Dissertations / Theses: 'Otorhinolaryngology'

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Jerhammar, Fredrik. "On Predictive Factors of Treatment Response in Head and Neck Squamous Cell Carcinoma." Licentiate thesis, Oto-Rhiono-Laryngology and Head & Neck Surgery, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-17781.

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Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer and yearly include 500 000 new cases worldwide. The outcomes for these patients have not been significantly improved over the last decades and the five year survival is still around 50 %. Establishing predictive markers of treatment response will have great impact on the clinical management of this disease.

The aim of this thesis was to elucidate markers of intrinsic response to radiotherapy and cisplatin. Combining expression patterns of 14 proteins and identifying mutations in the p53 gene, we were able to incorporate both protein and genetic changes to create a predictive model termed Number of Negative Points (NNP). We used the NNP model to statistically calculate the combination of factors that had the best correlation to intrinsic radiosensitivity (IR). We established that a panel of three markers, epidermal growth factor receptor (EGFR), survivin and splice site/missence mutations of p53, had the best correlation to IR (R=0.990, p<0.0001).

We also conducted gene expression analysis to investigate what genes and gene ontologies that are different between cell lines with varying IR. Furthermore, we wanted to identify key regulator genes with central positions of molecular networks, which were generated from the transcripts included in the deregulated gene ontologies. A transcriptional profile of 28 key regulator genes was generated. Immunoblot analysis supported deregulation at the protein level of three markers implicated from the transcriptional profile. We propose that these proteins, notch1, thrombospondin 1, and pai‐1 are predictive markers of IR.

Finally, on a subset of cell lines with sensitivity or resistance to cisplatin, we performed gene expression analysis. Markers of intrinsic cisplatin sensitivity (ICS) such as gene ontologies and key regulators of molecular networks were proposed and five genes, APOE, CTNNB1, MMP7, MMP13, and THBS1 were selected for further analysis. Quantitative polymerase chain reaction (qPCR) analysis of these genes in 25 cell lines established that MMP7 (p=0.0013) and MMP13 (p=0.058) are possible predictive markers of ICS.

The markers of IR and ICS presented here could, if confirmed in a clinical setting, guide clinicians in the choice of treatment and thus give a more individualized and effective therapy for patients with HNSCC.

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Nosrati-Zarenoe, Ramesh. "Idiopathic Sudden Sensorineural Hearing Loss in Sweden : Diagnostic Protocol and Treatment in Relation to Outcome." Licentiate thesis, Linköping University, Linköping University, Oto-Rhiono-Laryngology and Head & Neck Surgery, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-19023.

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Idiopathic Sudden Sensorineural Hearing Loss (ISSNHL) is a rapid loss of hearing caused by damage to the cochlea (inner ear) or auditory nerve. Spontaneous recovery has been seen in 32% - 81%. The incidence of the ISSNHL has been estimated to be between 5 and 20 per 100,000 per year. Different theories (infections, vascular catastrophes, immunologic damage or intracochlear membrane break) about the etiology have resulted in different treatment policies. The effect of therapy is difficult to evaluate for a single physician who sees just a few patients annually.

The aim of the present thesis was to analyze the management and treatment of ISSNHL patients in Sweden with regard to outcome.

A national database was developed for Sweden with half of all ENT clinics in Sweden participating by submitting a questionnaire for each patient with SSNHL. The questionnaire covered the patient’s background, current disorder, past and family history of different diseases, examinations and treatment. Audiograms at the onset of SSNHL and after three months were requested.

All results were analyzed using ordinal logistic regression looking for interactions with hearing recovery and remaining hearing loss as dependent variables. Independent of treatment or no therapy heredity for hearing loss (I, II), older age (I, II) and presence of vertigo (II) was significantly associated with negative outcome. 40% of all patients had an MRI or CT, where 3 – 4% had acoustic neuroma. 24% of patients with ISSNHL who had hematological tests taken had one or more pathological findings. Blood screening varied from simple routine tests to a complete analysis with such tests as HSP70, Anti-Neutrophilic Cytoplasmic Antibodies (ANCA) and Borrelia tests. There was no association between any of these laboratory tests and either hearing improvement or remaining hearing loss evaluating the tests separately (I, II) or after categorization in comparison with those who had normal laboratory findings (II). Patients with hearing loss in the mid-frequency region had significantly better odds for hearing improvement compared to the other three frequency regions (low, high and “flat loss”). Almost 60% of patients with ISSNHL were medically treated, of which nearly 90% got corticosteroids. The medication had no association with either hearing improvement or remaining hearing loss. However, patients who were prescribed rest or sick leave had higher odds for hearing improvement regardless of other treatment. Those patients who did not receive any treatment at all also came significantly later to the ENT clinics than those treated medically and consequently had worse prognosis.

Conclusion: There is no standard program for management or treatment of ISSNHL in Sweden. The diagnostic protocol varies. MRI is an underused resource to get specific diagnoses for the condition especially acoustic neuromas. Regardless of pathological findings, treatment is mainly limited to corticosteroids or no medication with no difference in outcome. A randomized placebo controlled study is necessary to evaluate whether there is an effect of corticosteroids on ISSNHL.

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Lundeborg, Hammarström Inger. "Oral Motor Function, Voice, Speech and Language in Children with Tonsillar Hypertrophy in Relation to Surgical Outcome." Doctoral thesis, Linköpings universitet, Logopedi, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-61246.

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The aim of this thesis was two-fold: first, to evaluate four different functional aspects of the speech and language spectrum; oral-motor function, voice, /s/-articulation and phonology in preschool children with tonsillar hypertrophy before and after surgical treatment. The second aim was to investigate weather the outcome of surgery was equal for two surgical techniques; tonsillectomy or tonsillotomy combined with adenoidectomy when necessary. In all included publications (I-IV), 67 children on waiting list for tonsil surgery and randomized to either tonsillectomy (33) or tonsillotomy (34) participated. The children were assessed and audio-recorded within a month before surgery and six months postoperatively. Results were compared to age-matched control groups. In the first study, oral motor function was assessed using the Nordic Orofacial Test-Screening, NOT-S, consisting of a structured interview and a clinical examination. Before surgery, the children in the study group differed in all domains of the structured interview in comparison to age-matched controls and in the clinical examination regarding the parameters deviant lip position and trouble nose-breathing. Postoperatively oral motor functions were normalized in both surgical groups and no differences to age matched controls were observed. In study two, recordings of three sustained vowels (/α , u, i/) and 14 words elicited by picture naming were analysed both perceptually and acoustically. Compared to the controls, significant differences were found in the study group preoperatively with higher ratings on Visual Analogue Scales (VAS) for the voice quality parameters “hyponasality” and “compressed/throaty” and also lower for pitch. Significantly higher values on all studied perturbation measures (jitter, shimmer and Noise to Harmonics Ratio) were found. Regarding center frequencies of formants, the study groups had lower F3 values for /u / and also lower F2 and F3 for / i / compared to age-matched controls. After surgery there were no significant differences between the perceptual ratings of voice quality of the two surgical groups and there were no significant differences between the children in the surgical groups and the corresponding controls. The acoustic analyses showed a decrease in all the measures of perturbation for the study group after surgery with a slight difference between the two surgical groups. The children in the tonsillotomy group had higher shimmer value for /u/ and higher NHR for /α/. In comparison to the older controls significantly higher values were found an all perturbation measures and the difference seen regarding formant frequencies for the /i/-sound in comparison to controls still remained. The significantly lower third formant (F3) of the /u/-sound also remained. When comparing pre- versus postoperative results for the surgical group as a whole, a decrease was found on all perturbation measures postoperatively, however the differences were not statistically significant. A significant increase was found in formant 3 for /α/ and /u/ was found. The material used in the third study were speech samples containing the /s/-sound and elicited by picture naming and sentence repetition. Before surgery the study group was rated to have more indistinct /s/-sounds than agematched controls. The acoustic analyses showed that the study group had lower spectral peak values for the /s/-sound than controls. After surgery the operated children’s /s/-production did not differ perceptually from the older controls, neither as a whole group nor when divided according to surgical methods. Regarding the acoustic analyses however, the study groups differed from the age-matched control group showing that noise duration was longer and the peak location higher in the study groups. In study four, a Swedish phonology test was performed and transcribed phonetically. The transcription of each child was analyzed in terms of phonological processes and categorized into one of six developmental stages according to the model developed by Nettelbladt (1983) and adapted by Sahlén, Reuterskiold-Wagner, Nettelbladt & Radeborg (1999). A majority of the children in the study group (62.7 %) showed a slowed phonological development preoperatively (developmental stages 0-4), compared to the age-matched control group. Postoperatively the children in both surgical groups had improved their phonological skills. However, they were still behind in comparison to age-matched controls and the difference was even larger than before surgery. The results of this thesis project have clinical relevance for both speech and language pathologists (SLP’s) and ear-nose and throat-surgeons (ENT-surgeons). SLP’s must be aware of the potential impact of tonsillar hypertrophy on oral-motor function and the speech and language spectrum to be able to help affected children adequately and ENT- surgeons should include oral motor and speech and language problems as additional indications for tonsillar surgery.

