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Biomedical subjects

R J Nozza

Publications and source records attributed to R J Nozza.

At least 19 recordsLinked to original sources
PubMed2000

Developmental changes in aural acoustic admittance measurements.

Tympanometry is a clinical measurement routinely included in the assessment of middle ear function. Despite its widespread use, however, fundamental questions remain regarding the need for age-dependent normative data. This study examines normal developmental changes associated with four tympanometric measurements: (1) ear canal volume, (2) peak compensated acoustic admittance, (3) tympanometric width, and (4) tympanometric peak pressure. Of 221 infants and children, aged 6 months to 5 years, enrolled in this study, 99 met the criteria for normal middle ear function as determined via pneumatic tympanoscopy by an experienced pediatric otolaryngologist, and data analysis was confined to those 99 volunteers. Analysis of variance revealed statistically significant main effects showing increases in ear canal volume and peak compensated acoustic admittance and decreases in tympanometric width as age increased. Statistically significant differences were not achieved for tympanometric peak pressure. Although statistically significant differences were found, the differences were small and of questionable clinical significance.

Acoustic Impedance Tests↗
PubMed1999

Age-related hearing loss, vitamin B-12, and folate in elderly women.

BACKGROUND: Hearing impairment is 1 of the 4 most prevalent chronic conditions in the elderly. However, the biological basis of age-related hearing loss is unknown. OBJECTIVE: The objective was to test the hypothesis that age-related hearing loss may be associated with poor vitamin B-12 and folate status. DESIGN: A thorough audiometric assessment was conducted in 55 healthy women aged 60-71 y. Hearing function was determined by the average of pure-tone air conduction thresholds at 0.5, 1, 2, and 4 kHz and was categorized into 2 groups for logistic regression analyses: normal hearing (<20 dB hearing level; n = 44) and impaired hearing (> or = 20 dB hearing level; n = 11). RESULTS: Mean age was the same (65 y) for the normal hearing and impaired hearing groups. Pure-tone averages were inversely correlated with serum vitamin B-12 (r = -0.58, P = 0.0001) and red cell folate (r = -0.37, P = 0.01). Women with impaired hearing had 38% lower serum vitamin B-12 (236 compared with 380 pmol/L, respectively, P = 0.008) and 31% lower red cell folate (425 compared with 619 nmol/L, respectively, P = 0.02) than women with normal hearing. Among participants who did not take supplements containing vitamin B-12 or folate, women with impaired hearing had 48% lower serum vitamin B-12 (156 compared with 302 pmol/L, respectively, P = 0.0007) and 43% lower red cell folate (288 compared with 502 nmol/L, respectively, P = 0.001) than women with normal hearing. CONCLUSION: Poor vitamin B-12 and folate status may be associated with age-related auditory dysfunction.

Aged↗
PubMed1999

Unmasked thresholds and minimum masking in infants and adults: separating sensory from nonsensory contributions to infant-adult differences in behavioral thresholds.

