PubMed HealthSearch

Biomedical subjects

M L Hyde

Publications and source records attributed to M L Hyde.

At least 19 recordsLinked to original sources

Unilateral otosclerosis and noise-induced occupational hearing loss.

The interaction between noise-induced hearing loss and otosclerosis remains unclear and controversial. In the present study, the effect of chronic noise exposure was examined in 31 patients with unilateral otosclerosis. Consideration was given to hearing loss at specific frequencies, the influence of age, and the effect of the size of the air-bone gap. A small, though statistically significant, protective effect of otosclerosis was demonstrated at 4 kHz. This effect was maintained despite advancing age. An apparent inverse relationship was found between the amount of hearing loss and the size of the air-bone gap at 4 kHz, but multiple linear regression analysis suggested that this finding was contaminated by age effects.

Adult

ABR latency in infants: properties and applications of various measures.

ABR latency ratios have been proposed as useful clinical tools in the assessment of infants at risk for auditory or neurologic deficits. These parameters, together with classical absolute and interwave latency measures, were examined in 131 infants with normal ABR thresholds at 48-64 weeks post-conceptional age, and with no conventional risk factor for hearing impairment or neurological abnormality. Latency of wave I is unaffected by age or gender, but that of waves III and V decreases linearly with age and is smaller in females. These effects must be accounted for in clinical evaluation. However, latency ratios V/I, V/III and III/I show no significant age or gender effects. Wave I latency and the V/I latency ratio both permitted very good discrimination between normal infants and those with presumed conductive hearing losses, but the effects of sensorineural impairment have yet to be determined. On a priori grounds it seems improbable that latency ratios will outperform classical ABR parameters, at least for the goals and age range considered in this study.

Acoustic Stimulation

Audiometric estimation error with the ABR in high risk infants.

Click ABR wave V thresholds in the first year were compared with follow-up behavioural pure-tone audiometry under earphones at age 3 to 6 years in 713 infants (yielding 1,367 ears) at risk for hearing loss. The observed accuracy of the ABR depends strongly on the precise definitions of the target disorder and the test abnormality criteria. For sensorineural hearing loss of more than 20 dB averaged at 2 kHz and 4 kHz, the click ABR provides an accurate test, with both false positive and false negative rates of less than 10%, using an ABR threshold criterion of 30 dB nHL. The false positive error rate can be at least halved by using a simple rule for wave V latency that discriminates conductive and sensorineural ABR threshold abnormalities. False negative errors may be explicable in terms of the lack of frequency specificity of the click stimulus.

Audiometry, Evoked Response

Parietal area 5 neuronal activity encodes movement kinematics, not movement dynamics.

A previous study reported that proximal-arm related area 5 neurons showed continuously-graded changes in activity during unloaded arm movements in different directions (Kalaska et al. 1983), which resembled the responses of primary motor cortex cells in several respects (Georgopoulos et al. 1982). We report here that loading the arm reveals an important difference between cell activity in the two areas. Loads were continuously applied to the arm in different directions. The loads produced large continuously-graded changes in muscle activity but did not alter the handpath or joint angle changes of the arm during the movements. The activity of most area 5 cells was only weakly affected by the loads, and the overall pattern of population activity was virtually unaltered under all load conditions. This indicates that area 5 activity encodes the invariant spatial parameters (kinematics) of the movements. In contrast, many motor cortex cells showed large changes in activity during loading, and so signal the changing forces, torques or muscle activity (movement dynamics; Kalaska et al. 1989).

Animals

Audiometric accuracy of the click ABR in infants at risk for hearing loss.

The auditory brainstem response (ABR) to clicks is widely used for early detection of hearing loss in the child at risk for hearing dysfunction, but there is a lack of direct, large-sample estimates of test accuracy. In this report, results and preliminary analyses are presented that relate click ABR thresholds obtained at 3 to 12 months corrected age to detailed follow-up behavioral puretone audiometry at 3 to 8 years of age, for 1,367 ears in 713 children at risk for hearing loss. The data are analyzed in terms of conventional 2 x 2 decision matrices and associated parameters, using dichotomous (binary) measures of hearing loss and ABR test outcome. The accuracy of the ABR appears to depend strongly on the precise criteria that are chosen to define both hearing loss and ABR outcome. ABR accuracy is excellent for detecting average sensorineural hearing loss at 2 and 4 kHz in excess of 30 dB, and the overall results for a wide range of hearing loss and ABR abnormality criteria can be conveniently summarized in terms of relative operating characteristics (ROCs).

Audiometry, Evoked Response

Hearing aid usage in occupational hearing loss claimants.

