136 results on '"Kileny PR"'
Search Results
2. Incomplete electrode extraction during cochlear implant revision.
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Kang SY, Zwolan TA, Kileny PR, Niparko JK, Driscoll CL, Shelton C, Telian SA, Kang, Stephen Y, Zwolan, Teresa A, Kileny, Paul R, Niparko, John K, Driscoll, Colin L, Shelton, Clough, and Telian, Steven A
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- 2009
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3. Reversible electrocochleographic abnormalities in superior canal dehiscence.
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Arts HA, Adams ME, Telian SA, El-Kashlan H, Kileny PR, Arts, H Alexander, Adams, Meredith E, Telian, Steven A, El-Kashlan, Hussam, and Kileny, Paul R
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- 2009
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4. Role of electrically evoked auditory brainstem response in cochlear implantation of children with inner ear malformations.
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Kim AH, Kileny PR, Arts HA, El-Kashlan HK, Telian SA, and Zwolan TA
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- 2008
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5. Phonetic processing in children with cochlear implants: an auditory event-related potentials study.
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Henkin Y, Kileny PR, Hildesheimer M, Kishon-Rabin L, Henkin, Yael, Kileny, Paul R, Hildesheimer, Minka, and Kishon-Rabin, Liat
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- 2008
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6. Comment: the New York State Project.
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Kileny PR, Jacobson GP, Prieve BA, Dalzell L, Spivak L, Orlando M, Gravel J, Kileny, P R, and Jacobson, G P
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- 2000
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7. Clinical note. Audiovestibular phenotype associated with a COL11A1 mutation in Marshall syndrome.
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Griffith AJ, Gebarski SS, Shepard NT, and Kileny PR
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- 2000
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8. Auditory brain stem response in small acoustic neuromas.
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El-Kashlan HK, Eisenmann D, Kileny PR, El-Kashlan, H K, Eisenmann, D, and Kileny, P R
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- 2000
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9. Facial paralysis: diagnosis and management.
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Kileny PR, Disher MJ, and El-Kashlan H
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- 1999
10. Objective diagnostic measures in contemporary audiology.
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Kileny PR
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- 1999
11. Audiologists in intraoperative neurophysiologic monitoring.
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Edwards BM and Kileny PR
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- 1998
12. Cochlear implantation in patients with cochlear malformations... presented in part at the Third International Cochlear Implant Conference, Innsbruck, Austria, April 6, 1993.
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Tucci D, Telian SA, Zimmerman-Phillips S, Zwolan TA, and Kileny PR
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- 1995
13. Cochlear implantation of children with minimal open-set speech recognition skills.
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Zwolan TA, Zimmerman-Phillips S, Ashbaugh CJ, Hieber SJ, Kileny PR, Telian SA, Zwolan, T A, Zimmerman-Phillips, S, Ashbaugh, C J, Hieber, S J, Kileny, P R, and Telian, S A
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- 1997
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14. Self-report of cochlear implant use and satisfaction by prelingually deafened adults.
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Zwolan TA, Kileny PR, Telian SA, Zwolan, T A, Kileny, P R, and Telian, S A
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- 1996
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15. Effects of intratympanically delivered lidocaine on the auditory system in humans.
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Laurikainen EA, Johansson RK, Kileny PR, Laurikainen, E A, Johansson, R K, and Kileny, P R
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- 1996
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16. Clinical focus: site visit. Adult and pediatric Cochlear impant programs at the University of Michigan.
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Zwolan TA, Kileny PR, Zimmerman-Phillips S, and Telian SA
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- 1996
17. Otoacoustic emissions.
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Kileny PR, Lesperance MM, Parthasarathy TK, and Klostermann B
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- 2003
18. Otoacoustic emissions.
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Kileny PR, Parthasarathy TK, and Klostermann B
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- 2002
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19. Intraoperative neurophysiologic monitoring: a contemporary brief.
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Edwards BM, Kileny PR, Kovach DJ, McCue J, and Spak C
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- 2004
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20. Evoked potentials in the management of patients with cochlear implants: research and clinical applications.
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Kileny PR
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- 2007
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21. Pre-perioperative, transtympanic electrically evoked auditory brainstem response in children.
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Kileny PR and Zwolan TA
- Abstract
The purpose of this study was to characterize the transtympanically evoked, perioperative electrically evoked auditory brainstem response (EABR) and define its relationship with preoperative hearing, age and hearing loss etiology in 59 children (10-60 months of age) who had received cochlear implants. The results indicate that there was no difference between wave V latency obtained from the younger (10-36 months) and the older (37-60 months) children. There was a statistically significant difference in the preoperative pure-tone average between the higher-EABR threshold group (650 microA and above) and the lower-EABR threshold group (600 microA or less). Patients with post-meningitic deafness exhibited the longest EABR wave V latencies. Perioperative, trans-tympanic, promontory EABR is an effective clinical procedure which can decrease the likelihood of placing a cochlear implant in a non-stimulable ear, and may provide the clinician with a valuable tool for selecting the most appropriate ear for implantation. [ABSTRACT FROM AUTHOR]
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- 2004
22. Editorial.
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Kileny PR
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- 2004
23. Low-resolution electromagnetic tomography (LORETA) in children with cochlear implants: a preliminary report.
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Henkin Y, Kishon-Rabin L, Tatin-Schneider S, Urbach D, Hildescheimer M, and Kileny PR
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The current preliminary report describes the utilization of low-resolution electromagnetic tomography (LORETA) in a small group of highly performing children using the Nucleus 22 cochlear implant (CI) and in normal-hearing (NH) adults. LORETA current density estimations were performed on an averaged target P3 component that was elicited by non-speech and speech oddball discrimination tasks. The results indicated that, when stimulated with tones, patients with right implants and NH adults (regardless of stimulated ear) showed enhanced activation in the right temporal lobe, whereas patients with left implants showed enhanced activation in the left temporal lobe. When stimulated with speech, patients with right implants showed bilateral activation of the temporal and frontal lobes, whereas patients with left implants showed only left temporal lobe activation. NH adults (regardless of stimulated ear) showed enhanced bilateral activation of the temporal and parietal lobes. The differences in activation patterns between patients with CI and NH subjects may be attributed to the long-term exposure to degraded input conditions which may have resulted in reorganization in terms of functional specialization. The difference between patients with right versus left implants, however, is intriguing and requires further investigation. [ABSTRACT FROM AUTHOR]
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- 2004
24. Electrocochleography in the diagnosis of third window conditions.
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Kileny PR, Cherry MM, and McCaslin DL
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Introduction: Superior semicircular canal dehiscence (SSCD) is the best-known and most common presentation of so-called "third window conditions." There are a variety of diagnostic measures and tests for this condition in the current literature, including air-bone gap, vestibular-evoked myogenic potentials, and electrocochleography (EcochG). The purpose of this study was to investigate the diagnostic utility of EcochG and its relationship to air-bone gap in a cohort of patients with confirmed SSCD., Methods: We reviewed data from 20 patients (11 female and 9 male subjects, age ranging 21-78 years), with confirmed unilateral or bilateral superior canal dehiscence. In total, 11 patients had unilateral SSCD and 9 patients had bilateral SSCD as determined by high-resolution CT scan. This resulted in the inclusion of twenty-nine ears with superior canal dehiscence and 11 normal ears., Results: Our results indicated that all confirmed SSCD ears presented with an abnormal EcochG SP/AP value and that there was a statistically significant difference between normal and dehiscent ears. There was no statistically significant relationship between air-bone gap and SP/AP ratio in the ears diagnosed with SSCD nor was there a significant difference between dehiscent and normal ears in terms of air-bone gap at three frequencies., Discussion: These results are consistent with previous studies showing the diagnostic utility of EcochG for this condition and the variability of air-bone gap. While an unexpected air-bone gap continues to be a red flag for SSCD, its absence along with the presence of subjective symptoms is a reasonable indicator for further clinical investigation to include EcochG., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kileny, Cherry and McCaslin.)
