Reflex Threshold Research Articles

Mild Stroke Affects Pointing Movements Made in Different Frames of Reference

Background Motor performance is a complex process controlled in task-specific spatial frames of reference (FRs). Movements can be made within the framework of the body (egocentric FR) or external space (exocentric FR). People with stroke have impaired reaching, which may be related to deficits in movement production in different FRs. Objective To characterize rapid motor responses to changes in the number of degrees of freedom for movements made in different FRs and their relationship with sensorimotor and cognitive impairment in individuals with mild chronic stroke. Methods Healthy and poststroke individuals moved their hand along the contralateral forearm (egocentric task) and between targets in the peripersonal space (exocentric task) without vision while flexing the trunk. Trunk movement was blocked in randomized trials. Results For the egocentric task, controls produced the same endpoint trajectories in both conditions (free- and blocked-trunk) by preserving similar shoulder-elbow interjoint coordination (IJC). However, endpoint trajectories were dissimilar because of altered IJC in stroke. For the exocentric task, controls produced the same endpoint trajectories when the trunk was free or blocked by rapidly changing the IJC, whereas this was not the case in stroke. Deficits in exocentric movement after stroke were related to cognitive but not sensorimotor impairment. Conclusions Individuals with mild stroke have deficits rapidly responding to changing conditions for complex reaching tasks. This may be related to cognitive deficits and limitations in the regulation of tonic stretch reflex thresholds. Such deficits should be considered in rehabilitation programs encouraging the reintegration of the affected arm into activities of daily living.

Short chain fatty acids and colon motility in a mouse model of irritable bowel syndrome

BackgroundIrritable bowel syndrome (IBS) is defined as a multifactorial disorder associated with visceral hypersensitivity, altered gut motility and dysfunction of the brain-gut axis. Gut microbiota and its metabolites are proposed as possible etiological factors of IBS. Short chain fatty acids (SCFAs) induce both inhibitory and stimulatory action on colon motility, however, their effects on the IBS model were not investigated. The aim of our study was to investigate the level of SFCAs in feces and their effects on colon motility in a mouse model of IBS.MethodsIBS model was induced in mice by intracolonic infusion of 1% acetic acid during the early postnatal period. Mice colon hypersensitivity was assessed by the threshold of the abdominal withdrawal reflex in response to colorectal distention. Colon contractility was studied using proximal colon specimens in isometric conditions. Transit rates were assessed by the pellet propulsion in the isolated colon. Concentrations of SCFAs in feces were measured using gas–liquid chromatography.ResultsThe concentration of SCFAs in feces of IBS model mice was higher compared to the control group. Visceral sensitivity to colorectal distension and colonic transit rate were increased indicating IBS with predominant diarrhea. The frequency and amplitude of spontaneous contractions of proximal colon segments from IBS mice were higher, but carbachol induced contractions were lower compared to control. During acute application of SCFAs (sodium propionate, sodium acetate or butyric acid) dose-dependently (0.5–30 mM) decreased tonic tension, frequency and amplitude of spontaneous and carbachol-evoked contractions. In the mouse IBS group the inhibitory effects SCFAs on spontaneous and carbachol-evoked contractions were less pronounced. At the same time intraluminal administration of butyrate (5 mM) increased the transit rate in the colon of both groups, but its stimulatory effect was more pronounced in mouse IBS model group.ConclusionOur data indicate that the increased transit rate in the mouse IBS model group is associated with a disbalance of activating and inhibiting action of SCFAs due to chronically elevated SCFA levels, which may impact the pathogenesis of IBS with predominant diarrhea syndrome.

Acoustic Reflexes in Aural Atresia Patients: Evidence of an Intact Efferent System?

