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Background The prevalence of balance and gait deficits increases with age and is associated with the increased incidence of falls seen in the elderly population; these falls are associated with significant morbidity and mortality. Objectives To review changes in gait and balance associated with aging and the effect of visual perturbations on gait and balance in the elderly to provide a basis for future research. Methods PubMed and Cochrane Library were searched for articles from 1980 to present pertaining to gait and balance in older adults (>60) and younger adults (

Objective To demonstrate that brief exposure to subway noise causes temporary threshold shift and is preventable with noise protection. Methods The study was conducted as a randomized crossover trial. Twenty subjects were randomly assigned to two groups, one with hearing protection and one without. Subjects were exposed to subway platform noise for 15 minutes. Pre‐ and post‐exposure pure tone audiometry (PTA) and otoacoustic emissions were compared. After a washout period, subjects switched hearing protection groups and repeated the process. Results A statistically significant reduction in PTA thresholds after subway noise exposure was identified, for subjects with and without hearing protection (P

The round window membrane (RWM) has become the preferred route, over cochleostomy, for the introduction of cochlear implant electrodes as it minimizes inner ear trauma. However, in the absence of a tool designed for creating precise perforation, current practices lead to tearing of the RWM and significant intracochlear pressure fluctuations. On the basis of RWM mechanical properties, we have designed a multi-serrated needle to create consistent holes without membrane tearing or damaging inner ear structures. Four and eight-serrated needles were designed and produced with wire electrical discharge machining (EDM). The needle's ability to create RWM perforations was tested in deidentified, commercially acquired temporal bones with the assistance of a micromanipulator. Subsequently, specimens were imaged under light and scanning electron microscopy (SEM). The needles created consistent, appropriately sized holes in the membrane with minimal tearing. While a four-serrated crown needle made rectangular/trapezoid perforations, the octagonal crown formed smooth oval holes within the membrane. Though designed for single use, the needle tolerated repeated use without significant damage. The serrated needles formed precise perforations in the RWM while minimizing damage during cochlear implantation. The octagonal needle design created the preferred oval perforation better than the quad needle. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 1633-1637, 2016.

To investigate the hypothesis that second-hand smoke (SHS) exposure is associated with sensorineural hearing loss (SNHL) in adolescents.A complex, multistage, stratified geographic area design for collecting representative data from the noninstitutionalized US population.Cross-sectional data from National Health and Nutrition Examination Survey (2005-2006) were available for 1533 participants 12 to 19 years of age who underwent audiometric testing, had serum cotinine levels available, and were not actively smoking.SNHL was defined as an average pure-tone level greater than 15 dB for 0.5, 1, and 2 kHz (low frequency) and 3, 4, 6, and 8 kHz (high frequency).Secondhand smoke exposure, as assessed by serum cotinine levels, was associated with elevated pure-tone hearing thresholds at 2, 3, and 4 kHz, a higher rate of unilateral low-frequency SNHL (11.8% vs 7.5%; P.04), and a 1.83-fold increased risk of unilateral low-frequency SNHL in multivariate analyses (95% confidence interval, 1.08-3.41). The prevalence of SNHL was directly related to level of SHS exposure as reflected by serum cotinine levels. In addition, nearly 82% of adolescents with SNHL did not recognize hearing difficulties.Secondhand smoke is associated with elevated pure-tone thresholds and an increased prevalence of low-frequency SNHL that is directly related to level of exposure, and most affected individuals are unaware of the hearing loss. Thus, adolescents exposed to SHS may need to be closely monitored for early hearing loss with periodic audiologic testing.

A mutation in PDS causes non-syndromic recessive deafness

FUNCTIONAL magnetic resonance imaging (fMRI) was used to compare the cerebral organization during sentence processing in English and in American sign language (ASL). Classical language areas within the left hemisphere were recruited by both English in native speakers and ASL in native signers. This suggests a bias of the left hemisphere to process natural languages independently of the modality through which language is perceived. Furthermore, in contrast to English, ASL strongly recruited right hemisphere structures. This was true irrespective of whether the native signers were deaf or hearing. Thus, the specific processing requirements of the language also in part determine the organization of the language systems of the brain.

A locus for recessive neurosensory nonsyndromic hearing impairment maps to chromosome 9q13–q21 in two regionally separate consanguineous families from India. Each family demonstrates a LOD score greater than 4.5 to this region. D9S15, tightly linked to the Friedreich's ataxia locus, a region that has been defined with over 1 Mb of YAC contig information and several expressed sequences, is one of the flanking markers. In mice, the deafness (dn) locus maps to mouse chromosome 19 and flanking loci are syntenic to human chromosome 9q11–q21. The dn mouse is a potential model for the hearing impairment found in both these families.

