Average Threshold Research Articles

Salinity management of reservoirs by linking hydrodynamic model, surrogate model, and evolutionary optimization

This study proposes a combined system for salinity management of reservoirs in which the lake ecosystem simulation is integrated with the reservoir operation optimization. A finite volume-based depth-averaged model is applied for simulating salinity in the reservoir for a long-term period. Then, a surrogate model is developed by applying outputs of the fluid dynamic model using adaptive neuro-fuzzy inference system. The surrogate model is used in the structure of the optimization model to estimate the average salinity concentration in the reservoir. Two objectives are defined in the reservoir operation optimization including minimizing water supply loss and mitigating salinity impacts on the aquatic habitats in the lake ecosystem. According to case study results, the fluid dynamic model is reliable for simulating salinity distribution in the reservoir, which means it is recommendable for simulating salinity distribution of reservoirs. Moreover, The Nash–Sutcliff coefficient of surrogate model is 0.79, which implies it is reliable for applying in the optimization model as a surrogate model of salinity. Based on the environmental considerations, 0.55 ppt was defined as the average threshold of habitat suitability. Average optimal salinity during the simulated period is 0.52 ppt, which implies the optimization model is able to reduce salinity impacts properly. We recommend using the proposed method for the case studies in which increasing salinity is an environmental challenge for the aquatic species those living in the artificial lakes of large dams.

Cardiometabolic diseases according to the type and degree of hearing loss in noise-exposed workers.

This study aimed to determine the association between cardiometabolic diseases, including metabolic syndrome, hypertension, and diabetes, and the type and degree of hearing loss in noise-exposed workers. A total of 237,028 workers underwent air conduction pure tone audiometry in 2015 to assess their health and diagnose cardiometabolic diseases. The study defined metabolic syndrome, hypertension, and diabetes using blood pressure, fasting blood sugar, cholesterol, and triglyceride levels. Mid-frequency hearing loss was defined as ≥ 30 dB at 2,000 Hz, whereas high-frequency hearing loss was ≥ 40 dB at 4,000 Hz. The average air conduction hearing thresholds at these frequencies were used to determine hearing loss degrees. The odds ratio (OR) of combined exposure to noise and night-shift work in all cardiometabolic diseases was higher than that of noise exposure alone. The risk of cardiometabolic diseases was dose-response, with higher hearing loss causing higher ORs. The ORs of hypertension compared with the normal group were 1.147 (1.098-1.198), 1.196 (1.127-1.270), and 1.212 (1.124-1.306), and those of diabetes were 1.177 (1.119-1.239), 1.234 (1.154-1.319), and 1.346 (1.241-1.459) for mild, moderate, and moderate-severe hearing loss, respectively. Workers who are exposed to noise tend to demonstrate high risks of hearing loss and cardiometabolic diseases; thus, bio-monitoring of cardiometabolic diseases, as well as auditory observation, is necessary.

Triglyceride to High-Density Lipoprotein Cholesterol Ratio and Sensorineural Hearing Loss in Community-Dwelling Adults: an NHANES Analysis.

Sensorineural hearing loss (SNHL) is prevalent among older adults in the United States. Recent studies suggest the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio as a potential marker for metabolic and cardiovascular conditions. Our research investigates the association between the TG/HDL-C ratio and SNHL using a comprehensive national dataset. This cross-sectional study utilized the National Health and Nutrition Examination Survey (NHANES) data cycle 1999-2000, 2001-2002, 2003-2004, 2011-2012, and 2015-2016. Participants aged 50-69 years with complete audiometry and TG/HDL-C data were included. The outcome was the presence of SNHL, defined as an average hearing threshold >25 dB in the better ear. We employed multivariate logistic regression adjusted for demographics, smoking, noise exposure, and comorbidities to explore the association. A total of 1148 participants constituted the analytic sample, and 31.4% had SNHL. Compared to no SNHL, those with SNHL exhibited higher TG/HDL-C ratios (3.5 vs. 2.7). Elevated TG/HDL-C tertiles correlated with increased SNHL odds [tertile 2: adjusted odds ratio (aOR)=1.50, 95% confidence interval (CI): 0.97-2.32, p=0.069; tertile 3: aOR=1.64, 95% CI: 1.03-2.63, p=0.039]. The link was stronger in participants without diabetes or obesity, with significant predictive values for SNHL presence (area under the ROC curve=0.716 and 0.753, respectively). A higher TG/HDL-C ratio was significantly associated with SNHL in US adults aged 50-69 years, especially in those free from diabetes or obesity. These findings support considering TG/HDL-C as a useful marker for SNHL risk, highlighting the importance of combined metabolic and auditory health assessments.

A Qualitative Analysis of Knowledge Levels, Perceived Susceptibility, and Perceived Severity Surrounding Anal Cancer and Human Papillomavirus.