To record crossed acoustic reflex thresholds (xART's) postoperatively from patients after surgical repair of unilateral congenital aural atresia (CAA). To seek explanations for when xARTs can and cannot be recorded. We hope to understand the implications for this central auditory reflex despite early afferent deprivation. Patients who underwent surgery to correct unilateral CAA at a tertiary academic medical were prospectively enrolled to evaluate for the presence of xART. Preoperative ARTs in the normal (non-atretic) ear, and postoperative ipsilateral ARTs (stimulus in the normal ear) and contralateral ARTs (stimulus in the newly reconstructed atretic ear; record in the normal ear) were measured at 500, 1000, and 2000 Hz. Four of 11 patients with normal ipsilateral reflex thresholds preoperatively demonstrated crossed acoustic reflexes postoperatively (stimulus in reconstructed ear; record from normal ear). Four other patients demonstrated normal ipsilateral thresholds preoperatively but did not have crossed reflexes postoperatively. No reflexes (pre- or postoperatively) could be recorded in 3 patients. Crossed reflex threshold is significantly correlated with the postoperative audiometric threshold. There was no correlation between ipsilateral and contralateral reflex thresholds. Crossed acoustic reflexes can be recorded from some but not all postoperative atresia patients, and the thresholds for those reflexes correlate with the postoperative pure tone threshold. The presence of acoustic reflexes implies an intact CN VIII-to-opposite CN VII central reflex arc despite early unilateral sound deprivation.

Effect of Number of Electrodes Used to Elicit Electrical Stapedius Reflex Thresholds in Cochlear Implants

Introduction: When mapping cochlear implant (CI) patients with limited reporting abilities, the lowest electrical stimulus level that produces a stapedial reflex (i.e., the electrical stapedius reflex threshold [eSRT]) can be measured to estimate the upper bound of stimulation on individual or a subset of CI electrodes. However, eSRTs measured for individual electrodes or a subset of electrodes cannot be used to predict the global adjustment of electrical stimulation levels needed to achieve comfortable loudness sensations that can be readily used in a speech coding strategy. In the present study, eSRTs were measured for 1-, 4-, and 15-electrode stimulation to (1) determine changes in eSRT levels as a function of the electrode stimulation mode and (2) determine which stimulation mode eSRT levels best approximate comfortable loudness levels from patients’ clinical maps. Methods: eSRTs were measured with the 3 different electrical stimulation configurations in 9 CI patients and compared with behaviorally measured, comfortable loudness levels or M-levels from patients’ clinical maps. Results: A linear, mixed-effects, repeated-measures analysis revealed significant differences (p < 0.01) between eSRTs measured as a function of the stimulation mode. No significant differences (p = 0.059) were measured between 15-electrode eSRTs and M-levels from patients’ clinical maps. The eSRTs measured for 1- and 4-electrode stimulation differed significantly (p < 0.05) from the M-levels on the corresponding electrodes from the patients’ clinical map. Conclusion: eSRT profiles based on 1- or 4-electrode stimulation can be used to determine comfortable loudness level on either individual or a subset of electrodes, and 15-electrode eSRT profiles can be used to determine the upper bound of electrical stimulation that can be used in a speech coding strategy.

Stapedius reflex evoked in free sound field in cochlear implant users compared to normal-hearing listeners

Objective To determine the relation between stapedius reflex thresholds in cochlear implant users evoked once through direct electric stimulation on single channels (ESRT) and once through acoustic stimulation in free sound field. For comparison, stapedius reflex thresholds were obtained in free sound field in a normal-hearing control group. Design For each participant a new ESRT-based fitting was created. Stapedius reflex thresholds were obtained for this new fitting in free sound field for different loudness adjustments. Acoustic stimuli for eliciting the stapedius reflex were narrow band noise signals covering the audiometric frequency range. Study sample N = 29 experienced CI users (34 ears) and N = 10 normal hearing listeners. Results ESRT-based fitting resulted in different stapedius reflex behaviour compared to normal-hearing listeners. A frequency dependence was observed. Stapedius reflex thresholds decreased with increasing centre frequencies of acoustic narrow band noise stimuli. A linear relation between upper stimulation levels on the implant channels and corresponding stapedius reflex thresholds evoked in free sound field was found. Conclusion The found correlation may be a guideline for adjusting the electrical dynamic range during cochlear implant fitting. This allows the implant system to mimic the natural reflex behaviour in the best possible way and potentially avoid overstimulation.

