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PubMed1994

Silicone rubber contact lenses for the compromised cornea.

Silicone rubber contact lenses (SRCLs) are infrequently used because of the risk of developing unpredictable lens tightening, their poor availability, and their expense. However, their high oxygen transmissibility and nonabsorption of water make them valuable as therapeutic lenses. SRCLs are routinely used in our management of severely dry eyes, decompensated or vascularised corneas, and conditions where the corneal shape is flat or irregular. The records of 48 consecutive patients fitted with SRCLs between January 1989 and June 1990 were studied. The clinical history, indications, complications, success, and duration of SRCL wear were analysed. Therapeutic goals, which included epithelial healing, sealing of corneal perforations, and improved comfort and vision, were achieved in 53 of 62 eyes. The best corrected acuity was attained using SRCLs in 58 of 62 eyes. Failure of lens wear was due to lens tightening (four eyes), spoilation (two), discomfort, fornix shortening, handling problems, and decentration (one each). Infective keratitis complicated one case, but SRCL wear was resumed after successful treatment. With adequate follow-up, SRCLs have a low complication rate and are well tolerated even in severely compromised eyes, for which conventional lenses may be contraindicated. Their continued use as therapeutic lenses is advocated in carefully selected cases.

Aged↗
PubMed2001

Femoral condylar lift-off in vivo in total knee arthroplasty.

We carried out weight-bearing video radiological studies on 40 patients with a total knee arthroplasty (TKA), to determine the presence and magnitude of femoral condylar lift-off. Half (20) had posterior-cruciate-retaining (PCR) and half (20) posterior-cruciate-substituting (PS) prostheses. The selected patients had successful arthroplasties with no pain or instability. Each carried out successive weight-bearing knee bends to maximum flexion, and the radiological video tapes were analysed using an interactive model-fitting technique. Femoral lift-off was seen at some increment of knee flexion in 75% of patients (PCR TKA 70%; PS TKA 80%). The mean values for lift-off were 1.2 mm with a PCR TKA and 1.4 mm with a PS TKA. Lift-off occurred mostly laterally with the PCR TKA, and both medially and laterally with the PS TKA. Separation between the femoral condyles and the articular surface of the tibia was recorded at 0 degrees, 30 degrees, 60 degrees and 90 degrees of flexion. Femoral condylar lift-off may contribute to eccentric polyethylene wear, particularly in designs of TKA which have flatter condyles. Coronal conformity is an important consideration in the design of a TKA.

Aged↗
PubMedDate not supplied

Rehabilitation of hearing-impaired children: intervention and outcome.

A cohort of 72 hearing-impaired children of a median age of 9.7 years, range 4.3-13.9, born during 1980-1990 and living in the health district of Copenhagen City was examined cross-sectionally in order to evaluate the interval from identification to the initial fitting of hearing aids (HAs) and children's use of HAs. As measures of outcome, the use of HAs at 1, 6, 12 months after fitting, and at the time of data collection was assessed along with the primary language of each child. One month after the fitting, 53% of the total sample used the HAs > 8 h/day, and no significant longitudinal changes in the proportion of time-related use were found. 56% of the children stayed in the same user category during the years, while the rest either increased (25%) or decreased (19%) the use of amplification from 1 month after fitting to the time of data collection. Children with better ear hearing level (BEHL) 0.5-4 kHz between 60 and 89 dB used the HAs significantly more than those with mild or profound hearing impairments, whereas age at onset (congenital, acquired, age at onset unknown) and age at intervention were unrelated to use of amplification. 72% of the children were oral, while 25% were manual (unknown 3%), and no differences in the use of HAs were found between these two groups. A subdivision of congenitally hearing-impaired children according to BEHL 0.5-4 kHz below/above 75 dB demonstrated a significantly larger proportion of manual children in the poorer hearing group despite a significantly younger amplification age. It is concluded that age at intervention is unrelated to primary language, although the number of children precludes dependable conclusions.

Adolescent↗
PubMed1996

Speech recognition with a CIS strategy for the ineraid multichannel cochlear implant.

