Publications by authors named "Antti A Aarnisalo"

51 Publications

Hearing impairment in Angolan children with acute bacterial meningitis with and without otitis media.

Acta Paediatr 2022 Aug 11;111(8):1585-1593. Epub 2022 May 11.

University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Aim: Bacterial meningitis (BM) is a common cause of hearing loss in childhood. Our aim was to investigate bacterial aetiology, hearing impairment and outcome in childhood BM with vs. without otitis media (OM) in Angola.

Methods: Hearing was tested by auditory brainstem response in 391 (76%) children with confirmed BM. The bacteria identified from the ear discharge were compared to those from cerebrospinal fluid (CSF). The hearing findings were compared among children with vs. without OM on days 1 and 7 of hospitalization, and at follow-ups of 1, 3 and 6 month(s).

Results: No correlation was found in bacteriology between the ear discharge and CSF. On day 7 in hospital, hearing impairment (>40 dB) was common, regardless of whether concomitant OM or not (in 27% vs. 30%, respectively). Any hearing deficit on day 7 was associated with a higher risk of complicated or fatal clinical course (OR 2.76, CI 1.43-5.29, p = 0.002).

Conclusion: No significant difference prevailed in hearing thresholds between children with or without OM in hospital on day 7 or at later follow-ups. Any hearing impairment during hospital stay associated with a higher risk for complicated clinical course or death.
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http://dx.doi.org/10.1111/apa.16383DOI Listing
August 2022

MANF supports the inner hair cell synapse and the outer hair cell stereocilia bundle in the cochlea.

Life Sci Alliance 2022 02 23;5(2). Epub 2021 Nov 23.

Molecular and Integrative Biosciences Research Programme, University of Helsinki, Helsinki, Finland

Failure in the structural maintenance of the hair cell stereocilia bundle and ribbon synapse causes hearing loss. Here, we have studied how ER stress elicits hair cell pathology, using mouse models with inactivation of (mesencephalic astrocyte-derived neurotrophic factor), encoding an ER-homeostasis-promoting protein. From hearing onset, deficiency caused disarray of the outer hair cell stereocilia bundle and reduced cochlear sound amplification capability throughout the tonotopic axis. In high-frequency outer hair cells, the pathology ended in molecular changes in the stereocilia taper region and in strong stereocilia fusion. In high-frequency inner hair cells, deficiency degraded ribbon synapses. The altered phenotype strongly depended on the mouse genetic background. Altogether, the failure in the ER homeostasis maintenance induced early-onset stereociliopathy and synaptopathy and accelerated the effect of genetic causes driving age-related hearing loss. Correspondingly, mutation in a human patient induced severe sensorineural hearing loss from a young age onward. Thus, we present MANF as a novel protein and ER stress as a mechanism that regulate auditory hair cell maintenance in both mice and humans.
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http://dx.doi.org/10.26508/lsa.202101068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8616558PMC
February 2022

Spoken Language Skills in Children With Bilateral Hearing Aids or Bilateral Cochlear Implants at the Age of Three Years.

Ear Hear 2022 Jan/Feb;43(1):220-233

Department of Otorhinolaryngology-Head and Neck Surgery, Kuopio University Hospital, Kuopio, Finland.

Objectives: Early hearing aid (HA) fitting and cochlear implants (CIs) aim to reduce the effects of hearing loss (HL) on spoken language development. The goals of this study were (1) to examine spoken language skills of children with bilateral HAs and children with bilateral CIs; (2) to compare their language skills to the age-norms of peers with normal hearing (NH); and (3) to investigate factors associated with spoken language outcomes.

Design: Spoken language results of 56 Finnish children with HL were obtained from a nationwide prospective multicenter study. Children with HL comprised two groups: children with mild-to-severe HL who used bilateral HAs (BiHA group, n = 28) and children with profound HL who used bilateral CIs (BiCI group, n = 28). Children's spoken language comprehension, expressive and receptive vocabulary, and phonological skills were compared with normative values of children with NH at the age of three years. Odds ratio (OR) was calculated to compare proportions of children below age-norms in BiHA and BiCI groups. Factors associated with spoken language outcomes were modeled with analysis of covariance.

Results: At the age of 3 years, 50%-96% of children with HL performed 1 SD or more below the mean of the normative sample of age-peers with NH in spoken language skills, depending on the language domain. Receptive vocabulary and phonological skills were the most vulnerable language domains. In receptive vocabulary, 82% of the children in the BiHA group and 50% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 4.4 times more likely to have poorer receptive vocabulary than the BiCI group. In phonological skills, 96% of children in the BiHA group and 60% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 18.0 times more likely to have poorer phonological skills than the BiCI group. The analysis of covariance models showed that unaided pure-tone average, PTA0.5-4 kHz, had a significant effect on spoken language comprehension in the BiHA group. For the BiCI group, age at HL diagnosis and age at CI activation had a significant effect on expressive vocabulary. High maternal level of education had a significant effect on language comprehension and expressive vocabulary and female gender on phonological skills.

Conclusions: At the age of 3 years, especially receptive vocabulary and phonological skills caused difficulties for children with HL showing also considerable individual variation. Children with bilateral HAs seemed to be more likely to have poorer receptive vocabulary and phonological skills than children with bilateral CIs. A variety of factors was associated with outcomes in both groups. Close monitoring of spoken language skills of children with HL is important for ensuring similar opportunities for all children with HL and timely intervention, when needed.
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http://dx.doi.org/10.1097/AUD.0000000000001092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8694252PMC
April 2022

Development of otology specific outcome measure: Ear Outcome Survey-16 (EOS-16).

J Otol 2021 Jul 20;16(3):150-157. Epub 2021 Jan 20.

Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Purpose: An important outcome measure of patient care is the impact on the patient's health-related quality of life (HRQoL). Current ear-specific HRQoL instruments are designed for one diagnosis and emphasize different subdivisions such as symptoms, hearing problems, psychosocial impact, and the need for care. The optimal length of the recall period has not been studied. For these reasons, a new survey is needed that would cover most chronic ear diseases.

