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The sensitivity of postural responses to the effects of work fatigue and circadian changes was explored in a pilot study using a specific method of multiplate posturography based on the differential assessment of vertical pressure on four separate platforms for each heel and set of toes of each foot, respectively. 8 normal subjects, M.D.s, were given six posturographic examinations immediately before and after three 8-hr. work shifts in the emergency room of a major hospital in Tel-Aviv. 3 posturographic measures (stability, spectral power of postural sway at low frequency of 0.1-0.25 Hz, and unilateral weakening of heel-toe synchronisation) were significantly affected by work fatigue whilst also showing interaction with circadian rhythm. 2 additional measures (power of sway at high frequency of 1.00-3.00 Hz and dysharmonic distribution of weight over the four platforms) were not related to workload but showed significant circadian changes. These effects appeared only on positions involving restricted visual and somatosensory feedback causing vestibular stress. Results justify the application of multiplate posturography as an ancillary tool in measuring objectively the effects of fatigue and circadian changes as well as the interaction between endogenous chronobiological processes and their external conditioning factors (Zeitgebers). Pragmatic implications of the findings in the context of industrial medicine and interdisciplinary efforts to prevent road and air accidents are discussed.

Objective: To evaluate the effects of conductive hearing loss and occlusion on bone-conducted cervical vestibular evoked myogenic potentials (cVEMPs)., Study Design: Prospective cohort study conducted in the year 2018. The right ear of each volunteer was evaluated under 3 conditions by using bone-conducted cVEMPs: normal (open external auditory canal), occluded (conductive hearing loss with occlusion effect), and closed (conductive hearing loss without the occlusion effect)., Setting: Single academic center., Subjects and Methods: The study comprised 30 healthy volunteers aged 20 to 35 years (16 women, 14 men). All had normal hearing and no vestibular or auditory pathologies. The thresholds and amplitudes of cVEMP responses were recorded for the 3 conditions. The results of each condition for a particular participant were compared., Results: As compared with the open condition, the conductive condition increased thresholds by 2.8 dB ( P = .01), and the occluded condition decreased thresholds by 3.8 dB ( P = .008). The amplitude in the occluded condition was larger than the normal condition and the conductive condition (mean difference: 20.64 [ P = .009] and 31.76 [ P < .001], respectively)., Conclusion: The occlusion effect is present in cVEMP responses. The mechanism is not due to the conductive hearing loss induced. Clinical implications include potentially altering vestibular function with sealed hearing aids and in the surgically modified ears (ie, obliterated ears and open cavity mastoidectomy).

Background: Balance is a complex process involving the coordinated activities of multiple sensory, motor and biomechanical components. Balance function may be disturbed in subjects suffering from hearing loss but the impairment has been attributed to the pathology underlying the hearing loss., Aim: The purpose of the study was to investigate the possible interference of simulated conductive hearing loss with the ability to maintain postural balance., Methods: Twenty normal-hearing subjects, 20-30 years old, underwent the computerised dynamic posturography test battery before and after plugging their external ear canals with earplugs, thus simulating a 40dB conductive hearing loss., Results: Eighteen females and two males were tested before and after plugging their ear canals. Average CHL was 40 ± 4.9dB. The composite equilibrium score was significantly diminished after plugging the ears with an average sway score of 73.5% (P < .05, T = 2.27). The fourth test condition was specifically affected with an average sway score of 72.85% with earplugs (P < .05, T = 2.37)., Conclusions: Conductive hearing loss has a negative effect on balance. This can be theoretically explained by the association between hearing loss and saccular dysfunction., (© 2019 John Wiley & Sons Ltd.)

Background: Vestibular evoked myogenic potentials (VEMP) are transient alteration in tonic activity of muscles elicited by auditory stimulation of the otolithic organs of the ear. VEMP can be triggered by auditory stimulation via air or bone conduction. Occlusion of the external auditory meatus has long been known to decrease thresholds for sound perception medicated by the cochlea., Objective: Proof that the occlusion effect is present for bone conducted (BC) cervical VEMPs (cVEMP)., Methods: Measurement of the thresholds and raw amplitudes of BC-VEMPs in twenty healthy adults with the external auditory canal open and occluded., Results: Thresholds for BC-VEMPs were similar for the open vs. the occluded condition. However, amplitudes were statistically significantly higher in the occluded (average 76.34μV) vs. open group (average 69.9μV)., Conclusions: The occlusion effect is present in cVEMPs. This finding, described herein for the first time, has a number of clinical implications such as the surgically altered ear and the use of occluding hearing aids.