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- 2024
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25. The Association of Hearing Loss with Hospitalization.
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Zazove P, Plegue MA, Mulhem E, Panzer K, Ratakonda S, Sen A, Greenberg J, McEvoy A, Kileny PR, and McKee MM
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- Humans, Male, Middle Aged, Prospective Studies, Retrospective Studies, Educational Status, Hospitalization, Hearing Loss diagnosis, Hearing Loss epidemiology, Hearing Loss etiology
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Background: Individuals with hearing loss (HL) are at higher risk for hospitalizations, and may be for readmissions, compared with their hearing peers. The objective of this prospective study was to confirm retrospective studies suggesting that HL increases hospital readmissions, and, if confirmed, possible causes for it., Methods: A prospective cohort study of English-speaking patients > 55 years old admitted to general medical and surgical floors at 2 large hospital systems in southeastern Michigan over a 2-year period was conducted. All patients underwent bedside audiometric testing. HL presence and severity were categorized using World Health Organization pure tone assessment parameters. Readmission rates, Charlson comorbidity index, socio-demographic and medical variables were obtained from Epic EMR databases., Outcomes: There were 1247 hospitalized patients enrolled. Of these, 76.8% had documented HL of which 50.5% (630) was mild HL and 26.3% (328) moderate or worse HL. Patients with any HL were older and more likely to be non-Hispanic, white, male, and had less education, lower health literacy, more comorbidities, and more difficulty communicating with their doctor. Readmission rates at 30 and 90-days were similar between HL and hearing groups, after adjusting for HL severity, Charlston index, and numerous potential confounders., Conclusion: Patients with HL do not seem to have higher rates of hospital readmissions. We did find high frequency of HL in hospitalized patients along with significant communication difficulties that patients had with their clinicians. These findings have implications for measures to improve patient-physician communication, potentially improving long-term health outcomes., Competing Interests: Conflict of interest: The authors of this manuscript have no conflicts of interest, financial or otherwise., (© Copyright by the American Board of Family Medicine.)
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- 2023
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26. Click-evoked auditory brainstem responses and autism spectrum disorder: a meta-analytic investigation of disorder specificity.
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Talge NM, Adkins M, Kileny PR, and Frownfelter I
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- Cross-Sectional Studies, Data Collection, Evoked Potentials, Auditory, Brain Stem physiology, Humans, Attention Deficit Disorder with Hyperactivity complications, Attention Deficit Disorder with Hyperactivity diagnosis, Autism Spectrum Disorder, Hearing Loss
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Background: Click-evoked auditory brainstem response (ABR) alterations are associated with autism spectrum disorder (ASD), but the specificity of these findings to the disorder is unclear. We therefore performed a meta-analysis on ABRs and attention-deficit/hyperactivity disorder (ADHD), a neurodevelopmental disorder that shares some etiologic and symptom overlap with ASD., Methods: Seven papers compared ABR latency components (I, III, V, I-III, III-V, and I-V) between participants with and without ADHD. We used random-effects regression to generate component-specific estimates (Hedges's g) that adjusted for study sample sizes and the number of studies contributing to each estimate. We compared these estimates to our recently published meta-analysis of ABRs and ASD., Results: All ADHD studies employed cross-sectional designs. ADHD was associated with longer latencies for waves III and V (g = 0.6, 95% confidence interval (CI) 0.3, 1.0 and g = 0.6, 95% CI 0.3, 0.9) and waves I-III and I-V (g = 0.7, 95% CI 0.2, 1.3 and g = 0.6, 95% CI 0.3, 1.0). Effect sizes from the ASD and ADHD meta-analyses did not differ from each other., Conclusions: Similar patterns of ABR alterations are observed in ADHD and ASD. However, studies rarely screen for middle ear dysfunction or hearing loss and rely upon cross-sectional designs. Addressing these issues will inform the viability of ABRs as a prognostic and/or etiologic biomarker for these disorders., Impact: Click-evoked ABR alterations are associated with ASD, but the specificity of these findings to the disorder is unclear. We therefore performed a meta-analysis of the association between ABRs and ADHD, a disorder that shares some etiologic and symptom overlap with ASD. ADHD was associated with longer ABR latencies for several components. These components are identical to those implicated in ASD. Effect sizes were similar in magnitude across disorders. The viability of ABRs as prognostic and/or etiologic biomarkers for neurodevelopmental risk requires addressing limitations in the literature (e.g., cross-sectional data, non-standardized ABR protocols, minimal characterization of symptom heterogeneity)., (© 2021. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)
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- 2022
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27. Intraoperative Electrocochleography Correlates to Outcomes in Transmastoid and Middle Cranial Fossa Superior Semicircular Canal Dehiscence Repair.