Methods: A preliminary 24-item survey (EOS-24) was created. Untreated adult patients (included n = 186) with one of seven different chronic otologic conditions from all university hospitals in Finland were recruited to respond to EOS-24 and the 15D general HRQoL instrument. The recruiting otologists evaluated the severity of the disease and the disability caused by it. A control group was recruited. Based on the patients' responses in different diagnosis groups, the items were reduced according to pre-defined criteria. The resulting survey was validated using a thorough statistical analysis.

Results: The relevance and necessity of the original 24 items were thoroughly investigated, leading to the exclusion of 8 items and the modification of 1. The remaining 16 items were well-balanced between subdivisions and were useful in all seven diagnosis groups, thus constituting the final instrument, EOS-16. The most suitable recall period was three months.

Conclusions: EOS-16 has been created according to the HRQoL survey guidelines with a versatile nationwide patient population. The survey has been validated and can be used for a wide range of chronic ear diseases as a HRQoL instrument.
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http://dx.doi.org/10.1016/j.joto.2021.01.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8241709PMC
July 2021

Evaluation of pure-tone audiometric protocols in vestibular schwannoma screening.

J Otol 2021 Jul 31;16(3):138-143. Epub 2020 Dec 31.

Head and Neck Center, Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, And University of Helsinki, Helsinki, Finland.

The objective was to evaluate the pure-tone audiogram-based screening protocols in VS diagnostics. We retrospectively analyzed presenting symptoms, pure tone audiometry and MRI finding from 246 VS patients and 442 controls were collected to test screening protocols (AAO-HNS, AMCLASS-A/B, Charing Cross, Cueva, DOH, Nashville, Oxford, Rule3000, Schlauch, Seattle, Sunderland) for sensitivity and specificity. Results were pooled with data from five other studies, and analysis of sensitivity, specificity and positive likelihood ratio (LR+) for each protocol was performed. Our results show that protocols with significantly higher sensitivity (AMCLASS-A/B, Nashville) show also significantly lowest specificity, and tend to have low association (positive likelihood ratio, LR+) to the VS. The highest LR+ was found for protocols AAO-HNS, Rule3000 and Seattle. In conclusions, knowing their properties, screening protocols are simple decision-making tools in VS diagnostic. To use the advantage of the highest sensitivity, protocols AMCLASS-A + B or Nashville can be of choice. For more reasonable approach, applying the protocols with high LR+ (AAO-HNS, Rule3000, Seattle) may reduce the overall number of MRI scans at expense of only few primarily undiagnosed VS.
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http://dx.doi.org/10.1016/j.joto.2020.12.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8241708PMC
July 2021

Improvements in Hearing and in Quality of Life after Sequential Bilateral Cochlear Implantation in a Consecutive Sample of Adult Patients with Severe-to-Profound Hearing Loss.

J Clin Med 2021 May 28;10(11). Epub 2021 May 28.

Department of Otorhinolaryngology, Kuopio University Hospital, 70029 Kuopio, Finland.

Bilateral cochlear implantation is increasing worldwide. In adults, bilateral cochlear implants (BICI) are often performed sequentially with a time delay between the first (CI1) and the second (CI2) implant. The benefits of BICI have been reported for well over a decade. This study aimed at investigating these benefits for a consecutive sample of adult patients. Improvements in speech-in-noise recognition after CI2 were followed up longitudinally for 12 months with the internationally comparable Finnish matrix sentence test. The test scores were statistically significantly better for BICI than for either CI alone in all assessments during the 12-month period. At the end of the follow-up period, the bilateral benefit for co-located speech and noise was 1.4 dB over CI1 and 1.7 dB over CI2, and when the noise was moved from the front to 90 degrees on the side, spatial release from masking amounted to an improvement of 2.5 dB in signal-to-noise ratio. To assess subjective improvements in hearing and in quality of life, two questionnaires were used. Both questionnaires revealed statistically significant improvements due to CI2 and BICI. The association between speech recognition in noise and background factors (duration of hearing loss/deafness, time between implants) or subjective improvements was markedly smaller than what has been previously reported on sequential BICI in adults. Despite the relatively heterogeneous sample, BICI improved hearing and quality of life.
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http://dx.doi.org/10.3390/jcm10112394DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8199295PMC
May 2021

Low inter-rater consistency in semantic profiles of tinnitus-like sounds rated by tinnitus patients.

Prog Brain Res 2021 13;262:93-113. Epub 2020 Aug 13.

Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Characterizations of the tinnitus sound percept are always based on a subjective description by the person affected. Since the experimenter cannot have access to the tinnitus percept, it is not possible to verify whether individuals use the adjectives describing the sound in the expected way, i.e., whether a label given to the tinnitus percept corresponds to the label that the experimenter or another individual would give to the same sound percept. However, if it is assumed that tinnitus patients can reliably describe their own tinnitus, then they should also be able to reliably describe tinnitus-like sounds, presented acoustically. In this study, 26 tinnitus patients used a tablet computer to rate 18 pre-defined adjectives on their level of descriptiveness for their own tinnitus percept as well as 17 tinnitus-like sounds presented via headphones. The main interest of the current study was to calculate intraclass correlation (ICC) and Krippendorff's alpha coefficients for the rating profiles of the acoustically-presented sounds, in order to quantify how well the individuals agreed on the ratings of known sounds, i.e., whether the adjectives would receive similar ratings from all participants for a specific tinnitus-like sound. The results show that the level of agreement was low for all adjectives and sounds, meaning that the different individuals did not use the adjectives in a consistent manner. The conclusion is that subjective tinnitus descriptions should be interpreted with great caution, and that the inherent variability involved in the characterization of sounds by naïve listeners can contribute to the observed heterogeneity in tinnitus symptoms and treatment outcomes.
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http://dx.doi.org/10.1016/bs.pbr.2020.06.021DOI Listing
November 2021

An exploratory investigation of speech recognition thresholds in noise with auralisations of two reverberant rooms.

Int J Audiol 2021 03 23;60(3):210-219. Epub 2020 Sep 23.

Aalto Acoustics Lab, Department of Signal Processing and Acoustics, Aalto University, Espoo, Finland.

Objective: Speech-in-noise tests are widely used in hearing diagnostics but typically without reverberation, although reverberation is an inextricable part of everyday listening conditions. To support the development of more real-life-like test paradigms, the objective of this study was to explore how spatially reproduced reverberation affects speech recognition thresholds in normal-hearing and hearing-impaired listeners.

