Goals of the study were investigation the perception of vibro-acoustic signals, spreading in water, by deaf patients and the possibility of use hydrovibrotactile stimulation for habilitation of deaf children. In the first part of study 5 experienced cochlear implants (CI) users were involved – 2 adults and 3 children with congenital deafness. Participants were presented modulated tones (100-4000 Hz) and natural sounds (horn, pipe, march melody) though underwater loudspeakers in small swimming pool. Each participant was sitting in the swimming pool without CI during the stimulation. It was shown that deaf subjects are able to detect vibro-acoustic signals, spreading in water, which they feel as a vibrotactile sense. The most vibrotactile sensitivity was between 100 and 400 Hz, while stimuli between 1000 Hz and 4000 Hz didn’t evoke any sensation. In the second part of the study 30 early aged children with severe or profound sensorineural hearing loss without hearing aids or CI experience were participated. It was observed typical oriented behavioral reactions in response to test stimuli in water in 15 children from the experimental group, but there weren’t reactions to the acoustic component of stimuli on air (out of water). Hydrovibrotactile stimulation sessions prior amplification and CI processor fitting accelerated the development of oriented and stable condition motor reflex reactions to sounds in children with hearing aids and CI, including even near-threshold stimuli, in comparison with control group children, who got only traditional lessons with speech-language therapist. As a result, an adequate fitting of hearing aids or CI processor and spontaneous development of hearing behavior in everyday situations were achieved significantly faster.
The article presents the results of a study of the acoustic characteristics of the voice in voice professionals and non-voice professionals. We examined 80 people aged 23 to 45 years with functional dysphonia of the hypotonic type, who applied to the phoniatric office of the St. Petersburg Research Institute of ENT. Of these, 23 were professional vocalists, 12 were representatives of speech professions, and 45 were non-professional voices. First, the phoniatrist examined the larynx and assessed its condition with video endostroboscopy (K. Storz) or video pharyngolaryngoscopy (VIVIDEO, KayPentax). Objective acoustic analysis was performed using the Multi-Speech software and hardware complex and the MDVP software (KayPentax). The numerical and graphical expressions of the following parameters were evaluated: noise-to-harmonic ratio (NHR), voice turbulence index (VTI), and soft phonation index (SPI). The results of the study showed that the SPI index is the most informative in assessing hoarseness in patients with hypotonic functional dysphonia. The lower values of this indicator in vocalists can be explained by the presence of a sufficiently developed resonator system of the vocal apparatus, which is reflected in the amplification of the high-frequency components of the voice spectrum.
Cochlear implantation is the optimal method for hearing and speech rehabilitation in patients with congenital deafness. Over the last several years, the interest to the problems of etiopathogenetic mechanisms of congenital deafness and the results of hearing and speech rehabilitation of patients, mainly of younger children, has increased in international and Russian scientific literature. The two most common factors, according to the data, are cytomegalovirus infection and genetic disorders, associated with mutation of the GJB2 gene encoding connexin-26 – gap-junction proteins, which is responsible for the connection of hair cells of the organ of Corti and dendrites of neurons of the spiral ganglion. However, in the vast majority of scientific works, devoted to the problems of cochlear implantation, the attention of researchers was focused on the audiological and pedagogical aspects of this program, while data on the surgical stage remain relatively small. In our work, we attempted to analyze the features of the surgical stage of cochlear implantation in patients with the most common etiological factors of congenital deafness: a mutation, associated with the GJB2 gene, and persistent cytomegalovirus infection.
Along with the respiratory, cardiovascular, gastrointestinal, rheumatological, and neurological manifestations of the new coronavirus infection (COVID-19), the effects of this virus on the ENT organs is undeniable, as the main portal of entry of any respiratory infection. It has been proven that symptoms such as hypo- and anosmia are associated with one of the ways of the virus penetration – transnasal, through the olfactory nerves into the central nervous system. Otorhinolaryngological complaints of patients are not limited only to deterioration or loss of smell, many note the appearance of dizziness, tinnitus, worsening of the course of chronic sensorineural hearing loss, and in some cases – sudden hearing loss, which may indicate damage to the auditory and vestibular analyzer by a viral agent. The mechanisms of development of the corresponding complications at the moment are still unclear. The presented article is a review of the literature data of foreign and domestic sources, which examines the central and peripheral neurological complications, the pathways and molecular features of the penetration of the virus, as well as clinical cases of hearing impairment and the appearance of tinnitus against the background of new coronavirus infection. At the moment, information on the direct effect of the SARS-CoV-2 virus on the auditory and vestibular analyzer is insufficient and scattered, which requires further observation with subsequent detailed analysis of the results.
