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PubMed1995

[Early diagnosis of acoustic neuroma].

The diagnostic findings in 31 patients (32 ears) with acoustic neuromas are reported. In patients suspicious of acoustic neuroma, case history and clinical examination are important. In our material of 31 patients with acoustic neuromas, hearing loss was presented in 94% (slow onset 87%, sudden onset 10% and fluctuating 3%), tinnitus in 91%, vestibular symptoms (dizziness or vertigo) in 62%. It should be stressed that in patients with unilateral hearing loss (or tinnitus) or vestibular symptoms, it is necessary to exclude the presence of an acoustic neuroma. In addition, the trigeminal never was affected in 34%, which was encountered in tumours larger than 26-40 mm. There was a positive correlation between duration of symptoms and size of the tumour, but there was no correlation between hearing loss and size of the tumour. Brainstem response audiometry (ABR) exhibited a very high sensitivity (100%), making it a suitable single test for screening patients suspected to have an acoustic neuroma.

Adolescent↗
PubMed1996

[Estimation of left ventricular volumes and ejection fraction with acoustic quantification in myocardial infarction. Comparison with echocardiographic, angiographic and scintigraphic data].

The object of this study was to assess the reliability of measurements of left ventricular volumes and ejection fraction by acoustic quantification by the method of summation of discs in acute myocardial infarction. Thirty-two patients with an average age of 55.9 +/- 12 years were studied prospectively on average 6 +/- 2 days after the onset of myocardial infarction. Within 48 hours, the patients underwent TM echocardiography (Teichholz's method) two-dimensional echocardiography (Simpson's method on freeze frames and acoustic quantification) before left ventricular angiography and isotopic ventriculography, considered as the reference methods for comparing left ventricular volumes and ejection fractions. The data displayed in real time by acoustic quantification correlated well with the results of left ventricular angiography (r = 0.77; p = 0.0001) and moderately underestimated (+4.1 +/- 11.9%) the ejection fraction, but were relatively disappointing for estimating volumes. When compared with isotopic ejection fraction, the correlation coefficient was r = 0.71 (p = 0.0004) and the values were overestimated. In this study, acoustic quantification was the most reliable echocardiographic method of assessing the left ventricular ejection fraction with reference to contrast angiography (Teichholz: r = 0.56; p = 0.0014; Simpson: r = 0.76; p = 0.001). The authors conclude that assessing the left ventricular ejection fraction with acoustic quantification is reliable in acute myocardial infarction. However, the method is not very accurate in measuring end systolic and end diastolic volumes.

Acoustics↗
PubMed1996

Detection of acoustic schwannoma: use of constructive interference in the steady state three-dimensional MR.

PURPOSE: To compare constructive interference in the steady state (CISS) three-dimensional Fourier transform (3DFT) MR imaging with contrast-enhanced T1-weighted spin-echo MR imaging for accuracy in detecting acoustic schwannoma. METHODS: One hundred twenty-five consecutive patients with possible acoustic schwannoma were examined. The accuracy of CISS-3DFT MR imaging in detecting abnormalities of the cerebellopontine angle, the internal auditory canal, and the inner ear was compared with T1-weighted contrast-enhanced spin-echo MR imaging by independent assessment of both image sets by two observers. RESULTS: The postcontrast T1-weighted MR images revealed 18 cases of unilateral disease of the cerebellopontine angle and/or the internal auditory canal and no case of an abnormal bilateral cerebellopontine angle and/or internal auditory canal. Twelve cases were pathologically proved acoustic schwannomas. One meningioma of the cerebellopontine angle and one metastatic ependymoma to the cerebellopontine angle and the internal auditory canal was encountered. The four remaining cases had a provisional diagnosis of acoustic schwannoma and were scheduled for follow-up imaging and clinical review. Analysis of whether contrast material would have been administered to the appropriate patients (ie, those with disease of the cerebellopontine angle and/or internal auditory canal) according to CISS MR imaging findings revealed a sensitivity of 100% and a specificity of 98% for observer 1 and a sensitivity of 94% and a specificity of 94% for observer 2. CONCLUSION: CISS-3DFT MR imaging, in this patient population, provided high sensitivity and specificity in detecting lesions of the cerebellopontine angle and internal auditory canal; however, further experience is required before a definitive statement regarding the suitability of this technique as a screening procedure can be made. When contrast material cannot be administered, CISS MR imaging may be considered an adequate examination for the evaluation of possible acoustic schwannoma.