When examining health literacy and disease specific knowledge levels across ethnicities and communities, ethnic minority groups are known to be at a higher risk of being below the average health literacy threshold which is a factor linked to poor health status and higher mortality rates. This study examined disease specific knowledge levels, perceived severity, and perceived susceptibility surrounding anal cancer and HPV-related screening behaviors. The following research questions were explored: (1) "What are the common themes and/or beliefs when asked about anal cancer, HPV, and preventive screening?" and (2) "What are the common themes and beliefs surrounding the severity and susceptibility of contracting anal cancer?". This study utilized a cross-sectional design to survey 26 individuals regarding their knowledge level and perspectives regarding anal cancer and HPV. An 8-question survey was developed de novo based on an application of the Health Belief Model (HBM) elements. This study employed thematic analysis to explore critical themes to construct a model to understand knowledge levels, attitudes, and risk perceptions regarding anal cancer and intention to participate in preventive screenings. The fundamental attitudes and themes related to anal cancer risk and intention to participate in preventative screenings were elicited using a qualitative descriptive technique. Coded data was utilized to analyze themes based on (1) knowledge and (2) perceived risk, both severity and susceptibility. Overall, the findings indicate very low levels of knowledge regarding screening, anal cancer, and HPV across all genders. The low levels of anal cancer and HPV knowledge were seen in 13 coded segments (50% of surveys) which showed no familiarity with or comprehension of HPV, and 4 coded segments indicated no familiarity with anal cancer. In addition, 15 respondents (57%) had low or no preventive or screening-related knowledge. While some respondents (46%) illustrated high perceived severity for anal cancer, only 23% indicated high perceived susceptibility for anal cancer. The results from this study may be used to inform practitioners, providers, and policymakers in developing interventions addressing low levels of understanding and disease specific knowledge surrounding anal cancer in support of creating a standardized health screening procedure.

Impact of haemoglobin variants on the diagnostic sensitivity of glycated haemoglobin (HbA1c) assay methodologies in sub-Saharan Africa: a laboratory-based method validation study.

the utility of glycated haemoglobin (HbA1c) for the diagnosis and monitoring of diabetes in sub-Saharan Africa is uncertain due to limited data on the performance of the available HbA1c assay methods in this population, which has a high prevalence of haemoglobin variants. We aimed to compare the diagnostic accuracy of the major HbA1c methodologies (Boronate Affinity, Capillary Electrophoresis, High Performance Liquid Chromatography, Immunoassay) in an African population, and assess the impact of the common haemoglobin variant HbAS (sickle cell trait). whole blood samples were obtained from 182 individuals living with type 2 diabetes in Uganda. HbA1c values for each method were compared to average glucose measured over 14 days by continuous glucose monitoring (CGM). To determine concordance, the three HbA1c assay methods were compared to the capillary electrophoresis method. there was a strong correlation between CGM average glucose levels and all four HbA1c methodologies (r=0.81-0.89) which did not differ in those with and without HbAS (present in 37/182 participants). The presence of HbAS did not alter the relationship between HbA1c and CGM glucose for any assay (p for interaction >0.2 for all methods). Diagnostic accuracy for CGM average glucose thresholds of 7 and 10mmol/L was similar across methods (area under the receiver operating characteristic curve 0.80-0.84 and 0.76-0.84 respectively). The maximum bias between the HbA1c assay methodologies was 2 mmol/mol (2.07%). all major HbA1c technologies offer accurate and comparable HbA1c measurement even in this population with high prevalence of haemoglobin variants.

Genetic and phenotypic analysis of MYO15A rare variants associated with autosomal recessive hearing loss

Objective:To analyze the phenotype and genotype characteristics of autosomal recessive hearing loss caused by MYO15A gene variants, and to provide genetic diagnosis and genetic counseling for patients and their families. Methods:Identification of MYO15A gene variants by next generation sequencing in two sporadic cases of hearing loss at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. The sequence variants were verified by Sanger sequencing.The pathogenicity of these variants was determined according to the American College of Medical Genetics and Genomics（ACMG） variant classification guidelines, in conjuction with clinical data. Results:The probands of the two families have bilateral,severe or complete hearing loss.Four variants of MYO15A were identified, including one pathogenic variant that has been reported, two likely pathogenic variants,and one splicing variant of uncertain significance. Patient I carries c. 3524dupA（p. Ser1176Valfs*14）, a reported pathogenic variant, and a splicing variant c. 10082+3G>A of uncertain significance according to the ACMG guidelines. Patient I was treated with bilateral hearing aids with satisfactory effect, demonstrated average hearing thresholds of 37.5 dB in the right ear and 33.75 dB in the left ear. Patient Ⅱ carries c. 7441_7442del（p. Leu2481Glufs*86） and c. 10250_10252del（p. Ser3417del）,a pair of as likely pathogenic variants according to the ACMG guidelines. Patient Ⅱ, who underwent right cochlear implantation eight years ago, achieved scores of 9 on the Categorical Auditory Performance-Ⅱ（CAP-Ⅱ） and 5 on the Speech Intelligibility Rating（SIR）. Conclusion:This study's discovery of the rare c. 7441_7442del variant and the splicing variant c. 10082+3G>A in the MYO15A gene is closely associated with autosomal recessive hearing loss, expanding the MYO15A variant spectrum. Additionally, the pathogenicity assessment of the splicing variant facilitates classification of splicing variations.

