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PubMed2002

Influence of replacement schedule and care regimen on patient comfort and satisfaction with daily wear frequent-replacement contact lenses.

PURPOSE: This study examines what effects replacement schedule and care regimen have on overall patient satisfaction with daily wear frequent-replacement contact lenses. METHODS: Over 3000 patients were recruited from 313 ophthalmologic practices in France to participate in a 1-month prospective observational clinical study. Subjects included 2108 experienced and 957 novice users of the predominantly prescribed soft contact lenses and care systems in France. All subjects were required to use ACUVUE 2 (Vistakon, Jacksonville, FL) brand contact lenses, replaced once every 2 weeks, and using COMPLETE brand multipurpose solution (Allergan, Irvine, CA) during the study. Practitioners assessed lens fit, and refractive and ocular physiological status. Subjects were surveyed about various subjective attributes at the baseline examination and at the end of the study. RESULTS: Patient satisfaction with the test lenses and care system was found to be excellent for the majority of patients, as evidenced by high subjective satisfaction ratings and the desire of approximately 9 of 10 subjects to continue using the test products after completing the study. Significant improvements were noted with the test lenses and solution compared to previous lenses and solutions for overall satisfaction and comfort variables. CONCLUSIONS: Replacing lenses once every 2 weeks combined with a multipurpose care system incorporating ingredients designed for lens conditioning contributed to significant improvements in lens wearing comfort. Thus, lens replacement frequency and lens-and-solution compatibility should be considered in addition to lens material and design when prescribing contact lenses for new or existing wearers.

Adolescent↗
PubMed1996

Effects of improvements of poorly fitting dentures and new dentures on masticatory performance.

The effect of four modifications to improve the fit and maxillomandibular relationships of poorly fitting dentures and the insertion of new dentures on masticatory performance was assessed in 21 denture wearers. A 2-week adaptation period was allowed for each of the four modifications and 3 weeks and 12 weeks of adaptation for new dentures. The preferred side masticatory performances were not appreciably affected by either the modifications to improve the fit of the original dentures or the new dentures. In most instances there was a slight decline in performance. Three denture modifications caused significant declines in the carrot-swallowing threshold performances and the new dentures in the peanut-swallowing threshold performance. In other words, the denture wearers had a greater percentage of coarse particles in their bolus ready for ingestion when they chewed with altered or new dentures compared with original dentures. However, they chewed faster and applied fewer chewing strokes with their modified and new dentures. A steady but gradual improvement in the mean performance score with carrots was noted with time after the insertion of new dentures. Dentists and patients need to understand that adaptation to new or modified old dentures may be a long, drawn-out process for some patients.

Adaptation, Psychological↗
PubMed2006

Effects of fluid insert volume changes on socket pressures and shear stresses: case studies from two trans-tibial amputee subjects.

Fluid inserts potentially help to overcome prosthetic fit problems resulting from stump volume change. The purpose of this investigation was to add fluid to fluid inserts positioned on the inner socket walls of trans-tibial prostheses and to assess their influence on socket stresses. Pressures and shear stresses were measured at 13 sites on the sockets of two trans-tibial amputee subjects while they ambulated at their self-selected walking speeds. Stresses at the transducer sites generally increased with greater fluid addition and, interestingly, both subjects found relatively high fluid insert volumes most comfortable. The magnitudes of stress change were larger than those resulting from alignment, cadence, and componentry changes as reported in the literature. Possible explanations for why subjects found settings that induced higher measured socket stresses more comfortable than those that induced lower measured stresses include: A reduced shear: pressure ratio; the short duration of the study; and reduced stresses at sites not monitored with transducers.

Adult↗
PubMed2004

Comparison of the performance of 6- or 30-night extended wear schedules with silicone hydrogel lenses over 3 years.

