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The impact of vibrotactile feedback of the gravity vector, provided by a “balance” belt worn around the waist, was evaluated in 39 patients with a severe bilateral vestibular loss, confirmed by extensive laboratory testing and suffering from a low quality of life, mainly due to imbalance. The mobility and balance score (MBS) of all patients prior to the use of the belt was equal or less than 5 out of a scale of 10. Thirty-one out of the 39 patients experienced the effect of the belt on their balance and mobility as positive in a preselection trial of 2 h in the hospital. The 31 positive responders then used the belt for 1 month in daily life. The average MBS increased significantly from 4.2 to 7.9 (paired T test, T = 9.82, p < 0.00001). Twenty-three out of 31 patients reported a benefit ranging from an improvement of 60–200% in their MBS. Eight patients did not experience any benefit. In summary, 23 out of 39 patients with a severe imbalance due to a bilateral vestibular loss experienced a clear benefit of vibrotactile feed = back in daily life. We conclude that vibrotactile feedback via the waist can serve as an effective prothesis for patients with severe bilateral vestibular loss to improve the quality of life.

Little is known about the evolution of vestibular dysfunction and health-related quality of life in bilateral vestibulopathy patients over time. Furthermore, it is unknown whether etiology influences the evolution. A retrospective study was performed investigating the vestibular function at two different time points during a median follow-up time of 24 months in 97 bilateral vestibulopathy patients. Additionally, to evaluate the quality of life and symptoms, validated questionnaires were analyzed. The sum of the caloric testing on the right side and the gain of the rotatory chair torsion swing test significantly decreased over time ( p  = 0.020 and p  = 0.017, respectively). The left-sided caloric tests remained stable, but the median was already 0°/sec at baseline testing. On the contrary, vHIT gain significantly improved on both sides during follow-up (right: p  = 0.003, left: p  = 0.000). However, the median differences were not clinically relevant. Only two patients (2%) who improved on caloric testing, failed to reach the criteria for bilateral vestibulopathy at follow-up. Both patients had idiopathic bilateral vestibulopathy. At baseline, these patients did already not comply with the criteria for bilateral vestibulopathy based on the vHIT and/or torsion swing test. There was no significant change in the total DHI, EQ-5D-5 L VAS, or HADS scores. The EQ-5D-5 L index significantly increased ( p  = 0.034). No significant relationship could be determined between etiology and the evolution of vestibular function, quality of life, and symptoms. In conclusion, in the majority of bilateral vestibulopathy patients, vestibular function, health-related quality of life and symptoms did not show a clinically relevant improvement over time.

Eight adults with severe vestibular hypofunction underwent implantation of a device that stimulates the semicircular canal branches with continuous information about the angular motion of the head. At 6 months and 1 year, most tests of posture, gait, and quality of life showed improvement. There was hearing loss in the ear with the implant in seven participants.

Users of hearing-assistive devices often struggle to locate and segregate sounds, which can make listening in schools, cafes, and busy workplaces extremely challenging. A recent study in unilaterally implanted CI users showed that sound-localisation was improved when the audio received by behind-the-ear devices was converted to haptic stimulation on each wrist. We built on this work, using a new signal-processing approach to improve localisation accuracy and increase generalisability to a wide range of stimuli. We aimed to: (1) improve haptic sound-localisation accuracy using a varied stimulus set and (2) assess whether accuracy improved with prolonged training. Thirty-two adults with normal touch perception were randomly assigned to an experimental or control group. The experimental group completed a 5-h training regime and the control group were not trained. Without training, haptic sound-localisation was substantially better than in previous work on haptic sound-localisation. It was also markedly better than sound-localisation by either unilaterally or bilaterally implanted CI users. After training, accuracy improved, becoming better than for sound-localisation by bilateral hearing-aid users. These findings suggest that a wrist-worn haptic device could be effective for improving spatial hearing for a range of hearing-impaired listeners.