Adult↗
PubMed1997

Endoscopically assisted prevention of cerebrospinal fluid leak in suboccipital acoustic neuroma surgery.

HYPOTHESIS: The purpose of this prospective study was to determine if direct inspection of air cells using endoscopy could reduce the occurrence of cerebrospinal fluid (CSF) leak in suboccipital acoustic neuroma surgery. BACKGROUND: Cerebrospinal fluid leak remains one of the most common complications after acoustic neuroma surgery. The suboccipital approach for excision of acoustic neuromas has been used increasingly since gadolinium-enhanced magnetic resonance imaging has improved the ability to diagnose smaller tumors. Suboccipital approaches are reported to have CSF leak rates of as high as 27% with an average rate of 12%, most presenting as rhinorrhea. Ideally, this complication could be avoided by careful closure of all air cells exposed during the approach, especially those commonly found in the posterior wall of the internal auditory canal and in the retrosigmoid area. Packing these cells with a variety of materials has been done but often indirectly, as visualization of all cells by the conventional operating microscopes may not be possible. Failure to recognize patent cells because of limited visualization may be an important cause of postoperative CSF leak. METHODS: This study compared CSF rhinorrhea rates of 38 consecutive suboccipital acoustic neuroma operations, in which conventional techniques were used to pack the temporal bone defect around the internal auditory canal, with the succeeding 24 consecutive operations, in which endoscopes were used to visualize all exposed air cells directly. After locating all patent air cells endoscopically, they were specifically sealed with bone wax, and then a small fat graft harvested from the wound margin was used to fill the remaining defect. RESULTS: Postoperative CSF rhinorrhea occurred in 7 of 38 (18.4%) operations in which no endoscopic technique was used and in 0 of 24 operations in which endoscopes were used. CONCLUSIONS: The use of endoscopes to visualize the temporal bone air cells that cannot be directly observed otherwise appears to reduce the incidence of postoperative CSF leak in suboccipital acoustic neuroma surgery.

Adolescent↗
PubMed1997

Preoperative electroneuronography and facial nerve outcome in acoustic neuroma surgery.

OBJECTIVE: To determine whether preoperative electroneuronography (ENoG) predicts facial nerve outcome in patients undergoing acoustic neuroma surgery. STUDY DESIGN: Prospective, consecutive patients undergoing surgery for acoustic neuroma. SETTING: A private tertiary otology and neurotology practice. PATIENTS: One hundred consecutive patients presented for surgical removal of an acoustic neuroma between May 1992 and September 1993. The mean patient age was 49 years (range 17-77). Forty-three percent were male and 57% were female. The mean tumor size was 1.77 cm (range 3 mm to 5 cm). The tumors were removed by a translabyrinthine approach in 59% of patients, via the middle fossa in 40%, and retrosigmoid in 1%. The facial nerve was anatomically intact at the conclusion of the operation in all but one patient. INTERVENTION: Preoperative ENoG in all patients undergoing surgical removal of their acoustic neuromas. MAIN OUTCOME MEASURES: Facial nerve outcome was measured using the House-Brackmann scale immediately after the operation. 5-7 days after surgery, and > 1 year after surgical resection. RESULTS: Preoperative ENoG had no predictive value in determining immediate or eventual facial nerve outcome. CONCLUSIONS: ENoG has no value in predicting the facial nerve outcome in acoustic neuroma patients. The results of this study are similar to reports with smaller series in the literature. Preoperative ENoG has proven useful, in another study from this institution, in predicting the possible presence of a facial nerve neuroma. This test may be helpful in determining the possible etiology of an intracanalicular mass.

Adolescent↗
PubMed1997

Segmentation of acoustic neuromas with magnetic resonance imaging and Eigen image filtering.