AIM: To compare the clinical performance of silicone hydrogel lenses worn for 6- or 30-nights, with monthly replacement, for 3 years. METHODS: In this 3-year prospective clinical trial, 161 subjects were enrolled and 154 commenced extended wear. Clinical performance was assessed by comparing discontinuations and lens surface characteristics (front surface deposits, lens wettability, number of mucin balls), lens fitting performance (primary gaze movement, lens tightness), and physiologic parameters (limbal and bulbar redness, corneal and conjunctival staining, microcysts) and subjective parameters (ratings of comfort and vision) between groups. RESULTS: Eighty-eight subjects remained in the study after 36 months. There were no differences in the probability of subjects surviving in either group, and the major cause of lens-related discontinuation in both groups was contact lens-induced papillary conjunctivitis. There were no clinically important differences in performance between wear schedules. CONCLUSION: The long-term clinical performance of silicone hydrogels worn for 6- or 30-nights continuously was similar. Clinical markers of hypoxia were low in both groups, and the 6-night wear schedule was not superior to the 30-night wear schedule with regard to preventing lens spoilage, improving corneal physiology, or subjective symptoms of comfort and vision.

Adult↗
PubMed2004

Effect of augmented cup fixation on stability, wear, and osteolysis: a 5-year follow-up of total hip arthroplasty with RSA.

To evaluate different modes of cementless fixation of hemispherical cups, we operated on 87 hips in 81 patients using 4 different means of cup fixation. The hips were randomly assigned to fixation with press-fit technique only (PF), or with augmentation with screws (S), pegs (P), or hydroxyapatite (HA) coating. The patients were evaluated with radiostereometric analysis (RSA) for cup migration and wear, conventional radiography for osteolysis, and Harris Hip Score for clinical outcome over 5 years. The fixation of the cups did not differ between the groups, but HA showed a tendency to decrease proximal migration. HA-coated cups displayed the best interface with hardly any signs of radiolucent lines, indicating a superior sealing effect of the HA coating. Cups with screws or pegs had more radiolucent lines and osteolytic lesions than the other groups. Radiolucent lines were correlated to higher proximal migration, young age, and female gender (r2=.2). The wear rate of the ethylene oxide-sterilized polyethylene liner was high (0.2 mm/y) but did not differ between the groups. Two cups with a perioperative fracture of the acetabular rim showed large initial migration but stabilized thereafter.

Aged↗
PubMed2002

Unilateral sensorineural hearing impairment in childhood: analysis of 31 consecutive cases.

This report presents the selected variables of a consecutive series of 1-10-year-old children with unilateral sensorineural hearing impairment (USNHI; defined as four-frequency pure-tone audiometry (PTA) 0.5, 1, 2, 4 kHz > or = 30 dB HL): severity, presumptive aetiologies, age at ascertainment, hearing aid acceptance, non-verbal intelligence, time of occurrence of first words and two-word utterances, size of vocabulary, and linguistic achievements. During a 4-year-period in a defined geographical area of Germany (Lower Saxony), 31 children were carefully audiologically and psychologically examined at the Department of Phoniatrics/Pedaudiology, University of Göttingen. All children were fitted unilaterally with a hearing aid. The HI was mild in 3%, moderate in 23%, severe in 29% and profound in 45% of the cases. The hearing defect was congenital in 23%, postnatally acquired in 16%, and of unknown onset in 61% of the cases. The affected side was the right in 17 cases, and the left in 14. The mean age at ascertainment was 65.5 months (SD 25.5; median 70). According to parental judgement, nearly 81% of the children had accepted their hearing aid (based on the daily/weekly time for which the child was using the hearing aid). On average, the children scored in the normal range in standardized non-verbal intelligence tests. They were delayed in using two-word phrases (on average for 5 months), but not in using their first words. However, children with USNHI experienced no more difficulty on standardized linguistic tasks than normally hearing subjects of the same age and gender.

Audiometry, Pure-Tone↗
PubMedDate not supplied

Clinical design and evaluation of the prototype of a new digital audioprosthesis for profound hearing loss: speech recognition aspects.