OBJECTIVE: The purposes were to determine the degree to which infant unmasked thresholds differed from those of adults, to determine the effect of signal frequency on those differences, and to determine whether there is a difference in minimum effective masking as a function of age and frequency. The data were applied to a model to address the question of the origin (sensory versus nonsensory) of infant-adult differences in behavioral unmasked thresholds. DESIGN: Infant behavioral thresholds in quiet and in noise for pure tones of 0.5 and 2 kHz were measured using computer-based visual reinforcement audiometry. Adult thresholds were measured using the same apparatus and a modified conventional audiometric procedure. Twenty-three infants and 24 adults were included in the analyses. The masked thresholds versus masker intensity data were used to estimate minimum masking levels (MMLs). RESULTS: Group mean unmasked thresholds of infants were greater than those of adults at both frequencies and the difference was greater at 0.5 kHz (14.2 dB) than at 2 kHz (5.5 dB). Infant MMLs were greater than those of adults by 10.1 dB at 0.5 kHz and by 1.2 dB at 2 kHz. The fact that a masker had to be 10.1 dB greater in intensity for infants than for adults at 0.5 kHz and 1.2 dB greater at 2 kHz suggests that there is a difference in sensitivity between the groups of about 10 and 1 dB for the two frequencies, respectively. According to a proposed model, the difference between infants and adults in MMLs is less than the difference in unmasked thresholds owing to the influence of nonsensory factors that bias infant unmasked thresholds. Such factors, therefore, contribute 4.1 dB (i.e., 14.2 dB-10.1 dB) at 0.5 kHz and 4.3 dB (i.e., 5.5 dB-1.2 dB) at 2 kHz based on the data. CONCLUSIONS: The infant-adult differences in unmasked thresholds, with greater difference at 0.5 kHz than at 2 kHz, are consistent with earlier research on infant hearing. The data reveal that the greater difference between infants and adults at 0.5 kHz relative to 2 kHz is not a result of nonsensory factors alone, but is largely due to a difference in sensory processing. Only about 4 dB of the difference between infants and adults in unmasked thresholds can be attributed to nonsensory factors and the effect is not frequency specific according to the proposed model. Consideration of establishing audiometric reference values for infants that are different than those based on adults, owing to the elevated behavioral unmasked thresholds of normal-hearing infants, is suggested.

Adult↗
PubMed1998

Topical ofloxacin versus systemic amoxicillin/clavulanate in purulent otorrhea in children with tympanostomy tubes.

Acute otitis media (AOM) in children with tympanostomy tubes in place typically presents with otorrhea (draining ear). Because therapy is not standardized, various topical and systemic antibiotics of unproven efficacy and safety have been used in this indication. This study compared the safety and efficacy of ofloxacin otic solution, 0.3% (OFLX) with that of Augmentin oral suspension (AUG) in pediatric subjects 1-12 years of age with tympanostomy tubes and acute purulent otorrhea. Subjects were randomized to receive 10d of OFLX, 0.25 ml topically bid, or of AUG, 40 mg/kg per day. Audiometry was performed in subjects > or =4 years of age. Overall cure rate for clinically evaluable subjects was 76% with OFLX (n = 140) and 69% with AUG (n = 146; P = 0.169). Overall eradication rates for OFLX and AUG were similar for Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis and were superior with OFLX for Staphylococcus aureus and Pseudomonas aeruginosa (P<0.05 for both). OFLX had a greater overall pathogen eradication rate (96% vs. 67%; P<0.001). Treatment-related adverse event rates were 31% for AUG and 6% for OFLX (P<0.001). Neither treatment significantly altered hearing acuity. Topical ofloxacin 0.3% otic solution 0.25 ml bid was as effective and better tolerated than systemic therapy with Augmentin oral suspension 40 mg/kg per day in treating AOM in children with tympanostomy tubes.

Acute Disease↗
PubMed1997

A role for otoacoustic emissions in screening for hearing impairment and middle ear disorders in school-age children.