Quantitative proteomics reveal the protective effects of EDS against osteoarthritis via attenuating inflammation and modulating immune response

Ethnopharmacological relevanceEpimedium brevicornu Maxim, Dioscorea nipponica Makino, and Salvia miltiorrhiza Bunge formula (EDS) are three traditional Chinese medicines commonly combined and used to treat osteoarthritis (OA). However, the mechanism of its therapeutic effect on OA is still unclear. Aim of the studyThe aim of this study was to investigate the potential anti osteoarthritis mechanism of EDS in the treatment of OA rats’ model by quantitative proteomics. Materials and methodsA papain-induced rat OA model was established, and then EDS was intragastrically administered for 28 days. A label-free quantification proteomics was performed to evaluate the holistic efficacy of EDS against OA and identify the possible protein profiles mechanisms. The expression levels of critical changed proteins were validated by RT-qPCR and Western blotting. The effects of EDS were then assessed by evaluating pathologic changes in the affected knee joint and measuring pressure pain threshold, acoustic reflex threshold, angle of joint curvature. ResultsProteomics analysis showed that 62 proteins were significantly upregulated and 208 proteins were downregulated in OA group compared to control group. The changed proteins were involved in activation of humoral immunity response, complement cascade activation, leukocyte mediated immunity, acute inflammatory response, endocytosis regulation, and proteolysis regulation. The EDS treatment partially restored the protein profile changes. The protective effects of EDS on pathologic changes in OA rats’ knee joint and pain threshold assessment were consisted with the proteomics results. ConclusionsThe results suggest that EDS exerted synergistic therapeutic efficacies to against OA through suppressing inflammation, modulating the immune system, relieving joint pain, and attenuating cartilage degradation.

Examination of the use of electrical stapedius reflex thresholds in attaining upper stimulation levels in cochlear implant mapping in children: A systematic review

Examination of the use of electrical stapedius reflex thresholds in attaining upper stimulation levels in cochlear implant mapping in children: A systematic review

The Assessment of Upper-Limb Spasticity Based on a Multi-Layer Process Using a Portable Measurement System.

Spasticity is a common disabling complication caused by the upper motor neurons dysfunction following neurological diseases such as stroke. Currently, the assessment of the spastic hypertonia triggered by stretch reflexes is manually performed by clinicians using perception-based clinical scales, however, their reliability is still questionable due to the inter-rater and intra-rater variability. In order to objectively quantify the complex spasticity phenomenon in post-stroke patients, this study proposed a multi-layer assessment system based on a novel measurement device. The exoskeletal device was developed to synchronously record the kinematic, biomechanical and electrophysiological information in sixteen spastic patients and ten age-matched healthy subjects, while the spastic limb was stretched at low, moderate and high velocities. The mechanical impedance of the elbow joint was identified using a modified genetic algorithm to quantify the alterations in viscoelastic properties underlying pathological resistance. Simultaneously, the time-frequency features were extracted from the surface electromyography (sEMG) signals to reveal the neurophysiological mechanisms of the spastic muscles. By concatenating these single-layer decisions, a support vector regression (SVR)-based fusion model was developed to generate a more comprehensive quantification of spasticity severity. Experimental results demonstrated that the stiffness and damping components of the spastic arm significantly deviated from the nonspastic baseline, and strong correlations were observed between the proposed spasticity assessment and the severity level measured by clinical scales ( R = 0.86, P = 1.67e - 5 ), as well as the tonic stretch reflex threshold (TSRT) value ( R = - 0.89, P = 3.54e - 6 ). These promising results suggest that the proposed assessment system holds great potential to support the clinical diagnosis of motor abnormalities in spastic patients, and ultimately enables optimal adjustment of treatment protocols.

Vestibular agnosia in traumatic brain injury and its link to imbalance.