OBJECTIVE: This study aimed to determine whether magnetic resonance imaging with Eigen image filtering can segment acoustic neuromas as a preliminary requirement to the development and validation of a volumetric method of measuring tumor size and growth using Eigen image filtering. STUDY DESIGN: This was an observational study. SETTING: The study was performed in an academic, comprehensive multi-specialty group practice. PATIENTS: Patients were a convenience sample of adults of both sexes who had acoustic neuromas identified by magnetic resonance imaging. Tumors ranged widely in size. INTERVENTION: Magnetic resonance imaging with digital image analysis using Eigen image filtering was the intervention. MAIN OUTCOME MEASURE: Observation and analysis of magnetic resonance images was the main outcome measure. RESULTS: The ability of magnetic resonance imaging with Eigen image filtering to segment acoustic neuromas of various sizes and shapes is illustrated. CONCLUSIONS: Magnetic resonance imaging with digital image analysis using Eigen image filtering is a promising method for volumetric measurement of acoustic neuroma size and growth. The potential for acoustic neuromas to grow may be underestimated by linear methods because of their relative lack of precision and of the geometric error that occurs in representing the volumetric growth of a three-dimensional tumor as a linear diameter.

Adult↗
PubMedDate not supplied

Temporal summation of the acoustic reflex in normal and sensorineural hearing-impaired ears.

Psychophysical and acoustic reflex temporal summation measures were obtained on normal-hearing and sensorineural hearing-impaired persons. Bursts of one-third octave noise with center frequencies of 500, 1000, 2000, and 4000 Hz and durations of 15, 20, 50, 100, 200, and 300 msec were used as stimuli. Reflexes were obtained using an acoustic impedance measuring technique. Results demonstrated that the duration of the noise stimuli had a profound effect on the acoustic reflex response and that the ear with Ménière's disease was clearly distinguishable from the normal ear by both psychophysical and acoustic reflex temporal summation measurements. The presbycusic subjects were separated from the normal subjects to a greater extent in the psychophysical data at the higher frequencies. The reflex thresholds for the noise bands and durations used in this study occurred at lower sound pressure levels than those previously obtained. The normal-hearing subjects failed to show any differences in either psychophysical or acoustic reflex temporal summation as a function of stimulus frequency.

Acoustic Stimulation↗
PubMed1995

Cochlear implantation in a patient after removal of an acoustic neuroma. The implications of magnetic resonance imaging with gadolinium on patient management.

The advent of magnetic resonance imaging has allowed otologists to focus on the early removal of acoustic neuromas with the goal of hearing preservation. Clearly, there are some unpredictable factors, such as placement of the tumor in the medial vs the lateral segment of the internal auditory canal and the capricious nature of the blood supply to these benign neoplasms, that make prediction of hearing preservation difficult. Nonetheless, the present goal of surgery for removal of acoustic tumors has changed its focus from preservation of the facial nerve alone to preservation of the facial nerve and preservation of hearing. In a patient with an only-hearing ear and a small acoustic neuroma, there is some controversy concerning whether the tumor should be removed early, with the goal of hearing preservation, or if the patient should be allowed to progress to a considerable hearing loss in an effort to preserve natural hearing as long as possible. We report a case in which an acoustic tumor was removed from an only-hearing ear in a patient with neurofibromatosis after hearing loss had progressed in that ear but before the development of total deafness. Postoperatively, the patient successfully underwent cochlear implantation. We also discuss decisions that we made during the surgical procedure, as well as the feasibility of cochlear implantation in patients with profound deafness after the excision of acoustic neuromas.

Adult↗
PubMed2000

Gradient-induced acoustic and magnetic field fluctuations in a 4T whole-body MR imager.

Both the acoustic and magnetic fluctuation frequency response functions for a Siemens AS25 body gradient coil inside a 4 Tesla whole-body MR system were measured and analyzed in this study. In an attempt to correlate the acoustic noise inside the gradient coil with magnetic field oscillations, triangular and trapezoidal gradient impulses of varying amplitudes and widths were used to excite the gradient coil. The acoustic and magnetic responses to these inputs were measured. The results show the existence of discrete resonances in both acoustic and uniform magnetic field fluctuation spectra, while gradient magnetic field fluctuation spectra show no such resonances. In addition, the dominant amplitude peaks in spectra fluctuate similarly with respect to trapezoidal gradient impulse flat-top widths. This implies that these phenomena are correlated, and that the trapezoidal impulse flat-top width may be used as a way to suppress both acoustic noise and uniform magnetic field oscillations.

Electromagnetic Fields↗
PubMed1998

Effects of the acoustic noise of the gradient systems on fMRI: a study on auditory, motor, and visual cortices.