Wilson et al. proposed a new sound-processing strategy for multichannel cochlear implants, the Continuous Interleaved Sampling (CIS) strategy. Their study was performed on seven American patients, selected for their excellent performance with the Ineraid multichannel cochlear implant, and involved refined testing of several parameter modifications of the CIS strategy during a 1-week period. At the end of the week, the CIS strategy produced large improvements in speech-recognition tests for all subjects. To evaluate the generality of this promising result, the goal of this study was to assess whether similar improvements of performance could be observed in a typical population of Ineraid users and implemented as a clinical protocol. Therefore we designed one unique, predetermined CIS processor that could be temporarily fitted to the patients in < 2 h, and we evaluated speech recognition with consonant-and vowel-identification tests in a group of patients with performances ranging from star to almost chance levels and speaking six different native languages. Scores of vowel and consonant identifications obtained with this predetermined CIS processor and with the standard processor of the Ineraid system were compared in 15 Ineraid users. Fourteen of 15 patients had significantly better scores of consonant identification with the new CIS strategy. The group mean scores of vowel identification with either strategy were not statistically different. In agreement with these observations, most patients immediately reported that the CIS strategy sounded subjectively "more clear" for real-time speech recognition. It is now possible to implement a CIS speech-coding strategy as a standard clinical procedure to improve speech-recognition performances of all Ineraid users.

Adolescent↗
PubMed1999

[Primary stability of cement-free press-fit acetabulum cups. In vitro displacement studies].

The initial stability of 6 different hemispherical press-fit titanium acetabular cups was investigated by lever-out tests using a foam model. Each cup was implanted in a standardised manner into machined PVC-foam blocks with an underreaming of 1/2/3 mm, and levered out 5 times. A computer recorded the load-displacement curves. Both insertion forces and lever-out forces increased with increasing press-fit from 1 to 2 mm. With underreaming of 2 mm, insertion forces varied between 9 and 34 Nm, and lever-out torques between 13 and 23 Nm. The cup made up of multi-layer irregular titanium wire mesh had the highest initial stability of all the cups tested. 3 mm underreaming was associated with insertion difficulties, so that lever-out is difficult to compare with that with 1 and 2 mm. The amount of contact on the equatorial rim, where we saw the most attrition after lever-out, is the most important factor for determining the lever-out torque. The quality of the PVC foam blocks, the accuracy of reaming, and the definition of cup insertion are very important parameters for test reproduction. Since the trials were conducted under laboratory conditions, translation of the results to the intraoperative situation should be undertaken only with certain reservations.

Acetabulum↗
PubMed2003

Evidence of acclimatization in persons with severe-to-profound hearing loss.

The present study examined the phenomenon of acclimatization in persons with a severe-to-profound hearing loss. A secondary purpose was to examine the efficacy of a digital nonlinear power hearing aid that has a low compression threshold with expansion for this population. Twenty experienced hearing aid users wore the study hearing aids for three months and their performance with the study hearing aids was evaluated at the initial fitting, one month, and three months after the initial fitting. Performance of their current hearing aids was also evaluated at the initial fitting. Speech recognition testing was conducted at input levels of 50 dB SPL and 65 dB SPL in quiet, and 75 dB SPL in noise at a +10 SNR. Questionnaires were used to measure subjective performance at each evaluation interval. The results showed improvement in speech recognition score at the one-month evaluation over the initial evaluation. No significant improvement was seen at the three-month evaluation from the one-month visit. In addition, subjective and objective performance of the study hearing aids was significantly better than the participants' own hearing aids at all evaluation intervals. These results provided evidence of acclimatization in persons with a severe-to-profound hearing loss and reinforced the precaution that any trial of amplification, especially from linear to nonlinear mode, should consider this phenomenon.

Acclimatization↗
PubMed2004

Objective measurements of auditory nerve recovery function in nucleus CI 24 implantees in relation to subjective preference of stimulation rate.