Vestibular dysfunction, causing dizziness and imbalance, is a common yet poorly understood feature in patients with TBI. Damage to the inner ear, nerve, brainstem, cerebellum and cerebral hemispheres may all affect vestibular functioning, hence, a multi-level assessment-from reflex to perception-is required. In a previous report, postural instability was the commonest neurological feature in ambulating acute patients with TBI. During ward assessment, we also frequently observe a loss of vertigo sensation in patients with acute TBI, common inner ear conditions and a related vigorous vestibular-ocular reflex nystagmus, suggesting a 'vestibular agnosia'. Patients with vestibular agnosia were also more unbalanced; however, the link between vestibular agnosia and imbalance was confounded by the presence of inner ear conditions. We investigated the brain mechanisms of imbalance in acute TBI, its link with vestibular agnosia, and potential clinical impact, by prospective laboratory assessment of vestibular function, from reflex to perception, in patients with preserved peripheral vestibular function. Assessment included: vestibular reflex function, vestibular perception by participants' report of their passive yaw rotations in the dark, objective balance via posturography, subjective symptoms via questionnaires, and structural neuroimaging. We prospectively screened 918 acute admissions, assessed 146 and recruited 37. Compared to 37 matched controls, patients showed elevated vestibular-perceptual thresholds (patients 12.92°/s versus 3.87°/s) but normal vestibular-ocular reflex thresholds (patients 2.52°/s versus 1.78°/s). Patients with elevated vestibular-perceptual thresholds [3 standard deviations (SD) above controls' average], were designated as having vestibular agnosia, and displayed worse posturography than non-vestibular-agnosia patients, despite no difference in vestibular symptom scores. Only in patients with impaired postural control (3 SD above controls' mean), whole brain diffusion tensor voxel-wise analysis showed elevated mean diffusivity (and trend lower fractional anisotropy) in the inferior longitudinal fasciculus in the right temporal lobe that correlated with vestibular agnosia severity. Thus, impaired balance and vestibular agnosia are co-localized to the inferior longitudinal fasciculus in the right temporal lobe. Finally, a clinical audit showed a sevenfold reduction in clinician recognition of a common peripheral vestibular condition (benign paroxysmal positional vertigo) in acute patients with clinically apparent vestibular agnosia. That vestibular agnosia patients show worse balance, but without increased dizziness symptoms, explains why clinicians may miss treatable vestibular diagnoses in these patients. In conclusion, vestibular agnosia mediates imbalance in traumatic brain injury both directly via white matter tract damage in the right temporal lobe, and indirectly via reduced clinical recognition of common, treatable vestibular diagnoses.

Endoscopic measurement of the stapedius reflex threshold

【背景】強大音から蝸牛を防御するアブミ骨筋反射（SR）は，音刺激が閾値を超えると両側の顔面神経核が刺激され両側性に生じる．検査としてはインピーダンスオージオメトリーによるレフレックス検査があるが，アブミ骨筋が収縮してアブミ骨の可動が耳小骨やMI joint を逆行に経由して鼓膜まで可動したものを間接的に検出しているにすぎない．そのため，真の閾値は測定できておらず，実際はさらに小さな音刺激でもSRが生じているはずである．SR を直接観察することができれば，より正確な閾値を評価することができるはずである． 【目的】正確なSR 閾値を測定する方法の開発 【対象と方法】健側耳聴力が正常かつ患側の鼓室に病変を伴わない，局所麻酔下に内視鏡下耳科手術を施行する患者を対象とする．術中に健側耳への音刺激にて対側耳に生じるSRを内視鏡下にアブミ骨の可動を直接確認し閾値の測定を行う．また，鼓室に銀ボール電極を設置し，筋電図を測定することにより，電気生理学的にも閾値を評価する． 【結果】内視鏡下にSRを直接確認することができた．術前のレフレックス検査によるSR閾値と比べて，内視鏡下で観察した最小音刺激閾値は低かった．アブミ骨筋筋電図も測定することができ，内視鏡下に観察した閾値とほぼ同じであった． 【考察】この検討結果はSRのより正確な閾値を測定する方法の開発に寄与する．本検討の臨床応用として，末梢性顔面神経麻痺の超早期予後診断への活用が挙げられる．SRが検出されれば顔面神経麻痺は回復しやすいとされているが，検出されなくても麻痺が回復することも多く，レフレックス検査では正確な予後診断に限界がある．それは，SRの真の閾値を測定できていないことが関係しており，より正確な閾値を測定できれば，予後診断の精度も向上するはずである．今後更なる検討を行っていく．

The Long-Term Stability of the Electrical Stapedial Reflex Threshold.