The design and implementation of the prototype of a digital hearing aid and its computerized fitting interface, followed by a basic preliminary clinical evaluation concerning speech recognition aspects, is reported. The final device is particularly destined to those patients suffering sensorineural hearing losses with recruitment and problems for speech recognition. The prototype is based on the digital signal processor TMS320C30. The host is a personal computer. The primary concept of the processing strategy is the 'integral treatment of acoustic information' within the remaining auditory field of the patient leading to minimum modification of the signal profile. The processing stages include linear amplification, specially designed AD conversion, real fast Fourier transform, 128 multiband single treatment (compression threshold and magnitude of compression), inverse fast Fourier transform, and DA conversion. Compression parameters and pure-tone audiometry data are entered by the computerized fitting interface which also provides real time information of input and output spectral profile. The preliminary clinical evaluation here reported corresponds to a series of 13 patients and it is focused on speech recognition performances. Ten patients had sensorineural hearing loss. Three subjects served as controls. All subjects were studied by an extensive audiological protocol. In 6 patients the prototype improved the maximum intelligibility with respect to unaided hearing reaching levels in the range of 90-100%. In 4 patients using conventional hearing aids, the prototype improved the maximum intelligibility with respect to the previous aided hearing. Values reached the same range as in the former 6 patients. Straightening of the speech audiometry curves was observed in those patients with recruitment. Two controls with previously normal speech recognition showed no worsening and others with conductive deafness reported additional improvement of the responses in noisy conditions with respect to the audioprosthesis in use.

Adult↗
PubMed2006

Practice parameters for the treatment of snoring and Obstructive Sleep Apnea with oral appliances: an update for 2005.

These practice parameters are an update of the previously published recommendations regarding use of oral appliances in the treatment of snoring and Obstructive Sleep Apnea (OSA). Oral appliances (OAs) are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP. Until there is higher quality evidence to suggest efficacy, CPAP is indicated whenever possible for patients with severe OSA before considering OAs. Oral appliances should be fitted by qualified dental personnel who are trained and experienced in the overall care of oral health, the temporomandibular joint, dental occlusion and associated oral structures. Follow-up polysomnography or an attended cardiorespiratory (Type 3) sleep study is needed to verify efficacy, and may be needed when symptoms of OSA worsen or recur. Patients with OSA who are treated with oral appliances should return for follow-up office visits with the dental specialist at regular intervals to monitor patient adherence, evaluate device deterioration or maladjustment, and to evaluate the health of the oral structures and integrity of the occlusion. Regular follow up is also needed to assess the patient for signs and symptoms of worsening OSA. Research to define patient characteristics more clearly for OA acceptance, success, and adherence is needed.

Continuous Positive Airway Pressure↗
PubMed2006

Output vibration measurements of bone-anchored hearing AIDS.

HYPOTHESIS: Different bone-anchored hearing aids (BAHAs) processors have different output vibration characteristics, which depend on the mechanical load and the volume setting. Responses will differ between live heads and dry or plastic skulls. BACKGROUND: The BAHA is an implantable bone-conduction device. Three different BAHA models are available. Their output vibrations have not been reported using a noncontact method with differing impedance loads, including the BAHA-fitted patient head. METHODS: Using a laser-Doppler vibrometer, vibration responses with sound input of 70- to 80-dB sound pressure level were measured on unloaded BAHAs, a dry skull, a plastic skull, and on the abutments of three live BAHA-fitted patients. Responses at different volume settings and distances from the vibrator were also tested. Frequency responses were calculated for displacement, velocity, and acceleration. RESULTS: Unloaded BAHA accelerations were approximately 30 to 50 dB higher than live-head accelerations. Live-head accelerations were similar to dry skulls in frequencies of more than 500 Hz, but much higher than the plastic skull responses. Live-head responses were more damped. The Cordelle II outperformed the other two processors by approximately 20 dB. The Classic 300 had better low-frequency responses than the Compact. The volume settings had little effect on vibration output overall. Acceleration peak was at approximately 2.5 kHz for all conditions. CONCLUSION: The BAHA processors differ in the output acceleration they can achieve with differing loads. The volume control setting has little impact on accelerations produced for most processors. The live-head responses are similar to the dry skull in frequencies of more than 500 Hz.

Acoustic Stimulation↗
PubMed2001

A comparison of trans-tibial amputee suction and vacuum socket conditions.