OBJECTIVE: Setting the optimal rate of stimulation for individual cochlear implant recipients is critical to the successful functional outcome of cochlear implantation. In the absence of an objective methodology, cochlear implants are currently fitted by means of a time-consuming (and therefore expensive) trial-and-error process of limited accuracy. The aim of this study was to evaluate a possible relationship between the patient's subjectively preferred stimulation rate and an objective measurement of auditory nerve recovery time. MATERIAL AND METHODS: Eleven recipients of Nucleus CI 24 implants initially fitted with a speech processor using the advanced combination encoders speech-coding strategy at a rate of 900 Hz were introduced to 2 other stimulation rate options, 1200 and 1800 Hz, at 2 different fitting sessions and were asked to choose their preferred rate. Preferences were compared with objective measurements of auditory nerve recovery time obtained with the refractory recovery function of neural response telemetry. RESULTS: The auditory nerve recovery time for individuals with a subjective preference for a slow stimulation rate was longer than that for individuals who preferred a fast stimulation rate, with significant differences between the 2 groups for 3 of the tested electrodes (Nos. 7, 11 and 15): p = 0.024, 0.009 and 0.03, respectively (Mann-Whitney test). CONCLUSIONS: The association observed between subjective stimulation rate preference and measurements of auditory nerve recovery time indicates that the measured auditory nerve recovery time can be used as a reliable predictor for setting up a basic stimulation rate of a particular individual's map, thus reducing the cost of the technology and significantly increasing its effectiveness.

Acoustic Stimulation↗
PubMed1998

Open earmold fittings for improving aided auditory localization for sensorineural hearing losses with good high-frequency hearing.

OBJECTIVE: We tested the hypothesis that the use of nonoccluding earmolds for hearing aid fittings could optimize auditory localization in the vertical plane for people with moderate, low-frequency hearing losses and good hearing at frequencies above 4000 Hz. This benefit was expected to arise from leaving the pinna unobstructed and by optimizing hearing (unaided) for frequencies above the hearing aid's limit. DESIGN: Twenty-two participants had hearing losses greater than 30 dB over the range 250 to 2000 Hz and had minimal losses (< 30 dB) at 6000 Hz and 8000 Hz. Their auditory localization was tested, using a horizontal arc and a vertical arc of loudspeakers, when listening unaided and when fitted bilaterally with Behind The Ear hearing aids with three earmold types--closed (occluded), open (partly occluded), sleeve (nonoccluded). RESULTS: Localization of vertical plane sound sources was significantly poorer for the closed earmold condition than for unaided. The open and sleeve conditions were better than the closed condition, and, for the sleeve earmold, vertical localization was almost equal to that unaided. The capacity to benefit from using open rather than closed earmolds was related to hearing level; people with the best hearing at 4000, 6000, and 8000 Hz received the most benefit. There was limited evidence that open earmolds also can be advantageous for some aspects of horizontal plane localization. CONCLUSIONS: Nonoccluding earmolds optimize aided vertical localization for hearing aid users with good high-frequency hearing. The "sleeve" earmold, so far used only in research, may be a useful clinical option.

Adolescent↗
PubMed2003

Examination of differences between successful and unsuccessful elderly hearing aid candidates matched for age, hearing loss and gender.

This study examined group differences on a variety of measures for three groups of elderly hearing aid candidates matched for gender, age and hearing loss. These three groups were: (1) 26 candidates who declined amplification (non-adherents); (2) 24 individuals who purchased hearing aids, but subsequently returned them (rejected HA); and (3) 26 who purchased hearing aids and continued to use their hearing aids for at least the first 6 months following delivery (accepted HA). Following demonstration of adequate reliability for these measures, using the non-adherents as the test retest study sample, group differences were examined for each pre-fit measure. The group of non-adherents who declined amplification differed from the two groups who purchased hearing aids on their scores for the Hearing Handicap Inventory for the Elderly (HHIE) and for several scales of the Communication Profile for the Hearing Impaired (CPHI) that assessed the individual's personal adjustment to hearing impairment. These findings were generally confirmed for the individual data, with the use of discriminant analysis. For the two groups who tried hearing aids, there were no group differences between those who retained them and those who did not. Discriminant analysis, however, indicated that those in the group who retained their (linear) hearing aids tended to have better finger dexterity and higher loudness discomfort levels than those who did not.

Adaptation, Physiological↗
PubMed2003

Pilot study: data-capturing consistency of two trans-tibial casting concepts, using a manikin stump model: a comparison between the hands-on PTB and hands-off ICECAST compact concepts.