To 1) describe changes in the electrical stapedial reflex threshold (eSRT), within and across patients over time and 2) to identify the clinical relationship between eSRT and an individual's upper limit of loudness. Retrospective chart review and analysis using a multilevel modeling approach to describe changes in eSRT over time. Secondary care center. Two-hundred five cochlear implant recipients treated at the cochlear implant center during a 3-year time period. Cochlear implantation, eSRT testing, and, electrical upper limits of loudness. The eSRT over multiple appointments and the cochlear implant recipients' final upper limits of loudness. Analysis of the eSRT testing indicated stability over time; no global trend was seen in trajectory across the population, b = -0.010, p = 0.899. The relationship between eSRT and user upper limits of loudness revealed a mean decrease of 19.47, units for manufacturer 1, 30.53 units for manufacturer 2, and 0.7 units for manufacturer 3. Electrical stapedial reflex thresholds remain consistent for individual subjects over time with implant experience being the only variable correlated with eSRT stability (increase in 5% of one standard deviation with each year of experience). In addition, a clinical relationship between eSRT and behaviorally set upper limits of loudness was identified for all three cochlear implant manufacturers available in the United States.

Asymmetry of Reflex Thresholds Between Contralateral Limbs in Hemispheric Stroke Survivors and Dominant Limbs in Neurologically Intact Individuals

Asymmetry of Reflex Thresholds Between Contralateral Limbs in Hemispheric Stroke Survivors and Dominant Limbs in Neurologically Intact Individuals

Nociceptive Flexion Reflex Threshold in Chronic Pain Patients: A Needed Update for the Current Evidence.

The nociceptive flexion reflex is a physiological, polysynaptic reflex triggered by a nociceptive stimulus activating a withdrawal response. In chronic musculoskeletal-related pain conditions, a decreased nociceptive flexion reflex threshold has been suggested as a possible recognition evidence for central sensitization that may cause alteration of central nervous system processing. The aim of the study was to systematically review reported comparisons of the nociceptive flexion reflex threshold in chronic pain patients and healthy individuals. Electronic databases covering studies published between January 1990 and December 2019 were systematically searched. After application of exclusion criteria, 20 studies including 28 trials were included in this review. For meta-analysis, we used a random-effects model and funnel plot for publication bias. This research was registered at PROSPERO (CRD42019140354). Compared with healthy controls, standardized mean differences in nociceptive flexion reflex threshold were significantly lower in the total sample of chronic pain patients. Subgroup analysis indicated a homogenous decreased nociceptive flexion reflex threshold in studies reporting fibromyalgia, chronic pain, and joint pain while heterogeneity existed in other included pain conditions. A lower nociceptive flexion reflex threshold in patients experiencing chronic pain conditions may imply hyperexcitability in central nervous system processing. As a preliminary study, the findings would act as a basis for developing a methodology assisting current clinical practices.

Neurodegenerative Diseases and the Auditory-Vestibular System

Neurodegenerative Diseases and the Auditory-Vestibular System

Effects of familial Mediterranean fever on the middle ear

ObjectiveTo evaluate middle and inner ear function and hearing status of children with familial Mediterranean fever (FMF). MethodsWe assigned 56 patients with FMF to the study group and 52 healthy volunteers to the control group. The mean age of patients in the study and control groups were 10.10 ± 3.70 and 9.77 ± 3.74 years, respectively. Physical examination and hearing evaluation were performed in both groups. The audiological test battery included 226-Hz tympanometry, pure tone audiometric evaluation, acoustic stapedial reflex measurements, distortion product otoacoustic emission recording, and wide-band tympanometry assessment. ResultsThe groups were similar in age and sex ratio (p > 0.05 for both comparisons). Pure tone audiogram and distortion product otoacoustic emission results were also similar for both groups (p > 0.05). The ipsilateral acoustic stapedial reflex were present in both of the groups and all participants had Type A tympanogram. The contralateral acoustic stapedial reflex thresholds were significantly higher in the familial Mediterranean fever group (p < 0.05 for all comparisons). The ambient and peak pressure absorbance values of wide-band tympanometry were significantly lower at 2000 Hz and significantly higher at 4000 Hz in the familial Mediterranean fever group (p < 0.05 for both comparisons). The severity and duration of disease adversely affected the absorbance values of wide-band tympanometry at 2000 and 4000 Hz (p < 0.05). ConclusionTo our knowledge, this is the first study to demonstrate the adverse subclinical effects of familial Mediterranean fever on the middle ear. We recommend that children diagnosed with FMF should be closely monitored for future clinical middle ear pathologies.

Does the short-term exposure to radiofrequency electromagnetic field originating from mobile phone affect auditory functions as measured by Acoustic Admittance and Evoked Otoacoustic Emission tests?

