Vowel intelligibility in children with cochlear implants: An acoustic and articulatory study

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Christine Turgeon, Pamela Trudeau-Fisette, Elizabeth Fitzpatrick, Lucie Ménard
In child cochlear implant (CI) users, early implantation generally results in highly intelligible speech. However, for some children developing a high level of speech intelligibility may be problematic. Studies of speech production in CI users have principally been based on perceptual judgment and acoustic measures. Articulatory measures, such as those collected using ultrasound provide the opportunity to more precisely evaluate what makes child CI users more intelligible. This study investigates speech production and intelligibility in children with CI using acoustic and articulatory measures. Ten children with unilateral or bilateral CIs and 13 children with normal hearing (NH) participated in the study. Participants repeated five English vowels (/a/, /e/, /i/, /o/, /u/) with and without auditory feedback. Ultrasound was used to capture tongue positions and acoustic signals were recorded simultaneously. The results showed that, despite quite similar acoustic results, the two speaker groups made different use of the tongue to implement vowel contrasts. Indeed, the tongue position was lower in the feedback OFF condition than the feedback ON condition for all participants, but the magnitude of this difference was larger for CI users than for their NH peers. This difference led to diminished intelligibility scores for CI users. This study shows the limitation of acoustic measurements alone and demonstrates how the use of articulatory measurements can explain intelligibility patterns. Moreover, our results show that when cochlear implantation occurs early in life and auditory feedback is available, CI users' intelligibility is comparable to that of their NH peers.



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Environmental contributions to otitis media requiring tympanostomy tubes

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Reema Padia, Jeremiah A. Alt, Karen Curtin, Harlan R. Muntz, Richard R. Orlandi, Justin Berger, Jeremy D. Meier
ObjectiveOtitis media requiring tympanostomy tubes (OMwTT) is a prevalent disease process that has been previously shown to have a strong familial link. The impact from the environmental versus genetic contributions to this link is unknown. The objective was to determine the environmental involvement in the development of OMwTT.MethodsUsing an extensive genealogical database linked to medical records, we evaluated the risk of OMwTT in children of probands as compared to children of controls, individually matched 5:1 on sex and birth year, from a conditional logistic regression model. The model included adjustments for geographic and socioeconomic environmental risk factors mapped to residence location of study subjects within 63 small health statistical areas of ∼33,500 persons each.Results37,814 case probands diagnosed with OMwTT and 181,339 controls were included in our analysis. Children of probands with OMwTT had an overall 2.5× higher risk of also having OMwTT as compared to the children of controls (p < 10⁻⁹), independent of environmental factors (PM2.5 [particulate matter] air pollution, education level of parents, and density of primary care providers).ConclusionAfter accounting for geographic and socioeconomic differences that may influence risk between cases and controls, our findings suggest evidence of a genetic predisposition in families of OMwTT patients. Further characterization of high-risk pedigrees is needed for future genomic studies.



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Expression and localization of histamine H1, H2, and H3 receptors in rat olfactory epithelium

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Chao Yu, Li Li, Qingjie Xia, Yuedi Tang
ObjectiveHistamine is an important chemical mediator in the development of allergic rhinitis and plays a key role in eliciting the nasal symptoms of the disorder. Histamine may also affect smell as a neurotransmitter. However, whether histamine receptors are present in the mammalian olfactory epithelium has not yet been examined. The aim of this study was to investigate the expression and distribution of histamine H1, H2, and H3 receptors in rat olfactory epithelium.MethodsReal-time quantitative PCR and immunohistochemical staining were performed to examine the mRNA level and protein expression and localization of histamine receptors (H1, H2, and H3) in rat olfactory epithelium.ResultsWe demonstrated that mRNAs encoding histamine H1, H2, and H3 receptors were detected in rat olfactory epithelium. Immunohistochemistry also showed strong positive staining for these receptors. Co-localization of histamine H1, H2, and H3 receptors with olfactory mature protein revealed that these three histamine receptors were mainly localized in olfactory receptor neurons.ConclusionsThese findings indicate that histamine H1, H2, and H3 receptors are present in rat olfactory epithelium and may play a physiological role in olfactory transmission.



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Determinants of caregivers' awareness of Universal Newborn Hearing Screening in Malaysia

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Abdul Halim Abdul Majid, Mohd Normani Zakaria, Nor Azimah Chew Abdullah, Sulaiman Hamzah, Siti Zamratol-Mai Sarah Mukari
ObjectiveThis paper aims to investigate the effects of perceived attitude and anxiety on awareness of UNHS among caregivers in Malaysia.MethodsUsing cross sectional research approach, data were collected and some 46 out of 87 questionnaires distributed to caregivers attending UNHS programs at selected public hospitals were usable for analysis (response rate of 52.8%). Partial Least Squares Method (PLS) algorithm and bootstrapping technique were employed to test the hypotheses of the study.ResultsR square value is 0.205, and it implies that exogenous latent variables explained 21% of the variance of the endogenous latent variable. This value indicates moderate and acceptable level of R-squared values. Findings from PLS structural model evaluation revealed that anxiety has no significant influence (β = −0.091, t = 0.753, p > 0.10) on caregivers' awareness; but perceived attitude has significant effect (β = −0.444, t = 3.434, p < 0.01) on caregivers' awareness.ConclusionCaregivers' awareness of UNHS is influenced by their perceived attitude while anxiety is not associated with caregivers' awareness. This implies that caregivers may not believe in early detection of hearing impairment in children, thinking that their babies are too young to be tested for hearing loss. Moreover, socio-economic situation of the caregivers may have contributed to their failure to honor UNHS screening appointments as some of them may need to work to earn a living while some may perceive it a waste of time honoring such appointments. Non-significant relationship between anxiety and caregivers' awareness may be due to religious beliefs of caregivers. Limitations and suggestions were discussed.



