1/20. Evaluation of hearing handicaps and presbyacusis using World Wide Web-based calculators. This article is a clinical report on the applicability of computer software in determining hearing handicaps and presbyacusis. The software is now World Wide Web based and can be implemented in a clinical setting by using JavaScript calculators housed on the World Wide Web at . Added features consist of calculating the maximum recommended allowable noise exposure using the National Institute of Occupational safety and health 1997 frequencies in handicap determination and the projection of future audiometric thresholds using the International Standards Organization 1999 compression factor. A review of the literature and the theoretical and clinical applications of these new features are discussed. A guide in the selection of Web-based development software is also presented in the hope of encouraging other researchers to develop Web-based versions of their software applications. ( info) |
2/20. Histopathological observations of presbycusis. temporal bone histopathology of 17 aged patients who had spontaneous and gradually progressive bilateral sensorineural hearing losses associated with aging was studied. Six cases in the present material showed the gradually sloping audiometric curve; nine cases, abrupt high tone hearing loss; and two cases, the flat audiometric curve. The most prominent histopathological change in the inner ear was a decrease in the population of the spiral ganglion cells. However, diffuse senile atrophy was also often seen in the organ of corti and the stria vascularis. A positive correlation between the degree of artheriosclerosis and the degree of sensorineural degeneration in the cochlea was not obtained in the present cases. Also, the correlation was not found to be consistent between the type of the audiometric curve and the localization of lesions in the sensory, the neural or the vascular elements in the cochlea. Our observations show that a certain type of audiometric curve does not necessarily indicate a lesion in a specific cochlear element. ( info) |
3/20. Screening and management of adult hearing loss in primary care: clinical applications. hearing loss is one of the most common chronic health conditions and has important implications for patient quality of life. However, hearing loss is substantially underdetected and undertreated. We present clinical cases to illustrate common situations in which primary care physicians may be called on to identify or to manage hearing loss. With the data reported in the companion scientific review as a guide, we present potential answers to important questions pertaining to hearing loss and suggest ways in which primary care physicians can improve the detection, evaluation, and treatment of hearing loss. The cases focus on screening for chronic hearing loss, evaluation of hearing loss, and treatment of patients with presbycusis. ( info) |
4/20. presbycusis: correlations of clinical audiology with morphological changes in the cochlea and the ventral cochlear nucleus. Five cases of presbycusis are presented. Analysis included audiological tests, cochlear hair cell and ganglion cell counts, assessment of degree of strial atrophy, and ventral cochlear nucleus neuron counts. One case showed a reduction in cochlear nucleus neuron counts without significant cochlear changes, indicating that this pattern of pathological changes is a possible cause of high tone sensorineural deafness. ( info) |
5/20. Multicentre evaluation of the temporal bones obtained from a patient with suspected Meniere's disease. A multicentre study of the inner ears of an 88-year-old patient with vertiginous spells and severe hearing loss in the left ear was performed, employing regular and block surface preparations, light and electron microscopy with qualitative and quantitative evaluation of the cochlear and vestibular nerves. There was severe hydrops of the left cochlea and saccule. Reissner's membrane extended into the vestibule and herniated into the perilymphatic space of the non-ampullated end of the horizontal canal. Furthermore, the short canal connecting the posterior ampulla with the utricle had a small, exceedingly thin balloon-like expansion. Only slight hydrops limited to the cochlea was found in the right ear. Sensorineural degeneration was much more pronounced in the left cochlea than in the right. The number of cochlear and vestibular nerve fibres was greatly reduced in the left ear where more fibres with degenerative changes were present. In both specimens the number of myelinated nerve fibres in osseous spiral lamina was smaller than that in the cochlear nerve in the internal auditory canal. Changes occurred in the endolymphatic sacs but were considered non-specific. In this case severe, apparently progressive hydrops and sensorineural degeneration, characteristic of Meniere's disease, were associated with atypical onset of clinical symptoms at a late age. ( info) |
6/20. Evaluation of occupational hearing loss and presbyacusis using a microcomputer. Occupational noise-induced hearing loss remains a common problem in industry. This report presents a systematic method of patient evaluation and describes software that is capable of calculating hearing handicaps from audiometric data and the proportion of the handicap due to presbyacusis. The software also has the capability of subtracting the effects of presbyacusis from the current audiometric thresholds and to estimate hearing thresholds at any future age of the patient. Four patients are presented that illustrate the utility of this type of computer analysis. ( info) |
7/20. Lesion site in idiopathic bilateral vestibulopathy: a galvanic vestibular-evoked myogenic potential study. CONCLUSION: The result suggests that patients with idiopathic bilateral vestibulopathy may have nerve lesions when the inferior nerve system is affected, while the inferior vestibular nerve system may be spared. OBJECTIVE: To clarify the lesion site in idiopathic bilateral vestibulopathy, an acquired bilateral vestibulopathy of unknown cause. MATERIAL AND methods: Two 75-year-old males diagnosed with idiopathic bilateral vestibulopathy were enrolled. Both showed absent or highly decreased responses on the caloric test on both sides. They underwent vestibular-evoked myogenic potential (VEMP) testing by means of acoustical and electrical stimulation. As acoustic stimulation, 95 dB nHL clicks and short tone bursts (500 Hz) were presented, while 3 mA (1 ms) short-duration galvanic stimuli were presented as electrical stimulation. Responses were recorded on the sternocleidomastoid muscles. RESULTS: Both patients showed unilateral absence of VEMPs with both acoustic and short-duration galvanic stimuli. ( info) |
8/20. Musical hallucinations: report of two unusual cases. Two elderly patients with musical hallucinations are described. In the first case, the musical hallucinations were precipitated by the administration of benzodiazepines. The symptoms in the second case resembled those described in cases of visual hallucinosis (Charles Bonnet syndrome) in the elderly. Issues related to the presentation and course of musical hallucinations are discussed. ( info) |
9/20. Case history: asking the right questions. The importance of asking the right question is highlighted in this case study. The patient was a 76-yr-old man with hearing loss that initially appeared to be a classic case of presbycusis. Without asking the right question this patient might have been managed in a manner inappropriate to his true hearing sensitivity. ( info) |
10/20. Subcortical auditory agnosia. A case of generalized auditory agnosia without aphasia secondary to cardiogenic cerebral embolism is reported. The infarcts in this patient were localized within the bitemporal subcortices as confirmed by computerized axial tomography and magnetic resonance imaging. The findings suggested that interruption of both auditory radiations by bilateral subcortical lesions may play an important role in the occurrence of "cerebral auditory disorders." ( info) |