Otitis media with effusion in adults during the SARS-CoV-2 epidemic.

The purpose of this study was to investigate the fluctuations in the prevalence of individuals diagnosed with otitis media with effusion (OME) during the SARS-CoV-2 pandemic, while also evaluating the persistence of SARS-CoV-2 in middle ear effusion (MEE) and assessing the effectiveness of tympanocentesis as a treatment modality for OME in this specific period. The total number of outpatients and patients diagnosed with OME in our department was recorded for January 2022 and January 2023. Thirty patients (aged 15-86 years) were categorized into two groups: group A (n = 12), who developed OME during their SARS-CoV-2 infection and group B (n = 18), who experienced OME after the resolution of SARS-CoV-2 infection. All patients underwent otoendoscopic tympanocentesis (without a ventilation tube), where MEE and nasopharyngeal secretions were simultaneously collected for SARS-CoV-2 detection by polymerase chain reaction. The time interval from SARS-CoV-2 infection to tympanocentesis, results of SARS-CoV-2 detection, preoperative and postoperative average hearing threshold, and Eustachian Tube Dysfunction Questionnaire (ETDQ-7) scores were documented. The proportion of outpatients with OME in January 2023 was higher than that in January 2022. There were five patients who had positive test results for SARS-CoV-2 on MEE after tympanocentesis. These 5 patients underwent tympanocentesis at a mean of 28 ± 7.28 days following confirmation of SARS-CoV-2 infection. The ETDQ-7 scores of group A exhibited a reduction from 21.85 ± 4.8 to 10.00 ± 4.07 following tympanocentesis, while the ETDQ-7 scores of group B also demonstrated a decrease from 21.22 ± 4.65 to 10.11 ± 3.68 after undergoing tympanocentesis. The tympanocentesis was effective in both groups. The study confirmed that the proportion of outpatients with OME in the Clinics of Otolaryngology during the SARS-CoV-2 epidemic increased significantly. SARS-CoV-2 RNA was detectable in MEE of COVID-19-related OME patients. Tympanocentesis was therapeutic for OME during SARS-CoV-2 infection, which facilitated viral clearance in MEE.

Ribonucleotides differentially modulate oral glutamate detection thresholds.

The savory or umami taste of the amino acid glutamate is synergistically enhanced by the addition of the purines inosine 5'-monophosphate (IMP) and guanosine 5'-monophosphate (GMP) disodium salt. We hypothesized that the addition of purinergic ribonucleotides, along with the pyrimidine ribonucleotides, would decrease the absolute detection threshold of (increase sensitivity to) l-glutamic acid potassium salt (MPG). To test this, we measured both the absolute detection threshold of MPG alone and with a background level (3mM) of 5 different 5'-ribonucleotides. The addition of the 3 purines IMP, GMP, and adenosine 5'-monophosphate (AMP) lowered the MPG threshold in all participants (P < 0.001), indicating they are positive modulators or enhancers of glutamate taste. The average detection threshold of MPG was 2.08mM, and with the addition of IMP, the threshold was decreased by approximately 1.5 orders of magnitude to 0.046mM. In contrast to the purines, the pyrimidines uridine 5'-monophosphate (UMP) and cytidine 5'-monophosphate (CMP) yielded different results. CMP reliably raised glutamate thresholds in 10 of 17 subjects, suggesting it is a negative modulator or diminisher of glutamate taste for them. The rank order of effects on increasing sensitivity to glutamate was IMP > GMP> AMP >> UMP// CMP. These data confirm that ribonucleotides are modulators of glutamate taste, with purines enhancing sensitivity and pyrimidines displaying variable and even negative modulatory effects. Our ability to detect the co-occurrence of glutamate and purines is meaningful as both are relatively high in evolutionarily important sources of nutrition, such as insects and fermented foods.

Evaluation of Canopy Temperature Based Crop Water Stress Index for Deficit Irrigation Management of Sugar Beet in Semi-Arid Climate