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Pediatric neck abscesses: No increase in methicillin-resistant Staphylococcus aureus

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Avital Fellner, Tal Marom, Limor Muallem-Kalmovich, Nathan Shlamkovitch, Ephraim Eviatar, Tzilia Lazarovitch, Jacob Pitaro
IntroductionRecent studies from Western countries showed an increased incidence rate of methicillin-resistant Staphylococcus aureus (MRSA) isolated from pediatric neck abscesses cultures. We sought to examine the microbiology and antibiotic susceptibility of such samples over a 10-year period, and particularly of Staphylococcus aureus (SA), in order to determine whether a similar trend exists in our institution.MethodsA retrospective chart review of children ≤18 years that underwent needle aspiration or surgical drainage of neck abscesses, including suppurative lymphadenitis, retropharyngeal abscesses, and parapharyngeal abscesses was conducted between 1/1/06–31/12/15.ResultsSixty-two children were identified with a male predominance (34, 55%). The median age was 2 years. There were 37 (60%) suppurative lymphadenitis, 15 (24%) parapharyngeal abscess, and 10 (16%) retropharyngeal abscess cases. Twenty-nine (47%) children received antibiotic treatment prior to admission, most commonly β-lactam agents. Of them, 15 (52%) had positive cultures, including 7 (47%) with SA. On admission, 45 (73%) children had already received amoxicillin-clavulanate. Of those who did not improve, 16 (26%) received ceftriaxone and clindamycin. Twenty-one (38%) cultures were negative. The most common isolated bacteria were SA in 13 (24%), Streptococcus pyogenes in 7 (13%), and Streptococcus viridians group in 9 (16%). Of the SA isolates, there was only 1 (8%) case of MRSA; however, there were 4 (31%) clindamycin-resistant SA isolates.ConclusionUnlike previously published data, there was no increase in MRSA incidence at our institution. However, the high prevalence of clindamycin-resistant SA was in line with previous reports. These findings should be considered when starting empirical therapy in pediatric neck abscesses.



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Working memory span in Persian-speaking children with speech sound disorders and normal speech development

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Mohamad reza Afshar, Ali Ghorbani, Vahid Rashedi, Nahid Jalilevand, Mohamad kamali
ObjectivesThe aim of this study was to compare working memory span in Persian-speaking preschool children with speech sound disorder (SSD) and their typically speaking peers. Additionally, the study aimed to examine Non-Word Repetition (NWR), Forward Digit Span (FDS) and Backward Digit Span (BDS) in four groups of children with varying severity levels of SSD.MethodsThe participants in this study comprised 35 children with SSD and 35 typically developing (TD) children -matched for age and sex-as a control group. The participants were between the age range of 48 and 72 months. Two components of working memory including phonological loop and central executive were compared between two groups. We used two tasks (NWR and FDS) to assess phonological loop component, and one task (BDS) to assess central executive component. Percentage of correct consonants (PCC) was used to calculate the severity of SSD.ResultsSignificant differences were observed between the two groups in all tasks that assess working memory (p < 0.001). In addition, the comparison of the phonological loop of working memory between the various severity groups indicated significant differences between different severities of both NWR and FDS tasks among the SSD children (p < 0.001). Nevertheless, comparison of the central executive between various severity groups, which was assessed with the BDS task, did not show any significant differences (p > 0.05). The result showed that PCC scores in TD children were associated with NWR (p < 0.001), FDS (p = 0.001), and BDS (p < 0.001). Furthermore, PCC scores in SSD children were associated with NWR and FDS (p < 0.001), but not with BDS (p > 0.05).ConclusionThe working memory skills were weaker in SSD children, in comparison to TD children. In addition, children with varying levels of severity of SSD differed in terms of NWR and FSD, but not BDS.



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New Developments in the Prophylactic Drug Treatment of Pediatric Migraine: What Is New in 2017 and Where Does It Leave Us?

Abstract

Purpose of Review

Headaches in children are quite common; however, the study and characterization of headache disorders in the pediatric age group has historically been limited. Because of the lack of controlled studies on prophylactic treatment of headache disorders in this age group, the diagnosis of migraine rests on criteria similar those in adults. Likewise, data from adult studies is often inferred and applied to children. Although it appears that many preventives are safe in children, currently none are FDA or EMA approved for this age group. Consequently, many children who present to their primary care physicians with migraines do not receive any preventive therapy despite experiencing significant disability.

Recent Findings

Controlled clinical trials investigating the use of preventive medications in children have suffered from high placebo response rates. The shorter duration of headaches and other characteristic features seen in children are such that designing randomized controlled trials in this age group is more problematic and limiting. Treatment practices vary widely, even among specialists, due to the absence of evidence-based guidelines from clinical trials. The Childhood and Adolescent Migraine Prevention Study (CHAMP) was developed to examine the effectiveness of two of the most widely prescribed preventive medications for pediatric migraine and help narrow this gap. To date, it has been the largest enrolling study of its kind within the pediatric migraine world; its results and implications will be discussed and considered here.

Summary

The CHAMP trial was discontinued early on account of futility and exhibited that neither of two preventive medications for pediatric migraine was more effective than placebo in reducing the number of headache days over a period of 24 weeks. Subjects in the amitriptyline and topiramate groups had higher rates of adverse events than those who had received placebo.

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