Temporal bone (TB) cancers account for less than 0.2% of all head and neck cancers, with a reported incidence of 1–6 cases per million population years. They spread primarily by direct invasion into the TB and neighbouring structures, occasionally from neighbouring structures or as distant metastases to the TB. Schwannomas, paragangliomas (PGs), and meningiomas are three of the most prevalent benign TB tumours. Squamous cell carcinoma is the most investigated and frequently encountered malignant TB tumour, followed by basal cell carcinoma, and adenoid cystic carcinoma. While benign tumours range from indolent to locally destructive tumours, malignant tumours always display varying degrees of aggression. Diagnosis of TB tumours arises from amalgamation of clinical, radiologic, and audiologic investigation results. A biopsy is frequently needed for diagnostic verification. The position, extent, and biologic characteristics of the tumour together with patient related factors influence decisions about optimal management. Surgery and radiotherapy (RT) are used either solely or in combination, occasionally with chemotherapy, to eradicate the tumour in question. For benign, slow-growing tumours such as schwannomas and PGs, a wait-and-see approach is also occasionally opted for. Because of TB’s proximity to vital structures of the inner ear and the intracranial fossa, the trend over the past decades has been to favour conservative, function-preserving surgical approaches in the treatment of all TB tumours. Pharmacologic treatments have, in addition, become a treatment option for selected benign but potentially notorious tumours, such as neurofibromatosis type 1 -related plexiform neurofibroma (PN). The prognosis of TB and related tumours depends on patient and tumour characteristics as well as the chosen treatment plan. Most benign tumours carry an excellent prognosis. Malignant tumours nearly always portend dismal prognosis if not diagnosed and treated early. The purpose of this thesis was to discuss different aspects of TB and related upper neck tumour diagnosis and management. Studies I and II focused on the diagnosis and management of head and neck paragangliomas (HNPGs). Study II discussed jugulotympanic paragangliomas (JTPGs) in detail and aimed to provide guidance on their treatment for improvement of outcome. The aim of Study III was to review and discuss diagnostic and treatment-related difficulties in the management of head and neck plexiform schwannomas (PSs) and PNs. Study IV reviewed the diagnostic and treatment strategies of external auditory canal (EAC) and middle ear tumours for improvement of outcome and prognosis. All studies were retrospective case-note studies. All studies were carried out at the Helsinki University Hospital, apart from Study III which was pursued in collaboration with Helsinki University Hospital and Turku University Hospital. Study I showed that surgical treatment of HNPGs should be carefully planned to consider patients’ preoperative state and the expected post-operative comorbidities. A four-year follow-up of HNPG patients was too short. Study I recommended family history to be collected and genetic consultation to be organized for all HNPG patients. An algorithm was proposed for the treatment of HNPG patients with a succinate dehydrogenase subunit genetic mutation. Study II recommended radical surgery for JTPGs if complete removal of tumour is possible. RT showed great potential for local tumour control in case of inoperable JTPGs. Function-preserving surgery was recommended with or without adjuvant RT if cranial nerves VII-XII are in danger. Study III demonstrated that sclerotherapy may offer a treatment option for cutaneous PNs. In the treatment of PNs, Study III recommended surgical risks to be carefully balanced with risks of non-operative treatment. Study IV revealed that EAC and middle ear tumours show great diagnostic and histopathologic heterogenicity with a need for individualized investigative and treatment approaches. In benign tumours, aggressive local surgical control was recommended without sacrificing vital structures. In malignant tumours, local surgical control with or without adjunct RT and/or chemotherapy was advocated. Ohimoluun kasvaimet ovat harvinaisia pään ja kaulan alueen kasvaimia. Niiden esiintyvyys on 1–6 tapausta miljoonaa väestövuotta