Design: Thresholds were measured with a Finnish speech-in-noise test without reverberation and with two test conditions with reverberation times of ∼0.9 and 1.8 s. Reverberant conditions were produced with a multichannel auralisation technique not used before in this context.

Study Sample: Thirty-four normal-hearing and 14 hearing-impaired listeners participated in this study. Five people were tested with and without hearing aids.

Results: No significant differences between test conditions were found for the normal-hearing listeners. Results for the hearing-impaired listeners indicated better performance for the 0.9 s reverberation time compared to the reference and the 1.8 s conditions. Benefit from hearing aid use varied between individuals; for one person, an advantage was observed only with reverberation.

Conclusions: Auralisations may offer information on speech recognition performance that is not obtained with a test without reverberation. However, more complex stimuli and/or higher signal-to-noise ratios should be used in the future.
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http://dx.doi.org/10.1080/14992027.2020.1817993DOI Listing
March 2021

The long-term learning effect related to the repeated use of the Finnish matrix sentence test and the Finnish digit triplet test.

Int J Audiol 2020 10 27;59(10):753-762. Epub 2020 Apr 27.

Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland.

To assess are there learning-related improvements in the speech reception thresholds (SRTs) for the Finnish matrix sentence test (FMST) and the Finnish digit triplet test (FDTT) in repeated use over 12 months. Test sessions were scheduled at 0, 1, 3, 6 and 12 months, and each session included five FMST measurements and four FDTT measurements. The within-session and inter-session improvements in SRTs were analysed with a linear mixed model. Fifteen young normal-hearing participants. Statistically significant mean improvements of 2.0 dB SNR and 1.2 dB SNR were detected for the FMST and the FDTT, respectively, over the 12-month follow-up period. For the FMST, majority of the improvement occurred during the first two test sessions. For the FDTT, statistically significant differences were detected only in comparison to the first test session and to the first test measurement of every session over the 12-month follow-up. Repeated use of the FMST led to significant learning-related improvements, but the improvements appeared to plateau by the third test session. For the FDTT, the overall improvements were smaller, but a significant within-session difference between the first and consecutive FDTT measurements persisted throughout the test sessions.
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http://dx.doi.org/10.1080/14992027.2020.1753893DOI Listing
October 2020

The efficacy of microphone directionality in improving speech recognition in noise for three commercial cochlear-implant systems.

Cochlear Implants Int 2020 05 11;21(3):153-159. Epub 2020 Mar 11.

Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland.

To investigate the effect of fixed and adaptive microphone directionality on speech reception threshold (SRT) in noise when compared to omnidirectional mode in unilateral cochlear-implant (CI) use for three different CI systems. Twenty-four CI recipients with bilateral severe-to-profound hearing loss participated in the study. Eight recipients of each CI system were enrolled, and their SRT in noise was measured when the speech and noise signals were co-located in the front to serve as a baseline. The acute effect of different microphone directionalities on SRT in noise was measured with the noise emanating at 90° in the horizontal plane from the side of the CI sound processor (S0NCI). When compared to the baseline condition, the individual data revealed fairly similar patterns within each CI system. In the S0NCI condition, the average improvement in SRT in noise for fixed and adaptive directionalities over the omnidirectional mode was statistically significant and ranged from 1.2 to 6.0 dB SNR and from 3.7 to 12.7 dB SNR depending on the CI system, respectively. Directional microphones significantly improve SRT in noise for all three CI systems. However, relatively large differences were observed in the directional microphone efficacy between CI systems.
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http://dx.doi.org/10.1080/14670100.2019.1701236DOI Listing
May 2020

The efficacy of microphone directionality in improving speech recognition in noise for three commercial cochlear-implant systems.

Cochlear Implants Int 2020 05 11;21(3):153-159. Epub 2020 Mar 11.

Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland.

To investigate the effect of fixed and adaptive microphone directionality on speech reception threshold (SRT) in noise when compared to omnidirectional mode in unilateral cochlear-implant (CI) use for three different CI systems. Twenty-four CI recipients with bilateral severe-to-profound hearing loss participated in the study. Eight recipients of each CI system were enrolled, and their SRT in noise was measured when the speech and noise signals were co-located in the front to serve as a baseline. The acute effect of different microphone directionalities on SRT in noise was measured with the noise emanating at 90° in the horizontal plane from the side of the CI sound processor (S0NCI). When compared to the baseline condition, the individual data revealed fairly similar patterns within each CI system. In the S0NCI condition, the average improvement in SRT in noise for fixed and adaptive directionalities over the omnidirectional mode was statistically significant and ranged from 1.2 to 6.0 dB SNR and from 3.7 to 12.7 dB SNR depending on the CI system, respectively. Directional microphones significantly improve SRT in noise for all three CI systems. However, relatively large differences were observed in the directional microphone efficacy between CI systems.
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http://dx.doi.org/10.1080/14670100.2019.1701236DOI Listing
May 2020

Otitis Media-associated Bacterial Meningitis in Children in a Low-income Country.

Pediatr Infect Dis J 2019 08;38(8):791-797

Department of Otorhinolaryngology and Head and Neck Surgery, University of Turku, Turku, Finland.

Background: Otitis media (OM) is a common childhood infection that may result in bacterial meningitis (BM). However, OM-associated BM remains poorly characterized. We aimed to study the occurrence, clinical presentation and outcome of this type of childhood BM in Luanda, Angola.

Methods: Five hundred twelve children from our previous clinical BM trial, with the ear meticulously examined, were analyzed whether they had or not OM, and according to their age, ≤12 month old and >12 month old. Prospectively collected clinical data, laboratory test results and outcome for these groups were assessed.

Results: Sixty-two children (12%) had OM-associated BM, of whom 39 had otorrhea. Ear discharge was more common in older children (median age 45 months old vs. 12 months old; P < 0.001). Children with OM often showed an additional infectious focus (n = 20, 32% vs. n = 82, 18%; P = 0.016), were dehydrated (n = 16, 26% vs. n = 66, 15%; P = 0.04), and showed higher odds of complicated clinical course or death (odds ratios 2.27, 95% CI: 1.004-5.15, P = 0.049) compared with children without OM. The >12-month-old children with OM often arrived in poor clinical condition with coma and/or ptosis. Otorrhea was associated with HIV positivity. Infants with otorrhea frequently lived under poor socioeconomic conditions.