MR acoustic, or sound, noise due to gradient pulsing has been one of the problems in MRI, both in patient scanning as well as in many areas of psychiatric and neuroscience research, such as brain fMRI. Especially in brain fMRI, sound noise is one of the serious noise sources that obscures the small signals obtainable from the subtle changes occurring in oxygenation status in the cortex and blood capillaries. Therefore, we have studied the effects of acoustic, or sound, noise arising in fMR imaging of the auditory, motor, and visual cortices. The results show that the effects of acoustic noise on motor and visual responses are opposite. That is, for motor activity, there is an increased total motor activation, whereas for visual stimulation, the corresponding (visual) cortical activity is diminished substantially when the subject is exposed to a loud acoustic sound. Although the current observations are preliminary and require more experimental confirmation, it seems that the observed acoustic-noise effects on brain functions, such as in the motor and visual cortices, are new observations and could have significant consequences in data observation and interpretation in future fMRI studies.

Adult↗
PubMed2003

Protection from acoustic trauma is not a primary function of the medial olivocochlear efferent system.

The medial olivocochlear (MOC) efferent system is an important component of an active mechanical outer hair cell system in mammals. An extensive neurophysiological literature demonstrates that the MOC system attenuates the response of the cochlea to sound by reducing the gain of the outer hair cell mechanical response to stimulation. Despite a growing understanding of MOC physiology, the biological role of the MOC system in mammalian audition remains uncertain. Some evidence suggests that the MOC system functions in a protective role by acting to reduce receptor damage during intense acoustic exposure. For the MOC system to have evolved as a protective mechanism, however, the inner ears of mammals must be exposed to potentially damaging sources of noise that can elicit MOC-mediated protective effects under natural conditions. In this review, we evaluate the possibility that the MOC system evolved to protect the inner ear from naturally occurring environmental noise. Our survey of nonanthropogenic noise levels shows that while sustained sources of broadband noise are found in nearly all natural acoustic environments, frequency-averaged ambient noise levels in these environments rarely exceed 70 dB SPL. Similarly, sources reporting ambient noise spectra in natural acoustic environments suggest that noise levels within narrow frequency bands are typically low in intensity (<40 dB SPL). Only in rare instances (e.g., during frog choruses) are ambient noise levels sustained at moderately high intensities (~70-90 dB SPL). By contrast, all experiments in which an MOC-mediated protective effect was demonstrated used much higher sound intensities to traumatize the cochlea (100-150 dB SPL). This substantial difference between natural ambient noise levels and the experimental conditions necessary to evoke MOC-mediated protection suggests that even the noisiest natural acoustic environments are not sufficiently intense to have selected for the evolution of the MOC system as a protective mechanism. Furthermore, although relatively intense noise environments do exist in nature, they are insufficiently distributed to account for the widespread distribution of the MOC system in mammals. The paucity of high-intensity noise and the near ubiquity of low-level noise in natural environments supports the hypothesis that the MOC system evolved as a mechanism for "unmasking" biologically significant acoustic stimuli by reducing the response of the cochlea to simultaneous low-level noise. This suggested role enjoys widespread experimental support.

Animals↗
PubMed2006

Electrical excitation of the acoustically sensitive auditory nerve: single-fiber responses to electric pulse trains.

Nearly all studies on auditory-nerve responses to electric stimuli have been conducted using chemically deafened animals so as to more realistically model the implanted human ear that has typically been profoundly deaf. However, clinical criteria for implantation have recently been relaxed. Ears with "residual" acoustic sensitivity are now being implanted, calling for the systematic evaluation of auditory-nerve responses to electric stimuli as well as combined electric and acoustic stimuli in acoustically sensitive ears. This article presents a systematic investigation of single-fiber responses to electric stimuli in acoustically sensitive ears. Responses to 250 pulse/s electric pulse trains were collected from 18 cats. Properties such as threshold, dynamic range, and jitter were found to differ from those of deaf ears. Other types of fiber activity observed in acoustically sensitive ears (i.e., spontaneous activity and electrophonic responses) were found to alter the temporal coding of electric stimuli. The electrophonic response, which was shown to greatly change the information encoded by spike intervals, also exhibited fast adaptation relative to that observed in the "direct" response to electric stimuli. More complex responses, such as "buildup" (increased responsiveness to successive pulses) and "bursting" (alternating periods of responsiveness and unresponsiveness) were observed. Our findings suggest that bursting is a response unique to sustained electric stimulation in ears with functional hair cells.

