was administered. Subsequently the epidural block was tested. In 10 patients the device was also connected to the epidural catheter after its insertion into the epidural space. RESULTS: In all 100 patients included in the study the epidural space was successfully located by means of the acoustic signal. The only recorded complication was intravascular catheter placement in two patients. CONCLUSIONS: It is possible to localize the thoracic epidural space guided by an acoustic signal. The method was shown to be safe, reliable and simple. Potential implications of this technique include better needle control, improved monitoring for training purposes and for clinical documentation of the thoracic epidural puncture as well as identifying correct catheter placement.

Acoustics↗

Acoustically enhanced multicomponent NAPL ganglia dissolution in water saturated packed columns.

The impact of acoustic pressure waves on multicomponent nonaqueous phase liquid (NAPL) ganglia dissolution in water saturated columns packed with glass beads was investigated. Laboratory data from dissolution experiments with two and three component NAPL mixtures suggested that acoustic waves significantly enhance ganglia dissolution due to the imposed oscillatory interstitial water velocity. The dissolution enhancement was shown to be directly proportional to the acoustic wave frequency. Furthermore, it was demonstrated that the greatest dissolution enhancement in the presence of acoustic waves is associated with the component of the NAPL mixture having the smallest equilibrium aqueous solubility. Finally, square shaped acoustic waves were shown to lead to greater NAPL dissolution enhancement compared to sinusoidal and triangular acoustic waves. The results of this study suggested that aquifer remediation using acoustic waves is a promising method particularly for aquifers contaminated with NAPLs containing components with very low equilibrium aqueous solubilities.

Acoustics↗

The relationship between perception and acoustics for a high-low vowel contrast produced by speakers with dysarthria.

This study was designed to explore the relationship between perception of a high-low vowel contrast and its acoustic correlates in tokens produced by persons with motor speech disorders. An intelligibility test designed by Kent, Weismer, Kent, and Rosenbek (1989a) groups target and error words in minimal-pair contrasts. This format allows for construction of phonetic error profiles based on listener responses, thus allowing for a direct comparison of the acoustic characteristics of vowels perceived as the intended target with those heard as something other than the target. The high-low vowel contrast was found to be a consistent error across clinical groups and therefore was selected for acoustic analysis. The contrast was expected to have well-defined acoustic measures or correlates, derived from the literature, that directly relate to a listeners' responses for that token. These measures include the difference between the second and first formant frequency (F2-F1), the difference between F1 and the fundamental frequency (FO), and vowel duration. Results showed that the acoustic characteristics of tongue-height errors were not clearly differentiated from the acoustic characteristics of targets. Rather, the acoustic characteristics of errors often looked like noisy (nonprototypical) versions of the targets. Results are discussed in terms of the test from which the errors were derived and within the framework of speech perception theory.

Adult↗

Acoustic variations in reading produced by speakers with spasmodic dysphonia pre-botox injection and within early stages of post-botox injection.

Acoustic analysis of a reading passage was used to identify the abnormal phonatory events associated with adductor spasmodic dysphonia (ADSD) pre- and postinjection of Botulinum Toxin A (Botox). Thirty-one patients (age 22 to 74 years) diagnosed with ADSD were included for study. All patients were new recipients of Botox, and the examination of their voice occurred before and after their initial injection of Botox. Acoustic events were identified from reading samples of the Rainbow Passage produced by each of the patients. These events were examined from sentences containing primarily voiced sound segments. Dependent variables included the number of phonatory breaks, frequency shifts, and aperiodic segments--all variables previously defined by the investigators. Additionally, calculated variables were made of the percentage of time these events occurred relative to the duration of the cumulative voiced segments. A sex- and age-matched control group (+/-2 years) was included for statistical comparison. Results indicated that those with ADSD produced more aberrant acoustic events than the controls. Aperiodicity was the predominant acoustic event produced during the reading, followed by frequency shifts and phonatory breaks. Within the ADSD group, the number of atypical acoustic events decreased following Botox injection. It is important that the occurrence of specific abnormal acoustic events was sufficient to differentiate the disordered speakers from the controls following as well as preceding initial Botox injection, as indicated by discriminant function analysis. This paper complements our previous work using this acoustic analysis method for defining the abnormal events present in the voice of those with ADSD and further suggests that these measures can be used in conjunction with perceptual impressions to differentiate speakers on the basis of initial severity.