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Cheng, Junping. "Radioimmunotherapy in Experimental Head and Neck Squamous Cell Carcinoma : Tumour-targeting in vitro and in vivo." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-5834.

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Tylstedt, Sven. "The Human Spiral Ganglion." Doctoral thesis, Umeå University, Clinical Sciences, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-77.

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Our knowledge of the fine structure of the Human Spiral Ganglion (HSG) is still inadequate and new treatment techniques for deafness using electric stimulation, call for further information and studies on the neuronal elements of the human cochlea. This thesis presents results of analyses of human cochlear tissue and specimens obtained during neurosurgical transpetrosal removal of life-threatening meningeomas. The use of surgical biopsies produced a well-preserved material suitable for ultrastructural and immunohistochemical studies on the human inner ear. The SG was studied with respect to fine structure, using TEM technique and the immunostaining pattern of synaptophysin, which is an integral membrane protein of neuronal synaptic vesicles. The immunostaining patterns of the tight junctional protein ZO-1 and the gap junctional proteins Cx26 and Cx43 in the human cochlea were also studied. The ultrastructural morphology revealed an absence of myelination pattern in the HSG, thus differing from that in other species. Furthermore, formation of structural units as well as signs of neural interaction between the type 1 neurons could be observed. Type 1 cells were tightly packed in clusters, sharing the ensheathment of Schwann cells. The cells frequently made direct physical contact in Schwann cell gaps in which membrane specializations appeared. These specializations consisted of symmetrically or asymmetrically distributed filamentous densities along the apposed cell membranes. The same structures were also present between individual unmyelinated nerve fibres and the type 1 cells. Synapses were observed on the type 2 neurons, with nerve fibres originating from the intraganglionic spiral bundle. Such synapses, though rare, were also observed on the type 1 cells. The ultrastructural findings were confirmed by the synaptophysin study. A 3-D model of a Schwann cell gap between two type 1 cells was constructed, describing the distribution pattern of membrane specializations. In the immunohistochemical studies on the human cochlea, ZO-1 was expressed in tissues lining scala media, thus contributing to the formation of a closed compartment system, important for the maintenance of the specific ionic composition of the endolymph. Protein Cx26 could be identified in non-sensory epithelial cells of the organ of Corti, in connective tissue cells of the spiral ligament and spiral limbus, as well as in the basal and intermediate cell layers of stria vascularis. Cx26 in this region may be involved in the recycling of potassium. Protein Cx43 stained weakly in the spiral ligament, but intense staining in the SG may indicate that gap junctions exist between these neurons. A different functional role for the HSG can be assumed from the morphological characteristics and the signs of a neural interaction between the SG cells. This might be relevant for neural processing mechanisms in speech coding and could have implications for cochlear implant techniques.

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Tideström, Löfstrand Britta. "Sleep Disordered Breathing and Orofacial Morphology in Relation to Adenotonsillar Surgery : Development from 4-12 Years in a Community Based Cohort." Doctoral thesis, Uppsala universitet, Institutionen för kirurgiska vetenskaper, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-108031.

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Objective: To follow a cohort of children from age 4-6-12 with respect to sleep disordered breathing (SDB) and orofacial development. Questionnaires were completed about sleep, snoring, apneas, enuresis, sucking habits, and adenotonsillar surgery and, from age 12, about allergies, asthma, and general health. Children snoring regularly had an ENT- examinations including sleep studies (at ages 4 and 12) and an orthodontic evaluation. Development of biometric data in snoring children and not snoring controls was studied in relation to adenotonsillar surgery. Result: Of the original group of 615 children, 509 (83%) participated at age 6 and 393 (64%) at age 12. 27 snored regularly and 231 did not snore at age 12. Differences between groups were seen on all answers. From age 4–12 the prevalence of OSA decreased from 3.1% to 0.8%, and the minimum prevalence of snoring regularly from 5.3% to 4.2%. The odds for a child who snored regularly at four or six to be snoring regularly at age 12 was 3.7 times greater than for a not snoring child in spite of surgery (OR 3.7, 95% CI 2.4-5.7). 63 children were operated for snoring by age 12, of them 14 never snored and 17 snored regularly at age 12. Cross-bite was more common among snoring children at ages 4, 6 and 12 as was a narrower maxilla. In most cases, surgery cured the snoring temporarily, but the maxillar width was still smaller by age 12—even when nasal breathing was attained. Children snoring regularly at age 12, operated or not operated, showed long face anatomy and were oral breathers; the seven cases who were not operated and the five who were still snoring in spite of surgery, did not have reduced maxillary arch width. Conclusion: The prevalence of children snoring regularly is about the same from age four to twelve in a cohort where adenotonsillar surgery has been performed on obstructed cases, but the prevalence of OSA decreases considerably. The children snoring regularly have a more narrow maxilla compared to children not snoring—a condition that is not changed by adenotonsillar surgery regardless of symptom relief.

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Vats, Archana. "Tissue engineering of cartilage and its applications to otorhinolaryngology." Thesis, Imperial College London, 2005. http://hdl.handle.net/10044/1/11452.

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Monteiro, Pedro Vilas Boas. "Comparing the efficiency of beclomethasone, fluticasone and mometasone nasal sprays in a Samter's population." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/15753.

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Statement of problem: Topical corticosteroids nasal sprays remain first line of treatment for patients with chronic rhinosinusitis (with or without nasal polyps). The main aim of treatment is to improve nasal symptoms by reducing or eliminating the nasal polyps and preventing polyp recurrence post-operatively. Our aims were to determine if the type of corticosteroid nasal spray used post operatively influences polyp recurrence rate and if there were any subsequent economic implications as we only have beclomethasone available for prescription in our state hospital. Methods: Retrospective case note review of all Samter's patients who underwent fronto-spheno-ethmoidectomy by a single surgeon (2000 – 2014). Results: 58 patients were included in our study, divided into 3 study groups. When compared to patients using beclomethasone; patients using fluticasone had an 80% reduced risk of polyp recurrence and patients using mometasone a 90% reduced risk. This rose to 88% and 96% respectively when adjusted for age. Conclusion: Fluticasone and mometasone are both statistically significantly more effective at reducing polyp recurrence than beclomethasone in our population group. Mometasone appeared more effective than fluticasone, but this difference was not statistically significant.

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Alhadad, Abdulrauf I. "Endoscopic Resection and Post-Operative Brachytherapy in the Treatment of Sinonasal Melanoma." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31478.

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Background: Sino-Nasal Melanomas (SNM) are rare, aggressive tumours often associated with a poor prognosis due to advanced stage disease at presentation. Mean 5-year survival is 0-46%. Various treatment modalities are used in the management of SNM. Surgery is regarded as the primary treatment modality, but therapy remains controversial. Complete resection is a surgical challenge and it is often impossible to achieve adequate margins due to the fact that tumour often abuts vital anatomical structures. Incomplete resection has been shown to be a predictor of poor survival. Harris et al. (2014) were the first to report on the use of post-operative brachytherapy in an attempt to prevent local recurrence after endoscopic resection of SNM. Methods: A retrospective analysis of all patients undergoing endoscopic resection of SNMs and receiving adjuvant brachytherapy in a single surgeon’s practice between August 2004 and May 2014 was carried out. Outcome measures included local control rate and 5-year overall survival estimated by Kaplan-Meier analysis. The incidence of regional and distal recurrence (metastases) was calculated Results: Five cases of sinonasal melanoma (3 males 2, females) were managed with endoscopic resection and adjuvant brachytherapy. Patients were followed up for a median duration of 61 months (32-154 months) following adjuvant Brachytherapy. Local control was achieved in four out of five patients (80%). Three out of five patients developed distant metastasis. Median time to metastasis was 54 months. One patient received immunotherapy after diagnosis of distant metastasis (BRAF positive). Three out of five patients (60%) died from the complications of distant metastases of sinonasal melanoma. Median survival time following adjuvant Brachytherapy was 61 months (32-154 months). Five-year survival rate was 40% (95% CI 5.2% - 75.3%). Conclusion: This is the only case series describing the use of brachytherapy following endoscopic resection of sinonasal melanoma. Our case series, albeit small, describes a local control rate and 5-year survival comparable with the best reported in the literature. Adjuvant brachytherapy represents a novel approach and potentially a useful addition to the adjuvant therapy armamentarium. The advantages of brachytherapy include a favourable side-effect profile and a shorter duration of treatment, while delivering a dose of radiation similar to that of Conventional Radiotherapy. Further studies are necessary to define the role of brachytherapy in sinonasal melanoma.