Animals↗
PubMed2006

An investigation of the use of transmission ultrasound to measure acoustic attenuation changes in thermal therapy.

The potential of using a commercial ultrasound transmission imaging system to quantitatively monitor tissue attenuation changes after thermal therapy was investigated. The ultrasound transmission imaging system used, the AcoustoCam (Imperium Inc., MD) allows ultrasonic images to be captured using principles similar to that of a CCD-type camera that collects light. Ultrasound energy is focused onto a piezoelectric array by an acoustic lens system, creating a gray scale acoustic image. In this work, the pixel values from the acoustic images were assigned acoustic attenuation values by imaging polyacrylamide phantoms of varying known attenuation. After the calibration procedure, data from heated polyacrylamide/bovine serum albumin (BSA) based tissue-mimicking (TM) phantoms and porcine livers were acquired. Samples were heated in water at temperatures of 35, 45, 55, 65, and 75 degrees C for 1 h. Regions of interest were chosen in the images and acoustic attenuation values before and after heating were compared. An increase in ultrasound attenuation was found in phantoms containing BSA and in porcine liver. In the presence of BSA, attenuation in the TM phantom increased by a factor of 1.5, while without BSA no significant changes were observed. The attenuation of the porcine liver increased by up to a factor of 2.4, consistent with previously reported studies. The study demonstrates the feasibility of using a quantitative ultrasound transmission imaging system for monitoring thermal therapy.

Acrylic Resins↗
PubMed1984

Altered acoustic reflectance on two-dimensional echocardiography as an early predictor of myocardial infarct size.

P6 area of increased acoustic reflectance was readily observed by 2-dimensional echocardiography (2-D echo) in the acutely ischemic canine myocardium. Fifteen mongrel dogs subjected to closed-chest coronary artery occlusion were used to test the hypothesis that these areas of altered acoustic reflectance were predictors of subsequent myocardial infarction (MI). Each dog was studied by 2-D echo in short-axis views of the left ventricle at 4 levels before and after coronary artery occlusion. The dogs were killed after 48 hours and heart sections were stained with triphenyltetrazolium chloride to identify the areas of necrosis. Four sections were then selected, approximating the same location within the left ventricle as the short-axis views taken for 2-D echocardiographic analysis. The in vivo 2-D echocardiographic examination revealed alteration of acoustic reflectance immediately after coronary occlusion, which detected the presence of MI with a sensitivity of 92% and a specificity of 90%. The extent of altered acoustic reflectance seen by echo correlated closely (r = 0.81) with the extent of MI detected by triphenyltetrazolium staining of the excised heart. Altered acoustic reflectance seen by 2-D echo immediately after coronary artery occlusion reflects acute ischemic changes and may be an early predictor of MI size.

Animals↗
PubMed1989

Acoustic responses recorded from the saccular bundle on the eighth nerve of the guinea pig.

Previous studies have demonstrated the existence of acoustic responses from the saccule in guinea pigs for stimulus intensities above 75 dB SPL. It is well known that the saccule receives a double afferent innervation: a bundle of the superior branch of the eighth nerve reaches its anterior part and another bundle of the inferior branch innervates its posterior part. These two bundles join just at the exit of the internal auditory meatus. An electrophysiological experiment was performed to investigate whether saccular acoustic responses could be similarly recorded from both bundles. Recordings from an electrode tip of 0.2 mm diameter were obtained in normal animals and also in animals with a complete and selective destruction of the cochlear sensory epithelium induced by treatment with an ototoxic antibiotic combined with a loop diuretic. In both normal and treated animals acoustic responses with the peculiar very short latency were specifically recorded in the area of the junction of the two bundles, they were of maximal amplitude on the bundle of the inferior branch. These data confirm in a more direct way the saccular origin of the short latency acoustic responses and indicate that they are probably conveyed in both saccular nerve bundles but mostly in that of the inferior branch of the eighth nerve. Finally these data show unequivocally that saccular acoustic responses exist in normal guinea pig ears.