Highlights Sugar beet irrigation scheduling was based on daily average crop water stress index between 13:00 and 16:00 hours. Three crop water stress index thresholds, 0.2, 0.35, and 0.55, were evaluated for irrigation scheduling. Season evapotranspiration decreased and soil water extraction increased as crop water stress threshold increased. There was no significant difference in root or sucrose yield between full irrigation and 0.2 crop water stress index, while seasonal irrigation depths were reduced from133 to 185 mm. Abstract. Sugar beet is an economically important crop in the semi-arid Intermountain Western U.S., with seasonal water use ranging from 500 to 900 mm. Sugar beet is a deep-rooted crop (1.5-2 m) in unrestricted soil profiles that can utilize stored soil water to reduce seasonal irrigation requirements. Effective use of stored soil water below 0.6 m requires precise irrigation scheduling and knowledge of soil water availability below 0.6 m, which is usually unknown due to the labor and expense of soil water monitoring at deeper depths and uncertainty in effective rooting depth and soil water holding capacity. Deficit irrigation (DI) management of sugar beet using a thermal-based crop water stress index (CWSI) has the potential to overcome soil water monitoring limitations and facilitate the utilization of stored soil water to reduce seasonal irrigation requirements. The objective of the research summarized in this paper was to implement and evaluate the effect of automated DI scheduling of sugar beet using three daily average CWSI thresholds (0.2, 0.35, and 0.55) on seasonal irrigation requirement, crop evapotranspiration, seasonal soil water depletion, root yield, estimated recoverable sugar (ERS) yield, and water use efficiency compared to full irrigation. There were no significant differences in root and ERS yield between full irrigation and 0.2 CWSI DI treatment, while seasonal ET was significantly decreased, seasonal soil water extraction was significantly increased, and seasonal irrigation depths were reduced from 133 to 185 mm. Root and ERS yield water production functions were curvilinear with a downward concave. Root and ERS yield water use efficiencies were constant or increased slightly for crop evapotranspiration reductions up to 85% of full irrigation evapotranspiration. The results indicate that irrigating when the average daily CWSI sugar beet exceeds 0.2 is an effective means for mild deficit irrigation scheduling to reduce seasonal irrigation requirements with no significant effect on root and ERS yield. Keywords: Crop water stress index, Evapotranspiration, Irrigation, Irrigation scheduling, Root yield, Sucrose yield, Sugar beet.

Correlations between optic nerve OCT and macular functional alterations in patients who undergone successful RRD surgery

Purpose: The aim is to study the correlation between macular function measured by macular integrity assessment (MAIA) microperimetry and optic nerve (ON) evaluated by ON optical coherence tomography (OCT) in patients undergoing surgery after RRD.Methods: Cross‐sectional unicentric study including 64 eyes with RRD surgically treated compared with 136 healthy eyes. All underwent an ophthalmological examination including MAIA and ON OCT according to the total retina (TR) protocol and the retinal nerve fibre layer (RNFL) protocol.Results: Significant decrease in sensitivity and Macular Average Threshold were achieved in RRD group while macular integrity was higher. Temporal (T) sector of the TR protocol and superior (S) and inferior (I) sectors of the RNFL protocol showed greater thickness in the RRD group. Positive correlations were achieved between S sector of the OCT in both protocols and fixation stability P1; nasal (N) sector in the TR protocol and MAIA inferior outer (IO) sector; I sector in the TR protocol and MAIA IO and inferior inner (II) sectors while in the RNFL protocol with MAIA IO sector; T sector in the TR protocol and Macular Average Threshold; C (central) sector in the TR protocol and MAIA IO and II sectors. Negative correlations were showed between S sector in the RNFL protocol and MAIA C sector while in the TR protocol with BCEA 63% area; N sector in the RNFL protocol and MAIA central nasal (CN) sector; I sector in the RNFL protocol and MAIA IO sector and Macular Integrity; T sector in the RNFL protocol and MAIA C sector while in the TR protocol with BCEA 63% and 95% angles; C sector in the RNFL protocol and MAIA C and CN sectors.Conclusions: RRD causes loss of macular sensitivity together with anatomical changes in the ON. Inferior sectors of MAIA showed more correlations with the OCT TR protocol while C sectors correlated with the RNFL protocol.

Acute and chronic central nervous system oxidative stress/toxicity during hyperbaric oxygen treatment of subacute and chronic neurological conditions.

Oxygen toxicity has been defined as acute central nervous system (CNS), acute pulmonary, and chronic pulmonary oxygen toxicity. This study identifies acute and chronic CNS oxygen toxicity under 2.0 atmospheres absolute (ATA) pressure of oxygen. Methods: The authors' medical records from September 29, 1989 to January 20, 2023 and correspondence to the authors (9/1994 to 1/20.2023) from patients with signs and/or symptoms historically identified as acute CNS oxygen toxicity and those with neurological deterioration receiving hyperbaric oxygen for neurological conditions were reviewed. Acute cases were those occurring with ≤5 HBOTs and chronic cases >5 HBOTs. Chronic cases were separated into those at 1.5 ATA, > 1.5 ATA, or < 1.5 ATA oxygen. Cumulative dose of oxygen in atmosphere-hours (AHs) was calculated at symptom onset. Seven acute cases, average 4.0 ± 2.7 AHs, and 52 chronic cases were identified: 31 at 1.5 ATA (average 116 ± 106 AHs), 12 at >1.5 ATA (103 ± 74 AHs), and 9 at <1.5 ATA (114 ± 116 AHs). Second episodes occurred at 81 ± 55, 67 ± 49, and 22 ± 17 AHs, and three or more episodes at 25 ± 18, 83 ± 7.5, and 5.4 ± 6.0 AHs, respectively. Most cases were reversible. There was no difference between adults and children (p = 0.72). Acute intervention in cases (<3 months) was more sensitive than delayed intervention (21.1 ± 8.8 vs. 123 ± 102 AHs, p = 0.035). Outside sources reported one acute and two chronic exposure deaths and one patient institutionalized due to chronic oxygen toxicity. A withdrawal syndrome was also identified. Hyperbaric oxygen therapy-generated acute and chronic cases of CNS oxygen toxicity in chronic neurological conditions were identified at <2.0 ATA. Chronic CNS oxygen toxicity is idiosyncratic, unpredictable, and occurred at an average threshold of 103-116 AHs with wide variability. There was no difference between adults and children, but subacute cases were more sensitive than chronic intervention cases. When identified early it was reversible and an important aid in proper dosing of HBOT. If ignored permanent morbidity and mortality resulted with continued HBOT.