Conclusions: Children with OM-associated BM were prone to many problems, such as being especially ill at presentation, undergoing a difficult clinical course and showing a higher risk of complicated or fatal outcome. HIV infection and malnutrition were common in children with otorrhea, which was also associated with low socioeconomic status.
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http://dx.doi.org/10.1097/INF.0000000000002335DOI Listing
August 2019

tACS-mediated modulation of the auditory steady-state response as seen with MEG.

Hear Res 2018 07 28;364:90-95. Epub 2018 Mar 28.

Center for Mind/Brain Sciences, University of Trento, Italy; Centre for Cognitive Neuroscience, University of Salzburg, Austria.

Background: Previous studies have shown that transcranial electrical stimulation can be successfully applied during simultaneous MEG measurements. In particular, using beamforming they have established that changes of stimulus induced as well as evoked activity can be inspected during transcranial alternating current stimulation (tACS).

Objective/hypothesis: We studied tACS-mediated changes of the auditory steady-state response (ASSR), hypothesizing that-due to the putatively inhibitory role of alpha oscillations-these evoked responses would be diminished.

Methods: We compared ASSRs in conditions with and without 12-Hz and 6.5-Hz sinusoidal 1.5 mA tACS, applied bilaterally over temporal areas. Source-level activity was estimated using a linearly constrained minimum variance beamformer and compared across tACS conditions using paired t-tests following a condition-internal normalization procedure.

Conclusions: By separating the electrical and auditory stimulation to non-overlapping parts of the frequency spectrum, we were able to compare auditory-evoked steady-state activity across tACS conditions. We observed a significant decrease in normalized ASSR power in the 12-Hz tACS condition, illustrating that tACS could induce immediate changes in auditory evoked activity. This study sets a methodology to further interrogate the causal roles of oscillatory dynamics in auditory cortices, as well as suggests perspectives for employing tACS in clinical contexts.
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http://dx.doi.org/10.1016/j.heares.2018.03.023DOI Listing
July 2018

Prognostic Value and Changes of Auditory Brain Stem Response in Children With Bacterial Meningitis in Luanda, Angola.

Clin Med Insights Ear Nose Throat 2018 28;11:1179550618758648. Epub 2018 Feb 28.

Children's Hospital, Helsinki University Hospital, Helsinki, Finland.

Objective: To assess the role of single and repeated auditory brain stem response (ABR) in predicting mortality and severe neurological injury among children having bacterial meningitis (BM) in Luanda, Angola.

Methods: The morphology of ABR traces of 221 children (aged 2 months to 12 years) from admission day was analyzed and compared with age-matched normative data. Absence and delay of traces were compared with mortality and mortality or severe neurological injury in subgroup analyses. Outcome was also evaluated with repeated ABR of 166 children based on presence or absence of responses at 80 dB nHL (normal hearing level) stimulation level.

Results: Individually, the absence of typical ABR waveform did not signify poor outcome. At the group level, latencies and interpeak latencies (IPLs) were significantly prolonged among patients with BM in comparison with controls, and the prolongation correlated with higher mortality or severe neurological sequelae.

Conclusions: We confirmed the effect of BM on neural conduction time in auditory pathway. However, ABR in similar settings seems not useful for individual prognostication, although at the group level, delayed latencies, IPLs, or both associated with poorer outcome.
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http://dx.doi.org/10.1177/1179550618758648DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843090PMC
February 2018

Attenuation of Positive Valence in Ratings of Affective Sounds by Tinnitus Patients.

Trends Hear 2018 Jan-Dec;22:2331216518816215

1 Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Finland.

Affective processing appears to be altered in tinnitus, and the condition is to a large extent characterized by the emotional reaction to the phantom sound. Psychophysiological models of tinnitus and supporting brain imaging studies have suggested a role for the limbic system in the emergence and maintenance of tinnitus. It is not clear whether the tinnitus-related changes in these systems are specific for tinnitus only, or whether they affect emotional processing more generally. In this study, we aimed to quantify possible deviations in affective processing in tinnitus patients by behavioral and physiological measures. Tinnitus patients rated the valence and arousal of sounds from the database. Sounds were chosen based on the normative valence ratings, that is, negative, neutral, or positive. The individual autonomic response was measured simultaneously with pupillometry. We found that the subjective ratings of the sounds by tinnitus patients differed significantly from the normative ratings. The difference was most pronounced for positive sounds, where sounds were rated lower on both valence and arousal scales. Negative and neutral sounds were rated differently only for arousal. Pupil measurements paralleled the behavioral results, showing a dampened response to positive sounds. Taken together, our findings suggest that affective processing is altered in tinnitus patients. The results are in line with earlier studies in depressed patients, which have provided evidence in favor of the so-called positive attenuation hypothesis of depression. Thus, the current results highlight the close link between tinnitus and depression.
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http://dx.doi.org/10.1177/2331216518816215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6291869PMC
August 2019

Patient satisfaction in the long-term effects of Eustachian tube balloon dilation is encouraging.

Acta Otolaryngol 2018 Feb 10;138(2):122-127. Epub 2017 Oct 10.

a Department of Otorhinolaryngology, Head and Neck Center , Helsinki University Hospital, University of Helsinki , Helsinki , Finland.

Object: To investigate the long-term effects of balloon Eustachian tuboplasty (BET) from patient's perspective and to discover which symptoms of Eustachian tube dysfunction (ETD) benefit the most from BET.

Method: We designed a retrospective postal questionnaire based on the seven-item ETD questionnaire (ETDQ-7). Our questionnaire covered the severity of present ETD symptoms in comparison with the preoperative situation, the severity of current overall ear symptoms, and possible surgical interventions after BET. Forty-six patients treated in our institution between 2011 and 2013 fulfilled the inclusion criteria and 74% (34 patients; total 52 ears treated with BET) returned the questionnaire with a mean follow-up time of 3.1 years (range 1.8-4.6 years).

Results: Pain in the ears, feeling of pressure in the ears, and feeling that ears are clogged had reduced in 75% of the ears that suffered from these symptoms preoperatively. Seventy-seven percent of all the responders felt that their overall ear symptoms were reduced. Altogether, 82% of all the patients stated that they would undergo BET again if their ear symptoms returned to the preoperative level.