ABSTRACT Background Mobile phones constitute an important source of radiofrequency electromagnetic field (RF-EMF) for humans. Taking into account high sensitivity of sensory hair cells of the inner ear to endogenous and exogenous agents, the potential impact of mobile phone usage on auditory organs is of particular interest. Aim The aim of the study was to evaluate the impact of short-term exposure to RF-EMF generated by a mobile phone during 15-minute simulated phone call on human hearing as measured by Transient Evoked Otoacoustic Emission (TEOAE) and Acoustic Admittance Testing (AAT). Material and methods Within-subject study was performed on 23 healthy volunteers. All of the participants underwent TEOAE and AAT before and immediately after 15-minute simulated phone call with the use of a standard, modern smartphone. Analyzed parameters included: static compliance of tympanic membrane, middle ear pressure, ipsi- and contralateral acoustic reflex thresholds and percentage of signal reproducibility in TEOAE for exposed and non-exposed ear. Additionally, the results were compared in subgroups distinguished basing on self-reported sensitivity to RF-EMF originating from mobile phones. Results No statistically significant differences were identified between results of TEOAE and AAT before and after exposure, both in exposed and non-exposed ear. The results of EMF sensitive and non-sensitive subjects were comparable in all performed tests. Conclusions Short-term exposure to mobile phone electromagnetic field did not influence auditory functions as measured by Evoked Otoacoustic Emission test and Acoustic Admittance Testing.

Effect of water extracts from Cynanchum thesioides (Freyn) K. Schum. on visceral hypersensitivity and gut microbiota profile in maternally separated rats

Ethnopharmacological relevanceIrritable bowel syndrome (IBS) is a chronic, stress-related, functional gastrointestinal disorder characterized by abdominal discomfort and altered bowel habits; the manipulation of the microbiota is emerging as a promising therapeutic option for IBS. Cynanchum thesioides (CT) is an herb of traditional Mongolian medicine that has been employed in treating abdominal pain and diarrhea for hundreds of years. Phytochemical studies of this plant showed the presence of various flavonoids with antibacterial and anti-inflammatory activities. We hypothesized that Cynanchum thesioides manipulates the gut mycobiome and reverses visceral hypersensitivity in IBS rat model. Purpose of the studyThe aims of this study were to prove the in vivo efficacy of Cynanchum thesioides on improving visceral hypersensitivity in IBS rat model and to examine its effect on gut bacterial communities, focusing on the potential interrelationships among microbiota and visceral hypersensitivity. Materials and methodsWe induced visceral hypersensitivity rat models by maternal separation (MS) of Sprague-Dawley rats, and administered CT water extracts to MS rats for 10 consecutive days. The abdominal withdrawal reflex score and threshold of colorectal distention were employed to assess visceral sensitivity. We then used the Illumina HiSeq platform to analyze bacterial 16S rRNA gene. ResultsTreatment with CT improved visceral hypersensitivity in MS rats, and this was accompanied by alterations in the structure and composition of the gut microbiota. The extent of the stability of the gut microbiota was improved after treatment with CT. The genera Pseudomonas, Lachnospiracea_incertae_sedis, and Clostridium XlVa (which were more prevalent in MS rats) were significantly decreased, whereas the abundance of some genera were less prevalent in MS rats—for example, Clostridium IV, Elusimicrobium, Clostridium_sensu_stricto, and Acetatifactor were significantly enriched after treatment with CT. ConclusionWater-extracted CT was beneficial against visceral hypersensitivity in IBS and favorably affected the structure, composition, and functionality of gut microbiota. CT is therefore a promising agent in therapy of IBS.

Effect of Electrode to Modiolus Distance on Electrophysiological and Psychophysical Parameters in CI Patients With Perimodiolar and Lateral Electrode Arrays.