Patients with bilateral vestibular failure (BVF) exhibit imbalance when standing and walking that is linked to a higher fall risk. The purpose of this study was to identify risk factors for falls in BVF. We therefore systematically investigated the interrelationship of clinical and demographic characteristics, gait impairments, and the fall frequency of these patients. Clinical and demographic characteristics as well as quantitative measures of gait performance on a pressure-sensitive gait carpet were collected from 55 patients with different etiologies of BVF. Clinical and demographic data as well as spatiotemporal gait characteristics were used for ANOVA testing and a logistic regression model with categorized fall events as dependent variables. The impairment of peripheral vestibular function, duration of disease, and the overall gait status were not associated with the history of falls in patients with BVF. In contrast, the most predictive factors for falls in BVF were an increase in temporal gait variability, especially at slow walking speeds ( p  < 0.001; OR = 1.3), and the presence of a concomitant peripheral neuropathy ( p  < 0.045; OR = 3.6). BVF patients with a high risk of falling exhibit specific gait alterations in a speed-dependent manner. In particular, increased gait fluctuations during slow walking are most predictive for an increased fall risk. The presence of a concomitant peripheral neuropathy further critically impairs postural stability in these patients. Clinical assessment of both these aspects is therefore important to identify those patients at a particularly high fall risk and to initiate preventive procedures early.

This study aimed to characterize effects of bilateral bone conduction devices (BCD) including the Cochlear™ Osia ® (Osia) and the Cochlear™ percutaneous Baha ® Connect System (Baha) on localization of stationary and moving sound in children and adolescents with bilateral atresia. Participants were 11 listeners with BCDs [ M Age (SD) = 14.7(3.5) years] and 11 age-matched controls [ M Age (SD) = 14.9(1.9) years]. Outcomes were word recognition in quiet and noise, spatial release from masking (SRM) [spondee-word recognition thresholds in noise at co-located/0° or separated (90° left/right) positions], self-reported hearing using the Speech, Spatial and Qualities of Hearing Scale (SSQ), and localization of stationary and moving sound with tracking of real-time unrestricted head movements. BCD users had reduced speech perception accuracy in noise during unilateral listening ( p < .001) and higher speech recognition thresholds than controls ( p = .001). BCD users had higher errors than controls during stationary ( p < .001) and moving ( p < .001) sound localization consistent with self-reported spatial hearing challenges. BCD users had significantly reduced errors during bilateral use compared to unilateral use for stationary ( p < .01) but not always for moving (right unilateral: p < .01; left unilateral: p = .46) sound localization. BCD users spent less time moving their heads in the correct direction compared to controls for stationary and moving sound localization ( p < .01). Results indicate that children and adolescents with BCDs demonstrate improved localization of stationary but not moving sound-sources, with bilateral device use compared to unilateral use. This finding provides evidence for some access to binaural cues and mitigation of head shadow despite transcranial attenuation, but ineffective use of head movements.

Background Otitis media with effusion (OME) is an accumulation of fluid in the middle ear affecting about 80 % of children by the age of 4 years. While OME usually resolves spontaneously, it can affect speech, behaviour and development. Children with persistent hearing loss associated with OME are usually offered hearing aids or insertion of ventilation tubes through the tympanic membrane. Oral steroids may be a safe and effective treatment for OME, which could be delivered in primary care. Treatment with oral steroids has the potential to benefit large numbers of children and reduce the burden of care on them and on health services. However, previous trials have either been too small with too short a follow-up period, or of too poor quality to give a definite answer. The aim of the Oral Steroids for the Resolution of Otitis Media with Effusion in Children (OSTRICH) trial is to determine if a short course of oral steroids improves the hearing of children with OME in the short and longer term. Methods/design A total of 380 participants (children of 2 to 8 years of age) are recruited from Hospital Ear, Nose and Throat departments in Wales and England. A trained clinician seeks informed consent from parents of children with symptoms for at least 3 months that are attributable to OME and with confirmed bilateral hearing loss at study entry. Participants are randomised to a course of oral steroid or a matched placebo for 1 week. Outcomes include audiometry, tympanometry and otoscopy assessments; symptoms; adverse effects; functional health status; quality of life; resource use; and cost effectiveness. Participants are followed up at 5 weeks, and at 6 and 12 months after the day of randomisation. The primary outcome is audiometry-confirmed satisfactory hearing at 5 weeks. Discussion An important evidence gap exists regarding the clinical and cost effectiveness of short courses of oral steroid treatment for OME. Identifying an effective, safe, nonsurgical intervention for OME in children for use in primary care would be of great benefit to children, their families and the NHS. Trial registration ISRCTN: ISRCTN49798431 (Registered 7 December 2012)