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Ellsperman SE, Telian SA, Kileny PR, and Welch CM
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- Adult, Audiometry, Evoked Response, Cranial Fossa, Middle surgery, Humans, Reproducibility of Results, Retrospective Studies, Semicircular Canals surgery, Migraine Disorders, Semicircular Canal Dehiscence
- Abstract
Objective: To determine the degree to which electrocochleography (ECoG) correlates with auditory and vestibular outcomes after repair of superior semicircular canal dehiscence (SSCD) via transmastoid (TM) and middle cranial fossa (MCF) approaches., Study Design: Retrospective review., Setting: Academic tertiary referral center., Patients: Adults with SSCD who underwent repair between 2005 and 2019., Intervention: Pre-, intra-, and postoperative ECoG., Main Outcome Measures: Patient-reported vestibular and auditory symptoms; pre-, intra-, and postoperative ECoG measures, dizziness handicap inventory (DHI) scores., Results: Forty-six patients underwent SSCD repair (40 unilateral, six bilateral) between 2005 and 2019, including 24 MCF and 28 TM approaches. There were no differences in preoperative, intraoperative, or postrepair ECoG SP/AP values between the MCF and TM groups (p 0.12, 0.77, 0.58). Patients had subjective improvement in vestibular symptoms (or stable vestibular function in patients operated for predominantly auditory manifestations) with both approaches (MCF: 87.5%; TM: 92.3%; p 0.64). A successful outcome correlated with intraoperative SP/AP ratio normalization (p 0.0005). Similarly, DHI scores were similar in both groups preoperatively (p 0.66) and returned to their preoperative baseline postoperatively with both (p 0.52). Reported vestibular symptoms persisted or worsened more often in patients with migraine (66.6% vs. 28.9%, p 0.03), and with persistently abnormal ECoG measures, though the latter was not statistically significant in this population (38% vs. 15%, p 0.10). Patients had subjective improvement or stability in auditory symptoms using either approach (MCF: 96%; TM: 100%; p 0.62), also correlating with SP/AP ratio normalization (p 0.008)., Conclusions: Correction of abnormal preoperative ECoG reliably correlates to patient symptom improvement after SSCD repair. No significant differences in postoperative outcomes were noted between patients undergoing TM versus MCF repair. Circumspection regarding the likelihood of an ideal outcome after SSCD repair should be exercised when counseling patients with concomitant migraine., Define Professional Practice Gap and Educational Need: It is not certain whether outcomes differ between the two dominant approaches for SSCD repair. Surgeons and patients would benefit from an intraoperative metric that reflects satisfactory plugging of SSCD., Learning Objective: To highlight the reliability and unique utility of intraoperative ECoG and demonstrate the correlation between ECoG correction and symptom improvement for SSCD repair., Desired Result: To report subjective and objective outcomes following SSCD repair and encourage adoption of intraoperative ECoG monitoring., Level of Evidence: Level V., Indicate Irb or Iacuc: IRB review considers this study exempt (HUM00169949)., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2021, Otology & Neurotology, Inc.)
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- 2022
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28. Auditory Outcomes Following Transmastoid and Middle Cranial Fossa Approaches for Superior Semicircular Canal Dehiscence Repair.
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Ellsperman SE, Telian SA, Kileny PR, and Welch CM
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- Adult, Audiometry, Pure-Tone, Bone Conduction, Cranial Fossa, Middle surgery, Humans, Retrospective Studies, Semicircular Canals surgery, Treatment Outcome, Semicircular Canal Dehiscence
- Abstract
Objective: To describe postoperative hearing outcomes following transmastoid (TM) and middle cranial fossa (MCF) approaches for semicircular canal dehiscence (SSCD) repair., Study Design: Retrospective review., Setting: Academic, tertiary referral center., Patients: Adults with SSCD who underwent repair between 2005 and 2019., Interventions: Pure tone audiometry pre- and postoperatively after SSCD repair., Main Outcome Measures: Change in air-bone gap (ABG) at 250 and 500 Hz, pure tone average (PTA), bone conduction (BC), and air conduction (AC) thresholds at 500, 1000, 2000, and 4000 Hz for patients undergoing TM and MCF approaches for SSCD repair., Results: The average change in BC PTA for patients undergoing TM (n = 26) and MCF (n = 24) SSCD repair was not significantly different between the two groups. The first and final postoperative PTAs were recorded an average of 1.7 (range 0.30-3.0) and 29.1 (range 3.5-154) months postoperatively. For patients who underwent MCF repair, the average BC PTAs increased (+) by 2.2 dB HL (p 0.43) and 0.57 dB HL (p 0.88) at the first and final audiograms respectively compared to +1.27 dB HL (p 0.53) and a decrease (-) of 0.57 dB HL (p 0.63) for the TM group. The average changes in low frequency ABG for patients undergoing MCF repair were -4.7 dB (p 0.08) and -6.9 dB (p 0.15) at first and final audiograms respectively compared to -4.9 dB (p 0.06) and -4.1 dB (p 0.36) for patients who underwent TM repair. There was a high frequency hearing loss noted at 8000 Hz for the MCF (30.0 dB ± 18.7 preop; 41.7 dB ± 21.7 postop; p 0.01) and TM (32.1 dB ± 23.2 preop; 44.3 dB ± 29.6 postop; p 0.001) groups which persisted on long term follow up., Conclusions: Both TM and MCF approaches to SSCD repair can be performed with long-term preservation of hearing. ABGs were reduced in each treatment group but did not reach significance. A high frequency hearing loss (8000 Hz) may be expected with either approach., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2021, Otology & Neurotology, Inc.)
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- 2021
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29. Event-related potentials and cochlear implants: The "inside-the-brain" story.
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Kileny PR
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- Brain diagnostic imaging, Evoked Potentials, Evoked Potentials, Auditory, Humans, Cochlear Implantation, Cochlear Implants
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Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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- 2021
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30. Effective Hearing Loss Screening in Primary Care: The Early Auditory Referral-Primary Care Study.
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Zazove P, Plegue MA, McKee MM, DeJonckheere M, Kileny PR, Schleicher LS, Green LA, Sen A, Rapai ME, and Mulhem E
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- Aged, Family Practice statistics & numerical data, Female, Geriatric Assessment, Humans, Male, Mass Screening methods, Middle Aged, Primary Health Care methods, Referral and Consultation statistics & numerical data, Hearing Loss diagnosis, Hearing Tests statistics & numerical data, Mass Screening statistics & numerical data, Medical Order Entry Systems, Primary Health Care statistics & numerical data
- Abstract
Purpose: Hearing loss, the second most common disability in the United States, is under-diagnosed and under-treated. Identifying it in early stages could prevent its known substantial adverse outcomes., Methods: A multiple baseline design was implemented to assess a screening paradigm for identifying and referring patients aged ≥55 years with hearing loss at 10 family medicine clinics in 2 health systems. Patients completed a consent form and the Hearing Handicap Inventory for the Elderly (HHI). An electronic alert prompted clinicians to screen for hearing loss during visits., Results: The 14,877 eligible patients during the study period had 36,701 encounters. Referral rates in the family medicine clinics increased from a baseline rate of 3.2% to 14.4% in 1 health system and from a baseline rate of 0.7% to 4.7% in the other. A general medicine comparison group showed referral rate increase from the 3.0% baseline rate to 3.3%. Of the 5,883 study patients who completed the HHI 25.2% (n=1,484) had HHI scores suggestive of hearing loss; those patients had higher referral rates, 28% vs 9.2% ( P <.001). Of 1,660 patients referred for hearing testing, 717 had audiology data available for analysis: 669 (93.3%) were rated appropriately referred and 421 (58.7%) were considered hearing aid candidates. Overall, 71.5% of patients contacted felt their referral was appropriate., Conclusion: An electronic alert used to remind clinicians to ask patients aged ≥55 years about hearing loss significantly increased audiology referrals for at-risk patients. Audiologic and audiogram data support the effectiveness of the prompt. Clinicians should consider adopting this method to identify patients with hearing loss to reduce its known and adverse sequelae., (© 2020 Annals of Family Medicine, Inc.)
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- 2020
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31. Electrocochleography: New Uses for an Old Test and Normative Values.