To investigate the intracochlear position of the latest Cochlear Nucleus 532 electrode array compared with the straight Nucleus 522 and the precurved 512 arrays and determine the effect of the electrode-modiolus distance on electrically evoked compound action potential, C-levels, electrically evoked stapedius reflex thresholds (ESRTs), and impedances. Postoperative high-resolution cone beam computational tomography images of 30 patients with Cochlear Nucleus 532, 522, and 512 implants were evaluated using the Comet (Cochlea Measurement Tool) program to determine the distance between the 22 individual electrode contacts and the medial wall. ESRTs were documented intraoperatively and electrophysiological as well as psychophysical parameters were measured at multiple time points including the first fitting after the initial activation. The electrode-modiolus distance in perimodiolar arrays is uniformly small across the array, whereas in a straight electrode carrier it varies significantly along the length of the array. Electrically evoked compound action potential thresholds and C-levels are larger with increased distance to the modiolus. Impedances and stapedius reflex thresholds do not differ significantly between the arrays. Our results show that the electrode position has a significant effect on both electrophysiological and psychophysical parameters, while impedances and ESRTs are not impacted. Novel tools can be used in the evaluation of high resolution cone beam computational tomography images to determine individual electrode-modiolus distances after cochlear implantation. The results of this study suggest that the correlations between electrode-modiolus distance and electrophysiological and psychophysical parameters are not sufficiently strong to adjust CI-fitting based on imaging data.

Acoustic Reflexes in Individuals Having Hyperacusis of the Auditory Origin.

Functional role of the acoustic reflex in preventing over stimulation of the inner auditory system by decreasing sound intensity along with the previous reports of acoustic reflex abnormalities in individuals having hyperacusis point towards the involvement of acoustic reflex deficit in the origin of hyperacusis especially when any medical condition leading to hyperacusis is not associated. However this issue remains contradictory owing to limited comprehensive investigation. This study was undertaken to ascertain the relationship between hyperacusis and the acoustic reflex. Threshold, amplitude and latency of the acoustic reflex were measured in two different groups of individuals having hyperacusis; Group 1: 14 individuals having hyperacusis with hearing loss (HwHL) and Group 2: 17 individuals having hyperacusis without hearing loss (HwoHL). Control group (Group 3) consisted of 15 normal hearing individuals who never experienced hyperacusis. Result showed a significant group effect on all the measured characteristics of the acoustic reflex. ARTs were found to be significantly higher in HwHL and HwoHL when compared to NHwoH. ARTs were statistically similar for HwoHL and NHwoH. HwoHL's ARAs and ARLs were significantly smaller and prolonged, respectively, when compared to HwHL and NHwoH. HwHL and NHwoH had statistically similar ARAs and ARLs. This study confirms acoustic reflex abnormalities in some individuals having hyperacusis with or without hearing loss. It further highlight the importance of involving acoustic reflex testing in the assessment of hyperacusis especially when hyperacusis is not associated with hearing loss or any other medical condition that may lead to hyperacusis.

Comparison of Perimodiolar Electrodes: Imaging and Electrophysiological Outcomes.

The perimodiolar CI532 Slim Modiolar electrode has been designed to bring the electrode contacts close to auditory nerve while reducing cochlear trauma during its insertion. It is currently unknown to what extent the electrode position and electrophysiological outcomes of the Slim Modiolar electrode differ from other perimodiolar electrodes. The objective was to compare the electrode position and electrophysiological outcomes between the CI532 Slim Modiolar and CI512 Contour Advance electrode. Forty-six adult patients received a Slim Modiolar or Contour Advance electrode. Electrode types were compared using intraoperative electrode impedances, evoked compound action potential (ECAP) and stapedius reflex thresholds, as well as position parameters from postoperative computed tomography or digital volume tomography images (medial-lateral position, electrode-to-modiolus distance, insertion angle). The medial-lateral position indicates a closer modiolar placement of the Slim Modiolar compared with the Contour Advance. Individual electrode contact measurements, however, showed significantly larger electrode-to-modiolus distances and higher ECAP thresholds for the Slim Modiolar in the basal region. On contacts E20-22 the Slim Modiolar is slightly closer to the modiolus compared with the Contour Advance, but this did not result in lower ECAP thresholds. Perimodiolar electrodes can vary in their intracochlear position, leading to divergent electrophysiological outcomes. To detect these differences, investigations must be done for each electrode contact rather than using a global factor for the whole electrode array. While the electrode dislocation rate is lower with the Slim Modiolar than with the Contour Advance, electrode-to-modiolus proximity is smaller and ECAP thresholds are lower with the Contour Advance in the basal cochlear region.