Animals↗
PubMed2005

Impact of topical anesthesia on acoustic characteristics of voice during laryngeal telescopic examination.

OBJECTIVE: The purposes of this study are to investigate the impact of topical anesthetic alone and with concurrent laryngeal telescopic examination on acoustic characteristics of vocal fold function. Comparison with phonation in controlled conditions may imply diagnostic information from the examination. STUDY DESIGN: Thirty males evaluated as having a normal voice were included in the study. The subjects were asked to phonate sustained /i/ with a naturally comfortable pitch and loudness in three consecutive experimental sequences as "control condition," "anesthetic condition," and "telescopic condition." Acoustic analysis of fundamental frequency, jitter, shimmer, and harmonic to noise ratio in the three different conditions were executed. RESULTS: The mean and standard deviation of Fo in control condition, anesthetic condition, and telescopic condition were 130.1 +/- 18.5 Hz, 125.7 +/- 19.7 Hz, and 173.2 +/- 35.1 Hz, respectively. The telescopic condition showed more negative change than that in control condition and anesthetic condition in other parameters. There was a significant difference (P < 0.001) between control condition and telescopic condition in all four parameters. CONCLUSIONS: This study showed that anesthesia has little effect on voice performance for subjects with a normal voice. On the other hand, the acoustic characteristics changed significantly during telescopic performance. When doing interpretation of acoustic data, the abnormality of the acoustic characteristics might be the result of the procedures and not reflect vocal pathology. Laryngeal variations due to manipulation of telescope should be ruled out.

Administration, Topical↗
PubMed2006

Investigation of two-dimensional acoustic resonant modes in a particle separator.

Within an acoustic standing wave particles experience acoustic radiation forces, a phenomenon which is exploited in particle or cell manipulation devices. When developing such devices, one-dimensional acoustic characteristics corresponding to the transducer(s) are typically of most importance and determine the primary radiation forces acting on the particles. However, radiation forces have also been observed to act in the lateral direction, perpendicular to the primary radiation force, forming striated patterns. These lateral forces are due to lateral variations in the acoustic field influenced by the geometry and materials used in the resonator. The ability to control them would present an advantage where their effect is either detrimental or beneficial to the particle manipulation process. The two-dimensional characteristics of an ultrasonic separator device have been modelled within a finite element analysis (FEA) package. The fluid chamber of the device, within which the standing wave is produced, has a width to height ratio of approximately 30:1 and it is across the height that a half-wavelength standing wave is produced to control particle movement. Two-dimensional modal analyses have calculated resonant frequencies which agree well with both the one-dimensional modelling of the device and experimentally measured frequencies. However, these two-dimensional analyses also reveal that these modes exhibit distinctive periodic variations in the acoustic pressure field across the width of the fluid chamber. Such variations lead to lateral radiation forces forming particle bands (striations) and are indicative of enclosure modes. The striation spacings predicted by the FEA simulations for several modes compare well with those measured experimentally for the ultrasonic particle separator device. It is also shown that device geometry and materials control enclosure modes and therefore the strength and characteristics of lateral radiation forces, suggesting the potential use of FEA in designing for the control of enclosure modes in similar particle manipulator devices.

Journal Article↗
PubMed2006

Improving dispersion of nanometer-size diamond particles by acoustic cavitation.

A novel acoustic-dispersion method for fine diamond particles was developed. Two samples of nanometer-sized diamond particles were used. They had primary particle sizes of 5 nm (ND5) and 150 nm (ND150). Disaggregation of agglomerated particles using ultrasound and surface modification of ND5 and ND150 were investigated. The ND5 and ND150 particles aggregated to secondary particles, having sizes on the order of micrometers. The surfaces of ND5 and ND150 particle were modified due to chemical reactions and the particles were disaggregated by acoustic cavitation. The ND5 particles were disaggregated to give an average particle size of about 100 nm by ultrasound exposure with average acoustic intensities higher than 800 W/m(2). The agglomerated ND150 particles with size of 15 microm were disaggregated to reach an average particle size of about 300 nm by ultrasound exposure with an average acoustic intensity higher than 2000 W/m(2). The surfaces of ND5 and ND150 particles were found to be modified with hydroxyl groups resulting from acoustic cavitation. This could lead to a well dispersed solution of nanometer-sized diamond particles in water.

Journal Article↗