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Edkins, Oskar. "Sentinel node biopsy for the clinically N₊ & N₀ neck in squamous carcinoma of the head and neck." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/13821.

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Includes bibliographical references (leaves 33-34).
The objectives of the study were to determine the accuracy of Sentinel Lymph Node Biopsy (SLNB) in head and neck squamous cell carcinoma (SCC); to determine its role in the approach to the clinically N+ neck in a Developing World setting; and its accuracy as an indicator of regional lymph node status in the clinically N neck.

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Harris, Tashneem. "Incidence of aminoglycoside-induced hearing loss in HIV positive and HIV negative multidrug-resistant tuberculosis patients." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10587.

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Aims of the study: To document the incidence and severity of aminoglycoside-induced ototoxicity at Brooklyn Chest Hospital; To determine the prevalence of the 6 known aminoglycoside-induced deafness mutations in the MT-RNR1 gene (A1555G, C1494T, T1095C, T1291C, A827G and 961 indel C) in a cohort of MDR-TB patients; To determine whether HIV positive MDR-TB patients are more likely to develop aminoglycoside-induced hearing loss than HIV negative MDR-TB patients; To provide clinical guidelines to the medical fraternity on the use of aminoglycoside antibiotics with regard to the side-effect of ototoxicity.

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Quail, Gavin Sean. "The effect of Cloth Stoma Covers on the tracheal climate of laryngectomised patients." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/13386.

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Patients that have undergone a laryngectomy lose the normal heat-moisture-exchange functions of the nose and upper airways. Breathing unconditioned air can cause irritation of the tracheal and bronchial mucosa and lead to chest complaints such as irritating coughing and excessive mucus production and mucus plugs. Disposable HME's that cover the tracheostoma and are stuck to the skin with adhesives are believed to improve the condition of inspired air for laryngectomy patients. HME's work by accumulating heat and moisture during exhalation and reciprocally warming and humidifying in spired air. Due to the cost of HMEs they are not affordable to the general population in South Africa and many other countries. Stoma Covers are simple devices made of a single fabric or combinations of fabrics that are fastened around the neck with the cloth covering the tracheostoma. They are relatively inexpensive to manufacture and can be washed and re-used. No research has been conducted to date regarding the effect of using simple Stoma Covers to improve the tracheal climate in laryngectomy patients.

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Peer, Shazia. "Hearing loss in the developing world : evaluating the i-Phone mobile device as a screening tool." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/13922.

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Background: Hearing loss is a global health burden affecting 360 million people. The highest prevalence is in the Developing World where hearing screening programmes are scarce, and failure to address growing high-risk populations will result in new deaf communities. In resource stretched communities such as these, new strategies to alleviate this burden are necessary. Advances in technology have led to innovative mobile digital devices like smartphones and tablets with the potential to test hearing through audiometric applications. Given the recent upsurge of mobile technology in Africa, it is befitting to determine whether the implementation of science can translate to health service delivery. Objectives: To validate the Apple iPhone mobile device using the uHearâ„¢ application "app" as a possible hearing screening tool in the Developing World.

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Jonas, N. E. "The adenoid in children : a comparison of two methods of performing adenoidectomy and two methods of preparing the nose prior to endoscopy to assess adenoidal size." Master's thesis, University of Cape Town, 2007. http://hdl.handle.net/11427/2903.

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Stephenson, Katherine Anna. "Do proton pump inhibitors reduce the incidence of pharyngocutaneous fistulae following total laryngectomy?" Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/2904.

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Pharyngocutaneous fistula is a common complication of total laryngectomy. We hypothesised that perioperative proton pump inhibitor (PPI) treatment could reduce the incidence of pharyngocutaneous fistulae. This prospective placebo-controlled double-blind randomised controlled trial compared PPI treatment (14 days enteral omeprazole) with a placebo in patients undergoing primary total laryngectomy. The incidence of pharyngocutaneous fistula was recorded.

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Quail, Gavin. "The effect of cloth stoma covers on the tracheal climate of laryngectomised patients." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/5937.

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Kamedien, Mogammad Sauliegh. "Incidence of atrophic rhinitis after endoscopic sinonasal surgery : a retrospective review." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/13206.

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Includes bibliographical references.
Sinonasal tumours have been resected endoscopically at Groote Schuur Hospital Cape Town South Africa since 2003. Surgery, although seen as minimally invasive because no external incisions are visible, is often very aggressive and destructive to the nasal structures. The removal of the nasal turbinates has always been seen as sacrilege due to the risk of developing atrophic rhinitis. If the theory regarding developing atrophic rhinitis after a simple turbinectomy stands true, one would expect a high incidence of atrophic rhinitis after radical resection of the sinonasal structures. This has not been our experience. METHODS: The study population includes a retrospective case review of all patients that had endoscopic sinonasal tumour resection by the same surgeon between 2006 and 2010. All patients were assessed for symptoms and signs suggestive of atrophic rhinitis up to two years post resection. RESULTS: 51 patients (34M: 17F) were included in the study. Patients with residual or recurrent tumour (n=19) and patients who had received adjuvant radiotherapy (n=17) had a statistically significant chance of developing symptoms and signs suggestive of atrophic rhinitis over time. Variables such as age, gender, extent of surgery, bilateral disease, benign or malignant tumour, were not statistically significant in the development of symptoms and signs suggestive of atrophic rhinitis over time. CONCLUSIONS: Atrophic rhinitis is not more common in patients who undergo endoscopic sinonasal surgery without adjuvant therapy. However, patients with residual tumour (after debulking surgery) or recurrent tumour and those who had received adjuvant radiotherapy had a statistically significant chance of developing symptoms and signs suggestive of atrophic rhinitis over time. Keywords: atrophic rhinitis, endoscopic resection, turbinectomy, medial maxillectomy, sinonasal tumours.

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Douglas-Jones, Paul. "Tonsillectomy rates in the South African private healthcare sector." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/27824.

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Background. Adeno-/tonsillectomy is a commonly performed procedure with internationally standardised and recognised indications. Despite this, there exists considerable international (190 - 850/100 000 people ≤19 years of age) and regional variation in adeno-/tonsillectomy rates. This variation has been ascribed to differences in clinical practice and referral patterns, as well as social and family factors, rather than differences in clinical need or regional morbidity. Objectives. To describe the adeno-/tonsillectomy rate in the South African private healthcare sector, and regional variations thereof. To compare local rates with international rates and to assess current trends in adeno-/tonsillectomy clinical practice. Methods. Analysis of adeno-/tonsillectomy data from January 2012 to December 2013, provided by the largest South African private healthcare funder, accounting for 31% of the medical scheme market. Rates are expressed per 100 000 people ≤19 years of age. Results. The tonsillectomy rate in the South African private healthcare sector was 1888/100 000 people ≤19 years of age in 2012. In 2013, the rate dropped significantly (p-value <0.001) to 1755/100 000. Both are more than double the highest national tonsillectomy rate reported in the literature. There was also considerable regional variation in the adeno-/tonsillectomy rate within South Africa. Otorhinolaryngologists are responsible for approximately 80% of adeno- /tonsillectomies performed in the South African private healthcare sector. Discussion. The South African tonsillectomy rate is very high when compared to international trends and varies regionally within the country. The literature does not support an increased burden of disease as the reason behind this. Rather, it is differences in training and clinical practice of clinicians, as well as social and family factors that have been implicated. Conclusion. The adeno-/tonsillectomy rate in the South African private healthcare sector is substantially higher than international norms. The reasons for this discrepancy require further consideration and investigation.

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Mc, Guire Jessica Kate. "Radiological differences between HIV-positive and HIV-negative children with cholesteatoma." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27435.

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Introduction: HIV-positive children are possibly more prone to developing cholesteatoma. Chronic inflammation of the middle ear cleft may be more common in patients with HIV and this may predispose HIV-positive children to developing cholesteatoma. There are no studies that describe the radiological morphology of the middle ear cleft in HIV-positive compared to HIV-negative children with cholesteatoma. Aim: Compare the radiological differences of the middle ear cleft in HIV-positive and HIV-negative children with cholesteatoma. Method A retrospective, cross-sectional, observational analytical review of patients with cholesteatoma at Red Cross War Memorial Children's Hospital over a 6 year period. Results: Forty patients were included in the study, 11 of whom had bilateral cholesteatoma and therefore 51 ears were eligible for our evaluation. HIV-positive patients had smaller (p=0.02) mastoid air cell systems (MACS). Forty percent of HIV-positive patients had sclerotic mastoids, whereas the rate was 3% in HIV-negative ears (p<0.02). Eighty-two percent of the HIV-positive patients had bilateral cholesteatoma compared to 7% of the control group (p<0.02). There was no difference between the 2 groups with regards to aeration of the middle ear cleft, bony erosion of middle ear structures, Eustachian tube obstruction or soft tissue occlusion of the post-nasal space. Conclusion: HIV-positive paediatric patients with cholesteatoma are more likely to have smaller, sclerotic mastoids compared to HIV-negative patients. They are significantly more likely to have bilateral cholesteatoma. This may have implications in terms of surveillance of HIV-positive children, as well as, an approach to management, recurrence and follow-up. HIV infection should be flagged as a risk factor for developing cholesteatoma.