Hearing loss is widespread among the elderly. One of the main obstacles to rehabilitation is identifying individuals with potentially correctable hearing loss. Smartphone-based hearing tests can be administered at home, thus greatly facilitating access to screening. This study evaluates the use of a smartphone application as a screening tool for hearing loss in individuals aged ≥ 65 years. Twenty-six subjects aged 84.4 ± 6.73 years (mean ± SD) were recruited. Pure-tone audiometry was administered by both a smartphone application (uHear for iPhone, v1.0 Unitron, Canada) and a standard portable audiometer by trained personnel. Participants also completed a questionnaire on their hearing. Pure-tone thresholds were compared between the two testing modalities and correlated with the questionnaire results. The cutoff point for failing screening tests was a pure tone average of 40 dB for the frequencies 250-6,000 Hz. The smartphone application's pure tone thresholds were higher (poorer hearing) than the audiometric thresholds, with a significant difference in all frequencies but 2,000 Hz. The application and the audiometric values were in agreement for 24 subjects (92 %). The application had a sensitivity of 100 % and specificity of 60 % for screening compared with the audiometer. The questionnaire was significantly less accurate, having assigned a passing score to three participants who failed both the application and audiometric tests. While a smartphone application may not be able to accurately determine the level of hearing impairment, it is useful as a highly accessible portable audiometer substitute for screening for hearing loss in elderly populations.

Background: In a 2-stage neonatal hearing screening protocol, if an infant fails the first-stage abstract screening with an otoacoustic emissions test, an automated auditory brainstem response (ABR)test is performed. The purpose of this study was to estimate the rate of hearing loss detected byfirst-stage otoacoustic emissions test but missed by second-stage automated ABR testing., Methods: The data of 17 078 infants who were born at Lis Maternity Hospital between January 2013 and June 2014 were reviewed. Infants who failed screening with a transient evoked otoacoustic emissions (TEOAE) test and infants admitted to the NICU for more than 5 days underwent screening with an automated ABR test at 45 decibel hearing level (dB HL). All infants who failed screening with TEOAE were referred to a follow-up evaluation at the hearing clinic., Results: Twenty-four percent of the infants who failed the TEOAE and passed the automated ABR hearing screening tests were eventually diagnosed with hearing loss by diagnostic ABR testing (22/90). They comprised 52% of all of the infants in the birth cohort who were diagnosed with permanent or persistent hearing loss .25 dB HL in 1 or both ears (22/42).Hearing loss .45 dB HL, which is considered to be in the range of moderate to profound severity, was diagnosed in 36% of the infants in this group (8/22), comprising 42% of the infants with hearing loss of this degree (8/19)., Conclusions: The sensitivity of the diverse response detection methods of automated ABR devices needs to be further empirically evaluated.

Sudden sensorineural hearing loss (SSNHL) can cause significant morbidity. Treatment with steroids can improve outcome. Delay in initiation of treatment reduces the chance to regain hearing. For this reason SSNHL is considered an emergency. Diagnosis is based on history, physical examination and a standard audiogram, the latter requiring specialized equipment and personnel. Standard audiogram may not be available at the time and place of patient presentation. A smartphone or tablet computer-based hearing test may aid in the decision to prescribe steroids in this setting. In this study the uHear™ hearing test application was utilized. The output of this ear-level air conduction hearing test is reported in hearing grades for 6 frequencies ranging from 250 to 6000 Hz. A total of 32 patients with unilateral SSNHL proven by a standard audiogram were tested. The results of standard and iPod hearing tests were compared. Based on the accepted criterion of SSNHL (at least 30 dB loss - or 2 hearing grades - in 3 consecutive frequencies) the test had a sensitivity of 0.76 and specificity of 0.91. Using a less stringent criterion of a loss of 2 hearing grades over at least 2 frequencies the sensitivity was 0.96 and specificity 0.86. The correlation coefficient for the comparison of the average hearing grade across the 6 measured frequencies of the study and standard audiogram was 0.83. uHear more accurately reflected hearing thresholds at mid and high tones. Similarly to previously published data, low frequency thresholds could be artificially elevated. In conclusion, uHear can be useful in the initial evaluation of patients with single-sided SSNHL by providing important information guiding the decision to initiate treatment before a standard audiogram is available., (Copyright © 2013 S. Karger AG, Basel.)

The identification of novel disease-associated genes in gynaecological tumours has important implications for understanding the process of tumourigenesis and the development of novel treatment regimens. cDNA libraries from disease tissues may represent a valuable source to identify such genes. Recently, a bio-informatic procedure based on an 'electronic Northern' approach was established to screen expressed sequence tag (EST) libraries for genes differentially expressed in tumour and normal tissues, and identified 450 candidate genes differentially expressed in breast and ovarian cancer. In this report, the validation of an initial set of 40 candidate genes, which were selected due to their localization in chromosomal regions frequently altered in gynaecological tumours, is described. Differential expression of 29 of these genes, including three uncharacterized novel genes, was confirmed by applying cancer profiling arrays with 106 matched pairs of tumour/normal cDNAs and quantitative reverse transcription-polymerase chain reaction (RT-PCR) on 60 clinical specimens. The majority of these differentially expressed genes have not been described previously in the context of breast and ovarian cancer, and may constitute novel diagnostic markers for these tumour entities.