Daily volume loss of the stump leads to a poor fit of the prosthetic socket. A method of preventing this volume loss and maintaining a good fit was developed. A vacuum (-78 kPa) was drawn on the expulsion port of a total surface-bearing suction socket to hold the liner tightly against the socket. Stump volume of 10 trans-tibial amputees was measured prior to and immediately after a 30 minute walk with normal and vacuum socket conditions. Under the normal condition, the limb lost an average of 6.5% of its volume during the walk. In contrast, with the liner held tightly by vacuum, the limb gained an average of 3.7% in volume. It is believed that the difference observed between conditions resulted from a greater negative pressure developed during the swing phase of gait with the vacuum condition. X-rays revealed that the limb and tibia pistoned 4 mm and 7 mm less, respectively, under the vacuum condition. The combination of reduced pistoning and maintenance of volume is thought to account for the more symmetrical gait observed with the vacuum.

Adult↗
PubMed1998

Periotest method: implant-supported framework fit evaluation in vivo.

STATEMENT OF PROBLEM: In implant prosthodontics an accurate fit of the framework to the supporting implants is paramount. However, microgaps occur, unknown to the clinician until complications arise that implicate errors in fit. Therefore prosthodontics would welcome a tool or instrument that provides an objective evaluation of the fit at the implant prosthodontic interface. PURPOSE: This clinical investigation determined whether a correlation existed between the laboratory laser measurement of the abutment analog-framework fit and the intraoral abutment-framework fit as measured by the Periotest method. MATERIAL AND METHODS: Fifteen subjects received implant-supported remote fixed partial denture supported by five (11 subjects) or six (4 subjects) implants in the mandibular jaw opposed by a complete maxillary denture. Laser videography was used to quantify the fit of the framework to its respective master cast with six measurements, while the fit of the framework in the mouth was quantified with the Periotest method. Data were statistically analyzed with correlation analyses and multiple regression. RESULTS: The overall correlation coefficient between the two methods was r = 0.51. Regression analysis of variance revealed that the intercept of the laser videography measurement was significant (p < or = 0.05). The mean Periotest values and standard deviation for the abutment-framework interface were negative (-7.3 +/- 1.2). The variance in part for the Periotest values was explained by the misfits in the vertical axis (delta Z, +0.471) and in the misfit direction of the centroids in the x-y plane (X-YVD, -0.244). CONCLUSION: There was no single variable among the six measurement variables that strongly correlated with the periotest method in the identification of mistfit at the bearing surface as indicated by the Periotest value measurements. The misfit laser variables that were weakly correlated to the Periotest values should be observable clinically with greater scrutiny.

Aged↗
PubMed1997

Further studies into proximal interphalangeal joint dimensions for the design of a surface replacement prosthesis: medullary cavities and transverse plane shapes.

The proximal and middle phalanges from 83 proximal interphalangeal joints (PIPJs) were set in clear plastic and sectioned in the transverse plane leaving the heads whole. The sections were cleaned, shadowgraphed and measured. The medullary canals were marked on sagittal and frontal plane shadowgraphs of the intact bones and analysed. The information was then used in the design of a surface replacement prosthesis for the PIPJs. The main dorsal surface of the proximal phalanx (PP) was found to be angled to the longitudinal baseline of the bone by a mean of 5.19 degrees. This angle increased just proximal to the phalangeal head to a mean of 11.84 degrees. The mean ratio between these angles was 2.71. The phalangeal shaft bone was thicker laterally than dorsally and palmarly, and thicker dorsally than palmarly for the proximal and middle phalanges throughout the length of the bone. The shape and size of the transverse cross-section of the medullary canal changed throughout the length of the shaft. The centreline of the PP medullary canal coincided with the midline of the bone in the frontal plane and was approximately a straight line along the length of the canal. In the sagittal plane the centreline was slightly palmar to the midline and the angle between it and the longitudinal baseline of the bone changed along the length of the canal. In the region of the shaft just proximal to the PP head (where the stem of a surface replacement prosthesis would fit) the mean angle was 10.63 degrees. The centreline was offset dorsally from the centre of rotation of the PIPJ by a mean of 0.83 mm, 0.83 mm, 0.80 mm and 0.57 mm for the index, middle, ring and little fingers respectively, with an overall mean of 0.76 mm. The mean PP head heights (transverse plane) were 9.17 mm, 9.33 mm, 8.73 mm and 7.40 mm and the mean PP widths (transverse plane) were 12.86 mm, 13.25 mm, 12.75 mm and 10.54 mm for the index, middle, ring and little fingers respectively. The mean angle between the lateral sides of the condyles to the transverse baseline was 78.35 degrees and the mean distance from the centreline of the PP head (transverse plane) to the bases of the two condyles was 4.69 mm. The mean maximum depth of the PP head intercondylar sulcus in the frontal plane was 0.72 mm and in the transverse plane, the mean maximum depth of the intercondylar sulcus on the anterior face was 0.82 mm.