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Ferraro JA, Kileny PR, and Grasel SS
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- Adolescent, Adult, Female, Humans, Male, Meniere Disease diagnosis, Middle Aged, Predictive Value of Tests, Reference Values, Young Adult, Audiometry, Evoked Response methods, Audiometry, Evoked Response standards
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Purpose This article combines the results of 3 studies that were presented at the HeAL 2018 Conference in Lake Como, Italy, in June 2018. Each study involved electrocochleography (ECochG), a neurodiagnostic evaluation that has been used clinically for over 80 years but whose applications continue to expand. The 1st study describes recent research wherein ECochG was recorded from asymptomatic subjects who were siblings or offspring of patients with a confirmed diagnosis of Ménière's disease (MD). Our results provide evidence that ECochG may be helpful in not only diagnosing MD but also predicting it as well. Second, case studies are described where ECochG was important in both diagnosing superior semicircular canal dehiscence and monitoring the repair of this condition during surgery. Finally, although ECochG has been practiced clinically for over 8 decades, the protocols for recording, measuring, and interpreting the electrocochleogram continue to lack standardization among clinicians and scientists. We thus present normative data for some of these features based on noninvasive recordings made from the tympanic membrane from 100 normal hearing subjects. Conclusions Although the primary use of ECochG continues to be in the diagnosis of MD, we report on 2 additional clinical applications for this important test of inner ear/auditory nerve function. First, a preliminary study on a small sample of subjects indicates that ECochG may also be useful in predicting MD prior to the onset of symptoms in individuals who may be genetically predisposed to developing it. Second, through a series of case studies, we demonstrate how ECochG is used to help diagnose superior semicircular canal dehiscence and monitor the status of the inner ear during the surgical repair of this condition. Finally, normative values for clinically important components of the electrocochleogram based on tympanic membrane recordings have been established from a large sample of subjects.
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- 2019
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32. Click-evoked auditory brainstem responses and autism spectrum disorder: A meta-analytic review.
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Talge NM, Tudor BM, and Kileny PR
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- Auditory Threshold physiology, Child, Female, Humans, Male, Reproducibility of Results, Autism Spectrum Disorder physiopathology, Evoked Potentials, Auditory, Brain Stem physiology
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Behavior does not differentiate ASD risk prior to 12 months of age, but biomarkers may inform risk before symptoms emerge. Click-evoked auditory brainstem responses (ABRs) may be worth consideration due to their measurement properties (noninvasiveness; reliability) and conceptual features (well-characterized neural generators), but participant characteristics and assessment protocols vary considerably across studies. Our goal is to perform a meta-analysis of the association between ABRs and ASD. Following an electronic database search (PubMed, Medline, PsycInfo, PsycArticles), we included papers that were written in English, included ASD and typically-developing (TD) groups, and reported the information needed to calculate standardized mean differences (Hedges's g) for at least one ABR latency component (I, III, V, I-III, III-V, I-V). We weighted and averaged effect sizes across conditions and subsets of participants to yield one estimate per component per study. We then performed random-effects regressions to generate component-specific estimates. ASD was associated with longer ABR latencies for Waves III (g = 0.5, 95% CI 0.1, 0.9), V (g = 0.7, 95% CI 0.3, 1.1), I-III (g = 0.7, 95% CI 0.2, 1.2), and I-V (g = 0.6, 95% CI 0.2, 1.0). All components showed significant heterogeneity. Associations were strongest among participants ≤8 years of age and those without middle ear abnormalities or elevated auditory thresholds. In sum, associations between ABRs and ASD are medium-to-large in size, but exhibit heterogeneity. Identifying sources of heterogeneity is challenging, however, due to power limitations and co-occurrence of sample/design characteristics across studies. Research addressing the above limitations is crucial to determining the etiologic and/or prognostic value of ABRs for ASD. Autism Res 2018, 11: 916-927. © 2018 International Society for Autism Research, Wiley Periodicals, Inc., Lay Summary: Auditory brainstem responses (ABR) may be associated with ASD, but participant characteristics and assessment protocols vary considerably across individual studies. Our goal is to combine the results across these studies to facilitate clarity on the topic. Doing so represents a first step in evaluating whether ABRs yield potential for informing the etiology of ASD risk and/or ASD symptom profiles., (© 2018 International Society for Autism Research, Wiley Periodicals, Inc.)
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- 2018
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33. Electrocochleography Results in Patients With Bilateral Vestibular Paresis and Sound- or Pressure-Induced Horizontal Nystagmus.
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Heidenreich KD, Pitts CM, Angster K, Zajac T, Havard S, Melendez TL, and Kileny PR
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- Adult, Female, Humans, Male, Middle Aged, Retrospective Studies, Audiometry, Evoked Response methods, Ear Diseases physiopathology, Nystagmus, Pathologic physiopathology, Paresis physiopathology, Vestibule, Labyrinth physiopathology
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Objective: To describe the electrocochleography (ECochG) findings in patients with bilateral vestibular paresis and sound- and/or pressure-induced horizontal nystagmus., Design: Retrospective case series., Setting: Tertiary care center., Patients: Three adult patients with bilateral vestibular paresis and sound- and/or pressure-induced horizontal nystagmus were evaluated from 2012 to 2016., Main Outcome Measure: All patients underwent ECochG, vestibular evoked myogenic potential (VEMP) testing, bithermal caloric testing, rotary chair testing, audiometric testing, and temporal bone computed tomography (CT). For ECochG, the summating potential (SP) to action potential (AP) ratio was determined., Results: All patients had normal temporal bone CT, reduced caloric responses bilaterally, decreased gain on rotary chair, and abnormal ECochG. For two subjects, the SP/AP was elevated bilaterally. One subject had unilateral SP/AP elevation. Cervical VEMPs were present in all subjects, but at reduced thresholds in two subjects., Conclusion: SP/AP elevation was found in all three patients with the syndrome of bilateral vestibular paresis and/or sound- or pressure-induced horizontal nystagmus. As the etiology of this syndrome remains unclear, understanding the basis for abnormal ECochG may shed insight into the pathophysiology of this condition.
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- 2018
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34. Initial Results of the Early Auditory Referral-Primary Care (EAR-PC) Study.