Adult↗

Rate and loudness manipulations in dysarthria: acoustic and perceptual findings.

Both rate reduction and increased loudness reportedly are associated with an increase in the size of the articulatory-acoustic working space and improved acoustic distinctiveness for speakers with dysarthria. Improved intelligibility also has been reported. Few studies have directly compared rate and loudness effects for speakers with dysarthria, however, although rate reduction and increasing vocal loudness are common treatment techniques. In the current study, 15 speakers with dysarthria secondary to multiple sclerosis, 12 speakers with dysarthria secondary to Parkinson's disease (PD), and 15 healthy controls read a passage in habitual, loud, and slow conditions. Rate and loudness variations were elicited using magnitude production. Acoustic measures included articulatory rate, sound pressure level, vowel space area, first moment difference measures, and F2 trajectory characteristics for diphthongs. Ten listeners scaled intelligibility for reading passages produced by the speakers with dysarthria. Relationships between intelligibility estimates and acoustic measures were determined by regression analysis. All speaker groups reduced articulatory rate for the slow condition and increased vocal intensity for the loud condition, relative to the habitual condition. Vowel acoustic distinctiveness, as indexed by vowel space area, was maximized in the slow condition, but stop consonant acoustic distinctiveness, as indexed by first moment difference measures, was maximized in the loud condition. F2 slope measures for diphthongs were not consistently affected by rate or loudness. Scaled intelligibility for speakers with PD also improved in the loud condition relative to both the habitual and slow conditions. Intelligibility estimates for speakers with dysarthria, however, were not strongly related to acoustic measures of supraglottal behavior. Findings are compared with previous studies, and hypotheses for future treatment studies are discussed.

Adult↗

Cost-effective diagnosis of acoustic neuromas: a philosophical, macroeconomic, and technological decision.

OBJECTIVE: Our goals were to define the most sensitive techniques of acoustic neuroma diagnosis, to examine their relative costs, and to propose diagnostic modality selection given the rarity of acoustic neuroma incidence and given the other costs that society faces in more commonly encountered diseases. METHODS: We conducted a MEDLINE search of the English language from 1966 to 2001 using the following keywords: acoustic neuroma, acoustic tumor, vestibular schwannoma, diagnosis, cost effectiveness, MRI, auditory brainstem response, brainstem audiometric evoked response, incidence, and prevalence. RESULTS: Although magnetic resonance imaging with gadolinium remains the most sensitive diagnostic modality in the discovery of acoustic neuromas, its cost may be prohibitive for some societies. CONCLUSION: Which modality to use in acoustic neuroma diagnosis is just as much a philosophical and macroeconomic question as a technological one. CLINICAL SIGNIFICANCE: The cost of a timely diagnosis of acoustic neuromas must be weighed against using resources for other, more pressing, health concerns.

Audiometry, Evoked Response↗

Analysis of magnetic resonance imaging acoustic noise generated by a 4.7 T experimental system.

High intensity acoustic noise is an undesirable side-effect in magnetic resonance imaging (MRI) that can cause discomfort and hearing loss in patients and may be an impediment in functional MRI (fMRI) studies of the auditory system. Experimental MRI systems with high magnetic field strengths may generate acoustic noise of higher sound pressure levels (SPLs) than conventional 1.0 and 1.5 T clinical systems. We measured the SPL and spectral content of the acoustic noise generated by the Bruker Biospect 47/40 4.7 T experimental MRI system during scanning sequences commonly used in animal testing. Each sequence generated acoustic noise of high SPL, rapid pulse rates, amplitude-modulated pulse envelopes and multi-peaked spectra. The rapid acquisition with enhancement sequence with a 0.25 mm slice thickness generated SPLs of up to 129 dB peak SPL and 130 dB (A). Fourier analysis of the spectral content of the acoustic noise generated by each MRI sequence showed a wide band of acoustic energy with spectral peaks from 0.2-5 kHz. The intense MRI acoustic impulse noise generated by the 4.7 T system may cause masking of stimuli used in fMRI of the auditory cortex, reduce the hearing acuity of experimental animals and present a risk for unprotected human ears.