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Wasl, Hisham. "Perioperative cell salvage blood transfusions in endonasal angiofibroma surgery at Groote Schuur Hospital." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/15752.

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Surgical approaches for many tumours are often limited by blood loss, exposure and risk to vital anatomical structures; therefore, the standard of care for certain skull base tumours has become endoscopic transnasal resection. Other surgical disciplines often use cell salvage techniques, but review of the otolaryngology literature reveals very few case reports. General surgery procedures are often carried out in a contaminated field and concerns have been raised about its safety. This study investigates the value and safety of salvage-type autologous blood transfusion during the endoscopic resection of juvenile nasopharyngeal angiofibromas (JNA). Methods: Because JNA is a rare vascular nasal tumour, the study extended over a 3-year period to obtain adequate patient numbers. All patients undergoing endoscopic resection during this period were included in the population sample. Ten patients with JNA were identified and underwent embolization prior to endoscopic resection. In all cases the intraoperative blood salvage apparatus was used. Close post-operative monitoring was performed.

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Westman, Eva. "Experimental acute otitis media : aspects on treatment, protection and structural changes." Doctoral thesis, Umeå : Univ, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-162.

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Omoding, Sammy S. "Development and evaluation of a free-field voice test for potential use as a community screening tool for hearing impairment in children." Master's thesis, University of Cape Town, 1999. http://hdl.handle.net/11427/26923.

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Early identification of hearing impairment in children is essential to avoid potentially disabling effects of hearing loss or deafness. This necessitates effective screening measures appropriate to the community in question. Current methods used in South Africa, especially for pre-school and school going children have resulted in poor coverage as they are designed for the more developed countries. There is thus a need to devise a screening method that is appropriate to our local conditions. In this study, a free-field live voice test was developed based on three levels: whisper, conversational and loud. This was evaluated against pure tone audiometry for sensitivity, specificity, cost and ease of application in two studies: hospital and school- based. A total of 394 children were tested; 189 in hospital-based study and 205 in school based study. 378 of the total were eligible for analysis. In the hospital-based study, the results of 177 children were analysed. The age range was 3 - 12 years with a mean of 5.8 years. The sensitivity (ability of the test to detect hearing impairment) was 80.0%; and the specificity (ability to identify children with normal hearing) was 95.0%. In the school-based study, done after modification and standardisation of the test set, the sensitivity and specificity were 83.3% and 97.8% respectively. Age range was 3 - 8 years with 79% being 4- 6 years. In both studies, the voice test was simpler to perform, easily understood and acceptable to the children and the testers; and considerably cheaper as the only equipment required was picture/toy set. The main limitation was non-standardisation of the test set. This was rectified in the school-based study. The drawbacks noted were the inability of the voice test to detect unilateral hearing loss/deafness and high frequency hearing loss. The voice test generally correlated well with pure tone audiometry and could be used as alternative for screening for hearing impairment in the community especially for pre-school and school going children. However, it is recommended to repeat the study in actual community settings using Community Health Care Workers as the testers. This would also determine the reliability of the voice test, as this cannot be reliably established at this stage.

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23

Locke, Richard R. "Anatomy of the transmastoid endolymphatic sac decompression in the management of Ménière’s disease." Thesis, University of Glasgow, 2008. http://theses.gla.ac.uk/208/.

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Ménière’s disease affects 1 in 1000 people and produces vertigo and hearing loss (Morrison, 1981). Endolymphatic sac decompression has been advocated on the basis that endolymphatic hydrops is the underlying pathology. The endolymphatic sac is said to be the terminal dilatation of the membranous labyrinth. It has been proposed that endolymph flows from the semicircular canals and cochlea to the endolymphatic sac. Portman (1927) devised a procedure for ‘decompressing’ the endolymphatic sac by removal of the bone from the posterior cranial fossa to relieve the symptoms of Ménière’s disease. Surgery on the endolymphatic sac remains controversial. Shea (1979) and Bagger-Sjöbäck et al (1990, 1993) have studied the endolymphatic sac using different techniques. There are discrepancies in the results between the two studies. The hypothesis that the endolymphatic sac can be safely approached and decompressed by a transmastoid route was tested. A total of thirteen cadaver heads and ten isolated temporal bones were used. A series of dissections were performed to examine the endolymphatic sac, perform measurements and analyse surgical approaches to the sac. Histological and electron microscopic study were performed. The lumen of the endolymphatic sac was not always identifiable in the dura of the posterior cranial fossa or it frequently lay over the sigmoid sinus. In the dura of the posterior cranial fossa where the endolymphatic sac is located was a thickening of the dura. This thickening was present even in the absence of the endolymphatic sac. The endolymphatic sac can be safely approached by a transmastoid approach, if there is an extraosseous component to the endolymphatic sac. The proximal endolymphatic sac can be approached by posterior cranial fossa route.

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Alali, Ala. "The influence of breathing disorders on face shape : a three-dimensional study." Thesis, Cardiff University, 2013. http://orca.cf.ac.uk/60386/.

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Breathing disorders can potentially influence craniofacial development through interactions between the respiratory flow and genetic and environmental factors. It has been suggested that certain medical conditions such as persistent rhinitis and renal insufficiency may have an influence on face shape. The effects of these conditions are likely to be subtle; otherwise they would appear as an obvious visible facial feature. The use of three-dimensional imaging provides the opportunity to acquire accurate and high resolution facial data to explore the influence of medical condition on facial morphology. Therefore, the aim of the present study is to investigate the influence of breathing disorders (asthma, atopy, allergic rhinitis and sleep disordered breathing) on face shape in children. The study sample, comprising of 4784 British Caucasian children of which 2922 (61.1%) were diagnosed with a breathing disorder, was selected from the Avon Longitudinal Study of Parents and Children (ALSPAC), which had been conducted to investigate the genetic and environmental determinants of development, health and disease. Three-dimensional surface laser scans were conducted on the children when they were 15 years old. A total of 21 reproducible facial landmarks (x, y, z co-ordinates) were identified. Average facial shells were constructed for each of the different disease groups and compared to facial shells of healthy asymptomatic children. Face-shape variables (angular and linear measurements) were analysed with respect to the different breathing disorders by employing a variety of statistical methods, including t-tests, chi-square tests, principal component analysis, binary logistic regression and analysis of variance (ANOVA). The results reveal that individual breathing disorders have varying influences on facial features, including increased anterior lower face height, a more retrognathic mandible and reduced nose width and prominence. The study also shows that the early removal of adenoids and tonsils can have a significant effect on obstructive breathing, resulting in the restoration of the facial morphology to its normal shape. This was particularly evident in children with normal BMIs. Surprisingly, no significant differences in face shape were detected in children with multiple diseases (combinations of asthma, allergic rhinitis, atopy and sleep-disordered breathing) when compared to healthy children. This may indicate the multifactorial, complex character of this spectrum of diseases. The findings provide evidence of small but potentially real associations between breathing disorders and face shape. This was largely attributable to the use of high-resolution and reproducible three-dimensional facial imaging alongside a large study sample. They also provide the scientific community with a detailed and effective methodology for static facial modelling that could have clinical relevance for early diagnosis of breathing disorders. Furthermore, this research has demonstrated that the ALSPAC patient archive offers a valuable resource to clinicians and the scientific community for investigating associations between various breathing disorders and face shape.

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Ireland, Katie Helen. "Can the auditory late response indicate audibility of speech sounds from hearing aids with different digital processing strategies." Thesis, University of Southampton, 2014. https://eprints.soton.ac.uk/385314/.