OBJECTIVE: The primary purpose of this study was to investigate the potential role of transient-evoked otoacoustic emissions (TEOAEs) for screening for hearing impairment and middle ear disorders in school-age children. Because TEOAEs are present in ears with normal cochlear and middle ear function and typically are absent or reduced in ears with cochlear and/or middle ear disorders of even mild degree, TEOAE screening could serve as a first-stage screening to separate from the general population of school-age children those at greater risk for hearing impairment and/or middle ear disorder. There were two secondary objectives. First, the relationship between TEOAE measurement variables and measures of middle ear immittance in ears declared clinically normal was investigated. Second, the performance of TEOAEs in screening was compared with the performance of the pure-tone hearing and tympanometric screening protocol commonly used in the schools. DESIGN: Sixty-six children (ages 5 to 10 yr) participated. TEOAEs, pure-tone hearing screening, acoustic immittance (single-frequency and multi-frequency tympanometry), and an otoscopic exam by a pediatrician, who previously had been "validated" for identification of middle ear effusion, were done on each child under typical school hearing screening conditions. Performance of the TEOAE screening was determined based on the pediatrician's determination of middle ear status and the pure-tone hearing screening as the gold standards. RESULTS: Of the 66 subjects, 61 completed the study. Fifty-six children passed the hearing and otoscopic screenings bilaterally, and five children did not pass either or both the hearing screenings or otoscopic examination in at least one ear. A variety of TEOAE criteria were examined with respect to their ability to identify ears with either hearing impairment and/or middle ear disease. Several different otoacoustic emission criteria performed well according to our diagnostic criteria. Correlations between TEOAE variables and immittance measures of middle ear function were all low. In addition, tympenometric data were used to compare the TEOAE screening with the American Speech-Language-Hearing Association's (ASHA) recommended protocol for the same ears. The ASHA protocol, as recommended, did not do as well as the TEOAE screening. Using slightly modified criteria, the ASHA protocol did as well as TEOAEs. CONCLUSION: There were some screening criteria based on TEOAE measurement that produced good sensitivity and specificity. A TEOAE screening for hearing impairment and middle ear disease performed as well as or better than the ASHA-recommended protocol, which requires a minimum of two different tests, even when the ASHA protocol was modified to optimize performance. The results suggest that the TEOAE test has the potential to be incorporated successfully into hearing screening programs for school-age children and may have advantages over current screening protocols. Finally, no relationship between TEOAEs and middle ear function, as measured using single-frequency and multifrequency tympanometry, could be determined in ears with normal hearing and normal middle ear function.

Acoustic Impedance Tests↗
PubMed1996

Comparison of acoustic immittance measures obtained with different commercial instruments.

Three acoustic admittance measurements (tympanometric peak pressure, peak compensated static acoustic admittance, and tympanometric width) were compared across seven commercially available acoustic immittance systems. Forty-nine adult subjects (45 females and 4 males), 16 to 50 years of age (mean = 27.7 years), with normal middle ear function participated in this investigation. Small but statistically significant differences were observed for each of the tympanometric variables for several of the instruments evaluated. In most instances, the differences were small enough that the same normative data could be applied across the instrumentation employed in this study; however, there were two measurement conditions, peak compensated static acoustic admittance and tympanometric width, where, for selected instruments, the range in values differed by an amount great enough to warrant consideration in clinical decision making.

Acoustic Impedance Tests↗
PubMed1995

Estimating the contribution of non-sensory factors to infant-adult differences in behavioral thresholds.

Estimates of behavioral thresholds of infants are elevated relative to those of adults. Explanations for the differences include auditory sensory factors and non-sensory factors, but no direct estimates of the relative contributions of these two factors have been made. In this investigation, thresholds in quiet and in increasing levels of a masking noise for a 1 kHz tone, in infants 8 to 11 months old and in adults, were determined. The infant-adult differences in unmasked threshold was compared to the infant-adult difference in an estimate of the minimum masking level (MML) that was derived from the masking data. The intensity level of a masking noise at which masking begins is assumed to be independent of the non-sensory factors that impact on the threshold value itself. Therefore, it is reasoned that the infant-adult difference in MML reflects more closely differences in auditory sensory factors than does the infant-adult difference in unmasked threshold. In the region of 1 kHz, the infant-adult difference in behavioral threshold was 12 dB and the infant-adult difference in MML was 8 dB. Therefore, according to our assumptions, 8 dB of the infant-adult difference in unmasked threshold is accounted for by sensory factors and the remaining 4 dB must be attributable to non-sensory factors.

Acoustic Stimulation↗
PubMed1994

Identification of middle ear effusion by aural acoustic admittance and otoscopy.