To compare the visual outcomes, safety, and patient-reported outcomes of ISBCS versus DSBCS in adults undergoing cataract surgery. A systematic search of PubMed, Embase, CENTRAL, Web of Science, and gray literature (conference abstracts, registries) was conducted for studies published up to March 2023. Eligible studies directly compared ISBCS and DSBCS in adults, reporting best corrected visual acuity (BCVA), complications, or patient-reported outcomes. Two reviewers independently screened studies, extracted data, and resolved discrepancies by consensus. Nine studies were included (3 randomized controlled trials, 5 retrospective cohorts, 1 review), encompassing sample sizes ranging from 298 patients to over 496,000 eyes. Both ISBCS and DSBCS resulted in significant improvements in BCVA, with comparable refractive accuracy. No significant differences were observed in serious complications such as endophthalmitis, cystoid macular edema, or posterior capsular rupture. Some studies reported a trend toward slightly higher patient satisfaction and faster rehabilitation in the ISBCS group. ISBCS appears to be a safe and effective alternative to DSBCS in carefully selected patients, offering potential benefits in efficiency, recovery time, and patient satisfaction. Rigorous randomized controlled trials with standardized outcome measures and long-term follow-up are needed to further validate these findings.

ObjectiveTo study the behavioral relevance of postural and ocular-motor deficits on daily activity and risk of falling in patients with bilateral vestibular hypofunction (BVH).MethodsThirty patients with BVH and 30 age- and gender-matched healthy controls participated in a continuous 2-week assessment of daily activities and mobility using a body-worn inertial sensor and a 6-month prospective fall risk assessment. At inclusion, patients and controls further underwent a multi-modal clinical, score- and instrument-based assessment of general health and balance status. We analyzed the relationship between clinical, lab-, and sensor-based measures and their validity to identify those patients at a risk of general, frequent, and severe falling.ResultsPatients exhibited impairments in daily activity in particular in terms of reduced ambulatory activity (p = 0.009). 43% of patients experienced falls (13% in controls, p = 0.008) and 70% of these patients reported recurrent falling (0% in controls, p = 0.001) during prospective assessment. Severe fall-related injuries that would require medical attention neither occurred in patients nor in controls. Classificatory models based on multi-modal clinical, lab-, and sensor-based measures of balance and mobility identified patients who fell with an accuracy of 93% and patients who recurrently fell with an accuracy of 89%.ConclusionBVH is linked to particular impairments of patients’ daily activities which in turn are related to patients’ fall risk. Hence, off-laboratory measures of daily mobility may supplement standard clinical assessment in BVH to more adequately capture the burden of disease and to reliably identify those patients at a specific risk of falling.

Bilateral vestibular hypofunction (BVH) probably represents a heterogeneous disorder with different types of clinical pictures, with and without vertigo. In spite of increasingly sophisticated electrophysiological testing, still many challenges are met when establishing a diagnosis of BVH. Here, we review the main challenges, which are a reflection of its often difficult clinical presentation and the lack of diagnostic standards regarding the implementation and interpretation of vestibular tests. These challenges show that there is an urgent need for standardization. The resulting decisions should be used for the development of uniform diagnostic criteria for BVH, which are, at present, not yet available.