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Auditory late responses (ALR) have been proposed as a hearing aid (HA) evaluation tool but there is limited data exploring alterations to the waveform morphology from using digital HAs. The research had two phases: an adult normal hearing phase and an infant hearing impaired clinical feasibility phase. The adult normal hearing study investigated how different HA strategies and stimuli may influence the ALR. ALRs were recorded from 20 normally hearing young adults. Test sounds, /m/, /g/, /t/, processed in four HA conditions (unaided, linear, wide dynamic range compression (WDRC), non linear frequency compression (NLFC)) were presented at 65 dB nHL.Stimuli were 100 ms duration with a 3 second inter-stimulus interval. An Fsp measure of ALR quality was calculated and its significance determined using bootstrap analysis to objectively indicate response presence from background noise. Data from 16 subjects was included in the statistical analysis. ALRs were present in 96% of conditions and there was good repeatability between unaided ALRs. Unaided amplitude was significantly larger than all aided amplitudes and unaided latencies were significantly earlier than aided latencies in most conditions. There was no significant effect of NLFC on the ALR waveforms. Stimulus type had a significant effect on amplitude but not latency. The results showed that ALRs can be recorded reliably through a digital HA. There was an overall effect of aiding on the response likely due to the delay, compression characteristics and frequency shaping introduced by the HA. Type of HA strategy did not significantly alter the ALR waveform. The differences found in ALR amplitude due to stimulus type may be due to tonotopic organisation of the auditory cortex. The infant hearing impaired study was conducted to explore the feasibility of using ALRs as a means of indicating audibility of sound from HA’s in a clinical population. ALRs were recorded from 5 infants aged between 5-6 months with bilateral sensori neural hearing loss and wearing their customised HA’s. The speech sounds /m/ and /t/ from the adult study were presented at an rms level of 65 dB SPL in 3 conditions: unaided; WDRC; NLFC. Bootstrap analysis of Fsp was again used to determine response presence and probe microphone measures were recorded in the aided conditions to confirm audibility of the test sounds. ALRs were recordable in young infants wearing HAs. 85% of aided responses were present where only 10% of unaided were present. NLFC active improved aided response presence to the high frequency speech sound /t/ for 1 infant. There were no clear differences in the aided waveforms between the speech sounds. The results showed that it is feasible to record ALRs in an infant clinical population. The response appeared more sensitive to improved audibility than frequency alterations.

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Al, Saleh Hadeel. "Effects of reverberation and amplification on sound localisation." Thesis, University of Southampton, 2011. https://eprints.soton.ac.uk/333290/.

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Communication often takes place in reverberant spaces making it harder for listeners to understand speech. In such difficult environments, listeners would benefit from being able to locate the sound source. In noisy or reverberant environments hearing-aid wearers often complain that their aids do not sufficiently help to understand speech or to localise a sound source. Simple amplification does not fully resolve the problem and sometimes makes it worse. Recent improvements in hearing aids, such as compression and filtering, can significantly alter the Interaural Time Difference (ITD) and the Inter-aural Level Difference (ILD) cues. Digital signal processing also tends to restrict the availability of fine structure cues, thereby forcing the listener to rely on envelope and level cues. The effect of digital signal processing on localisation, as felt by hearing aid wearers in different listening environments, is not well investigated. In this thesis, we aimed to investigate the effect of reverberation on localisation performance of normal hearing and hearing impaired listeners, and to determine the effects that hearing aids have on localisation cues. Three sets of experiments were conducted: in the first set (n=22 normal hearing listeners) results showed that the participants’ sound localisation ability in simulated reverberant environments is not significantly different from performance in a real reverberation chamber. In the second set of four experiments (n=16 normal hearing listeners), sound localisation ability was tested by introducing simulated reverberation and varying signal onset/offset times of different stimuli – i.e. speech, high-pass speech, low-pass speech, pink noise, 4 kHz pure tone, and 500 Hz pure tone. In the third set of experiments (n=28 bilateral Siemens Prisma 2 Pro hearing aid users) we investigated aided and unaided localisation ability of hearing impaired listeners in anechoic and simulated reverberant environments. Participants were seated in the middle of 21 loudspeakers that were arranged in a frontal horizontal arc (180°) in an anechoic chamber. Simulated reverberation was presented from four corner-speakers. We also performed physical measurements of ITDs and ILDs using a KEMAR simulator. Normal hearing listeners were not significantly affected in their ability to localise speech and pink noise stimuli in reverberation, however reverberation did have a significant effect on localising a 500 Hz pure tone. Hearing impaired listeners performed consistently worse in all simulated reverberant conditions. However, performance for speech stimuli was only significantly worse in the aided conditions. Unaided hearing impaired listeners showed decreased performance in simulated reverberation, specifically, when sounds came from lateral directions. Moreover, low-pass pink noise was most affected by simulated reverberation both in aided and unaided conditions, indicating that reverberation mainly affects ITD cues. Hearing impaired listeners performed significantly worse in all conditions when using their hearing aids. Physical measurements and psychoacoustic experiments consistently indicated that amplification mainly affected the ILD cues. We concluded that reverberation destroys the fine structure ITD cues in sound signals to some extent, thereby reducing localisation performance of hearing impaired listeners for low frequency stimuli. Furthermore we found that hearing aid compression affects ILD cues, which impairs the ability of hearing impaired listener to localise a sound source. Aided sound localisation could be improved for bilateral hearing aid users, if the aids would synchronize compression between both sides.

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Phippen, Ginette. "A feasibility study of visual feedback speech therapy for nasal speech associated with velopharyngeal dysfunction." Thesis, University of Southampton, 2013. https://eprints.soton.ac.uk/354121/.

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Nasal speech associated with velopharyngeal dysfunction (VPD) is seen in children and adults with cleft palate and other conditions that affect soft palate function, with negative effects on quality of life. Treatment options include surgery and prosthetics depending on the nature of the problem. Speech therapy is rarely offered as an alternative treatment as evidence from previous studies is weak. However there is evidence that visual biofeedback approaches are beneficial in other speech disorders and that this approach could benefit individuals with nasal speech who demonstrate potential for improved speech. Theories of learning and feedback also lend support to the view that a combined feedback approach would be most suitable. This feasibility study therefore aimed to develop and evaluate Visual Feedback Therapy (VFTh), a new behavioural speech therapy intervention, incorporating speech activities supported by visual biofeedback and performance feedback, for individuals with mild to moderate nasal speech. Evaluation included perceptual, instrumental and quality of life measures. Eighteen individuals with nasal speech were recruited from a regional cleft palate centre and twelve completed the study, six female and six male, eleven children (7 to 13 years) and one adult, (43 years). Six participants had repaired cleft palate and six had VPD but no cleft. Participants received 8 sessions of VFTh from one therapist. The findings suggest that that the intervention is feasible but some changes are required, including participant screening for adverse response and minimising disruptions to intervention scheduling. In blinded evaluation there was considerable variation in individual results but positive changes occurred in at least one speech symptom between pre and post-intervention assessment for eight participants. Seven participants also showed improved nasalance scores and seven had improved quality of life scores. This small study has provided important information about the feasibility of delivering and evaluating VFTh. It suggests that VFTh shows promise as an alternative treatment option for nasal speech but that further preliminary development and evaluation is required before larger scale research is indicated.

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Athalye, Sheetal Purushottam. "Factors affecting speech recognition in noise and hearing loss in adults with a wide variety of auditory capabilities." Thesis, University of Southampton, 2010. https://eprints.soton.ac.uk/191083/.