Determining the sweet detection threshold of COVID-19 patients during infection and recovery periods.

The loss of taste and smell is a common symptom of COVID-19, affecting individuals' quality of life and nutritional status. Detecting sweet thresholds during infection and recovery periods can assist in implementing dietary modifications and nutritional strategies for these patients. To investigate the changes and differences in sweet detection thresholds of confirmed COVID-19 patients on Day 1, Day 10, and Day 14 of the infection and recovery periods. The demographic factors such as gender, smoking status, BMI, and age group were abstracted on Excel sheet from the medical health records for confirmed COVID-19 patients, who were admitted to King Fahad General Hospital in Jeddah, Saudi Arabia, a COVID-19 care facility, from September 2021 to July 2022. Sweet detection thresholds were determined using a pair-wise comparison procedure and sugar solutions with varying concentrations, arranged in ascending order and presented to participants until the lowest detected concentration was noted after three consecutive positive detections, with the median just noticeable difference (JND) value calculated as the population average threshold. Sensory tests were conducted on COVID-19 patients during their infection and recovery periods to evaluate their taste sensation thresholds. The demographic factors of gender, smoking status, BMI, and age group were considered in the analysis. A total of 37 patients who met the inclusion criteria of the study were enrolled as participants. Significant variances in sweet detection thresholds were observed among the COVID-19 patients, with consistent decreases over the three testing days, indicating increasing sucrose sensitivity. Infected men showed significant returns to sweet detection thresholds on Day 14 compared to women, while infected smokers exhibited greater recoveries than non-smokers. Overweight patients had consistently elevated thresholds and recovery rates that were comparable to those of normal-weight patients by Day 14, while younger patients had lower thresholds than their older counterparts. On Day 14, the thresholds had significantly recovered to a level comparable to that of healthy individuals (approximately 0.23%). These findings suggest that sweet detection thresholds can be used as a marker for assessing the progression and recovery of COVID-19 patients. These findings highlight the importance of recognizing and managing alterations in sweet detection thresholds promptly in COVID-19 patients, as this could positively impact dietary management, nutritional recommendations, and interventions during infection and recovery periods.

Analysis of the change path of news dissemination under the trend of short-video convergence - Based on multi-priority dynamic thresholding algorithm

Abstract This paper proposes a multi-priority dynamic threshold algorithm for short video news transmission. The average queue threshold is dynamically adjusted according to the packet priority and unused cache space, and the data frames of short video news nodes are processed into multiple pulse data segments after the encoding process. The success rate and confidentiality of data transmission are improved by scrambling each segment of pulse data. Finally, after updating the thresholds at all levels, the overall thresholds of short video news are kept full to meet the performance requirements of the highest priority queue of short video news. The results show that 95.03% of the short video news with a high dissemination degree has a file size of less than 5 MB, and its video length is most popular among users in the range of 8~15 seconds. Compared to the traditional news dissemination mode, short video news is not limited by time and space, which greatly improves the efficiency of information dissemination.

The effect of screen time on hearing and balance in 6–16 aged children

Background The increase in screen time and the decrease in physical- activity cause balance problems as well as many systemic handicaps. Aims/Objectives This study aimed to determine the effect of screen time on balance and the effect of headphone usage time on hearing. Method Thirty-four individuals aged 6–16 years who applied to our clinic with complaints of dizziness and/or balance disorder were included in the study. Participants were divided into 2 groups according to their screen time: Group 1 (4–8 h/day) and Group2(>8 h/day). The other two groups are grouped according to headphone usage time as Group A (2–4 h/day) and Group B (>4hours/day). Pure-tone audiometry, extended high frequency-audiometry, Videonystagmography (VNG) and Computerized Dynamic Posturography (CDP) tests and Pediatric Berg Balance Scale and Visual Analogue Scale were applied to all individuals. CDP scores and pure tone hearing thresholds between groups were compared. Results A significant difference was observed between Group 1 and Group 2 according to the CDP test (visual, vestibular and composite scores), and according to the VAS-dizziness and PBS (p ≤ .05). Pure tone average and pure tone thresholds at high frequencies were compared between Group A and Group B according to headphone usage time. Pure tone thresholds of Group B were worse at high frequencies than Group A (p ≤ .05). Conclusions It has been observed that prolonged screen time may cause balance impairment in children and prolonged use of headphones may affect high-frequency hearing thresholds.