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Zazove P, Plegue MA, Kileny PR, McKee MM, Schleicher LS, Green LA, Sen A, Rapai ME, Guetterman TC, and Mulhem E
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- Aged, Aged, 80 and over, Feasibility Studies, Female, Humans, Male, Middle Aged, Hearing Loss diagnosis, Mass Screening methods
- Abstract
Introduction: Hearing loss (HL) is the second most common disability in the U.S., yet is clinically underdiagnosed. To manage its common adverse psychosocial and cognitive outcomes, early identification of HL must be improved., Methods: A feasibility study conducted to increase screening for HL and referral of patients aged ≥55 years arriving at two family medicine clinics. Eligible patients were asked to complete a self-administered consent form and the Hearing Handicap Inventory (HHI). Independently, clinicians received a brief educational program after which an electronic clinical prompt (intervention) alerted them (blinded to HHI results) to screen for HL during applicable patient visits. Pre- and post-intervention differences were analyzed to assess the proportion of patients referred to audiology and those diagnosed with HL (primary outcomes) and the audiology referral appropriateness (secondary outcome). Referral rates for those who screened positive for HL on the HHI were compared with those who scored negatively., Results: There were 5,520 eligible patients during the study period, of which 1,236 (22.4%) consented. After the intervention's implementation, audiology referral rates increased from 1.2% to 7.1% (p<0.001). Overall, 293 consented patients (24%) completed the HHI and scored >10, indicating probable HL. Of these 293 patients, 28.0% were referred to audiology versus only 7.4% with scores <10 (p<0.001). Forty-two of the 54 referred patients seen by audiology were diagnosed with HL (78%). Overall, the diagnosis of HL on problem lists increased from 90 of 4,815 patients (1.9%) at baseline to 163 of 5,520 patients (3.0%, p<0.001) over only 8 months., Conclusions: The electronic clinical prompt significantly increased audiology referrals for at-risk patients for HL in two family medicine clinics. Larger-scale studies are needed to address the U.S. Preventive Services Task Force call to assess the long-term impact of HL screening in community populations., (Copyright © 2017. Published by Elsevier Inc.)
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- 2017
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35. Superior Canal Dehiscence Syndrome Affecting 3 Families.
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Heidenreich KD, Kileny PR, Ahmed S, El-Kashlan HK, Melendez TL, Basura GJ, and Lesperance MM
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- Adolescent, Adult, Audiometry, Evoked Response, Body Mass Index, Child, Diagnosis, Differential, Female, Humans, Male, Middle Aged, Retrospective Studies, Syndrome, Tomography, X-Ray Computed, Vestibular Evoked Myogenic Potentials, Labyrinth Diseases diagnosis, Labyrinth Diseases genetics, Semicircular Canals abnormalities, Temporal Bone abnormalities
- Abstract
Importance: Superior canal dehiscence syndrome (SCDS) is an increasingly recognized cause of hearing loss and vestibular symptoms, but the etiology of this condition remains unknown., Objective: To describe 7 cases of SCDS across 3 families., Design, Setting, and Participants: This retrospective case series included 7 patients from 3 different families treated at a neurotology clinic at a tertiary academic medical center from 2010 to 2014. Patients were referred by other otolaryngologists or were self-referred. Each patient demonstrated unilateral or bilateral SCDS or near dehiscence., Interventions: Clinical evaluation involved body mass index calculation, audiometry, cervical vestibular evoked myogenic potential testing, electrocochleography, and multiplanar computed tomographic (CT) scan of the temporal bones. Zygosity testing was performed on twin siblings., Main Outcomes and Measures: The diagnosis of SCDS was made if bone was absent over the superior semicircular canal on 2 consecutive CT images, in addition to 1 physiologic sign consistent with labyrinthine dehiscence. Near dehiscence was defined as absent bone on only 1 CT image but with symptoms and at least 1 physiologic sign of labyrinthine dehiscence., Results: A total of 7 patients (5 female and 2 male; age range, 8-49 years) from 3 families underwent evaluation. Family A consisted of 3 adult first-degree relatives, of whom 2 were diagnosed with SCDS and 1 with near dehiscence. Family B included a mother and her child, both of whom were diagnosed with unilateral SCDS. Family C consisted of adult monozygotic twins, each of whom was diagnosed with unilateral SCDS. For all cases, dehiscence was located at the arcuate eminence. Obesity alone did not explain the occurrence of SCDS because 5 of the 7 cases had a body mass index (calculated as weight in kilograms divided by height in meters squared) less than 30.0., Conclusions and Relevance: Superior canal dehiscence syndrome is a rare, often unrecognized condition. This report of 3 multiplex families with SCDS provides evidence in support of a potential genetic contribution to the etiology. Symptomatic first-degree relatives of patients diagnosed with SCDS should be offered evaluation to improve detection of this disorder.
- Published
- 2017
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36. Functional Near-Infrared Spectroscopy Brain Imaging Investigation of Phonological Awareness and Passage Comprehension Abilities in Adult Recipients of Cochlear Implants.
- Author
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Bisconti S, Shulkin M, Hu X, Basura GJ, Kileny PR, and Kovelman I
- Subjects
- Aged, Comprehension physiology, Female, Hearing Loss surgery, Hemodynamics physiology, Hemoglobins metabolism, Humans, Male, Middle Aged, Neuronal Plasticity, Neuropsychological Tests, Oxygen metabolism, Phonetics, Reaction Time, Spectroscopy, Near-Infrared, Treatment Outcome, Young Adult, Brain physiopathology, Cochlear Implants, Hearing Loss physiopathology, Hearing Loss rehabilitation, Speech Perception physiology
- Abstract
Purpose: The aim of this study was to examine how the brains of individuals with cochlear implants (CIs) respond to spoken language tasks that underlie successful language acquisition and processing., Method: During functional near-infrared spectroscopy imaging, CI recipients with hearing impairment (n = 10, mean age: 52.7 ± 17.3 years) and controls with normal hearing (n = 10, mean age: 50.6 ± 17.2 years) completed auditory tasks-phonological awareness and passage comprehension-commonly used to investigate neurodevelopmental disorders of language and literacy., Results: The 2 groups had similar reaction time and performance on experimental tasks, although participants with CIs had lower accuracy than controls. Overall, both CI recipients and controls exhibited similar patterns of brain activation during the tasks., Conclusions: The results demonstrate that CI recipients show an overall neurotypical pattern of activation during auditory language tasks on which individuals with neurodevelopmental language learning impairments (e.g., dyslexia) tend to show atypical brain activation. These findings suggest that advancements in functional near-infrared spectroscopy neuroimaging with CI recipients may help shed new light on how varying types of difficulties in language processing affect brain organization for language.
- Published
- 2016
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37. Prenatal Iron Deficiency and Auditory Brainstem Responses at 3 and 10 Months: A Pilot Study.
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Lou J, Mai X, Lozoff B, Felt BT, Kileny PR, Zhao Z, and Shao J
- Abstract
Purpose: To examine whether prenatal iron deficiency delays auditory brainstem response (ABR) maturation in infancy., Methods: One hundred and fifteen full-term healthy Chinese infants with maternal and cord blood haemoglobin and serum ferritin determinations were recruited into this study. Forty-eight infants received ABR testing at 3 months, and 45 infants were tested at 10 months. Comparison of the ABR variables were made between infants with and those without evidence of prenatal iron deficiency (maternal 3rd trimester haemoglobin <110 g/L, cord blood ferritin <75 μg/L); or anaemia at 10 months (haemoglobin <110 g/L)., Results: Latencies for wave V and wave III-V and I-V intervals were prolonged at 3 months in infants of anaemic mothers (effect sizes 1.02-1.19 SD). At 10 months, infants with low cord blood serum ferritin (indicating low iron stores at birth) showed longer wave I latency and possibly wave V latency also, besides demonstrating a smaller wave V amplitude (effect sizes 0.58-0.62 SD). Infants with low ferritin at birth and anemia at 10 months had longer wave III-V latency than other groups., Conclusion: In full-term healthy infants, prenatal iron deficiency appears to have adverse effects on the developing central nervous system and auditory system as assessed by ABRs at 3 and/or 10 months.