Conclusion: Patient satisfaction in the long-term effects of BET is encouraging. These results may help clinicians in preoperative patient selection and counselling.
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http://dx.doi.org/10.1080/00016489.2017.1384568DOI Listing
February 2018

Balloon Eustachian tuboplasty under local anesthesia: Is it feasible?

Laryngoscope 2017 May 3;127(5):1021-1025. Epub 2017 Feb 3.

Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Objective: To study whether balloon Eustachian tuboplasty (BET) is a feasible and safe procedure under local anesthesia.

Study Design: Prospective multicenter case-control study.

Methods: Patients undergoing either BET (n = 13) or endoscopic sinus surgery (ESS) (n = 12) under local anesthesia, with the possibility of sedation and analgesia, were monitored during the procedure and recovery period for possible adverse effects. After the procedure, the patients responded to a questionnaire assessing their experience.

Results: No adverse effects were detected in the BET group. Patients in the BET group reported similar Visual Analog Scale scores for pain during the operation as the ESS group (5.0 ± 0.7 vs. 3.2 ± 0.7, mean ± standard error of the mean). However, patients in the BET group experienced more discomfort (4.2 ± 0.6 vs. 2.5 ± 0.3, respectively, P = 0.049). Seventy-seven and 92% of the patients in the BET and ESS groups, respectively, considered the anesthesia and pain relief to be sufficient. Patients from both the BET and ESS groups were almost devoid of pain 1 to 2 hours postoperatively (0.8 ± 0.2 and 1.4 ± 0.3, respectively). In total, 12 of 13 patients in the BET group, and all 12 patients in the ESS group, would choose local anesthesia with sedation and analgesia if they needed to undergo the same procedure again.

Conclusion: BET is a safe and feasible procedure under monitored anesthesia care, including local anesthesia along with sedation and analgesia. There is need for further methodological improvement to reduce pain and discomfort during the operation.

Level Of Evidence: 4. Laryngoscope, 127:1021-1025, 2017.
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http://dx.doi.org/10.1002/lary.26488DOI Listing
May 2017

Prevention of Biomaterial Infection by Pre-Operative Incubation with Human Cells.

Surg Infect (Larchmt) 2017 Apr 7;18(3):336-344. Epub 2017 Mar 7.

1 Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki , Helsinki, Finland .

Background: Cells of tissues and biofilm forming bacteria compete for the living space on the surface of an implant. We hypothesized the incubation of the implant (titanium, polydimethylsiloxane, and polystyrene surface) with human cells before implantation as a strategy to prevent bacterial adhesion and biofilm formation.

Methods: After 24 hours of incubation with human osteogenic sarcoma SaOS-2 cells (1 × 10 cells/mL), the materials were incubated for 4.5 hours or two days with Staphylococcus aureus in serial 1:10 dilutions of 10 colony-forming units/mL. The bacterial adherence and biofilm biomass on materials pre-incubated with SaOS-2 cells were compared with our previous results on materials incubated only with bacteria or in simultaneous co-culture of SaOS-2 cells and S. aureus. Fluorescent microscopy and crystal violet stain were used. The number of viable SaOS-2 and bacterial cells present was tested using colorimetric methods (MTT, LDH) and drop plate method, respectively.

Results: The pre-treatment with human cells was associated with a reduction of bacterial colonization of the biomaterial at 4.5 hours and 48 hours compared with the non-pre-treated materials. The presence of bacteria decreased the number of viable human cells on all materials. ( Supplementary Fig. 1 ; see online supplementary materials at www.liebertpub.com/sur ).

Conclusions: These results suggest that the pre-operative incubation of prostheses with host cells could prevent infection of biomaterials.
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http://dx.doi.org/10.1089/sur.2016.263DOI Listing
April 2017

Otogenic Intracranial Abscesses, Our Experience Over the Last Four Decades.

J Int Adv Otol 2017 Apr 13;13(1):40-46. Epub 2017 Jan 13.

Department of Allergy, University of Helsinki and Helsinki University Hospital, Finland.

Objective: To evaluate the predisposing factors for otogenic intracranial abscesses, assess their changes over time, and analyze how they differ from those due to other causes.

Materials And Methods: The medical records of all patients treated for otogenic intracranial abscesses, between 1970 and 2012 at a tertiary referral center, were retrospectively analyzed. The analysis included patient demographics, clinical characteristics, causative pathogens, treatments, outcomes, and comparisons of otogenic and non-otogenic intracranial abscesses.

Results: Of all intracranial abscesses, 11% (n=18) were otogenic. In the 1970s, otogenic infections were a common predisposing factor for intracranial abscess; but within our study period, the incidence of otogenic intracranial abscesses decreased. Most (94%) otogenic cases were due to chronic suppurative otitis media and 78% were associated with cholesteatoma. Most patients (94%) had ear symptoms. The most common presenting symptoms were discharge from the infected ear (50%), headache (39%), neurological symptoms (28%), and fever (17%). The most common pathogens belonged to Streptococcus spp. (33%), Gram-negative enteric bacteria (22%), and Bacteroides spp. (11%). Neurosurgery was performed on all patients, 69% of which were prior to a later ear surgery. Surgery of the affected ear was performed on 14 patients (78%). A favorable recovery was typical (78%); however, one patient died.

Conclusion: Otogenic intracranial abscesses were most commonly due to a chronic ear infection with cholesteatoma. Ear symptoms and Gram-negative enteric bacteria were more common among patients with otogenic than non-otogenic intracranial abscesses.
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http://dx.doi.org/10.5152/iao.2016.2758DOI Listing
April 2017

Severe Acute Otitis Media and Acute Mastoiditis in Adults.

J Int Adv Otol 2016 Dec 28;12(3):224-230. Epub 2016 Nov 28.

Department of Otorhinolaryngology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Objective: To evaluate and compare clinical and microbiological findings in adults hospitalized for acute otitis media (AOM) or mastoid infections (acute or latent).

Materials And Methods: We retrospectively reviewed the medical records of all adults (≥17 years old) hospitalized (between 2003 and 2012) at a tertiary referral center for acute mastoid infections or AOM not responding to outpatient medical treatment.