Aged↗
PubMed2001

How to assess outcome of hearing aid fitting in children.

Assessment of outcome of hearing aid fitting in children should contain several dimensions: audibility, speech recognition, subjective benefit and speech production. Audibility may be determined by means of aided hearing thresholds or real-ear measurements. For determining speech recognition, methods different from those used for adult patients must be used, especially for children with congenital hearing loss. In these children the development of the spoken language and vocabulary has to be considered, especially when testing speech recognition but also with regard to speech production. Subjective assessment of benefit to a large extent has to rely on the assessment by parents and teachers for children younger than school age. However, several studies have shown that children from the age of around 7 years can usually produce reliable responses in this respect. Speech production has to be assessed in terms of intelligibility by others, who may or may not be used to the individual child's speech. Ideally, the outcome should be assessed repeatedly at suitable intervals in order to be able to follow the child's communicative development.

Adolescent↗
PubMed1995

Medical applications of scleral contact lenses: 2. Gas-permeable scleral contact lenses.

The indications and outcome of the wear of gas-permeable (GP) scleral contact lenses in 118 eyes of 85 patients attending a Scleral Contact Lens Clinic during a 5-year period from July 1988 to June 1993 were analysed. Ninety-nine eyes (83.9%) were originally fitted with PMMA lenses and were subsequently changed to GP lenses, whereas 19 (16.1%) were fitted with GP lenses from the outset. The mean duration of GP scleral lens wear was 15.3 months, with a range between 3 and 58 months. The indications for refitting the cases previously wearing PMMA scleral lenses with GP material were related to problems of chronic hypoxia. Thirty-three eyes (26.8%) had previous episodes of corneal oedema, and of the 27 that had a minimum of 3 months' follow-up, none experienced further episodes of oedema. Of the 32 eyes (26%) that had developed corneal vascularisation associated with PMMA scleral lens wear, two eyes were noted to have significant vessel regression after a period of GP wear, whereas in the remainder of cases, vessels remained static and nonprogressive. Thirty additional eyes (24.2%) experienced inadequate wear times associated with discomfort, and in these eyes the change to GP scleral lenses produced a statistically significant reduction in the inability to wear lenses beyond 4 h (p < 0.05).

Adolescent↗
PubMed2006

Pellucid marginal corneal degeneration: evaluation of the corneal surface and contact lens fitting.

AIM: To quantify corneal irregularities, to describe the fitting with contact lenses, and to answer the question whether or not contact lenses with a special back surface design could improve visual acuity in patients with pellucid marginal corneal degeneration (PMCD). METHODS: 13 eyes were fitted with contact lenses with a special back surface. Videokeratographic data were assessed. The patients were followed up for an average period of 22.2 months. Lens tolerance and corrected visual acuity were evaluated. RESULTS: The mean eccentricity did not exceed 0.7 in all patients. Either the superior or the inferior eccentricity, or both, were negative in all patients. Using Fourier analysis all PMCD subjects showed an increased irregular astigmatism of the anterior cornea. Using Zernike coefficients seven eyes (53.8%) had a higher order aberration root mean square error (HOA RMS error) out of the normal range. The visual acuity with contact lenses improved in all eyes with an average increase of 2.7 lines (maximum eight lines). No serious complications were observed. CONCLUSIONS: Quantitative evaluation of videokeratographic data may help to diagnose PMCD and to distinguish PMCD from other ectatic corneal diseases. Contact lenses with a special back surface design can improve visual acuity and lens tolerance.

Adult↗
PubMed2005

Empirical versus trial set fitting systems for accelerated orthokeratology.