Acoustics↗

Non-chemical biofouling control in heat exchangers and seawater piping systems using acoustic pulses generated by an electrical discharge.

Acoustic pulses generated by an electrical discharge (pulsed acoustics) were investigated as a means for biofouling control in two test formats, viz. a 5/8" outside diameter titanium tube and a mockup heat exchanger. The pulsed acoustic device, when operated at 17 kV, demonstrated 95% inhibition of microfouling over a 20 ft length of titanium tube over a 4-week period, comparable to chlorination in combination with a high-velocity flush. The pulsed acoustic device inhibited microfouling over a downstream distance of 15 ft, therefore, a single pulsed acoustic device is theoretically capable of protecting at least 30 ft of tube from microfouling (15 ft on either side of the device). A correlation between acoustic intensity in the frequency range 0.01-1 MHz and the level of biofouling inhibition was observed. The threshold acoustic intensity for microfouling inhibition was determined for this frequency range. It was also observed that the orientation of the device is critical to obtaining microfouling inhibition.

Acoustics↗

Noninvasive diagnosis of mechanical failure of the implanted total artificial heart using neural network analysis of acoustic signals.

Acoustic signal measurement has been proposed as a noninvasive method of detecting mechanical failure of the implanted total artificial heart. However, differences in acoustic spectra obtained from undamaged and damaged devices may be difficult to distinguish using standard techniques, such as visual inspection or statistical analysis. A new technique, artificial neural network analysis, which has been used successfully on other problems of pattern recognition and classification, was applied to improve the detectability of the acoustic method. Acoustic signals were measured using two different devices in one damaged and one undamaged electrohydraulic total artificial heart, both in a mock circulation set-up and in animal experiments where they were implanted in eight post mortem sheep and the acoustic signal measured using a microphone placed at the skin surface. Spectra of the acoustic waveforms were calculated by discrete Fourier transformation and 400 values (representing the log magnitude in each 2.5 Hz band of the spectrum between 0 and 1 kHz) and used as input to the neural network. A three layer backpropagation neural network containing 400 input nodes, 20 intermediate nodes, and one output node was able to forms. The trained neural network then perfectly distinguished damaged waveforms from undamaged ones, with good separability. Because the neural network's output can take on a value between two extremes denoting damaged and undamaged states, it is possible to detect any progressive failure at relatively earlier stages. With multiple output node configuration, it could also classify the different types of damage using single acoustic signal waveforms.

Acoustics↗

Adaptation of the acoustic reflex.

Acoustic reflex adaptation is reviewed in normal and abnormal auditory systems. The measurement variables affecting the acoustic reflex threshold are discussed with reference to the intensity level above reflex threshold at which the adaptation is measured. The effects of the activator frequency and activator intensity level on the time course of normal reflex adaptation are reviewed. The diagnostic application of acoustic reflex adaptation is discussed with reference to the different definitions of abnormality found in the literature. The acoustic reflex patterns, including absence, threshold, and adaptation of the reflex, are reported in patients with different degrees of hearing loss, in order to identify the false-positive rates associated with cochlear hearing losses. Finally, the diagnostic accuracy of acoustic reflexes is discussed in subjects having lesions of the CNVIII, brain stem, CNVII, and neuromuscular systems. In summary, a method is advocated for measuring acoustic reflex adaptation over 10 seconds, which allows analysis at both 5 and 10 seconds. Further research is needed on procedural variables including activator intensity level and ipsilateral recording methods, which may increase the diagnostic accuracy of acoustic reflex adaptation.

Adaptation, Physiological↗

Observations on the acoustic reflex threshold in institutionalized retarded adults taking mellaril and/or thorazine.