The ability of aural acoustic immittance measures and validated pneumatic otoscopy to identify middle ear effusion (MEE) was determined for a group of children with chronic or recurrent otitis media. The measures were made immediately prior to surgery for placement of tympanostomy tubes, with the validating diagnosis of MEE made by the surgeons. Aural acoustic admittance measures were made by a certified and licensed clinical audiologist using an instrument that meets current standards and otoscopic examinations were made by a nurse practitioner validated for use of otoscopy in the identification of MEE. Logistic regression analyses were done to determine the ability of admittance variables, otoscopy, and their combination to discriminate between ears with and ears without MEE. Of the individual admittance variables, tympanometric width had the best performance. Otoscopy alone had good sensitivity but only fair specificity. Combining acoustic admittance data with the otoscopist's findings did not improve sensitivity greatly, but improved the specificity relative to that of the otoscopist. The criterion tympanometric width > 150 daPa or Ytm < 0.2, a criterion commonly used based on interim norms published in an appendix of ASHA guidelines for screening, had good sensitivity but very poor specificity in the group of children scheduled for surgery. Also, a comparison was made for tympanometric width measures from the children undergoing surgery with those from a group of children more representative of the general population. Three distributions were found; one for ears with MEE, one for ears with no MEE of children scheduled for otologic surgery and one for ears with no MEE from the group of children from the general population. The data illustrate the importance of the population characteristics on the test measure used and have implications for choosing test criteria. In addition, group estimates of performance of acoustic admittance variables were approximately the same when otoscopy was used as the gold standard for identification of MEE as when findings at surgery were used. However, when comparing the two diagnostic methods on a case-by-case basis, it was determined that the otoscopist's diagnosis disagreed with the diagnosis of the surgeons in over 21% of the ears.

Acoustic Impedance Tests↗
PubMed1992

Towards the validation of aural acoustic immittance measures for diagnosis of middle ear effusion in children.

Acoustic admittance testing was done on the ears of two groups of children. The first group was comprised of children undergoing myringotomy and tube surgery for treatment of chronic or recurrent otitis media, and the second group was comprised of hospital outpatients who were unscreened with respect to a history of middle ear disease and who were more representative of children in the general population. The admittance measures were then analyzed with respect to middle ear status (effusion versus no effusion) as determined by the surgeon (surgery group) and by validated otoscopy (outpatient group). Based on the data from the surgery group, the best admittance criteria for the identification of middle ear effusion were determined and then tested with respect to the data from subjects in the outpatient group. Sensitivity and specificity of several different criteria were similar. The role of prevalence of disease and the value of admittance measures such as gradient and acoustic reflex are discussed in the context of diagnostic testing in clinical or research protocols as well as in the context of immittance screening programs.

Acoustic Impedance Tests↗
PubMed1992

Efficacy of myringotomy with and without tympanostomy tubes for chronic otitis media with effusion.

In a previous trial involving 109 children with chronic otitis media with effusion of at least a 2 months' duration that had been unresponsive to medical treatment, we compared the efficacy of myringotomy with tube insertion, myringotomy alone and no surgical intervention with regard to time with middle ear effusion, hearing status and other indices over a 3-year period. Because interpretation of the results was rendered difficult by certain complexities of study design, the present trial with a revised protocol was carried out in an additional group of 111 children. As in the previous trial, myringotomy with tube insertion resulted in less time with effusion and better hearing than did either myringotomy alone or no surgery. However, acute and chronic otorrhea and tympanic membrane perforation developed not uncommonly after tube insertion. Myringotomy alone offered no advantage over no surgery regarding the percent of time with effusion or the number of episodes of acute otitis media. Currently for children with long-standing middle ear effusion, we recommend either watchful waiting with periodic hearing assessment or myringotomy with tube insertion, individualizing the recommendation for each child.

Child↗
PubMed1992

Efficacy of antimicrobial prophylaxis and of tympanostomy tube insertion for prevention of recurrent acute otitis media: results of a randomized clinical trial.