PURPOSE: To compare the short-term clinical performance of two reverse-geometry rigid contact lens systems for accelerated orthokeratology with different fitting approaches and designs: an experimental lens that was fitted empirically (No. 7 Contact Lens Laboratory, Ltd.) and a more established lens using a trial set system, the BE lens (NKL). METHODS: Twenty-four subjects were enrolled in a clinical study in which the two reverse-geometry lenses were worn contralaterally for seven nights. The No. 7 lens was manufactured based on subject keratometric readings, refraction, and horizontal visible iris diameter. The BE lens was fitted in accordance with fitting guidelines provided by the manufacturer and included the use of proprietary computer software in addition to an overnight trial before lens ordering. Data were collected at baseline, day 1, and day 7 (morning and afternoon). Unaided visual acuity, best-corrected visual acuity, subjective refraction, corneal topography, biomicroscopy (corneal staining), and subjective reaction were recorded at each visit. RESULTS: Nine subjects (18 eyes) completed the study. All eyes fitted with the No. 7 lens and 67% of the eyes fitted with the BE lens were within +/-1.00 diopter of the attempted correction after seven nights of lens wear. There was more myopic reduction (F = 16.2, P=0.0002), better unaided high-contrast visual acuity (F = 8.7, P=0.005) and low-contrast visual acuity (F = 9.5, P=0.003), and more change in corneal numerical eccentricity (F = 8.6, P=0.005) with the BE lens than with the No. 7 lens. There were no significant differences between the lenses for best-corrected visual acuity, change in apical radius, corneal staining, and subjective reaction. DISCUSSION: Both lens types investigated in this study were effective in temporarily reducing myopia and in providing good unaided visual acuity during the day (without lenses) in subjects with low levels of myopia. Subjective reaction showed that the lenses were perceived as being equally effective, but clinical data showed that the BE lens effected more myopic reduction and better unaided visual acuity than did the No. 7 lens during the 7-day period investigated.

Adult↗
PubMed2000

Strength and marginal fit of full and partial porcelain crowns on Brånemark implants.

The aim of the present study was to evaluate strength and marginal fit of different designed single crowns screwed on titanium implants (Brånemark) without the usage of any abutment. Seven test groups with 10 specimens each (standardized maxillary central incisor crowns) were fabricated of Empress (staining/veneering technique), metal-based Empress (staining/veneering technique), metal-based In-Ceram and metal ceramic (with/without cervical porcelain margin). The marginal fit of 5 specimens of each group was evaluated (SEM-Analysis) and the crowns were incisally loaded at a 30 degrees angle in a Zwick testing machine until fracture. The 5 remaining specimens underwent a marginal evaluation (SEM-analyses) before and after thermo-mechanical stressing (tms) and were loaded in the Zwick testing machine as well. All Empress ceramic crowns without metal reinforcement fractured during fixing procedure on the implant (32 N cm). The gap medians of the fixed crowns ranged from 11 microns (metal ceramic crowns) to 34 microns (metal ceramic crowns with porcelain margin). No significant differences in gap width were observed before and after tms. In the strength analyses screw-binding forces (SBF) of about 135 N were registered in all test groups. Fracture failure forces (FFF) reached up to 280 N. The indication of the crown designs presented in this study is limited in clinical use because of low stability and esthetics.

Analysis of Variance↗
PubMedDate not supplied

Fitting hearing aids using clinical measures of loudness discomfort levels: an evidence-based review of effectiveness.

Clinical measurement of the loudness discomfort level (LDL) historically has been part of the hearing aid fitting procedure, and this clinical practice remains popular today. LDL measurements also are recommended in contemporary hearing aid fitting protocols. Yet, surveys show that many hearing aid users are dissatisfied with the loudness of their hearing aids. In this evidence-based review article, we evaluate the effectiveness of clinical LDL measurements. Specifically, we asked the question "Are the clinical measurements of LDL for adult patients predictive of aided acceptance and satisfaction of loudness for high inputs in the real world?" Nearly 200 articles were reviewed; three met the criteria set forth in this review. The evidence supported using unaided LDLs for selecting the maximum real-ear output of hearing aids. No study using aided LDLs or aided loudness verification met the criteria. The level of the evidence for the three articles using unaided LDLs was low; no higher than Level 4. The limited number of studies, the level of evidence, and the statistical power of the studies prevents us from making a strong recommendation concerning the clinical use of LDL measures. Additional research in this area, especially research employing randomized controlled trials would be a useful addition to this body of literature.

Hearing Aids↗