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Studies concerning speech recognition in noise constitute a very broad spectrum of work including aspects like the cocktail party effect or observing performance of individuals in different types of speech-signal or noise as well as benefit and improvement with hearing aids. Another important area that has received much attention is investigating the inter-relations among various auditory and non-auditory capabilities affecting speech intelligibility. Those studies have focussed on the relationship between auditory threshold (hearing sensitivity) and a number of suprathreshold abilities like speech recognition in quiet and noise, frequency resolution, temporal resolution and the non-auditory ability of cognition. There is considerable discrepancy regarding the relationship between speech recognition in noise and hearing threshold level. Some studies conclude that speech recognition performance in noise can be predicted solely from an individual’s hearing threshold level while others conclude that other supra-threshold factors such as frequency and/or temporal resolution must also play a role. Hearing loss involves more than deficits in recognising speech in noise, raising the question whether hearing impairment is a uni- or multi-dimensional construct. Moreover, different extents of hearing loss may display different relationships among measures of hearing ability, or different dimensionality. The present thesis attempts to address these three issues, by examining a wide range of hearing abilities in large samples of participants having a range of hearing ability from normal to moderate-severe impairment. The research extends previous work by including larger samples of participants, a wider range of measures of hearing ability and by differentiating among levels of hearing impairment. Method: Two large multi-centre studies were conducted, involving 103 and 128 participants respectively. A large battery of tests was devised and refined prior to the main studies and implemented on a common PC-based platform. The test domains included measurement of hearing sensitivity, speech recognition in quiet and noise, loudness perception, frequency resolution, temporal resolution, binaural hearing and localization, cognition and subjective measures like listening effort and self-report of hearing disability. Performance tests involved presentation of sounds via circum-aural earphones to one or both ears, as required, at intensities matched to individual hearing impairments to ensure audibility. Most tests involved measurements centred on a low frequency (500 Hz), high frequency (3000 Hz) and broadband. The second study included some refinements based on analysis of the first study. Analyses included multiple regression for prediction of speech recognition in stationary or fluctuating noise and factor analysis to explore the dimensionality of the data. Speech recognition performance was also compared with that predicted using the Speech Intelligibility Index (SII). iii Findings: Findings from regression analysis pooled across the two studies showed that speech recognition in noise can be predicted from a combination of hearing threshold at higher frequencies (3000/4000 Hz) and frequency resolution at low frequency (500 Hz). This supports previous studies that conclude that resolution is important in addition to hearing sensitivity. This was also confirmed by the fact that SII (representing sensitivity rather than resolution) underpredicted difficulties observed in hearing-impaired ears for speech recognition in noise. Speech recognition in stationary noise was predicted mainly by auditory threshold while speech recognition in fluctuating noise was predicted by a combination having a larger contribution from frequency resolution. In mild hearing losses (below 40 dB), speech recognition in noise was predicted mainly by hearing threshold, in moderate hearing losses (above 40 dB) it was predicted mainly by frequency resolution when combined for two studies. Thus it can be observed that the importance of auditory resolution (in this case frequency resolution) increases and the importance of the audiogram decreases as the degree of hearing loss increases, provided speech is presented at audible levels. However, for all degrees of hearing impairment included in the study, prediction based solely on hearing thresholds was not much worse than prediction based on a combination of thresholds and frequency resolution. Lastly, hearing impairment was shown to be multi-dimensional; main factors included hearing threshold, speech recognition in stationary and fluctuating noise, frequency and temporal resolution, binaural processing, loudness perception, cognition and self-reported hearing difficulties. A clinical test protocol for defining an individual auditory profile is suggested based on these findings. Conclusions: Speech recognition in noise depends on a combination of audibility of the speech components (hearing threshold) and frequency resolution. Models such as SII that do not include resolution tend to over-predict somewhat speech recognition performance in noise, especially for more severe hearing impairments. However, the over-prediction is not great. It follows that for clinical purposes there is not much to be gained from more complex psychoacoustic characterisation of sensorineural hearing impairment, when the purpose is to predict or explain difficulty understanding speech in noise. A conventional audiogram and possibly measurement of frequency resolution at 500 Hz is sufficient. However, if the purpose is to acquire a detailed individual auditory profile, the multidimensional nature of hearing loss should not be ignored. Findings from the present study show that, along with loss of sensitivity and reduced frequency resolution ability, binaural processing, loudness perception, cognition and self-report measures help to characterize this multi-dimensionality. Detailed studies should hence focus on these multiple dimensions of hearing loss and incorporate measuring a wide variety of different auditory capabilities, rather than inclusion of just a few, in order gain a complete picture of auditory functioning. Frequency resolution at low frequency (500 Hz) as a predictive factor for speech recognition in noise is a new finding. Few previous studies have included low-frequency measures of hearing, which may explain why it has not emerged previously. Yet this finding appears to be robust, as it was consistent across both of the present studies. It may relate to differentiation of vowel components of speech. The present work was unable to confirm the suggestion from previous studies that measures of temporal resolution help to predict speech recognition in fluctuating noise, possibly because few participants had extremely poor temporal resolution ability.

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Chowdhury, Shibasis. "Modelling the effect of cochlear implant filterbank characteristics on speech perception." Thesis, University of Southampton, 2013. https://eprints.soton.ac.uk/366252/.

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The characteristics of a cochlear implant (CI) filterbank determine the coding of spectral and temporal information in it. Hence, it is important to optimise the filterbank parameters to achieve optimal benefit in CI users. The present thesis aimed at modelling how the manipulation of the filterbank analysis length and the assignment of spectral channels may effect CI speech perception, using CI acoustical simulation techniques. Investigations were carried out to study the efficacy of providing additional spectral information in low and/or mid frequency channels using a longer filterbank analysis window, with respect to CI processed speech perception in various types of background noise. However, the increase of filterbank analysis length has an associated trade-off, which is a reduction in temporal information. Only a few CI acoustic simulations studies have modelled the characteristics of the FFT filterbank, the most commonly used filterbank in commercial CI processors. An initial experiment was carried out to validate the CI acoustical simulation technique used in the present thesis that implemented an FFT filterbank analysis. Next, the effect of a reduction in temporal information with the increase of the FFT analysis window length was studied. A filterbank with 16 ms analysis window, without the implementation of its finer spectral coding abilities, performed marginally poorer to that of a 4 ms analysis window in a sentence recognition test. The finer spectral coding abilities of the filterbank with 16 ms analysis window, when implemented, revealed that CI processed speech perception in noise could be significantly improved if additional spectral information is provided in the low and mid frequencies. The assignment of additional spectral channels to the low and mid frequencies led to a corresponding reduction in spectral channels assigned to high frequencies. However, no detrimental effect in speech perception was observed as long as at least two spectral channels represented information above 3 kHz. The assignment of additionallow and mid frequency spectral channels also led to significant levels of spectral shift. The significant benefits from additional low and mid frequency information, however, were lost when the effects of spectral shift were introduced in acute experiments, without any training or acclimatisation period. The findings of the present thesis highlight that a longer filterbank analysis, such as 16 ms, may be implemented in CI devices without the fear of any perceptual cost due to a reduction in temporal information, at least for tasks that do not require talker separation. Providing additional low and mid frequency spectral information with a longer filterbank analysis has the potential to improve CI speech perception. However, to obtain potential benefits, the effects of spectral shift should be overcome. The findings of this thesis, however, need to be interpreted considering the limitations of CI acoustical simulation experiments.

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Сміянов, Владислав Анатолійович, А. Бойко, Владислав Анатольевич Смиянов, and Vladyslav Anatoliiovych Smiianov. "Опыт применения эндоскопических методов диагностики в условиях поликлиники." Thesis, Видавництво СумДУ, 2008. http://essuir.sumdu.edu.ua/handle/123456789/6907.

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Сміянов, Євген Владиславович, Евгений Владиславович Смиянов, Yevhen Vladyslavovych Smiianov, Владислав Анатолійович Сміянов, Владислав Анатольевич Смиянов, and Vladyslav Anatoliiovych Smiianov. "Епідеміологія кандідозно-бактеріальних асоціацій при захворюваннях лор-органів." Thesis, Видавництво СумДУ, 2008. http://essuir.sumdu.edu.ua/handle/123456789/6913.

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32

Eriksson, Per Olof. "Developing otitis media : experimental studies in particular regarding inflammatory changes in the tympanic membrane." Doctoral thesis, Umeå : Univ, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-180.

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Schröder, Stina, and Linda Svensson. "Psykiskt välbefinnande, socialt stöd och tillit hos personer med Usher syndrom typ II och typ III. -En enkätstudie." Thesis, Örebro universitet, Hälsoakademin, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-8041.

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Carlsson, Ellinor, and Linda Norén. "Finns det samband mellan psykologiska symptom och sömnsvårigheter hos personer med hörselnedsättning?" Thesis, Örebro universitet, Hälsoakademin, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-8043.

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Sundstedt, Stina. "Swallowing and deep brain stimulation : swallowing function in Parkinson's disease after subthalamic nucleus and caudal zona incerta deep brain stimulation." Licentiate thesis, Umeå universitet, Öron- näs- och halssjukdomar, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-86133.

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Background Swallowing problems are common in Parkinson’s disease, and these affect morbidity and mortality largely due to aspiration-induced pneumonia. Even mild dysphagia affects patient Quality of Life. Deep Brain Stimulation (DBS), a surgical treatment for Parkinson’s disease, improves overall motor function, though the effect of DBS on swallowing function is not clear. The aim of the studies in this thesis was to improve our understanding of the effect from DBS of caudal zona incerta and subthalamic nucleus on pharyngeal swallowing function. Specific aims were to compare DBS effects over time postoperatively (6 & 12 months) for swallowing function, on and off stimulation, with a preoperative baseline assessment in order to identify possible negative swallowing effects of DBS. Methods Eight patients with DBS in caudal zona incerta and eleven patients with DBS in subthalamic nucleus were included in the two studies. The effect of DBS on swallowing function was evaluated by self-estimation on a visual analogue scale and fiberoptic endoscopic evaluation of swallowing function with a predefined swallowing protocol including Rosenbek’s Penetration/Aspiration Scale, Secretion Severity Scale,preswallow spillage, pharyngeal residue and pharyngeal clearance. The patients with caudal zona incerta DBS also answered questions regarding swallowing-related Quality of Life. All patients received L-dopa treatment during postoperative assessments. Results There was no clear effect of DBS on swallowing function in the two samples. The occurrence of aspiration, secretions, pharyngeal residue or clearance was not affected by the surgery or the stimulation. In the subthalamic nucleus DBS sample, self-estimations revealed an improvement with stimulation turned on. For the caudal zona incerta DBS patients, no effect of DBS was seen on the results from the swallowing-related QOL questions. Conclusion Subthalamic nucleus DBS and caudal zona incerta DBS did not appear to have a negative effect on swallowing function in this cohort. Patients with subthalamic nucleus DBS reported a self-perceived improvement in swallowing function after DBS. There appears to be no increased risk for aspiration or penetration due to surgery or stimulation regardless of stimulation site. Since the sample sizes in these cohorts are small, the findings need to be confirmed in larger studies.

