Gerber B.,Hearing Health Science
African journal of primary health care & family medicine | Year: 2016
Effective communication between the doctor and patient is crucial for good quality health care. Yet, this form of communication is often problematic, which may lead to several negative consequences for both patients and doctors. Clinical communication skills have become important components of medical training programmes. The traditional approach is to teach students particular communication skills, such as listening to patients and asking open-ended questions. Despite their importance, such training approaches do not seem to be enough to deliver medical practitioners who are able and committed to communicate effectively with patients. This might be due to the pervasive negative influence of the medical profession's (mistaken) understanding of itself as a natural science on doctor-patient communication. Doctors who have been trained according to a positivist framework may consider their only responsibility to be the physical treatment of physical disorders. They may thus have little regard for the patient's psychological and social world and by extension for communication with the patient and/or their caregivers. To address this problem, I propose a curriculum, based on the academic field of philosophy, for teaching clinical communication.
Beers A.N.,BC Childrens Hospital |
Shahnaz N.,University of British Columbia |
Westerberg B.D.,Hearing Health Science |
Kozak F.K.,BC Childrens Hospital |
Kozak F.K.,University of British Columbia
Ear and Hearing | Year: 2010
Objectives: Wideband reflectance (WBR) is a middle ear analysis technique that quantifies frequency-specific sound conduction over a wide range of frequencies. One shortcoming of WBR is that there is limited normative data, particularly for pediatric populations and children with middle ear pathology. The goals of this study were to establish normative WBR data for early school-aged children; to determine whether WBR differs significantly between Caucasian and Chinese children, male and female children, and children and adults (experiment 1); and to compare the normative pediatric WBR data with the WBR data obtained from children with abnormal middle ear conditions (experiment 2). Design: WBR was measured from 78 children with normal middle ear status with an average age of 6.15 yrs and 64 children with abnormal middle ear status with an average age of 6.34 yrs. Control group subjects and subjects without previously diagnosed middle ear pathology were recruited from eight elementary schools in the Greater Vancouver Area. Subjects with known middle ear pathology were recruited through the British Columbia Children's Hospital Otolaryngology department. Middle ear effusion (MEE) was identified in one of the two ways. In the British Columbia Children's Hospital group, MEE was diagnosed by a pediatric otolaryngologist (OTL) using pneumatic otoscopy and video otomicroscopy. These cases (21 ears) were classified as OTL confirmed. Subjects who were assessed through screenings at their elementary schools and suspected to have MEE based on audiological test battery results including elevated air conduction thresholds, flat low- and high-frequency tympanograms, and absent transient-evoked otoacoustic emissions were classified as not OTL confirmed (21 ears). Data were statistically analyzed for effects of gender, ethnicity (Caucasian versus Chinese), age (child versus adult), and middle ear condition. WBR equipment used for this study was from Mimosa Acoustics (RMS-system, version 4.03). Data were averaged in one-third octave bands collected from 248 frequencies ranging from 211 to 6000 Hz. Results: Control group subject data (experiment 1) revealed no effects of gender or ear, and their interactions with frequency were not significant. There was a significant interaction between ethnicity (Caucasian versus Chinese) and frequency. Chinese children had lower energy reflectance (ER) values over the mid-frequency range. ER was significantly different between pediatric data and previously collected adult data. Diseased group ER was significantly different among all four middle ear conditions (normal, mild negative middle ear pressure, severe negative middle ear pressure, and MEE) (experiment 2). The overall test performance of ER was objectively evaluated using receiver operating characteristic (ROC) curve analyses; it was compared across frequencies averaged in one-third octave bands. Statistical comparison of the area under ROC (AUROC) plots revealed that ER above 800 Hz (except for ER at 6300 Hz) had better test performance in distinguishing normal middle ear status from MEE compared with ER at 630 and 800 Hz. Although not statistically different from other frequencies between 800 and 5000 Hz, ER at 1250 Hz had the largest AUROC curve (sensitivity of 96% and specificity of 95%) and was selected for further analysis. Comparison of AUROC curves between WBR at 1250 Hz and static admittance at 226-Hz probe tone frequency revealed significantly better test performance for WBR in distinguishing between healthy ears and Mee. Conclusions: A preliminary set of normative ER data have been generated for a pediatric population between the ages of 5 and 7 yrs, which were significantly different from previously gathered normative adult ER data. In this study, pediatric normative data were warranted for testing children, but ethnic-specific norms were not required to detect middle ear pathology and changes in middle ear status. WBR shows promise as a clinical diagnostic tool for measuring the mechanoacoustic properties of the middle ear and the changes that result in the presence of negative middle ear pressure or MEE. Copyright © 2010 by Lippincott Williams & Wilkins.
Li W.,Fudan University |
Li W.,Harvard University |
Li W.,Massachusetts Eye and Ear Infirmary |
Wu J.,Fudan University |
And 8 more authors.
Proceedings of the National Academy of Sciences of the United States of America | Year: 2015
The activation of cochlear progenitor cells is a promising approach for hair cell (HC) regeneration and hearing recovery. The mechanisms underlying the initiation of proliferation of postnatal cochlear progenitor cells and their transdifferentiation to HCs remain to be determined. We show that Notch inhibition initiates proliferation of supporting cells (SCs) and mitotic regeneration of HCs in neonatal mouse cochlea in vivo and in vitro. Through lineage tracing, we identify that a majority of the proliferating SCs and mitotic-generated HCs induced by Notch inhibition are derived from the Wnt-responsive leucine-rich repeat-containing G protein-coupled receptor 5 (Lgr5+) progenitor cells. We demonstrate that Notch inhibition removes the brakes on the canonical Wnt signaling and promotes Lgr5+ progenitor cells to mitotically generate new HCs. Our study reveals a new function of Notch signaling in limiting proliferation and regeneration potential of postnatal cochlear progenitor cells, and provides a new route to regenerate HCs from progenitor cells by interrupting the interaction between the Notch and Wnt pathways. © 2014, National Academy of Sciences. All rights reserved.