Results: Of the 160 patients in the study sample, 19% had an infection caused by S. pyogenes, 14% by S. pneumoniae, and 11% by P. aeruginosa. AOM was the most common infection (38%), whereas 33% had acute mastoiditis (AM), 18% had latent mastoiditis (LM), and 13% AM of a chronically infected ear (AMc). In contrast to the other infections, P. aeruginosa (30%) and S. aureus (25%) were most common in AMc. Otorrhea (83%), tympanic membrane perforation (57%), and hearing problems (83%) were common in S. pyogenes infections. Patients with S. pneumoniae had longer lengths of hospitalization than those with other bacterial infections (7 vs. 4 days). Otorrhea (94%) and retroauricular symptoms were more common in P. aeruginosa infections. Hearing symptoms were common (67%) but fever (32%) and retroauricular symptoms were uncommon in AOM. Fever (44%) and mastoid tenderness (65%) were common in AM. Patients with LM underwent the most mastoidectomies (54%). Prior medical conditions, retroauricular symptoms, otorrhea (90%), and post-infection problems were common in AMc.

Conclusion: The bacteriological etiology of hospitalized AOM more closely resembled those of LM and AM than that of AMc. Adults hospitalized for AOM or AM required fewer mastoidectomies than those hospitalized for LM or AMc.
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http://dx.doi.org/10.5152/iao.2016.2620DOI Listing
December 2016

Differentiating Acute Otitis Media and Acute Mastoiditis in Hospitalized Children.

Curr Allergy Asthma Rep 2016 10;16(10):72

Department of Otorhinolaryngology, University of Helsinki and Helsinki University Hospital, Kasarmikatu 11-13, P.O. Box 263, Fin-00029 HUH, Helsinki, Finland.

Acute otitis media is a common infection in children. Most acute otitis media episodes can be treated at an outpatient setting with antimicrobials, or only expectant observation. Hospital treatment with parenteral medication, and myringotomy or tympanostomy, may be needed to treat those with severe, prolonged symptoms, or with complications. The most common intratemporal complication of acute otitis media is acute mastoiditis. If a child with acute mastoiditis does not respond to this treatment, or if complications develop, further examinations and other surgical procedures, including mastoidectomy, are considered. Since the treatment of complicated acute otitis media and complicated acute mastoiditis differs, it is important to differentiate these two conditions. This article focuses on the differential diagnostics of acute otitis media and acute mastoiditis in children.
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http://dx.doi.org/10.1007/s11882-016-0654-1DOI Listing
October 2016

Competitive colonization of prosthetic surfaces by staphylococcus aureus and human cells.

J Biomed Mater Res A 2017 01 27;105(1):62-72. Epub 2016 Aug 27.

Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Implantation of a biomaterial provides an adhesion substratum both to host cell integration and to contaminating bacteria. We studied simultaneous competitive adhesion of Staphylococcus aureus in serial 1:10 dilutions of 10 colony forming units (CFU)/mL and human osteogenic sarcoma (SaOS-2) or primary osteoblast (hOB) cells, both 1x10 cells/mL, to the surfaces of titanium, polydimethylsiloxane and polystyrene. The bacterial adherence and human cell proliferation, cytotoxicity and production of reactive oxygen species (ROS) were studied using fluorometric (fluorescent microscopy and flow cytometry) and colorimetric methods (MTT, LDH and crystal violet). The bacterial cell viability was also evaluated using the drop plate method. The presence of bacteria resulted in reduced adherence of human cells to the surface of the biomaterials, increased production of ROS, and into increased apoptosis. On the other hand, the presence of either type of human cells was associated with a reduction of bacterial colonization of the biomaterial with Staphylococcus aureus. These results suggest that increasing colonization of the biomaterial surface in vitro by one negatively affects colonization by the other. Host cell integration to an implant surface reduces bacterial contamination, which opens novel opportunities for the design of infection-resistant biomaterials in current implantology and future regenerative medicine. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 62-72, 2017.
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http://dx.doi.org/10.1002/jbm.a.35863DOI Listing
January 2017

Auditory localization by subjects with unilateral tinnitus.

J Acoust Soc Am 2016 05;139(5):2280

Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Biomedicum Helsinki 1, P.O. Box 220, FI-00029 HUS, Helsinki, Finland.

Tinnitus is associated with changes in neural activity. How such alterations impact the localization ability of subjects with tinnitus remains largely unexplored. In this study, subjects with self-reported unilateral tinnitus were compared to subjects with matching hearing loss at high frequencies and to normal-hearing subjects in horizontal and vertical plane localization tasks. Subjects were asked to localize a pink noise source either alone or over background noise. Results showed some degree of difference between subjects with tinnitus and subjects with normal hearing in horizontal plane localization, which was exacerbated by background noise. However, this difference could be explained by different hearing sensitivities between groups. In vertical plane localization there was no difference between groups in the binaural listening condition, but in monaural listening the tinnitus group localized significantly worse with the tinnitus ear. This effect remained when accounting for differences in hearing sensitivity. It is concluded that tinnitus may degrade auditory localization ability, but this effect is for the most part due to the associated levels of hearing loss. More detailed studies are needed to fully disentangle the effects of hearing loss and tinnitus.
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http://dx.doi.org/10.1121/1.4946897DOI Listing
May 2016

Self-Administered Domiciliary tDCS Treatment for Tinnitus: A Double-Blind Sham-Controlled Study.

PLoS One 2016 28;11(4):e0154286. Epub 2016 Apr 28.

Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Biomedicum Helsinki 1, P.O. Box 220, FI-00029 HUS, Helsinki, Finland.