- Published
- 2016
38. Temporal processing in the auditory brainstem response by full-term 6-week- and 9-month-old infants.
- Author
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Mai X, Tardif T, Xu L, Li M, Kileny PR, Shao J, and Lozoff B
- Subjects
- Female, Humans, Infant, Male, Auditory Perception physiology, Evoked Potentials, Auditory, Brain Stem physiology, Language Development
- Abstract
Early auditory temporal processing abilities are important for language acquisition and for later reading abilities. In the present study, auditory brainstem responses (ABRs) were recorded in a forward-masking paradigm in healthy, full-term infants aged 6 weeks (n = 111) and 9 months (n = 62). Our purpose was to establish normative values of forward-masking ABRs and investigate the development of auditory temporal processing in infants at these ages. Infants were presented with pairs of stimuli (an initial "masker" followed by a "probe") separated by different time intervals (8, 16, and 64 ms). Results showed that as masker-probe intervals became longer and as infants got older, Wave V latency to the probe shortened. The greatest improvements in Wave V latencies from 6 weeks to 9 months of age were observed in the 64-ms masker-probe interval, suggesting that central auditory nervous system related to the temporal processing at this interval might undergo rapid development during the first year of life.
- Published
- 2015
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39. In Support of a Post-Au.D. Fellowship.
- Author
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Jacobson GP and Kileny PR
- Published
- 2015
- Full Text
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40. Multiple electrostimulation treatments to the promontory for tinnitus.
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Perez R, Shaul C, Vardi M, Muhanna N, Kileny PR, and Sichel JY
- Subjects
- Adult, Aged, Audiometry, Female, Humans, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, Treatment Outcome, Visual Analog Scale, Electric Stimulation Therapy methods, Tinnitus diagnosis, Tinnitus therapy
- Abstract
Objectives: To assess the safety and efficacy of multiple sessions of electrostimulation by a transtympanic needle electrode on the promontory for tinnitus relief., Study Design: Prospective open, unblinded, uncontrolled clinical trial., Setting: Tertiary academic referral center., Patients: Ten patients (8 male and 2 female subjects), mean age 50.1 ± 12 years (range, 34-67) with severe unilateral tinnitus completed all stages of the study. Patients with tinnitus duration between 6 months to 3 years were included., Intervention: The patients underwent 3 consecutive 30-minute sessions, every other day, of biphasic, charge balanced electrostimulation pulses to the promontory delivered by a transtympanic needle electrode., Main Outcome Measures: 1) Tinnitus loudness reported by visual analog scale (VAS) between 1 and 10, at baseline, before and after each treatment, and 1, 2, 3, and 4 weeks after the last treatment. 2) Tinnitus Handicap Inventory (THI) questionnaire at baseline and 4 weeks after treatment. 3) Basic audiometry and tinnitus specific tests such as minimum masking level, tinnitus loudness, and pitch., Results: No long-term adverse safety outcomes were noted in physical examination or audiologic evaluation. VAS levels decreased by ≥2 levels in 5 patients (50%) and returned to baseline 4 weeks after treatment. The VAS decrease was found significant (p = 0.048) in those patients. A statistically significant decrease in THI score was noted 4 weeks after treatment. Tinnitus specific tests at that time were unchanged from baseline., Conclusion: Multiple sessions of electrostimulation to the promontory seem to be safe and may be beneficial for some tinnitus patients. Further clinical trials are warranted.
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- 2015
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41. Surgical treatment of hearing loss when otosclerosis coexists with superior semicircular canal dehiscence syndrome.
- Author
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Pritchett CV, Spector ME, Kileny PR, Heidenreich KD, and El-Kashlan HK
- Subjects
- Adult, Deafness surgery, Ear Diseases complications, Female, Hearing Loss, Mixed Conductive-Sensorineural etiology, Humans, Otosclerosis complications, Treatment Outcome, Ear Diseases surgery, Hearing Loss, Mixed Conductive-Sensorineural surgery, Otosclerosis surgery, Semicircular Canals surgery, Stapes Surgery
- Abstract
Objective: Document a case of bilateral otosclerosis with coexisting bilateral superior semicircular canal dehiscence syndrome and the treatment of hearing loss in this setting., Patient: A 33-year-old woman presented with bilateral mixed hearing loss; worse in the left ear. This was gradual in onset, and she denied dizziness. Computerized tomographic scan revealed fenestral otosclerosis and a large dehiscence of the superior semicircular canal bilaterally. She declined amplification., Intervention: Sequential laser-assisted stapedotomy with insertion of a Kurz titanium CliP Piston prosthesis., Main Outcome Measure: Comparison of audiovestibular symptoms, hearing thresholds, and neurodiagnostic testing results preoperatively and postoperatively., Results: Hearing improved bilaterally with closure of the air-bone gaps at most frequencies, and she has not had permanent vestibular symptoms. Postoperative follow-up time is 37 months for the left ear and 13 months for the right ear., Conclusion: When otosclerosis and superior semicircular canal dehiscence syndrome coexist and hearing loss is the dominant symptom, stapes surgery can be effective for improving hearing without permanent vestibular symptoms.
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- 2014
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42. Developmental trends in auditory processing can provide early predictions of language acquisition in young infants.
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Chonchaiya W, Tardif T, Mai X, Xu L, Li M, Kaciroti N, Kileny PR, Shao J, and Lozoff B
- Subjects
- Acoustic Stimulation, Electrophysiology, Evoked Potentials, Auditory, Brain Stem physiology, Female, Hearing, Humans, Infant, Learning, Male, Models, Neurological, Sex Factors, Time Factors, Auditory Threshold physiology, Language, Language Development
- Abstract
Auditory processing capabilities at the subcortical level have been hypothesized to impact an individual's development of both language and reading abilities. The present study examined whether auditory processing capabilities relate to language development in healthy 9-month-old infants. Participants were 71 infants (31 boys and 40 girls) with both Auditory Brainstem Response (ABR) and language assessments. At 6 weeks and/or 9 months of age, the infants underwent ABR testing using both a standard hearing screening protocol with 30 dB clicks and a second protocol using click pairs separated by 8, 16, and 64-ms intervals presented at 80 dB. We evaluated the effects of interval duration on ABR latency and amplitude elicited by the second click. At 9 months, language development was assessed via parent report on the Chinese Communicative Development Inventory - Putonghua version (CCDI-P). Wave V latency z-scores of the 64-ms condition at 6 weeks showed strong direct relationships with Wave V latency in the same condition at 9 months. More importantly, shorter Wave V latencies at 9 months showed strong relationships with the CCDI-P composite consisting of phrases understood, gestures, and words produced. Likewise, infants who had greater decreases in Wave V latencies from 6 weeks to 9 months had higher CCDI-P composite scores. Females had higher language development scores and shorter Wave V latencies at both ages than males. Interestingly, when the ABR Wave V latencies at both ages were taken into account, the direct effects of gender on language disappeared. In conclusion, these results support the importance of low-level auditory processing capabilities for early language acquisition in a population of typically developing young infants. Moreover, the auditory brainstem response in this paradigm shows promise as an electrophysiological marker to predict individual differences in language development in young children., (© 2012 Blackwell Publishing Ltd.)