Crary M.A.,Hearing Health Science |
Carnaby G.D.,Hearing Health Science |
Carnaby G.D.,University of Florida |
Sia I.,Hearing Health Science |
And 2 more authors.
Stroke | Year: 2013
BACKGROUND AND PURPOSE - Spontaneous swallowing frequency has been described as an index of dysphagia in various health conditions. This study evaluated the potential of spontaneous swallow frequency analysis as a screening protocol for dysphagia in acute stroke. METHODS - In a cohort of 63 acute stroke cases, swallow frequency rates (swallows per minute [SPM]) were compared with stroke and swallow severity indices, age, time from stroke to assessment, and consciousness level. Mean differences in SPM were compared between patients with versus without clinically significant dysphagia. Receiver operating characteristic curve analysis was used to identify the optimal threshold in SPM, which was compared with a validated clinical dysphagia examination for identification of dysphagia cases. Time series analysis was used to identify the minimally adequate time period to complete spontaneous swallow frequency analysis. RESULTS - SPM correlated significantly with stroke and swallow severity indices but not with age, time from stroke onset, or consciousness level. Patients with dysphagia demonstrated significantly lower SPM rates. SPM differed by dysphagia severity. Receiver operating characteristic curve analysis yielded a threshold of SPM≤0.40 that identified dysphagia (per the criterion referent) with 0.96 sensitivity, 0.68 specificity, and 0.96 negative predictive value. Time series analysis indicated that a 5- to 10-minute sampling window was sufficient to calculate spontaneous swallow frequency to identify dysphagia cases in acute stroke. CONCLUSIONS - Spontaneous swallowing frequency presents high potential to screen for dysphagia in acute stroke without the need for trained, available personnel. © 2013 American Heart Association, Inc.
Calandruccio L.,Hearing Health Science |
Buss E.,University of North Carolina at Chapel Hill |
Hall J.W.,University of North Carolina at Chapel Hill
Journal of the Acoustical Society of America | Year: 2014
Masked speech perception can often be improved by modulating the masker temporally and/or spectrally. These effects tend to be larger in normal-hearing listeners than hearing-impaired listeners, and effects of temporal modulation are larger in adults than young children [Hall et al. (2012). Ear Hear. 33, 340-348]. Initial reports indicate non-native adult speakers of the target language also have a reduced ability to benefit from temporal masker modulation [Stuart et al. (2010). J. Am. Acad. Aud. 21, 239-248]. The present study further investigated the effect of masker modulation on English speech recognition in normal-hearing adults who are non-native speakers of English. Sentence recognition was assessed in a steady-state baseline masker condition and in three modulated masker conditions, characterized by spectral, temporal, or spectro-temporal modulation. Thresholds for non-natives were poorer than those of native English speakers in all conditions, particularly in the presence of a modulated masker. The group differences were consistent across maskers when assessed in percent correct, suggesting that a single factor may limit the performance of non-native listeners similarly in all conditions. © 2014 Acoustical Society of America.
Maes L.,Hearing Health Science
Otology and Neurotology | Year: 2014
OBJECTIVE: The clinical balance performance of normal-hearing (NH) children was compared with the balance performance of hearing-impaired (HI) children with and without vestibular dysfunction to identify an association between vestibular function and motor performance.STUDY DESIGN: Prospective study.SETTING: Tertiary referral center.PATIENTS: Thirty-six children (mean age, 7 yr 5 mo; range, 3 yr 8 mo–12 yr 11 mo) divided into three groups: NH children with normal vestibular responses, HI children with normal vestibular responses, and HI children with abnormal vestibular function.INTERVENTIONS: A vestibular test protocol (rotatory and collic vestibular evoked myogenic potential testing) in combination with three clinical balance tests (balance beam walking, one-leg hopping, one-leg stance).MAIN OUTCOME MEASURES: Clinical balance performance.RESULTS: HI children with abnormal vestibular test results obtained the lowest quotients of motor performance, which were significantly lower compared with the NH group (p & 0.001 for balance beam walking and one-leg stance; p = 0.003 for one-leg hopping). The balance performance of the HI group with normal vestibular responses was better in comparison with the vestibular impaired group but still significantly lower compared with the NH group (p = 0.020 for balance beam walking; p = 0.001 for one-leg stance; not significant for one-leg hopping).CONCLUSION: These results indicate an association between vestibular function and motor performance in HI children, with a more distinct motor deterioration if a vestibular impairment is superimposed to the auditory dysfunction. Copyright © 2014 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company
Arriaga M.A.,Hearing Health Science |
Lin J.,Hearing Health Science
Otolaryngologic Clinics of North America | Year: 2012
This article presents a comprehensive review of the translabyrinthine surgical approach for vestibular schwannoma. Additionally, it addresses the traditional labyrinthectomy and identifies a time-efficient version. Indications and outcomes of the approach are presented, along with detailed procedural technique from opening incision through closure. Complications and management of complications are discussed in detail, as well as postoperative patient care. © 2012 Elsevier Inc.
Hearing Health Science | Date: 2014-04-25
Hearing Health Science | Date: 2014-04-25