Transcranial direct current stimulation (tDCS) has shown potential for providing tinnitus relief, although positive effects have usually been observed only during a short time period after treatment. In recent studies the focus has turned from one-session experiments towards multi-session treatment studies investigating long-term outcomes with double-blinded and sham-controlled study designs. Traditionally, tDCS has been administered in a clinical setting by a healthcare professional but in studies involving multiple treatment sessions, often a trade-off has to be made between sample size and the amount of labor needed to run the trial. Also, as the number of required visits to the clinic increases, the dropout rate is likely to rise proportionally.The aim of the current study was to find out if tDCS treatment for tinnitus could be patient-administered in a domiciliary setting and whether the results would be comparable to those from in-hospital treatment studies. Forty-three patients with chronic (> 6 months) tinnitus were involved in the study, and data on 35 out of these patients were included in final analysis. Patients received 20 minutes of left temporal area anodal (LTA) or bifrontal tDCS stimulation (2 mA) or sham stimulation (0.3 mA) for ten consecutive days. An overall reduction in the main outcome measure, Tinnitus Handicap Inventory (THI), was found (mean change -5.0 points, p < 0.05), but there was no significant difference between active and sham treatment outcomes. Patients found the tDCS treatment easy to administer and they all tolerated it well. In conclusion, self-administered domiciliary tDCS treatment for tinnitus was found safe and feasible and gave outcome results similar to recent randomized controlled long-term treatment trials. The results suggest better overall treatment response-as measured by THI-with domiciliary treatment than with in-hospital treatment, but this advantage is not related to the tDCS variant. The study protocol demonstrated in the current study is not restricted to tinnitus only.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0154286PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4849783PMC
March 2017

The development and evaluation of the Finnish digit triplet test.

Acta Otolaryngol 2016 Oct 28;136(10):1035-40. Epub 2016 Apr 28.

a Department of Otorhinolaryngology , Kuopio University Hospital , Kuopio , Finland ;

Objectives: The aim of the study was to develop a reliable and easily accessible screening test for primary detection of hearing impairment.

Methods: Digits 0-9 were used to form quasirandom digit triplets. First, digit specific intelligibility functions and speech recognition thresholds (SRTs) were determined. To homogenize the test material digits with steep intelligibility function slopes were chosen and level correction up to ±2 dB were applied to the digits as needed. Evaluation measurements were performed to check for systematic differences in intelligibility between the test lists and to obtain normative reference function for normal-hearing listeners.

Results: The mean SRT and the final slope of the test lists were -10.8 ± 0.1 dB signal-to-noise ratio (SNR) and 21.7 ± 1.8%/dB, respectively (measurements at constant level; inter-list variability). The mean SRT and slope of the test subjects were -10.8 ± 0.5 dB SNR and 23.4 ± 5.2%/dB (measurements at constant level; inter-subject variability). The mean SRT for normal-hearing young adults for a single adaptive measurement is -9.8 ± 0.9 dB SNR.

Conclusion: The Finnish digit triplet test is the first self-screening hearing test in the Finnish language. It was developed according to current standards, and it provides reliable and internationally comparable speech intelligibility measurements.
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http://dx.doi.org/10.1080/00016489.2016.1175662DOI Listing
October 2016

Intracranial abscesses over the last four decades; changes in aetiology, diagnostics, treatment and outcome.

Infect Dis (Lond) 2016 Apr 23;48(4):310-316. Epub 2015 Nov 23.

a Department of Otorhinolaryngology , HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital , Helsinki , Finland.

Background The development of modern medicine has resulted in changes in the predisposing conditions, clinical picture, treatment and results of treatment of intracranial abscesses. This study sought to evaluate these changes in a hospital district. Methods A retrospective analysis of the clinical data of all patients treated due to intracranial abscesses at a tertiary referral centre, between 1970-2012. Results The total number of intracranial abscesses was 166. The incidence of intracranial abscesses was 0.33/100 000/year (2000-2012). The most common predisposing conditions were infection of the ear-, nose- and throat region (22%), odontogenic infection (15%) and cardiac anomaly (13%). Lately (2000-2012), infections of the ear-, nose- and throat region (15%) and cardiac anomalies (5%) have become less common, whereas odontogenic infections (32%) have become more common. The most common pathogens belong to Streptococcus spp (42%), Fusobacteriae (14%), Actinomycetales (8%) and Staphylococcus spp (8%). Most patients (66%) experienced a favourable recovery; the proportion of patients with favourable outcome enabling return to prior occupation rose over time, from 12% in 1970-1989 to 24% in 1990-2012. Conclusions The predisposing conditions for intracranial abscesses have changed markedly within the study period. Odontogenic infections have become a common predisposing condition, whereas infections of the ear-, nose- and throat region and cardiac malformations are nowadays less common as predisposing conditions compared to at the beginning of the study period. The proportion of patients with favourable outcome enabling return to prior occupation seems to have increased with time.
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http://dx.doi.org/10.3109/23744235.2015.1113557DOI Listing
April 2016

Characteristics and international comparability of the Finnish matrix sentence test in cochlear implant recipients.

Int J Audiol 2015 28;54 Suppl 2:80-7. Epub 2015 Aug 28.

b HörTech gGmbH , Oldenburg , Germany.

Objectives: The first Finnish sentence-based speech test in noise--the Finnish matrix sentence test--was recently developed. The aim of this study was to determine the characteristics of the new test with respect to test-retest reliability, speech recognition curve, and international comparability in Finnish cochlear implant (CI) recipients.

Design: The speech reception thresholds (SRT) were measured by means of an adaptive test procedure and compared with the results of the traditional Finnish word test. Additional measurements for concurrent slope and SRT estimation were conducted to determine the speech recognition curve and to check the test-retest reliability.

Study Sample: The measurements were performed on 78 Finnish CI recipients. In a subset of 25 patients, additional measurements for test-retest reliability and slope determination were performed.

Results: The mean SRT was -3.5 ± 1.7 dB SNR, with only a weak correlation with the Finnish word test. Test-retest reliability was within ± 1 dB and the mean slope of the speech recognition curve was 14.6 ± 3.6 %/dB. The rehabilitation results were similar to the results published for the German matrix test.

Conclusions: The Finnish matrix test was found to be suitable and efficient in CI recipients with similar characteristics as the German matrix test.
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http://dx.doi.org/10.3109/14992027.2015.1070309DOI Listing
September 2016

Children hospitalized due to acute otitis media: how does this condition differ from acute mastoiditis?

Int J Pediatr Otorhinolaryngol 2015 Sep 25;79(9):1429-35. Epub 2015 Jun 25.

Department of Otorhinolaryngology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4E, PO Box 220, Helsinki FI-00029 HUS, Finland.

Objectives: To evaluate the clinical picture and microbiological findings of children hospitalized due to acute otitis media and to analyze how it differs from acute mastoiditis.

Methods: A retrospective review of the medical records of all children (0-16 years) hospitalized due to acute otitis media in the Department of Otorhinolaryngology at the Helsinki University Hospital, between 2003 and 2012. Comparison with previously published data of children with acute mastoiditis (n=56) from the same institute and period of time.