The quality of fit of a trans-tibial patellar tendon bearing (PTB) socket may be influenced by consistency in casting, rectification or alignment. For this study two distinctive different data-capturing concepts were tested in relation to prosthetist performance. The hands-on PTB and hands-off ICECAST compact concept were studied and compared for inter- and intra-prosthetist consistency using a specially designed manikin stump model. A purpose designed digitiser was used to scan a selected surface area of the produced models, 5 for each concept, 10 in total. The extent of casting consistency at each of 936 locations per plaster model was calculated and the level of consistency was quantified. This study has shown that by using the manikin model there is a clear indication that the investigated hands-off concept produces more consistent results than the hands-on concept.

Amputation Stumps↗
PubMed2004

Is normal or less than normal overall loudness preferred by first-time hearing aid users?

OBJECTIVE: Most prescriptive methods for nonlinear, wide dynamic range compression (WDRC) hearing aids are based on the assumption that a hearing-impaired listener should perceive amplified sounds at the same overall loudness as would a normal-hearing listener without amplification. However, some previous research on linear amplification has indicated that subjects prefer less overall gain than prescribed by the most commonly used prescriptive method for linear hearing aids, NAL-R, a method that gives close to normal overall loudness for a mid-level input. The current study aims at comparing two prescriptive methods for WDRC hearing aids. The methods differ in the overall loudness they aim to give the hearing aid user. One method, called NormLoudn, is based on a generic method that prescribes gain so that the overall loudness is restored to normal. Another method, called LessLoudn, is based on a hearing aid specific prescription, and gives the hearing aid user less than normal overall loudness. Do first-time hearing aid users prefer the method that restores overall loudness to normal or the method that gives less than normal overall loudness? DESIGN: Twenty-one first-time hearing aid users with typical hearing losses for this group of clients participated in a crossover blinded field study where the two fitting methods were compared using a multi-programmable hearing aid, Danalogic 163D. Preference in the field was evaluated using interview, questionnaire, and diary. The field test was accompanied by laboratory tests, which included paired comparison judgments of preference and loudness and a speech recognition test. Loudness calculations were also used when interpreting the results, and a theoretical comparison with other prescriptive methods for WDRC hearing aids was made. RESULTS: After necessary adjustments, the measured gain for the two methods was similar in gain-frequency shape, but NormLoudn gave more overall gain than LessLoudn. Generally, NormLoudn fittings led to calculated overall loudness that was close to normal, whereas LessLoudn fittings, in median, led to 3-7 phon less than normal calculated overall loudness according to the loudness model used. During the interview performed after the field test, 19 out of the 21 subjects stated that they preferred LessLoudn. Also the questionnaire and the diary showed a clear preference for LessLoudn in all types of listening situations. Paired comparisons of preference in the laboratory supported the findings in the field. LessLoudn was preferred to NormLoudn in all tested situations, except for soft speech in very soft noise where there was no significant preference for either method. Speech recognition scores were similar for the two fittings. The difference in calculated loudness was clearly distinguishable to the subjects and seemed to govern their preferences. CONCLUSIONS: LessLoudn, which gave less than normal overall loudness according to the loudness model used, was preferred both in the field and in the laboratory tests. Speech recognition scores were similar for both methods. A comparison between the measured gain for NormLoudn and the gain prescribed by CAMEQ, NAL-NL1, and DSL[i/o], suggests that all three prescriptive procedures (DSL[i/o] in particular) would probably overestimate the required gain for subjects without hearing aid experience and with mild to moderate hearing loss. When providing these clients with hearing aids, it seems important to include a careful adjustment of the overall gain to avoid overamplification if the prescription used aims at restoring overall loudness to normal according to the loudness model used here.

Aged↗
PubMed2002

Comparative clinical performance of two silicone hydrogel contact lenses for continuous wear.

BACKGROUND: Silicone hydrogel soft contact lenses are now available for use on a 30-day continuous wear basis. The aim of this study was to compare the clinical performance of two such lenses. METHODS: In a single-centre, randomised, subject-masked, two-period crossover study, 30 subjects wore a pair of PureVision lenses (Bausch & Lomb) and a pair of Focus Night & Day lenses (CIBA Vision), alternately, for successive eight-week periods. Assessment was made of lens fit and surface characteristics, logMAR visual acuity, ocular response and subjective reaction. RESULTS: Lens fit, deposition and post-lens debris were similar for the two lens types. High contrast visual acuity was statistically significantly better for the PureVision lens, as was the subject-reported quality of vision, although these differences were not considered clinically significant. For both lenses, limbal and conjunctival redness reduced throughout the duration of the study, whereas there was a slight increase in the overall amount of corneal staining. The incidence of mucin balls peaked four weeks after commencing lens wear and began to decline thereafter; more mucin balls were noticed in subjects wearing Focus Night & Day lenses. No differences between the lenses were observed for any other biomicroscopic signs. CONCLUSIONS: This study demonstrates similar clinical performance with the two silicone hydrogel lenses evaluated. We believe that, with careful monitoring, both of these new-generation lenses can be prescribed for continuous wear.