- Published
- 2013
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43. The right not to hear: the ethics of parental refusal of hearing rehabilitation.
- Author
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Byrd S, Shuman AG, Kileny S, and Kileny PR
- Subjects
- Child, Preschool, Hearing Loss, Sensorineural congenital, Humans, Infant, Male, Parental Consent ethics, Persons with Hearing Disabilities psychology, Cochlear Implantation ethics, Hearing Loss, Sensorineural surgery, Parents psychology, Treatment Refusal ethics
- Abstract
Objective: To explore the ethics of parental refusal of auditory-oral hearing rehabilitation., Study Design: Case study with medical ethical discussion and review., Methods: Two young brothers present with severe-to-profound congenital sensorineural hearing loss. The parents, both of whom have normal hearing and work as sign language interpreters, have decided to raise their children with American Sign Language as their only form of communication. They have chosen not to pursue cochlear implantation nor support the use of hearing aids., Discussion: This case raises significant questions concerning whether hearing rehabilitation should be mandated, and if there are circumstances in which parental preferences should be questioned or overridden with regard to this issue. In addition, legal concerns may be raised regarding the possible need to file a report with Child Protective Services. Although similar cases involving the Deaf community have historically favored parental rights to forego hearing rehabilitation with either cochlear implantation or hearing aids, we explore whether conclusions should be different because the parents in this case are not hearing impaired., Conclusions: The ethics of parental rights to refuse hearing rehabilitation are complex and strikingly context-dependent. A comprehensive appreciation of the medical, practical, and legal issues is crucial prior to intervening in such challenging situations., (Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.)
- Published
- 2011
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44. Audiovestibular testing in patients with Meniere's disease.
- Author
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Adams ME, Heidenreich KD, and Kileny PR
- Subjects
- Audiometry, Audiometry, Evoked Response, Dehydration, Humans, Meniere Disease physiopathology, Nystagmus, Pathologic physiopathology, Practice Guidelines as Topic, Proprioception physiology, Reflex, Vestibulo-Ocular physiology, Vestibular Evoked Myogenic Potentials physiology, Vestibular Function Tests, Meniere Disease diagnosis
- Abstract
In this article, the present state of the art with respect to audiovestibular testing for Meniere's disease (MD) is reviewed. There is no gold standard for MD diagnosis, and the classic dictum is that even the "best" tests yield positive results in only two-thirds of patients with MD. Still, we advocate the use and further investigation of advanced audiovestibular testing in patients with MD in an attempt to answer the questions that confront any clinician who cares for patients with audiovestibular symptoms., (Copyright 2010 Elsevier Inc. All rights reserved.)
- Published
- 2010
- Full Text
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45. Different manifestations of auditory neuropathy.
- Author
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Adams ME, Edwards BM, and Kileny PR
- Subjects
- Age Factors, Audiometry methods, Cohort Studies, Female, Hearing Loss, Central etiology, Hearing Loss, Central physiopathology, Hearing Loss, Central surgery, Humans, Hyperbilirubinemia, Neonatal complications, Hyperbilirubinemia, Neonatal diagnosis, Infant, Infant, Newborn, Male, Prognosis, Respiratory Distress Syndrome, Newborn complications, Respiratory Distress Syndrome, Newborn diagnosis, Retrospective Studies, Risk Assessment, Severity of Illness Index, Term Birth, Treatment Outcome, Cochlear Implantation methods, Hearing Loss, Central diagnosis, Infant, Premature
- Published
- 2010
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46. The predictive value of transtympanic promontory EABR in congenital temporal bone malformations.
- Author
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Kileny PR, Kim AH, Wiet RM, Telian SA, Arts HA, El-Kashlan H, and Zwolan TA
- Subjects
- Audiometry, Evoked Response, Auditory Threshold physiology, Child, Cochlear Implantation adverse effects, Cochlear Implants, Congenital Abnormalities diagnosis, Deafness congenital, Deafness diagnosis, Female, Follow-Up Studies, Humans, Postoperative Complications physiopathology, Predictive Value of Tests, Preoperative Care methods, Temporal Bone diagnostic imaging, Tomography, X-Ray Computed methods, Treatment Outcome, Tympanic Membrane, Cochlear Implantation methods, Deafness surgery, Evoked Potentials, Auditory, Brain Stem physiology, Temporal Bone abnormalities
- Published
- 2010
- Full Text
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47. A psychophysical study of auditory and pressure sensitivity in patients with fibromyalgia and healthy controls.
- Author
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Geisser ME, Glass JM, Rajcevska LD, Clauw DJ, Williams DA, Kileny PR, and Gracely RH
- Subjects
- Acoustic Stimulation adverse effects, Adult, Audiometry, Chronic Disease, Comorbidity, Female, Fibromyalgia physiopathology, Fibromyalgia psychology, Humans, Hyperacusis physiopathology, Hyperacusis psychology, Male, Middle Aged, Physical Stimulation, Pressure adverse effects, Psychometrics methods, Psychophysics methods, Reference Values, Sensation Disorders etiology, Sensation Disorders physiopathology, Sensation Disorders psychology, Fibromyalgia complications, Hyperacusis etiology
- Abstract
Unlabelled: Fibromyalgia (FM) is characterized by widespread tenderness. Studies have also reported that persons with FM are sensitive to other stimuli, such as auditory tones. We hypothesized that subjects with FM would display greater sensitivity to both pressure and auditory tones and report greater sensitivity to sounds encountered in daily activities. FM subjects (n = 30) and healthy control subjects (n = 28) were administered auditory tones and pressure using the same psychophysical methods to deliver the stimuli and a common way of scaling responses. Subjects were also administered a self-report questionnaire regarding sensitivity to everyday sounds. Participants with FM displayed significantly greater sensitivity to all levels of auditory stimulation (Ps < .05). The magnitude of difference between FM patients' lowered auditory sensitivity (relative to control subjects) was similar to that seen with pressure, and pressure and auditory ratings were significantly correlated in both control subjects and subjects with FM. FM patients also were more sensitive to everyday sounds (t = 8.65, P < .001). These findings support that FM is associated with a global central nervous system augmentation in sensory processing. Further research is needed to examine the neural substrates associated with this abnormality and its role in the etiology and maintenance of FM., Perspective: Muscle tenderness is the hallmark of FM, but the findings of this study and others suggest that persons with FM display sensitivity to a number of sensory stimuli. These findings suggest that FM is associated with a global central nervous system augmentation of sensory information. These findings may also help to explain why persons with FM display a number of comorbid physical symptoms other than pain.