Persistence of viral infections ((Epstein–Barr virus (EBV), cytomegalovirus (CMV)) contributes to the development of inflammatory pathology of the upper respiratory tract, as well as dystrophic processes in hepatocytes. The impact of this fact on the early postoperative period during cochlear implantation remains poorly understood. A clinical and audiological examination of 100 children with high-grade sensorineural hearing loss was performed. Within the framework of the work, a serological and molecular genetic examination of patients for herpesvirus infections (Epstein–Barr virus, cytomegalovirus) was performed. Two comparison groups are highlighted. The first group included 58 patients with detected latent infections. In the second group 42 patients did not have serological and molecular genetic markers of infection with herpesvirus infection. There is evidence in the literature that surgical trauma combined with general anesthesia can cause reactivation of persistent herpesvirus infection. In 4% (n = 4), markers of an active infectious process were detected. The analysis of the course of the postoperative period in children in two study groups after cochlear implantation was performed. In the hemostatic system, hypocoagulation disorders were found in a number of children. Persistent herpesvirus infection can be a trigger for the development of both inflammatory and non-inflammatory complications after surgical treatment.
Hearing organ damage caused by high-intensity noise continues to be one of the actual problems of modern otorhinolaryngology. This study aims to evaluate the effectiveness of transient evoked otoacoustic emissions (TEOAEs) as a screening method for hearing research. 15 patients (men aged 18 to 28 years) were examined before and after exposure to high-intensity noise of artillery weapons. All patients passed a set of diagnostic tests: otoscopy, whispered voice test, tonal threshold audiometry, and TEOAE. Hearing thresholds according to audiometry did not exceed normal values. However, the number of people who passed the test TEOAE after noise exposure was 46.6% in the right ear and 40.0% in the left ear, which was statistically significantly different from the data obtained before the shooting. The authors conclude that TEOAE allows evaluation of the functional state of the hearing organ better than tonal threshold audiometry. This technique can be used for mass screening of individuals who are most sensitive to the effects of high-intensity noise, as well as for their further in-depth audiological monitoring.
The presented method makes it possible to create a meta-analysis diagram (forest plot, or blobbogram), calculate the basic meta-analysis statistics and interpret them correctly. The article describes an example of construction of a forest plot and creation of its elements in detail, explaining the calculation of the basic meta-analysis statistics: effect size, effect heterogeneity index. The authors provide a description of the underlying features of the meta-analysis of models with fixed and random effects, suggesting recommendations on the choice of model depending on the general concept of the study. Using the example of published data of randomized controlled trials of one of tonsillectomy methods – coblation, the authors built a meta-analysis diagram with the calculation of the main indicators evaluating the effect of clinical impact and its variability. To solve the statistical problems, the authors used R-language software environment, which is currently considered the most powerful and flexible tool for performing statistical analysis of medical data and visualizing its results. The description of the tasks is accompanied with the introduction of full R-language program code, which can be used for reproduction of the results of this study and solution of similar problems on other source data. The article uses terms and concepts related to the meta-analysis method both in English and in Russian.
The article discusses the concepts of measures of the effect of clinical effects, quantitative methods for their calculation and interpretation, their importance for making medical decisions. Algorithms for calculating effect measures are described for different clinical trial endpoints represented by quantitative (numerical) or binary types of variables, and for different types of effect size indicator (absolute, relative effect size, or clinical effectiveness indicator). It is shown that in the context of assessing the effect of therapeutic effects and clinical efficacy in general, measuring the size of the effect provides a valuable tool for data analysis. Evaluation and interpretation of the effect of the therapeutic modality only on the basis of the level of significance p obtained by testing statistical hypotheses without specifying the size of the effect is not sufficient to understand the importance of using the effect in clinical practice. To obtain an adequate quantitative assessment of the effect and its interpretation, the concept of the size of the effect is a convenient system of methods that is widely used. To illustrate the calculation and interpretation of the size of the effect, published data from clinical studies of the effectiveness of local anesthesia to reduce pain after septoplasty were used. It is shown how, using the presented technique, it is possible to efficiently calculate and easily interpret measures of the effect of the application of local anesthesia. All calculations were performed in the statistical program R.
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