Adult↗
PubMed2006

Fitting range of the BAHA Cordelle.

The performance of the most powerful Bone-Anchored Hearing Aid (BAHA) currently available, the BAHA Cordelle, was evaluated in 25 patients with severe to profound mixed hearing loss. Patients showed bone conduction thresholds at 500, 1000 and 2000 Hz, ranged between 30 and 70 dB HL, and an additional air-bone gap of about at least 30 dB. With the BAHA Cordelle, free-field thresholds improve relative to bone-conduction thresholds with 1.5, 5.0, 17.8, and 4.3 dB at 500, 1000, 2000, and 4000 Hz, respectively, with substantial inter-individual variability. The differences in unaided air conduction thresholds and aided free-field thresholds amount to 45.3, 45.8, 47.5, and 43.5 dB at 500, 1000, 2000, and 4000 Hz, respectively. Speech perception, measured both with monosyllables of the consonant-vowel-consonant type and with bisyllables, showed highly similar results. The fitting range of a (linear) hearing aid is determined by its gain characteristics. Requiring aided speech reception thresholds at or better than 65 dB SPL results in an upper limit of the fitting range of the BAHA Cordelle for bone-conduction thresholds of 51, 56, 67, and 58 dB HL at 500, 1000, 2000, and 4000 Hz, respectively. The dynamic range provided by the BAHA Cordelle was estimated from loudness growth functions at 500, 1500, and 3000 Hz employing 7-point categorical scaling. On average, aided loudness growth functions exhibit normal slopes but they level off at input levels of about 80, 70, 65 dB SPL for 500, 1500, and 3000 Hz stimuli, respectively. Measurements with a skull simulator demonstrated that the levelling-off reflects saturation of the output of the Cordelle. The relatively low saturation levels of the device suggest that increasing maximum output levels may be a worthwhile consideration for candidates with more profound sensorineural loss.

Acoustic Stimulation↗
PubMed2002

Relationship of intraoperative electrically evoked stapedius reflex thresholds to maximum comfortable loudness levels of children with cochlear implants.

Previous studies of the relationship between the intraoperatively obtained electrically evoked stapedius reflex threshold (ESRT) and the maximum comfortable loudness (MCL) values used to program the speech processor of cochlear implant (CI) patients have indicated that ESRTs provide an inexact estimate of MCL. In order to determine whether this estimate might be more exact for electrodes in different parts of the electrode array, we studied the electrode-specific relationships between ESRT and MCL in 29 Med-E1 Combi 40+ and 25 Nucleus CI 24 M patients after first fitting of the speech processor and 2 and 6 months later. The MCL values were mostly less than the ESRT values, but increased progressively over the first 6 months, reaching 83% and 72% of the ESRT values, on average, across all electrodes for the Med-E1 and Nucleus systems respectively. The population variation across electrodes decreased over the 6-month observation period and was least for the apical half of the array, for which the correlation coefficients of regressions between ESRT and MCL were around 0.65 for both systems. These results indicate that estimates of MCL values from the ERST are more accurate for the apical half of the intra-cochlear array and could then be described by an offset value plus an increase of MCL by 0.62 and 0.53 of ESRT for the Med-E1 and Nucleus systems, respectively.

Adolescent↗
PubMed2002

Geometric analysis of selected press fit prosthetic systems for proximal humeral replacement.