kohden, jonka myötä ne muodostavat 0.2 % kaikista pään ja kaulan alueen kasvaimista. Ohimoluun kasvaimet leviävät suoraan ohimoluuhun tai tämän viereisiin rakenteisiin, ajoittain myös viereisistä rakenteista tai kauempaa lähtöisin olevista kasvaimista metastaaseina ohimoluuhun. Schwannoomat, paraganglioomat ja meningeoomat ovat kolme yleisintä ohimoluun hyvänlaatuista kasvainta. Yleisin ja tutkituin ohimoluun pahanlaatuinen kasvain on levyepiteelisyöpä, jota seuraavat yleisyydeltään tyvisolusyöpä ja adenokystinen syöpä. Siinä missä hyvänlaatuiset ohimoluun kasvaimet voivat vaihdella harmittomista paikallisesti destruktiivisiin kasvaimiin, pahanlaatuiset ohimoluun kasvaimet käyttäytyvät aina aggressiivisesti. Ohimoluun kasvainten diagnostiikassa huomioidaan kliiniset, radiologiset ja audiologiset tutkimustulokset. Diagnoosin varmistamiseksi tarvitaan useimmiten koepala. Kasvaimen sijainti, levinneisyys sekä muut kasvain- ja potilaskohtaiset tekijät vaikuttavat hoidon suunnitteluun. Kasvainten poistamiseen käytetään kirurgiaa ja kasvun pysäyttämiseen sädehoitoa joko erikseen tai yhdessä, ajoittain yhdistettynä solusalpaajahoitoon. Hyvänlaatuisten kasvainten kuten schwannoomien ja paraganglioomien hoidossa hyödynnetään ajoittain myös odottavaa seurantaa. Koska ohimoluu on lähellä tärkeitä kallonsisäisiä ja sisäkorvan rakenteita, kaikkien ohimoluun kasvainten kirurginen hoito on viime vuosikymmeninä muuttunut kohti konservatiivisempaa, toimintaa säilyttävää hoitoa. Lääkkeelliset hoidot ovat myös tulleet osaksi valikoitujen kasvainten, kuten neurofibromatoosi 1:n liittyvien pleksiformisten neurofibroomien hoitoa. Ohimoluun kasvainten ennuste riippuu kasvain- ja potilaskohtaisista tekijöistä sekä valitusta hoitomuodosta. Useimpien hyvänlaatuisten kasvainten ennuste on erinomainen. Pahanlaatuisten kasvainten ennuste on huono, mikäli kasvainta ei diagnosoida ja hoideta varhaisessa vaiheessa. Tämän väitöskirjatyön tarkoitus on tarkastella ohimoluun ja valikoitujen yläkaulan kasvainten diagnostiikkaa ja hoitoa. Työ koostuu takautuvista asiakirjatutkimuksista, jotka tehtiin Helsingin yliopistollisessa keskussairaalassa lukuun ottamatta osatyötä III, joka toteutettiin yhteistyössä Turun yliopistollisen keskussairaalan kanssa. Osatyöt I ja II keskittyvät pään ja kaulan paraganglioomien diagnosointiin ja hoitoon. Osatyö II tarkastelee jugulotympanaalisia paraganglioomia tavoitteena parantaa kyseisten kasvainten hoitoa ja ennustetta. Osatyö III käsittelee pään ja kaulan alueen pleksiformisten schwannoomien ja pleksiformisten neurofibroomien hoidollisia haasteita. Osatyö IV tarkastelee korvakäytävän ja välikorvan kasvainten hoitoa ja ennustetta. Osatyö I osoitti, että pään ja kaulan paraganglioomien kirurginen hoito tulee suunnitella tarkasti etukäteen ottaen huomioon potilaan preoperatiivinen tila sekä mahdolliset postoperatiiviset komplikaatiot. Pään ja kaulan paraganglioomien neljän vuoden seuranta osoittautui liian lyhyeksi. Sukuhistorian keräämistä ja perinnöllisyyslääkärin konsultaatiota suositeltiin kaikille pään ja kaulan paraganglioomia sairastaville potilaille. Osatyö I loi hoitokaavion potilaille, joilla on suksinaattidehydrogenaasin alayksikön mutaatio. Osatyö II suositteli jugulotympanaalisten paraganglioomien radikaalia kirurgista poistoa, jos kasvain on mahdollista poistaa turvallisesti kokonaisuudessaan. Sädehoito osoittautui lupaavaksi hoitomuodoksi paikallisten kasvainten hallinnassa, mikäli turvallinen kirurginen poisto ei ole mahdollista. Toiminnan säilyttävää kirurgiaa suositeltiin joko yksinään tai sädehoidon kanssa, jos aivohermot VII-XII ovat vaarassa. Osatyö III esitti ruiskutusterapian (skleroterapian) tarjoavan hoitomahdollisuuden ihoperäisiin pleksiformisiin neurofibroomiin. Sama osatyö suositteli pleksiformisten neurofibroomien kirurgisten riskien tarkkaa puntarointia kajoamattoman hoidon kanssa. Osatyö IV havaitsi, että korvakäytävän ja välikorvan kasvaimet ovat diagnostisesti ja histologisesti monimuotoisia, jonka myötä kasvainten diagnostiikka ja hoito on yksilöllisesti räätälöitävä kullekin kasvaimelle sopivaksi. Tässä osatyössä suositeltiin hyvänlaatuisten kasvainten radikaalia kirurgista poistoa ilman tärkeiden rakenteiden uhraamista. Pahanlaatuisten kasvainten suhteen suositeltiin kasvaimen paikallista kirurgista kontrollointia yksin tai yhdessä sädehoidon ja/tai solusalpaajahoidon kanssa.