Results: The most common pathogens in the children hospitalized due to acute otitis media (n=44) were Streptococcus pneumoniae (18%), Pseudomonas aeruginosa (16%), Streptococcus pyogenes (14%), and Staphylococcus aureus (14%). One of the most common pathogens of out-patient acute otitis media, Haemophilus influenzae, was absent. Otorrhea was common in infections caused by S. pyogenes and otorrhea via tympanostomy tube in infections caused by P. aeruginosa. In children under 2 years-of-age, the most common pathogens were S. pneumoniae (43%), Moraxella catarrhalis (14%), and S. aureus (7%). S. pyogenes and P. aeruginosa were only found in children over 2 years-of-age. Previous health problems, bilateral infections, and facial nerve paresis were more common in children hospitalized due to acute otitis media, compared with acute mastoiditis, but they also demonstrated lower CRP values and shorter duration of hospital stay. The number of performed tympanostomies and mastoidectomies was also comparatively smaller in the children hospitalized due to acute otitis media. S. aureus was more common and S. pneumoniae, especially its resistant strains, was less common in the children hospitalized due to acute otitis media than acute mastoiditis.

Conclusions: Acute otitis media requiring hospitalization and acute mastoiditis compose a continuum of complicated acute otitis media that differs from common out-patient acute otitis media. The bacteriology of children hospitalized due to acute otitis media resembled more the bacteriology of acute mastoiditis than that of out-patient acute otitis media. The children hospitalized due to acute otitis media needed less surgical treatment and a shorter hospitalization than those hospitalized due to acute mastoiditis.
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http://dx.doi.org/10.1016/j.ijporl.2015.06.019DOI Listing
September 2015

Transcutaneous vagus nerve stimulation modulates tinnitus-related beta- and gamma-band activity.

Ear Hear 2015 May-Jun;36(3):e76-85

1Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland; 2Department of Biomedical Engineering and Computational Science, Aalto University School of Science, Espoo, Finland; 3School of Medicine, University of Tampere, Tampere, Finland; 4BioMag Laboratory, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland; and 5Helsinki Ear Institute, Helsinki, Finland.

Objectives: The ability of a treatment method to interfere with tinnitus-related neural activity patterns, such as cortical gamma rhythms, has been suggested to indicate its potential in relieving tinnitus. Therapeutic modulation of gamma-band oscillations with vagus nerve stimulation has been recently reported in epileptic patients. The aim of this study was to investigate the effects of transcutaneous vagus nerve stimulation (tVNS) on neural oscillatory patterns.

Design: We calculated the power spectral density and synchrony of magnetoencephalography recordings during auditory stimulation in seven tinnitus patients and eight normal-hearing control subjects. Comparisons between subject groups were performed to reveal electrophysiological markers of tinnitus. tVNS-specific effects within each group were studied by comparing recording blocks with and without tVNS. We also investigated the correlation of each measure with individual ratings of tinnitus distress, as measured by the tinnitus handicap inventory questionnaire.

Results: Tinnitus patients differed from controls in the baseline condition (no tVNS applied), measured by both cortical oscillatory power and synchronization, particularly at beta and gamma frequencies. Importantly, we found tVNS-induced changes in synchrony, correlating strongly with tinnitus handicap inventory scores, at whole-head beta-band (r = -0.857, p = 0.007), whole-head gamma-band (r = -0.952, p = 0.0003), and frontal gamma-band (r = -0.952, p = 0.0003).

Conclusions: We conclude that tVNS was successful in modulating tinnitus-related beta- and gamma-band activity and thus could have potential as a treatment method for tinnitus.
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http://dx.doi.org/10.1097/AUD.0000000000000123DOI Listing
January 2016

Bacteriology in relation to clinical findings and treatment of acute mastoiditis in children.

Int J Pediatr Otorhinolaryngol 2014 Dec 17;78(12):2072-8. Epub 2014 Sep 17.

Department of Otorhinolaryngology, Helsinki University Central Hospital, Haartmaninkatu 4E, PO Box 220, FI-00029 HUS, Helsinki, Finland; University of Helsinki, Helsinki, Finland.

Objective: We assessed clinical, radiological, laboratory and microbiological findings in children with acute mastoiditis in order to improve the diagnostics and treatment of these patients. We also investigated whether different pathogens cause different clinical findings of mastoiditis.

Methods: A retrospective review of the medical records of all children aged 0-16 years treated as in-ward patients for acute mastoiditis at Helsinki University Central Hospital, Department of Otorhinolaryngology, between 2003 and 2012.

Results: Fifty-six patients met the inclusion criteria. The incidence of mastoiditis was 1.88/100000/year. The most common pathogens were Streptococcus pneumoniae (38%), Streptococcus pyogenes (11%) and Pseudomonas aeruginosa (11%). Of S. pneumoniae, 48% had reduced susceptibility (intermediate or resistant) for the common antimicrobials; this was clearly overrepresented relative to the background population (p<0.001). Otalgia and retroauricular symptoms were common in the patients with S. pneumoniae. Otorrhoea was less common (p=0.03) in these patients relative to the other pathogens. Patients with S. pneumoniae had more destruction of the mastoid septa (p=0.05) than patients with any of the other pathogens. Mastoidectomy was performed in 34% of all cases, it was most common (60%) in the patients with S. pneumoniae with reduced susceptibility. The patients with S. pyogenes had less otalgia and seemed to have less retroauricular symptoms relative to other pathogens. P. aeruginosa especially affected children with tympanostomy tubes, caused otorrhoea in all patients and caused a milder form of disease with less retroauricular swelling (p=0.04) than the other pathogens, and there was no need for mastoidectomies. The younger children (<2 years) had less otorrhoea and more retroauricular symptoms of infection than the older patients. No significant differences emerged in outcome of the patient groups.

Conclusions: The clinical findings of acute mastoiditis differ according to the causative pathogen. S. pneumoniae, especially strains with reduced susceptibility, causes severe symptoms and leads to mastoidectomy more often than the other pathogens. S. pyogenes causes less otalgia than the other pathogens. P. aeruginosa particularly affects children with tympanostomy tubes and causes a less aggressive form of disease.
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http://dx.doi.org/10.1016/j.ijporl.2014.09.007DOI Listing
December 2014
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