Between 1980 and 1986, the Department of Otolaryngology at Mount Sinai Hospital, Toronto, evaluated 3,509 occupational hearing loss claimants for the Workers' Compensation Board of Ontario. Detailed information about work, medical and audiologic findings for each claimant was entered into the departmental database system. The goals of this retrospective analysis were to examine some demographic characteristics and to describe the aural rehabilitation status of this population. Most claimants had bilateral mild or moderate hearing loss but all degrees and patterns of loss occurred. Of 2,657 first-time, reliable claimants, 881 (33.2%) arrived with a hearing aid, typically a monaural, behind-the-ear fitting. Twenty percent with bilateral mild loss owned an aid whereas 38% of claimants with bilateral severe loss did not have one. Ninety percent of aid owners reported that their device was of some help. This level of satisfaction was not affected by age, degree of loss, or speech discrimination ability. Substantial usage was reported for non-work situations. Hearing aids were especially helpful for TV and in small group situations. Ultimately, 81% of all claimants were determined to be hearing aid candidates.

Adult

Epidemiologic patterns in childhood hearing loss: a review.

In an attempt to clarify international epidemiologic trends, a review of the published literature pertaining to childhood hearing loss is presented. Inconsistencies of methodology and classification, which complicate the interpretation of data and make difficult the quantification of the influence of genuine population differences, are discussed. Selective review of the literature allows certain crude statements to be made regarding childhood hearing loss. In developed countries, serous otitis media is the most common cause of hearing loss in children, affecting up to two thirds of preschool children. In addition, 1.0-2.0/1000 children have bilateral SNHL of at least 50 dB. In underdeveloped countries, suppurative middle ear disease is common and is still frequently associated with either an intratemporal or intracranial complication. SNHL appears to occur almost twice as often as in developed countries, with a greater proportion being of infectious etiology. In specific populations, the Inuits, Amerindians and Aboriginals, acute and chronic suppurative otitis media are almost endemic, yet both cholesteatoma and serous otitis media are uncommon.

Child

A comparison of movement direction-related versus load direction-related activity in primate motor cortex, using a two-dimensional reaching task.

Shoulder joint-related motor cortex cells show continuously graded changes in activity, centered on a preferred movement direction, during active arm movements in 8 directions away from a central starting position (Georgopoulos et al., 1982). We demonstrate here that many of these cells show similar large continuously graded changes in discharge when the monkey compensates for inertial loads which pull the arm in 8 different directions. These load-dependent discharge variations are typically unimodal, centered on one load direction called the cell's load axis, and are often sufficiently continuous, symmetric, and broad as to show a good fit to a sinusoidal curve. A vectorial representation of cell activity indicates that the pattern of load-dependent activity changes in the population forms a signal whose direction is appropriate to compensate for the loads. The responses of single cells to different combinations of movement and load direction are often complex. Nevertheless, the mean activity of the sample population under any condition of movement direction and load direction can be described reasonably well by a simple linear summation of the movement-related discharge without any loads, and the change in tonic activity of the population caused by the load, measured prior to movement. The strength of the load-dependent discharge variation differs among cells. Cells can be sorted into 2 phasic and 2 tonic groups that show differing degrees of sensitivity to loads. In particular, it was found that the greater the degree of cell discharge variation associated with different actively maintained limb postures, the greater the activity changes caused by loads. No similar correlation was found for the degree of discharge variation during movement. Preliminary evidence suggests that phasic and tonic cell groups may be spatially segregated in the motor cortex. These observations are consistent with the idea that there exists in the motor cortex activity encoding aspects of movement kinematics, as well as movement dynamics. These observations are in agreement with studies of more distal arm joints, showing that the activity of certain motor cortex cells varies with the patterns of muscle activity and output forces required to produce a movement. These experiments extend the description of the control of the direction of movement of a multiple degree-of-freedom joint into the spatial (direction) domain to a greater extent than previously achieved.

Animals

Tinnitus prevalence in industrial hearing loss compensation claimants.

In a study of 3466 claimants for noise-induced occupational hearing loss tinnitus was reported by half of the patients. Its characteristics in this select group were different from tinnitus seen in other groups. Specifically, tinnitus prevalence seemed to be independent of age, state of hearing and duration of noise exposure if greater than 10 years. The reasons for these differences are unclear, though the possibility of financial motivation by some claimants is raised. Further work in this area is urgently required to achieve standardization and objectivity. Being a subjective complaint these aims will be difficult to accomplish. However not until then can a fair handicap scale be developed for workers who develop this disquieting symptom as a result of their occupation.

Adolescent

Epidemiology of hearing impairment in childhood.

Consensus about the etiology and prevalence of childhood hearing loss (HL) is difficult to discern. Genuine effects, such as those attributable to environment, are obscured by inconsistencies in data collection and analysis techniques. Prevalence, for example, depends upon test type, hearing loss criteria and age at evaluation. An etiologic classification which clarifies the interaction between time of insult, causation and time of expression of hearing loss is proposed and used for selective review. Much sensorineural hearing loss (SNHL) is of unknown cause. Where the cause is known, genetic causes are common, and influenced by consanguinity. Infectious causes of HL reflect seasonal and epidemic fluctuation, as well as geographic and temporal variation. Non-infectious causes vary more closely with differences in the environment and level of health care. In the western world, the most common cause of conductive hearing loss (CHL) is serous otitis media. In many developing regions, middle ear disease abounds and often is of the dangerous cholesteatomatous type. Certain populations are intermediate, with acute suppurative and chronic otitis media being almost endemic, yet rarely cholesteatomatous.