- Published
- 2008
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48. Transient evoked otoacoustic emissions pattern as a prognostic indicator for hearing preservation in acoustic neuroma surgery.
- Author
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Kim AH, Edwards BM, Telian SA, Kileny PR, and Arts HA
- Subjects
- Adolescent, Adult, Aged, Facial Nerve Diseases etiology, Female, Hearing Loss etiology, Humans, Logistic Models, Male, Middle Aged, Neuroma, Acoustic complications, Predictive Value of Tests, Preoperative Care, Prognosis, Retrospective Studies, Treatment Outcome, Auditory Threshold, Hearing Loss prevention & control, Neuroma, Acoustic surgery, Otoacoustic Emissions, Spontaneous physiology
- Abstract
Objective: To determine whether pre-operative transient otoacoustic emission (TEOAE) patterns are predictive of successful hearing preservation in acoustic neuroma surgery., Study Design: Retrospective observational study., Setting: Tertiary referral medical center., Patients: A convenience sample was identified in whom pre-operative TEOAE data were available in patients undergoing acoustic neuroma surgery from 1993-2004. Ninety-three patients were identified who met this inclusion criterion., Interventions: Subjects underwent attempted hearing preservation surgery via middle cranial fossa or retrosigmoid approaches. Routine audiometry, ABR, and TEOAE., Main Outcome Measures: Pre- and post-operative pure tone and speech results were categorized into hearing classes A, B, C, and D as described in the American Academy of Otolaryngology guidelines (1995). Hearing preservation was defined by maintenance of the pre-operative hearing class or downgrade to within one hearing class post-op. Pre-operative TEOAE results were divided into five frequency bands and described as positive in each band if there was a response above the noise floor with >50% reproducibility., Results: Hearing was preserved in 51 patients (55%). Of these, 11 (22%) had positive TEOAE response in all five frequency bands measured (1, 1.5, 2, 3, 4 kHz), whereas 40 (78%) had TEOAE responses ranging from 0 to 4 frequency bands. 42 patients failed to preserve their hearing. Of these, only three (7%) had positive TEOAE in all five frequency bands, and 39 (93%) had TEOAE responses ranging from 0 to 4 frequency bands (p<0.05). Other variables of prognostic significance to hearing preservation in our series included smaller tumor size, tumor location within the IAC, better pre-operative hearing, and shorter latencies on ABR. Logistic regression was then used to compare the prognostic value of TEOAE against these variables. In our series, ABR latencies and 5 frequency band response on TEOAE showed the highest significant correlation to hearing preservation (p<0.05)., Conclusion: A robust pre-operative TEOAE frequency band pattern may be used as a favorable prognostic indicator for potential hearing preservation in acoustic neuroma surgery. The prognostic value may be enhanced when combined with other prognostic factors such as tumor size, tumor location, pre-operative ABR and audiometric results.
- Published
- 2006
- Full Text
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49. Intraoperative neurophysiologic monitoring: indications and techniques for common procedures in otolaryngology-head and neck surgery.
- Author
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Edwards BM and Kileny PR
- Subjects
- Cost-Benefit Analysis, Electromyography, Evoked Potentials, Auditory, Evoked Potentials, Auditory, Brain Stem, Humans, Monitoring, Intraoperative, Otorhinolaryngologic Diseases physiopathology, Otorhinolaryngologic Diseases surgery
- Abstract
Intraoperative cranial nerve monitoring can be an effective adjunct in otolaryngology-head and neck surgery. Monitoring is not considered standard of care, despite indications of cost effectiveness and improved functional outcomes. Lessons learned performing facial nerve monitoring are applicable to upper and lower cranial motor nerves. Auditory nerve monitoring can be modified accord-ing to need for selected otologic and neurotologic surgery. Process standardization and effective communication can lead to improved patient outcomes.
- Published
- 2005
- Full Text
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50. Comparison of continuous interleaved sampling and simultaneous analog stimulation speech processing strategies in newly implanted adults with a Clarion 1.2 cochlear implant.
- Author
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Zwolan TA, Kileny PR, Smith S, Waltzman S, Chute P, Domico E, Firszt J, Hodges A, Mills D, Whearty M, Osberger MJ, and Fisher L
- Subjects
- Aged, Aged, 80 and over, Cross-Over Studies, Equipment Design, Female, Humans, Male, Middle Aged, Noise, Patient Satisfaction, Speech Discrimination Tests, Surveys and Questionnaires, Cochlear Implants, Deafness surgery, Signal Processing, Computer-Assisted, Speech Perception
- Abstract
Objective: This study consisted of a within-subjects comparison of speech recognition and patient preference when subjects used two different cochlear implant speech processing strategies with a Clarion 1.2 (enhanced bipolar) device: Simultaneous Analog Stimulation (SAS), and Continuous Interleaved Sampling (CIS). These two strategies used two different electrode configurations: the SAS strategy used bipolar stimulation, whereas the CIS strategy used monopolar stimulation., Study Design: This was a multicenter study that used a within-subjects balanced crossover design. Experience with the two strategies was replicated in each subject using an ABAB design. Order of strategy use was balanced across all subjects., Setting: The study was carried out at several cochlear implant centers affiliated with tertiary medical centers., Patients: Subjects consisted of 25 postlingually deafened adults who received a Clarion cochlear implant., Interventions: Total involvement by each subject was 14 weeks. Speech perception testing and sound quality assessments were performed after use with each strategy., Main Outcome Measures: Primary outcome measures include speech perception data and patient responses to questionnaires regarding speech and sound quality., Results: Analyses revealed that performance did not differ significantly by the strategy encountered first as relative to the strategy encountered second and that the order in which a strategy was used did not appear to affect subjects' eventual preference for a particular strategy. Although speech recognition scores tended to be higher for CIS for most of the test measures at most of the test intervals, the analysis of variance to evaluate differences in strategy did not reveal a significant effect of strategy. Further analysis of scores obtained at the replication interval, however, revealed that scores obtained with CIS were significantly higher than scores obtained with SAS on the Hearing in Noise Test sentences in quiet and noise. In addition, significantly more patients indicated a final preference for the CIS strategy than for the SAS strategy. Importantly, both the analysis evaluating order and the analysis evaluating strategy revealed significant effects of evaluation period, indicating that time/experience with the implant had a significant effect on scores for each strategy, regardless of the order in which it was used (first or second)., Conclusions: This study demonstrates that important learning occurs during the first several weeks of cochlear implant use, making it difficult to adequately compare performance with different speech processing strategies. However, the finding that patients often prefer the strategy they understand speech the best with supports the clinical practice of letting adult patients select their preferred strategy without formally evaluating speech perception with each available strategy.
- Published
- 2005
- Full Text
- View/download PDF
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