Diagnosis and treatment of congenital stenosis of external auditory canal with external auditory canal cholesteatoma complicated with exudative effusion in the middle ear and mastoid process

Background The optimal timing for surgery to promote postoperative recovery in children with congenital stenosis of the external auditory canal with external auditory canal cholesteatoma, who are susceptible to exudative inflammation of middle ear and mastoid process, is still uncertain. Objectives To investigate the treatment of congenital stenosis of external auditory canal with external auditory canal cholesteatoma complicated with exudative inflammation. Material and Methods A retrospective analysis of 45 patients with congenital stenosis of external auditory canal with external auditory canal cholesteatoma complicated with mastoiditis. Based on whether effusion had resolved at the time of surgery, the patients were divided into two groups. Pure-tone audiometry tests were performed before and after surgery for both groups. Results The average postoperative duration of dry ear was 36.38 days in Group 1 and 47.90 days in Group 2 (p < 0.05). Among patients who underwent hearing reconstruction, the average air conduction threshold decreased by 15–36 dBHL in Group 1 and by 7–22 dBHL in Group 2 (p < 0.05). Conclusions and significance The postoperative outcomes of dry ear and hearing improvement can be enhanced by performing operation after effusion resolution in cases of congenital external auditory canal stenosis with external auditory canal cholesteatoma exudative inflammation.

Determinants of Cognitive Trajectories in Lower Educated Older Adults: Evidence from Brazil.

AbstractBackgroundPatterns of cognitive change and modifiable factors for declining versus stable cognitive trajectories have rarely been described in a lower‐educated older population. Our goal was to identify heterogeneous long‐term trajectories of cognitive functioning and explore possible factors associated with cognitive decline beyond education, among older Brazilian adults.MethodWe used data on n = 1,042 adults aged ≥ 60 from the Health, Welfare and Aging (SABE) without cognitive impairment at baseline over four waves (2000‐2015) in São Paulo, Brazil. We applied group‐based trajectory modelling to identify cognitive trajectories. Cognition was measured using the abbreviated version of the Mini‐Mental State Examination (MMSE).ResultWe identified three cognitive groups: stable (n = 754), mild declining (n = 183), and strongly declining (n = 105). The probability of being in the strongly declining group membership was 10.7%. According to the MMSE classification, the mild declining group reached the average threshold for cognitive impairment on the last follow‐up, while the strongly declining group was on the second follow‐up. Furthermore, respondents in the stable trajectory were more likely to report more than primary education, to be white and married, to earn more than four times the minimum wage/month, to live in urban areas during childhood, and to practice vigorous physical activity at least three times a week. On the other hand, those in the strongly declining trajectory were more likely to identify as black or mixed, to self‐report subjective emptiness, and to have lower BMI, diabetes, and stroke. Moreover, both mild and strongly declining participants presented higher average age and lower MMSE scores at baseline compared to the stable trajectory. The multinomial logistic regression analysis revealed that respondents who self‐reported being mixed, had higher age, had primary education, had a stroke, and smoked at baseline were more likely to be in the strongly declining group.ConclusionOur findings suggest that besides education, interventions to reduce cognitive decline might include health and social policies addressing inequalities and modifiable risk factor burdens to improve later‐life cognitive functioning of at‐risk individuals. Sample attrition suggests estimates of the magnitude of the risk factors for cognitive decline to be conservative.

Analysis of the effectiveness of hearing solutions for congenital malformation of the middle and outer ear (CMMOE)