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Смородська, О. М. "Використання мобільного додатка LORHELPER у вивченні оториноларингології при проблемно - орієнтованому навчанні студентів." Thesis, Сумський державний університет, 2016. http://essuir.sumdu.edu.ua/handle/123456789/47688.

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Запальні хвороби ЛОР-органів – досить велика група запальних захворювань, кожне з яких людина переносить кілька разів у житті. У цю групу входять запальні хвороби навколоносових пазух, глотки і мигдаликів і середнього вуха. Значення цих захворювань визначається їх надзвичайної поширеністю, особливо в дитячому віці. Метою даної роботи було створення програмного забезпечення для опанування курсу оториноларингологія студентами, які навчаються за програмою проблемно-орієнтованого навчання.

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Berger, Joel I. "Behavioural and neural correlates of tinnitus." Thesis, University of Nottingham, 2014. http://eprints.nottingham.ac.uk/14315/.

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Tinnitus, often defined as the perception of sound in the absence of an external stimulus, affects millions of people worldwide and, in extreme cases, can be severely debilitating. While certain changes within the auditory system have been linked to tinnitus, the exact underlying causes of the phenomenon have not, as yet, been elucidated. Animal models of tinnitus have considerably furthered understanding of the some of the changes associated with the condition, allowing researchers to examine changes following noise exposure, the most common trigger for tinnitus. This thesis documents the development of an animal model of tinnitus, using the guinea pig to examine neural changes following induction of tinnitus. In the first study, a novel adaptation of a behavioural test was developed, in order to be able to determine whether guinea pigs were experiencing tinnitus following the administration of sodium salicylate, a common inducer of tinnitus in humans. This test relies on a phenomenon known as prepulse inhibition, whereby a startle response can be reduced in amplitude by placing a gap in a low-level, continuous background noise immediately prior to the startling stimulus. The hypothesis for this test is that if the background sound is adjusted to be similar to an animal’s tinnitus (induced artificially following noise exposure or drug administration), the tinnitus percept will fill in the gap and the startle response will not be reduced. The results from this first study indicated that using the Preyer reflex (a flexion of the pinnae in response to a startling stimulus) as this startle measure was more robust in guinea pigs than the commonly-used whole-body startle. Furthermore, transient tinnitus was reliably identified following salicylate administration. Following the development and validation of this test, a study was conducted to determine whether guinea pigs experienced tinnitus following unilateral noise exposure. Neural changes commonly associated with the condition (increases in spontaneous firing rates and changes in auditory brainstem responses) were examined, to determine whether there were any differences between animals that did develop tinnitus following noise exposure and those that did not. Two different methods were applied to the behavioural data to determine which animals were experiencing tinnitus. Regardless of the behavioural criteria used, increased spontaneous firing rates were observed in the inferior colliculus of noise-exposed guinea pigs, in comparison to control animals, but there were no differences between tinnitus and no-tinnitus animals. Conversely, significant reductions in the latency of components of the auditory brainstem response were present only in the tinnitus animals. The final study examined whether the original hypothesis for the behavioural test (that tinnitus is filling in the gap) was valid, or whether there was an alternative explanation for the deficits in behavioural gap detection observed previously, such as changes in the temporal acuity of the auditory system preventing detection of the gap. Recordings were made in the inferior colliculus of noise-exposed animals, separated into tinnitus and no-tinnitus groups according to the behavioural test, as well as unexposed control animals, to determine whether there were changes in the responses of single-units in detecting gaps of varying duration embedded in background noise. While some minor changes were present in no-tinnitus animals, tinnitus animals showed no significant changes in neural gap detection thresholds, demonstrating that changes in temporal acuity cannot account for behavioural gap detection deficits observed following noise exposure. Interestingly, significant shifts in the response types of cells were observed which did appear to relate to tinnitus. The present data indicate that the Preyer reflex gap detection test is appropriate for examining tinnitus in guinea pigs. It also suggests that increases in spontaneous firing rates at the level of the inferior colliculus cannot solely account for tinnitus. Changes in auditory brainstem responses, as well as shifts in response types, do appear to relate to tinnitus and warrant further investigation.

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Mirahmadizoghi, Seyedsiavash. "Benefits of multichannel recording of auditory late response (ALR)." Thesis, University of Southampton, 2015. https://eprints.soton.ac.uk/379884/.

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The main purpose of this work is to explore whether and how much multichannel signal processing strategies can be beneficial for improving the detection procedure for auditory late response (ALR) in clinical applications in comparison with single channel recording. To achieve this target, four multichannel noise reduction methods based on independent component analysis (ICA) were proposed for noise reduction for multichannel recording of ALR. The four alternative component selection strategies introduced in this work are: Magnitude Squared Coherence (MSC) [based on coherency of the ICs with an evoking stimulus], the maximum Signal to Noise Ratio (Max-SNR) of ICs over a particular interval, the kurtosis (maximum non-Gaussianity of the ICs), and minimum entropy of the ICs. The proposed methods are applied for the noise reduction of auditory late response (ALR) data captured using 63 channel EEG from 10 normal hearing participants. The performances of the proposed methods for improving signal quality were compared with each other and also with the single channel alternatives. All automated component selection approaches produced high SNR for multichannel ALR data. MSC-ICs produced significantly higher SNR than Max-Kurt-ICs or Min-Entropy-ICs. However the performance of MSC-ICs and Max-Fmp-ICs were not significantly different. Therefore, the MSC-ICs approach was selected for further work. MSC-ICs were used for three different clinical applications: Finding hearing threshold level, exploring the effect of attention and exploring inter- and intra- subject variability. The results for MSC-ICs were compared to the single channel signal processing alternative of weighted averaging. The results confirm that the multichannel signal processing can significantly improve the detection procedure for threshold measurement and for measuring the effects of attention. However, no significant enhancement was found for detecting inter- and intra- subject variability with multichannel processing over single channel alternative. The MSC-ICs method was also used in an application for removing cardiac artifact from the ALR recordings and the results was compared with an existing artifact rejection platform based on constraint ICA (cICA). The results of this comparison show that the proposed method can significantly improve the quality of cardiac artifact rejection from ALR data. Finally, the use of MSC-ICs was explored for reducing the required time for recording ALR. Time reduction was investigated in two senses: 1. reducing the number of stimulus repetitions. 2. Optimizing the position and the number of the recording electrodes in multichannel recordings (potentially saving the time required to place many electrodes on the scalp). The results show that using multichannel processing can significantly reduce the number of stimulus repetitions and consequently the time of recording in comparison with the single channel alternative. Minimum required number of stimulus repetition (average over10 subjects) for having SNR equal to single channel processing at Cz was found to be 74 for un-weighted averaging and 85 for weighted averaging. Moreover, the results of optimal electrode placement procedure confirm that, the ALR can be recorded form the vertex (with the same SNR as when ALR is recorded using 63 channels) by using fewer numbers of electrodes. For the data set of this study (10 normal hearing adults) the same SNR as with 63 channels was achieved by using 40 channels. Placing 40 electrodes (instead of 63) on the scalp decreases the required time for recording ALR considerably, i.e. 53% improved.

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39

Worsfold, Sarah. "Assessing expressive spoken language in children with permanent childhood hearing impairment in mid-childhood." Thesis, University of Southampton, 2011. https://eprints.soton.ac.uk/376873/.

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40

Nordang, Leif. "The Round Window Membrane - Gateway to the Cochlea : A Morphological and Electrophysiological study." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2002. http://publications.uu.se/theses/91-554-5277-9/.

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41

Licciardello, Musmeci Michela. "Sindrome di Forestier: osservazioni clinico-strumentali." Thesis, Universita' degli Studi di Catania, 2011. http://hdl.handle.net/10761/348.

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La Sindrome di Forestier, definita anche iperostosi scheletrica idiopatica diffusa (DISH),e una patologia degenerativa sistemica ad eziologia sconosciuta, caratterizzata da iperostosi della regione antero-laterale della colonna vertebrale e da ossificazione delle entesi extra-spinali. Essa puo causare rigidita e dolore, sintomi spesso secondari a tendiniti ed a compromissione vertebrale, mielopatia. Altri sintomi importanti associati alla Sindrome di Forestier sono disfagia, stridore laringeo, dispnea, russamento, raucedine, disturbi di comune riscontro nella pratica clinica otorinolaringoiatrica. Il presente studio si propone di analizzare e descrivere tre casi di Sindrome di Forestier a localizzazione prevalentemente cervicale, allo scopo di evidenziarne gli aspetti clinico-diagnostici di interesse specialistico otorinolaringoiatrico.