Adolescent

Exaggerated hearing loss in compensation claimants.

Overestimation of hearing loss is a significant problem in the assessment of workers exposed to industrial noise. Audiometric and epidemiologic aspects of this problem are examined in 2,528 compensation claimants. Electric Response Audiometry (ERA) using the cortical Slow Vertex Response (SVR) is accurate and very useful for quantification of true hearing levels. Based on this technique, 8% of claimants were shown to have volunteered excessively high behavioral thresholds. Using the term "exaggerated hearing loss" (EHL) as an umbrella for this phenomenon, true thresholds of EHL and non-EHL groups were identical. Several demographic and occupational factors appear to be associated with EHL. The performance of various audiometric rules for EHL prediction was highly dependent on the criteria adopted; all rules were better than chance, though none was impressive. Clinical acumen and ERA both play a vital part in accurate assessment of the compensation claimant.

Audiometry, Evoked Response

Area 4 and area 5: differences between the load direction-dependent discharge variability of cells during active postural fixation.

Previous experiments have shown that the activity of cells in both areas 4 and 5 is strongly modulated in a continuously-graded manner for movements of the arm in 8 different directions away from a central starting position. However, it is reported here that there is a clear difference between these two areas during postural fixation of the arm in one position against loads applied in 8 different directions. Area 4 cell activity shows large variations when the monkey holds its arm at the central position by exerting forces in different directions to counteract the loads. The activity of cells in area 5 is much less strongly modulated under the same isometric conditions. These observations suggest that cell activity in area 5 is less related to the level and pattern of force output than are cells in area 4. Area 5 may produce instead a signal related more to the limb position, per se, during actively maintained posture.

Animals

Hearing loss in early infancy: incidence, detection and assessment.

Auditory evoked potential techniques have revitalized programs for early detection, quantification, and management of hearing loss. Some issues underlying the need for such programs, and their structure, are reviewed with reference to recently-published guidelines. The prevalence of hearing loss in infancy is poorly understood; estimates depend on the type and degree of loss, the tests used, and their timing. Evidence that significant hearing loss can escape early detection continues to accumulate; delays are attributable to many factors, including insufficient awareness and deficiencies in conventional tests. High-risk registers are valuable but imperfect tools, and should not be the sole avenue of early detection. Electrophysiologic tests, especially the auditory brain stem response, have a major role in early assessment. Attention to many technical and patient-related factors is required, and frequency-specific testing is feasible and informative.

Age Factors

Issues in early identification of hearing loss.

In a general hospital, an early detection research program based on a high risk register and brain stem electric response audiometry (BERA) using click and frequency-specific stimuli identified 631 at-risk neonates from the well baby nursery and the neonatal intensive care nursery (ICN). BERA tests were done before discharge and four months later; comparison of outcomes revealed substantial discrepancies. From the follow-up test, 51 cases of mild to severe hearing loss were identified. Experience from the research program has raised some issues relevant for establishment of service programs. Evaluation of all babies (general nursery and ICN) is justified on the basis of yield but is resource consuming; strategies for minimizing work load are discussed. Risk factor criterion levels affect case loading and yield. Frequency-specific BERA identifies cases which would not be detected by click stimuli and which raise management questions. Deferral of testing to four months is feasible and desirable.

Apgar Score

Frequency-specific BERA in infants.

Click BERA has several limitations, both physical and physiological, for early audiological assessment. It cannot quantify the audiometric contour, detect high or low frequency hearing loss, or reveal residual low frequency hearing. Several methods of cochlear place-specific BERA are reviewed briefly. BERA using tonepip stimuli in band-reject masking noise is described in more detail for both nil-risk and at-risk infants. Technical and normative problems are outlined. Most babies give clear ABRs to 40 dBnHL tonepips, but threshold distributions are broader at 500 Hz than for higher frequency tonepips or clicks. Thresholds improve over the first four months, especially at 500 Hz. Cases of click/tonepip threshold differences are presented. Place-specific testing may be a useful component of early assessment. Further research is needed to determine its limitations and relevance to early management.

Acoustic Stimulation

Distancing for intimacy in lesbian relationships.

The authors present a collaborative treatment model designed to help the closely merged, troubled lesbian relationship. Therapeutic techniques focus on change in territorial, temporal, monetary, cognitive, emotional, and environmental space. A case example illustrates the interventions, which include individual and conjoint work, collaboration between therapists, education, bibliotherapy, referral to gay community resources, and specific suggestions for behavior change. The therapeutic goal is to restore intimacy to the relationship by offering each partner increased distance, personal space, and individual autonomy.

Adaptation, Psychological