The ability of a prosthetic system to replicate a wide range of normal anatomy appears dependent in part to its capacity to produce variable prosthetic geometries. Several modern designs have recently been developed in order to provide multiple prosthetic options. The purpose of this study was to compare the geometry of select press fit prosthetic systems in terms of their ability to match normal three-dimensional geometry of the proximal humerus. The anatomy of 60 humeral specimens from 30 cadavers known from CT data and computer-aided design (CAD) analysis was compared to a 1996 database of four conventional shoulder prosthetic systems (fixed inclination angle, one medial-lateral offset position per head) and one so-called anatomic system (variable inclination angles, multiple head offset positions). The prosthetic system with greatest geometric options allowed for a significantly better replication of the anatomy. Average displacement of the center of rotation was 2.1 mm compared to 9.7 mm for the other systems combined. Reduction in surface arc was 12 degrees compared to 32 degrees. The most problematic feature of conventional prosthetic systems in terms of replicating normal humeral anatomy is the gap created by the prosthetic collar and Morse taper.

Algorithms↗
PubMed2002

In vivo comparison of femorotibial contact positions for press-fit posterior stabilized and posterior cruciate-retaining total knee arthroplasties.

The objective of this study was to determine the in vivo medial and lateral femorotibial condyle contact positions for 20 subjects having either a posterior cruciate-retaining (PCR) or posterior-stabilized (PS) total knee arthroplasty (TKA) while sitting and kneeling. The two-dimensional radiographic images were converted into three-dimensional images using an iterative computer model-fitting technique. Anteroposterior contact positions, axial rotation, and condylar lift-off were assessed for each subject. In a seated position, the femorotibial contact points were, on average, posterior for both TKA groups (PCR: medial = -2.4 mm, lateral = -3.4 mm; PS: medial = -5.1 mm, lateral = -8.9 mm; medial, P=.21; lateral, P=.08). In a kneeling position, the contact position shifted anteriorly for the PCR TKA group (medial = 0.9 mm, lateral = -0.8 mm), whereas the contact positions in the PS TKA group remained posterior (medial = -5.6 mm, lateral = -8.3 mm; medial, P=.002; lateral, P=.0004). It is hypothesized that while in a kneeling position, the posterior cruciate ligament has less resistance to the anterior thrust of the femur relative to the tibia than in a PS TKA, in which this force is absorbed in the cam-and-post mechanism.

Arthroplasty, Replacement, Knee↗
PubMed1999

A self-report outcome measure for the evaluation of hearing aid fittings and services.

OBJECTIVE: To design, optimise and validate an outcome measure for the evaluation of adult hearing aid fittings. DESIGN: A multi-dimensional subject-specific and situation-specific questionnaire (the Glasgow Hearing Aid Benefit Profile--GHABP) to assess initial disability, handicap, use, benefit, residual disability and satisfaction before and after hearing aid provision. SUBJECTS: Hearing-impaired adults attending National Health Service clinics for the first time for whom amplification is an appropriate management option. RESULTS: A self-report instrument of length compatible with the requirements of routine clinical practice which retains psychometric leverage. The GHABP demonstrates sensitivity to the technological content and rehabilitative context of interventions. The scale properties facilitate the use of the GHABP in decision-making for individual hearing-impaired patients. CONCLUSION: An outcome measure such as the GHABP offers the various interested parties (purchasers, providers and patients) a tool for use in the evaluation of the effectiveness and cost effectiveness of existing services and future developments. Many of the design concepts embodied in the GHABP are applicable in other healthcare contexts.

Adult↗
PubMed2004

Challenges and recent developments in hearing aids. Part I. Speech understanding in noise, microphone technologies and noise reduction algorithms.

This review discusses the challenges in hearing aid design and fitting and the recent developments in advanced signal processing technologies to meet these challenges. The first part of the review discusses the basic concepts and the building blocks of digital signal processing algorithms, namely, the signal detection and analysis unit, the decision rules, and the time constants involved in the execution of the decision. In addition, mechanisms and the differences in the implementation of various strategies used to reduce the negative effects of noise are discussed. These technologies include the microphone technologies that take advantage of the spatial differences between speech and noise and the noise reduction algorithms that take advantage of the spectral difference and temporal separation between speech and noise. The specific technologies discussed in this paper include first-order directional microphones, adaptive directional microphones, second-order directional microphones, microphone matching algorithms, array microphones, multichannel adaptive noise reduction algorithms, and synchrony detection noise reduction algorithms. Verification data for these technologies, if available, are also summarized.

Algorithms↗