Background There are no reports about comprehensive comparative analysis of the effects after various hearing surgery solutions for congenital malformation of the middle and outer ear (CMMOE). Aims/objectives To analyze the improvement of Average Air-Conduction Threshold (AACT) of pure tone after various hearing surgery solutions for CMMOE and provide a reference for the selection of accurate hearing solutions. Materials and methods A retrospective analysis of 159 cases (170 ears) with CMMOE submitted to various ear surgery solutions, including: (1) Three situations of outer ear canal (OEC): ① atresia 85 ears, ② stenosis 28 ears, and ③ normal 57 ears. (2) Three commonly used hearing solutions: eardrum repair 53 ears, Porp 44 ears and Piston 32 ears implantation. (3) Three OEC situations with different hearing solutions: type I. Reconstruction of OEC (r-OEC), type II. r-OEC and/or different tympanoplasty, including ① eardrum repair, ② release of ossicular chain, ③ Porp implantation, and ④ Torp implantation, type III. Piston implantation with fenestration of the inner ear. Compare AACT of postoperative short term (0.5 years) or long term (0.5–10 years) and preoperative in the speech frequency range of 0.5–4 kHz to assess efficacy. If the sample number ≥10, and not subject to normal distribution, the Kruskal–Wallis multi-sample rank sum test is used for the comparison of multiple groups and Wilcoxon’s rank sum test for two groups, with P < 0.05 being statistically significant. If the sample size <10, the standard of clinical efficacy is one frequency improvement value ≥15 dB HL, or 10 dB HL ≤2 frequency improvements <15 dB HL at 0.125–8 KHz. Results Intra-group comparison of AACT: (1) three situations of OEC: atresia, stenosis and normal all had P < 0.05 postoperatively in short term, while in long term only the normal group had P < 0.05. (2) Three commonly used hearing solutions: eardrum repair, Porp and Piston implantation all had P < 0.05 in short and long terms, except for eardrum repair P >0 .05 in long term. (3) Three OEC situations with different hearing solutions: 1) Atresia of OEC: Porp and Piston implantation, r-OEC and release of ossicular chain were effective in short term and were not effective in long term, and the eardrum repair was not effective in both short and long term. 2) Stenosis of OEC: eardrum repair, Porp and Piston implantation were effective in short and long term. r-OEC P >0 .05 for short and long term, Torp implantation was not effective in long term, 3) Normal of OEC: Porp, Torp and Piston implantation were all P < 0.05 in short and long term except for Torp >0.05 in long term, and release of ossicular chain is both short and long term clinically effective. The AACT values of postoperative in long term for three groups of atresia, stenosis, normal of OEC are over 58.7 dB HL (except Porp implantation 52.5 dB HL), 51.3 dB HL (except Porp implantation 42.5 dB HL), and 37.5 dB HL (except Torp implantation are 32.6 dB HL), respectively. Conclusions and significance Intra-group comparison of AACT. (1) Three groups of the atresia, stenosis and normal of OEC are all effective in short term, while in long term only the normal group is effective. (2) The three most commonly used surgical solutions of eardrum repair, Porp and Piston implantation are effective in short and long terms, except for long term eardrum repair. (3) Three OEC situations with different hearing solutions: some of surgical solutions were effective in short term or long term for CMMOE, but based on the AACT values of postoperative in long term for three OEC situations, it is better to choose a hearing device for atresia of OEC, comprehensive review of surgical or hearing device for stenosis of OEC. Surgery can be considered for normal OEC.

Relationship between congenital malformation of the outer ear and hearing

Background: There is no report on the relationship between congenital malformation of the outer ear and hearing, which makes it possible to predict the hearing level just based on microtia grades. Aims/Objectives: To investigate the correlation between two types of congenital malformation of the outer ear [microtia and Outer Ear Canal Malformation (OECM)] and hearing, as well as the interrelationship among all three variables. Material and methods: A total of 535 cases (598 ears) of congenital malformation of the middle and outer ear (CMMOE) with hearing data, out of which 319 cases (349 ears) microtia with available images and graded by I–V, 449 cases (482 ears) OECM graded by atresia, stenosis and normal, and 87 cases (87 ears) OEC atresia graded I–IV, 301 cases (301 ears) with materials of microtia, OECM and hearing at the same time were carried out correlation analysis. The Average Air-Conduction Threshold of pure tone (AACT) at 0.5–4 KHz was calculated corresponding to the ears with different malformation grades. The differences in AACT among different malformation grades, the correlation between malformation severity and AACT, as well as the relationship among microtia, OECM and AACT were analyzed. The one-way analysis of variance (ANOVA) was employed to compare the differences in AACT, Kendall’s tau-b rank correlation coefficient test was used for correlation analysis. A statistical significance level of p < 0 .05 was applied. Results: Among the 349 ears with microtia, the corresponding AACT values for grades I to V were 61.6, 63.0, 69.9, 75.4, and 75.0 (dB HL), respectively. Comparing grade III to grades II or IV, both p < 0 .05. However, p > 0 .05 between grade I and II or between grade IV and V. The correlation coefficient between microtia grades and AACT r = 0.219, p < 0.05. Among the 482 ears of OECM, the distribution was as follows: 73.6% atresia, 19.1% stenosis, and 7.3% normal, the corresponding AACT values were 64.1, 61.7, and 52.5 (dB HL), respectively. Comparing normal to stenosis or atresia, both p < 0.05, while between atresia and stenosis p > 0.05. The correlation between OECM and AACT was r = 0.104, p < 0.05. The AACT values corresponding to grades I to IV of OEC atresia in the 87 ears were 59.9, 65.1, 71.1, and 64.1 (dB HL), respectively. Comparing these grades, all p > 0.05. The correlation between the degree of atresia and AACT r = 0.23, p < 0 .05. The correlation coefficients for 301 ears microtia to OECM, microtia to AACT, OECM to AACT were r = 0.339, r = 0.163 and r = 0.128 respectively, with all p < 0 .05. Conclusion and significance: There are positive correlations among the degree of microtia, degree of OECM, and AACT values for each other, and so between the degree of OEC atresia and AACT, suggesting that as the severity of microtia or OECM increased, the AACT also tended to be higher, which make it possible to predict the hearing level and the degree of OECM based on microtia grades in clinical practice. Additionally, there are significant differences in AACT values in microtia grade III to grades II or IV, OEC normal to stenosis or atresia, while no differences in microtia grade I to II and grade IV to V, OEC stenosis to atresia, and among the grades I–IV of the OEC atresia.