The present study was designed to investigate whether mellaril and thorazine, when used alone and in combination with other medications by mentally retarded clients, either abolish acoustic reflexes or compromise estimates of hearing sensitivity based on acoustic reflex measures. Acoustic reflex thresholds were determined in 35 normal-hearing institutionalized mentally retarded subjects who were regular users of the medications under investigation. Five sensitivity prediction methods based on acoustic reflex thresholds were applied to the data. The results of the study showed that acoustic reflexes were present in most subjects. However, the accuracy of all the acoustic reflex-based sensitivity prediction methods was quite poor with greatly exaggerated predictions of hearing loss. The methods based solely on noise reflex thresholds provided better accuracy than those based on noise-tone differences. In general, the accuracy of the prediction methods decreased as the number of medications used by the subjects increased. It is argued that the results provide evidence for reticular activating system mediation of acoustic reflex activity.

Adult↗

Acoustic neuroma surgery outcomes.

OBJECTIVE: The outcomes of surgery for acoustic neuromas have improved dramatically since the development of modern surgical techniques, the operating microscope, magnetic resonance imaging (MRI), and cranial nerve monitoring. The goals of acoustic neuroma surgery are now preservation of facial nerve function and, when feasible, hearing preservation. Many large series do not report standardized hearing and facial function grading, and they include patients who did not benefit from the most modern techniques. The purpose of this study was to present the results of acoustic neuroma surgery using the most modern techniques and equipment, using standardized grading systems. STUDY DESIGN: Retrospective review. SETTING: Tertiary referral center. PATIENTS: 97 patients who underwent surgical removal of acoustic neuromas from 1992 to 1998. INTERVENTION: All patients underwent acoustic neuroma surgery and had preoperative audiograms and MRI with contrast. In addition, all patients had preoperative and postoperative facial function graded by the House-Brackmann scale and intraoperative facial nerve monitoring. Hearing preservation was attempted in patients with tumors of any size who had preoperative function of grade A or B according to the Committee on Hearing and Equilibrium guidelines for reporting results of acoustic neuroma surgery. MAIN OUTCOME MEASURES: Hearing preservation was considered successful if the patient retained serviceable hearing grade A or B. House-Brackmann grade 1 or 2 was considered excellent facial function. Complications were recorded. RESULTS: Facial nerve integrity was preserved in 96 of 97 patients (99%). Eight of 8 (100%) patients with intracanalicular tumors had excellent facial nerve function (HB 1-2). Fifty-two of 55 (95%) of patients with small tumors had excellent facial nerve function, and 15 of 24 (63%) with medium tumors had HB grade 1-2. Hearing was preserved in 29% of patients with tumors under 2 cm. The overall complication rate was 20%; cerebrospinal fluid leak was the most common. CONCLUSION: These results show that with modern imaging and surgical techniques, acoustic neuroma surgery is extremely safe and outcomes are very good. Surgery remains the treatment of choice for most tumors until alternative therapies, such as gamma knife, use uniform grading scales and show long-term facial and hearing results.

Adult↗

Incidence and management of acoustic neuromas in South Africa.

OBJECTIVES: To determine the extent to which the various treatment modalities are used in the management of acoustic neuromas treated in South Africa and to estimate the incidence of acoustic neuromas in South Africa. METHODS: A telephonic survey was conducted of all otorhinolaryngologists, neurosurgeons, and radiotherapy centers in South Africa to determine whether they had treated any patients with acoustic neuromas during the calendar year 2000. RESULTS: One hundred and fifteen patients with acoustic neuromas were treated in South Africa during the calendar year 2000, and 8 patients were referred to other countries for treatment. This resulted in an incidence of approximately 0.3 per 100,000 population per year. There was a marked difference in the incidence between the various racial groups: the incidence was at least 1.76 per 100,000 population per year among whites and at least 0.01 per 100,000 population per year among blacks. Of the 115 patients, 78 (68%) were treated surgically and 24 (21%) by stereotactic radiotherapy. Fourteen (12%) patients had newly diagnosed acoustic neuromas that were managed conservatively in the year concerned. The surgical approach used was middle fossa in 8 (7%) patients, retrosigmoid in 61 (53%) patients, and translabyrinthine in 9 (8%) patients. CONCLUSIONS: The majority of acoustic neuromas in South Africa were treated surgically, mainly by a retrosigmoid approach. The incidence of acoustic neuromas in South Africa was approximately 0.3 per 100000 population per year. There were significant racial differences in the incidence.