The inter-alpha-trypsin inhibitor (ITI) family constitutes a group of proteins built up from one light chain and a variable set of heavy chains. Originally identified as plasma protease inhibitors, recent data indicate that ITI plays a role in extracellular matrix (ECM) stabilization and in prevention of tumor metastasis. Here we describe cloning as well as phylogenetic and expression analysis of a novel member of the heavy chain gene family, ITIH5. ITIH5 contains the two domains conserved in all known ITIHs, the vault protein inter-alpha-trypsin (VIT) domain and a von Willebrand type A (vWA) domain. However, ITIH5 diverged early from a common ancestor of the other subfamilies. We found strong downregulation of ITIH5 expression in breast tumors by real-time PCR and RNA in situ hybridization. While normal breast epithelial cells clearly express ITIH5, expression is consistantly lost or strongly downregulated in invasive ductal carcinoma. ITIH5 mRNA was neither detectable in cancerous nor benign breast cell lines. We propose that loss of ITIH5 expression may be involved in breast cancer development.

Testing of otoacoustic emissions (OAE) has been successfully applied to study outer hair cell function. We used this methodology to evaluate and compare the effect of topically applied normal saline, and gentamicin- and ciprofloxacin-containing drops into the middle ear of guinea pigs. All three solutions similarly decreased the distortion product OAE (DPOAE) and all three caused an inflammatory reaction in the guinea pig's middle-ear. OAE failed to detect adequately the ototoxicity of topically administered drops in this animal model because the opening of the bulla affected DPOAE, and both inflamed middle-ear mucosa and osteoneogenesis caused a decrease in DPOAE amplitude. This is the first report examining the influence of topically used otic drops on inner ear function as demonstrated by OAE.

A prospective study of hearing loss in 120 cases with non-explosive blast injury of the ear, gathered over a six-year period, is presented. Thirty-three (27.5 per cent) patients had normal hearing, 57 (47.5 per cent) conductive hearing loss, 29 (24.2 per cent) mixed loss and one (0.8 per cent) had pure sensorineural loss. The severity of conductive hearing loss correlated with the size of the eardrum perforation; only a marginal difference was found between water and air pressure injuries, with respect to this type of hearing loss. Of all locations, perforations involving the posterior-inferior quadrant of the eardrum were associated with the largest air-bone gap. Audiometric assessment revealed that none of the patients suffered ossicular chain damage. Three patterns of sensorineural hearing loss were identified: a dip at a single frequency, two separate dips, and abnormality of bone conduction in several adjacent high frequencies. Involvement of several frequencies was associated with a more severe hearing loss than a dip in a single frequency. Healing of the perforation was always accompanied by closure of the air-bone gap, while the recovery of the sensorineural hearing loss was less favourable.

The clinical efficacy and safety of orally administered ofloxacin (400 mg twice daily) were evaluated in 24 adult patients (17 men and 7 women; mean age, 65.8 years) with pseudomonal invasive external otitis (IEO). The patients were divided into two groups: group A, (n = 9) suffering from a mild form of IEO, and group B (n = 15), suffering from a more severe form of the disease. Diabetes mellitus was the main underlying disease in these patients. Pseudomonas aeruginosa was the only pathogen in 18 infected ears and part of the polymicrobial flora in an additional 6. Cure was observed in 83.3% of the patients. Two of the cured patients required more than one course of ofloxacin treatment. Development of P aeruginosa resistant to ofloxacin (n = 3) and severe allergic reaction (n = 1) required the discontinuation of ofloxacin therapy. Other side effects such as nausea, arthralgia, and vaginal itching were minimal. Oral administration of ofloxacin seems to be an effective, convenient, relatively safe, and economical therapy of IEO caused by the susceptible organism.

Auditory evoked potentials of the cochlear nerve and the brain stem were recorded in ten patients with multiple sclerosis (MS) and four patients thought to possibly have MS. A characteristic pattern materialized, with a prolonged N1-P4 conduction time and absent or small N2 and/or N5 waves. We discuss possible clinical implications.

Otoadmittance audiometry was performed on a group of young subjects (18-30 years old) with normal hearing. Mean values and standard deviations for static admittance, conductance and susceptance were computed on the basis of the point of maximum compliance, as well as the point of zero cross (drum-free position). In addition, the values of curve width for conductance and susceptance, middle ear pressure and the threshold of the acoustic reflex for pure tones and interrupted tones were evaluated. Subjects presenting an abnormality of the tympanic membrane were studied as a separate group. The results obtained in this study were compared with those reported in the literature.