Pure tone audiometry is a new method for evaluating congenital malformation of the middle and outer ear (CMMOE)

Background: The preoperative evaluation of Congenital Malformation of the Middle and Outer Ear (CMMOE) is very important. Jahrsdoerfer score commonly used at present, based on CT scanning images of the temporal bone, is often unable to accurately evaluate deformity and hearing level. Aims/Objectives: To investigate and promote a straightforward and easily accessible assessment method, pure tone audiometry, for the evaluation of CMMOE. Material and Methods: A total of 223 cases (244 ears) CMMOE with hearing data were retrospectively analyzed. Among them, 180 cases (197 ears) underwent exploratory tympanoplasty with clear conditions: ossicle numbers in 136 cases (147 ears) and morphology in 128 cases (138 ears) and vestibular window development in 137 cases (146 ears), and CT scans of temporal bone in 113 cases (120 ears). 1). The correlation was analyzed between ossicle numbers, ossicle morphology, Jahrsdoerfer score groups and their corresponding Average Air-Conduction Threshold of pure tone (AACT) at 0.5–4 KHz. 2) The AACT difference is compared among the above groups respectively and between the developed and undeveloped groups of vestibular window at 0.5–4 KHz and each frequency of 0.125–8 KHz. Spearman method was used for correlation analysis (calculating coefficient r and p values). For the data followed a normal distribution, a one-way analysis of variance (ANOVA) and t-test were employed, otherwise, Kruskal Wallis multiple local rank coincidence test and Wilcoxon rank sum test were used. p <0 .05 was considered statistically significant. Results: 1) The correlation coefficients between the groups of ossicle number scores, ossicle morphology scores, Jahrsdoerfer scores and their corresponding AACT are r = −0.187 (p <0 .05), r = −0.073 (p >0 .05) and r = −0.079 (p > 0.05), respectively. 2) Comparison of AACT difference based on ossicle number or morphological scores and Jahrsdoerfer scores with p > 0.05 among all groups, respectively. The AACT difference between the developed and undeveloped vestibular window groups is 5.5 (63.5/69.0) dB HL(p < .05) at 0.5–4KHz, out of 0.125–8 KHz frequency 1, 2, 4 KHz were 5.7 (65.0/70.7) dB HL, 8.4 (60.7/69.1) dB HL and 2 (61.5/63.5) dB HL, respectively, all p < 0.05, the other frequencies with all p > 0.05. Conclusions and Significance: 1) Ossicle number was correlated with AACT, but not for ossicle morphology and Jahrsdoerfer scores. 2) There was no significant difference in AACT corresponding to ossicle number or morphology scores and Jahrsdoerfer scores groups, but the patients with undeveloped vestibular window had poorer hearing than those with developed ones. Therefore, the AACT can evaluate the development of ossicle and vestibular window, and more directly reflect the hearing level than Jahrsdoerfer score. Pure tone audiometry is simple, widely used, and easily accessible, which making it a new assessment method of CMMOE.

Does experience with hearing aid amplification influence electrophysiological measures of speech comprehension?

Objective To explore if experience with hearing aid (HA) amplification affects speech-evoked cortical potentials reflecting comprehension abilities. Design N400 and late positive complex (LPC) responses as well as behavioural response times to congruent and incongruent digit triplets were measured. The digits were presented against stationary speech-shaped noise 10 dB above individually measured speech recognition thresholds. Stimulus presentation was either acoustic (digits 1-3) or first visual (digits 1-2) and then acoustic (digit 3). Study sample Three groups of older participants (N = 3 × 15) with (1) pure-tone average hearing thresholds <25 dB HL from 500-4000 Hz, (2) mild-to-moderate sensorineural hearing loss (SNHL) but no prior HA experience, and (3) mild-to-moderate SNHL and >2 years of HA experience. Groups 2-3 were fitted with test devices in accordance with clinical gain targets. Results No group differences were found in the electrophysiological data. N400 amplitudes were larger and LPC latencies shorter with acoustic presentation. For group 1, behavioural response times were shorter with visual-then-acoustic presentation. Conclusion When speech audibility is ensured, comprehension-related electrophysiological responses appear intact in individuals with mild-to-moderate SNHL, regardless of prior experience with amplified sound. Further research into the effects of audibility versus acclimatisation-related neurophysiological changes is warranted.