Black People↗

Measurement of cellular elastic properties by acoustic microscopy.

The acoustic microscope is used to investigate the elastic properties of living biological cells. A quantitative model is developed relating acoustic microscope image contrast to cellular elastic properties. Cytoplasmic acoustic attenuation is measured by focusing the acoustic microscope on the surface of the underlying substrate. Cytoplasmic acoustic impedance is measured by focusing the acoustic microscope on the top surface of the cell. The model allows the acoustic microscope to give quantitative information about cellular elasticity on a subcellular scale.

Acoustics↗

Effect of acute acoustic stress on anorectal function sensation in healthy human.

Little is known about the effects of acute acoustic stress on anorectal function. To determine the effects of acute acoustic stress on anorectal function and sensation in healthy volunteers. Ten healthy volunteers (7 M, 3 F, mean age 34 +/- 3 years) underwent anorectal manometry, testing of rectal compliance and sensation using a barostat with and without acute noise stress on separate days. Rectal perception was assessed using an ascending method of limits protocol and a 5-point Likert scale. Arousal and anxiety status were evaluated using a visual analogue scale. Acoustic stress significantly increased anxiety score (P < 0.05). Rectal compliance was significantly decreased with acoustic stress compared with control P (P < 0.000001). In addition, less intraballoon volume was needed to induce the sensation of severe urgency with acoustic stress (P < 0.05). Acoustic stress had no effect on hemodynamic parameters, anal sphincter pressure, threshold for first sensation, sensation of stool, or pain. Acute acoustic stimulation increased anxiety scores, decreased rectal compliance, and enhanced perception of severe urgency to balloon distention but did not affect anal sphincter pressure in healthy volunteers. These results may offer insight into the pathogenesis of stress-in-induced diarrhoea and faecal urgency.

Acoustic Stimulation↗

The acoustic and structural properties of the human femur.

This study evaluates the variations in the acoustic properties of the human femur at ten evenly spaced locations along its length, as well as differences that exist within given transverse sections. Six pairs of human femora, three male and three female, were sectioned, ground, and polished, and scanned with a microprocessor-driven scanning acoustic microscope. Images with a resolution of approximately 140 microns were used to calculate the average acoustic impedances for each transverse cross section and each quadrant within a cross section. The mean acoustic impedance for all the cross sections was 7.69 +/- 0.18 Mrayls. Variations were observed among the cross sections, and the central sections (4-7) had values that were statistically greater than the other more distal and proximal sections. Within the cross sections, the posterior quadrant had a lower average acoustic impedance compared to the other quadrants and this was statistically significant (Tukey's multiple comparison test). The cross sections were further analyzed to determine several geometric parameters including the principal moments of inertia, polar moment of inertia, and the biomechanical shape index. The product of the acoustic impedance and the maximum moment of inertia provided a result that attempted to account for the acoustic property variation and the change in shape at the different section locations.

Acoustics↗

Energy: converting from acoustic to biological resource units.

Acoustic backscattering strength is often used as an index of biomass; however, the relationship between these variables has not been directly validated. Relationships were investigated between acoustic cross section at 200 kHz, measured as part of a previous study, and measured values of length, biovolume, dry weight, ash-free dry weight, and caloric content of the same individual specimens. Animals were part of the Hawaiian mesopelagic boundary community and included shrimps, squids, and myctophid fishes. The strong relationships found between all the variables measured make it possible to approximate any one variable from the measured values of others within a class of animals. The data show that for these midwater animals, acoustic scattering can be used as an index of biomass. Dorsal-aspect acoustic cross section at 200 kHz predicted dry weight and ash-free dry weight at least as well as did body length, a standard predictor. Dorsal-aspect acoustic cross section at 200 kHz was also a strong predictor of total caloric content. The relationship between dorsal-aspect acoustic cross section and caloric content of Hawaiian mesopelagic animals was linear and additive. Consequently, it is possible to directly convert acoustic energy from these animals to organic resource units without having knowledge of the size distribution of the populations being studied.

Acoustics↗