To determine the efficacy of amoxicillin prophylaxis and of tympanostomy tube insertion in preventing recurrences of acute otitis media, we randomized 264 children 7 to 35 months of age who had a history of recurrent otitis media but were free of middle ear effusion to receive either amoxicillin prophylaxis, bilateral tympanostomy tube insertion or placebo. The average rate of new episodes per child year of either acute otitis media or otorrhea was 0.60 in the amoxicillin group, 1.08 in the placebo group and 1.02 in the tympanostomy tube group (amoxicillin vs. placebo, P less than 0.001; tubes vs. placebo, P = 0.25). The average proportion of time with otitis media of any type was 10.0% in the amoxicillin group, 15.0% in the placebo group and 6.6% in the tympanostomy tube group (amoxicillin vs. placebo, P = 0.03; tubes vs. placebo, P less than 0.001). At the 2-year end point, the rate of attrition was 42.2% in the amoxicillin group, 45.5% in the placebo group and 26.7% in the tympanostomy tube group. Adverse drug reactions occurred in 7.0% of the amoxicillin group and persistent tympanic membrane perforations developed in 3.9% of the tympanostomy tube group. The observed degree of efficacy of amoxicillin prophylaxis and of tympanostomy tube insertion must be viewed in light of the fact that study subjects proved not to have been at as high risk for acute otitis media as had been anticipated and in view of the differential attrition rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1991

Reliability and validity of infant speech-sound discrimination-in-noise thresholds.

Infants were tested on a speech-sound discrimination-in-noise task using the visual reinforcement infant speech discrimination (VRISD) procedure with an adaptive (up-down) threshold protocol. An adult control group was tested using the same stimuli and apparatus. The speech sounds were synthetic magnitude of ba and magnitude of ga. The masker was band-passed presented continuously at 48 dB SPL. Test-retest reliability was good for both groups, although test-retest differences were smaller for adults. For infants the mean of the absolute values of the differences between tests was only 5.2 dB, and there was less than a 10-dB difference between the two tests of 14 (87.5%) of the 16 infants completing the study. The infant-adult difference in discrimination threshold in noise was 6.9 dB, which agrees well with detection-in-noise thresholds from earlier studies and with discrimination-in-noise thresholds obtained on a subset of subjects in our earlier work. Advantages of the adaptive threshold procedure and its possible applications both in research studies and in the clinic are discussed.

Adult↗
PubMed1991

Comparative efficacy of erythromycin-sulfisoxazole, cefaclor, amoxicillin or placebo for otitis media with effusion in children.

We randomly assigned children with otitis media with effusion to receive either erythromycin-sulfisoxazole, cefaclor, amoxicillin or placebo for a 2-week period, primarily to determine whether either erythromycin-sulfisoxazole or cefaclor would have greater short term efficacy than that found previously for amoxicillin, and secondarily to supplement earlier data on outcomes in placebo-treated subjects. Interim analyses showed no statistically significant (P less than 0.05) differences between the three antimicrobial treatment groups in the primary outcome measures, i.e. the prevalence of middle-ear effusion 2 and 4 weeks after entry, and indicated that postulated differences favoring the erythromycin-sulfisoxazole and cefaclor groups over the amoxicillin group were unlikely to be found even if the originally calculated sample size were attained. Subject accrual was therefore terminated. Final analysis showed no significant between-group differences in other outcome measures as well. In antimicrobial vs. placebo comparisons neither erythromycin-sulfisoxazole nor cefaclor gave more favorable outcomes than placebo, whereas more children were effusion-free in the amoxicillin group than in the placebo group at 2 weeks (31.6% vs. 14.1%, P = 0.007), but not at 4 weeks. We conclude that when antimicrobial treatment for otitis media with effusion is deemed advisable, neither erythromycin-sulfisoxazole nor cefaclor should replace amoxicillin as first line treatment.

Amoxicillin↗
PubMed1991

Audiological and medical considerations for children with cochlear implants.

Recent advancements in technology have resulted in the development of implantable devices--cochlear implants--designed to maximize the sensation of hearing in the hearing-impaired population. For children who meet the numerous preselection criteria, the cochlear implant can be effective and beneficial. The implants must be inserted surgically, which involves placing an electrode array in the cochlea and attaching the receiver/stimulator to the skull. The child can usually be discharged from the hospital by the third postoperative day. The external device is fitted and initially stimulated about four to six weeks after surgery. During initial stimulation, all 22 electrodes are individually adjusted, or mapped. The electrodes are readjusted and remapped at frequent intervals during the initial months following stimulation. These follow-up visits also allow the audiologist to evaluate the child's progress in the home and educational environments.