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Kihlsten, Jessica, and Jenny Strömblad. "King-Kopetzkys syndrom : - en sammanställning och jämförelse av vetenskaplig litteratur." Thesis, Örebro University, Academy of Health Science, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-2158.

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King-Kopetzkys syndrom (KKS) beskrivs som när en person upplever svårigheter med att uppfatta tal, speciellt i bullriga miljöer, men har normala tontrösklar. Orsaken till syndromet är fortfarande oviss och detta gör att de som jobbar inom hörselvården ställs inför ett val då de möter dessa patienter. Patienten kan antingen avfärdas då denne anses höra normalt, eller så tas problemet på allvar och vidare utredning utförs.

Genom att göra en systematisk litteraturstudie belyses och förklaras syndromet och syftet har varit att göra en sammanställning och ge en översikt över KKS utifrån de vetenskapliga artiklar som berör ämnet. Målet med detta arbete är att öka förståelsen för KKS.

Resultatet pekar på att det är fler kvinnor än män som drabbas och att medelåldern för de med syndromet är ganska låg, runt 32 år. Det finns många olika teorier till orsaken och ingen är i dagsläget mer rätt än den andra. Detsamma gäller mätningar som använts för att försöka utreda syndromet, här framkommer många olika förslag på vägen till diagnostisering. Slutsatsen som dras är att mer forskning kring ämnet är nödvändigt för att få en förklaring och ett tillvägagångssätt för diagnostisering av syndromet.

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Lundgren, Tove, and Sofie Järlesäter. "Hörselnedsättning och självmordsbeteende. : En undersökning av sambandet mellan självskattad hörselnedsätttning och två aspekter av självmordsbeteende." Thesis, Örebro University, Örebro University, Örebro University, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-7043.

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Simon, Galvez Marcos F. "Design of an array-based aid for the hearing impaired." Thesis, University of Southampton, 2014. https://eprints.soton.ac.uk/375092/.

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The performance of our hearing system degrades with age, causing a reduction in our ability to understand speech. This thesis describes the design of a personal audio system, aimed at enhancing the audio signal from a TV, for hard of hearing listeners. Such system generates a zone of high acoustic pressure in a specific area of a room, whilst minimising the sound radiated to other zones. In order to obtain a very narrow sound radiation, superdirective techniques are used. Such techniques improve the performance of an array of small dimensions at mid and low frequencies, but they can require the use of a large amount of power and can be very sensitive to errors in the source transfer functions. A practical balance between performance and array effort is achieved in a design that uses phase-shift sources. Two arrays have been built. The first array uses 8 phase-shift sources and provides a high directionality in the free field. The second array uses 4 phase-shift sources vertically plus 8 horizontally and is more directional in a 3D sense, hence reducing the reverberant field excitation. The design of superdirective filters has been considered in both time and frequency domains. The effect of the reverberant field in the performance of superdirective radiators has also been investigated, by first examining how the radiation pattern is modified, and then by observing how the reverberant field affects the robustness of the control. The performance has been assessed by means of off-line simulations with point source Green functions and measured transfer responses, and by real time measurements in free-field and reverberant environments. The later chapters of the thesis consider the subjective assessment of arrays as an aid for speech intelligibility. The assessment has first been performed using an objective metric, in particular the speech transmission index (STI). The performance has also been assessed in a subjective study, in which 30 participants have judged the increase in intelligibility. A cochlear model has also been utilised to investigate equalisation methods that minimise masking and provide a better speech intelligibility, particularly for the hearing impaired. Although this has not been tested with behavioural experiments, STI simulations have predicted that it can lead to an intelligibility improvement.

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45

Eaton, Sharyn. "The technical and physiological characteristics of the vibromyographic signal." Thesis, University of Southampton, 1999. https://eprints.soton.ac.uk/47621/.

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Skeletal muscle contractions emit a low frequency sound (<100Hz) that can be detected by vibromyography (VMG) or mechanomyography (MMG). The aim of this study was to determine the future application of the VMG signal as a clinical tool in reflecting the physiological state or function of muscle during rehabilifation and diagnosis. In order to achieve this aim, the following was investigated. A) The technical characteristics: Three different transducers (the capacitance and piezoelectric accelerometers and the contact sensor) and the transducer/ amplifier system. B) The repeatability of the VMG signal at different force levels. C) Physiological characteristics of the VMG signal comparing 'normal' and 'abnormal' muscle function. Past studies on VMG have revealed that these three areas have received little attention. The VMG signal was taken from the biceps brachii muscle at different contraction levels 10%, 50% and 80% maximum voluntary contraction (MVC) for within day (n=3) and between day (n=17) recordings. The signal from asymptomatic (n=29) and symptomatic (n=23) low back pain subjects was then compared. Recordings were taken from the erector spinae muscle at an incremental increase in voluntary contraction (10%-100%MVC). These recordings were repeated on the next day. Results from this study have revealed the following: A) Technical characteristics : the lower cut-off frequency is important and insufficient attention in past studies has been given to the transducer-amplifier system. Additionally, the capacitance accelerometer was the favoured transducer due to its greater sensitivity to low frequencies, simplicity of use and ease of stabilising and coupling techniques to the skin. B) Repeatability of the VMG signal: For successive recordings, compared with precision (%C.O.V and L.O.A) and reliability (I.C.C), correlation (r value) of the VMG signal appears a much stronger and a more consistent statistic in the time and frequency domains. C) Physiological Characteristics: Although having a high individual variation, the erector spinae demonstrated a strong curvilinear relationship with increasing submaximal voluntary contraction (%MVC) reflecting the recruitment and rate coding strategies for this muscle. The VMG RMS for symptomatic low back pain subjects was considerably less than asymptomatic subjects suggesting a deficiency in muscle function. In contrast, the PSD was less favourable in distinguishing between the two subject groups. Reasons for these findings are discussed. In future, the clinical application of the VMG RMS values may quantitatively assess paraspinal muscle force reflecting physiological changes in recruitment and rate coding strategies in 'normal' and 'abnormal' muscle function during rehabilitative care.

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Frykholm, Carina. "Clinical and Genetic Studies of Hearing Impairment." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Universitetsbiblioteket [distributör], 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8290.

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47

Adura, Peter. "Virus-host interactions following experimental rhinovirus infection in airways disease." Thesis, University of Southampton, 2013. https://eprints.soton.ac.uk/374747/.

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48

Berg, Thomas. "Medical treatment and grading of Bell's palsy." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-100947.

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49

Winter, Andrew John. "Hearing loss in experimental bacterial meningitis." Thesis, University of Birmingham, 1997. http://etheses.bham.ac.uk//id/eprint/32/.

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Experimental meningitis was induced in pigmented guinea pigs by subarachnoid inoculation of \(1 \times 10^9\) Escherichia coli K-12 or \(3 \times 10^7\) CFU Streptococcus pneumoniae serotype 2 D39 (NCTC 7466) or PLN-A, \(\Delta\)NA1 or \(\Delta\)HY1, defined isogenic derivatives of D39 deficient in pneumolysin, neuraminidase or hyaluronidase respectively. All animals developed a meningeal inflammatory response and a labyrinthitis. Hearing loss in pneumococcal meningitis was measured by recording the evoked auditory nerve compound action potential from the round window membrane. Animals infected with PLN-A sustained significantly less hearing loss than those infected with wild-type D39 (12 dB vs. 50 dB 12 h post inoculation; P<0.0001), Neuraminidase deficiency did not alter the course of the meningeal inflammatory response nor affect hearing loss. The \(\Delta\)HY1 mutant survived poorly in the cerebrospinal fluid and blood but still caused hearing loss. Both pneumococcal and E. coli meningitis induced specific ultrastructural lesions in the organ of Corti as judged by high-resolution scanning and transmission electron microscopy, and these lesions were most severe with pneumolysin-sufficient pneumococcal infection. Microperfusion of \(5\times10^6\) CFU S.pneumoniae D39 directly into the scala tympani of guinea pigs also resulted in electrophysiological and ultrastructural damage to the organ of Corti that could be diminished by pretreatment with antibiotics. The data confirm the cochlea as the site of meningogenic deafness. They suggest that pneumolysin expression is chiefly responsible for meningogenic deafness and that if pneumococci invade the inner ear during bacterial meningitis, cochlear deafhess will rapidly ensue.

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Сміян, Олександр Іванович, Александр Иванович Смиян, Oleksandr Ivanovych Smiian, and Л. И. Мишанина. "Случай врожденного околоушного свища в отоларингической практике." Thesis, Видавництво СумДУ, 2004. http://essuir.sumdu.edu.ua/handle/123456789/8754.

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Dissertations / Theses on the topic 'Otorhinolaryngology'

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