Aftercare↗
PubMed1991

Infant-adult differences in unmasked thresholds for the discrimination of consonant-vowel syllable pairs.

Speech sound discrimination thresholds were obtained for two speech sound contrasts (/ba/ vs. /da/ and /ba/ vs. /ga/) for infant and adult subjects. The stimuli were computer-generated synthetic tokens. An adaptive (one-up, one-down) threshold procedure was used with the visual reinforcement infant speech discrimination procedure for the infant subjects. Adults were tested using the same apparatus and threshold-tracking protocol as the infants. There was a 28-dB difference in threshold for discrimination of /ba/ versus /da/ and a 25-dB difference in threshold for discrimination of /ba/versus/ga/ between the infants and the adults. The differences reveal that to reach a criterion level of performance on a simple speech perception task, infants require much greater stimulus intensity than do adults. This has implications for our understanding of normal auditory development, for our notions of hearing impairment in infants and for the role of intensity in research studies of infant speech perception.

Adolescent↗
PubMed1991

Ten years of extracorporeal membrane oxygenation: neurodevelopmental outcome.

Cf the 87 survivors of extracorporeal membrane oxygenation over a 10-year period, 67 participated in a follow-up study which included neurologic examination (n = 67), cognitive testing (n = 67), and audiologic assessment (n = 33). Matched control subjects for those older than 5 years were also evaluated. Outcome was defined as normal for cognitive scores greater than or equal to 85 and normal neurologic examination results, suspect for cognitive scores 70 through 84 or nonfocal neurologic findings such as hypertonia/hypotonia, and abnormal for cognitive scores less than 70 or abnormal neurologic examination results. Of the 10 school-aged children studied, 9 were normal and there were no differences in mean cognitive scores between subjects and controls (IQ subjects = 109 +/- 12 [SD], IQ controls = 107 +/- 13). For preschoolers aged 2.7 through 4.11 years, the mean cognitive score was 91 +/- 11 and 7 (70%) were normal. For infants 6 through 30 months, the mean cognitive score was 101 +/- 22 and 27 (57%) were normal. A total of 7 children (21% of those studied) had abnormal audiologic assessments. Three children demonstrated mild high-frequency and 4 moderately severe high-frequency sensorineural hearing loss which was bilateral in 3 and of undetermined laterality in 1. Abnormal neurodevelopmental outcome was significantly associated with cerebral infarction and chronic lung disease. Outcome was not related to demographic or perinatal variables, illness severity prior to extracorporeal membrane oxygenation, or underlying diagnosis. Neurodevelopmental outcome among survivors of extracorporeal membrane oxygenation in this series is consistent with previous reports of morbidity among neonates with severe respiratory failure treated conventionally.

Child↗
PubMed1990

Infant speech-sound discrimination in noise.

The effects of noise on 7- to 11-month-old infants' speech-sound discrimination (/ba/vs/ga/) were determined using a conditioned head-turn procedure. Variation in performance as a function of signal-to-noise ratio (S/N) was estimated by testing each infant at four S/N's (-8, 0, 8, and 16 dB). Adults were tested for comparison at four S/N's (-12, -8, -4, and 0 dB). The S/N's were chosen based on pilot data. Performance varied monotonically with S/N for both age groups, but infants required greater S/N than adults to achieve comparable levels of performance. Both groups were also tested using an adaptive (1-up, 1-down) threshold procedure with a 3-dB step size. There was a group mean difference in threshold of 5.8-dB S/N favoring the adults. Weighted group psychometric functions, derived from the responses obtained in the adaptive runs, showed good correspondence with the data points at the four S/N's. The slopes of these functions were the same (7.5%/dB) for infants and adults. The results suggest that infants are at a greater disadvantage than adults when processing speech in noise and that concern over the effects of a noisy environment on the acquisition of language is justified. In addition, the adaptive threshold procedure can be used as an efficient way to estimate the limits of discrimination ability as a function of S/N or intensity, both for individual subjects and for groups of subjects, in developmental research.

Auditory Pathways↗