Comparison of Uncomfortable Loudness Level in Stapedotomy with or without Stapedial Tendon Preservation

Background: Otosclerosis is one of the commonest diseases of the ear mostly involves the otic capsule. Most often otosclerotic foci appear in stapes region leading to stapes fixation, predominantly affect the adolescence female. The most common presenting symptom of clinical otosclerosis is conductive deafness. The mainstay of treatment for otosclerosis is surgery. Surgical options include stapedectomy, stapedotomy with or without stapedial tendon preservation. The latter being is the procedure of choice. Aim: The aim of this study is to compare the outcome of uncomfortable loudness level in stapedotomy with or without stapedial tendon preservation. Methods: A prospective observational study was conducted in the Department of Otolaryngology-Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka for 18 months in patients with otosclerosis. Total 30 subjects were selected based on the inclusion and exclusion criteria. All patients were assessed pre-operatively by clinical examination, otoscopy and microscopic examination. Hearing was assessed by pure tone audiometry. Uncomfortable level and stapedial reflex threshold were tested in all cases. The selected cases were placed into two groups. Stapedial tendon resection in Group-I and stapedial tendon preservation in Group-II. Post-operative follow up was done at 3 months and 6 months. Hearing and uncomfortable loudness level were evaluated with PTA during follow up by calculating the average of 500Hz, 1000Hz, 2000Hz and 4000HZ. The data were calculated manually. The statistical significance was set to P< 0.05. Results of the study were expressed as mean, standard deviation (± SD), frequency and percentages. Means and standard deviations were reported for continuous variables. Frequencies and percentages were reported for categorical variables. Unpaired Student’s t test was done to compare the continuous variables and Chi Square test was done to compare the categorical variables. Results: In this study preoperative average ABG for group I and group II were 35 ± 4.57 dB and 34 ± 4.17 dB respectively. In group I, post operative average ABG after 3 months and 6 months were 14 ± 3.7 dB and 13±3.3 dB respectively. Post operative average ABG after 3 months was 13 ± 5.7 dB and was 12 ± 4.4 dB for group II. But the hearing improvement between two groups was not statistically significant. In case of preoperative mean UCL was 95 ± 1.8 dB and 96 ± 2.5 dB for group I and group II respectively. Postoperative mean UCL after 3 months was 96 ± 3.57 dB and after 6 months was 99 ± 6.28 dB in group I. For group II, postoperative mean UCL after 3 months and 6 months was 107±4.2 dB and 113 ± 3.2 dB respectively. Here mean UCL was on average 11 dB higher for group II in 3 months and additional 6 dB improvement noted after 6 months, but show minimal change in group I. This finding was statistically significant. Conclusion: Preservation of the stapedial tendon is the choice in the surgical treatment of otosclerosis which helps to improve functional outcomes as well as to provide the more physiologic protection of middle ear. Postoperative discomfort threshold levels were increased in patients who had their stapedial tendon restored. Bangladesh J Otorhinolaryngol 2021; 27(2): 117-123

Tissue Mobilization During Double Source of Vibration Semioccluded Vocal Tract Exercises: A Neck and Face Surface Acceleration Study

Purpose This study primarily aimed at observing the possible tissue mobilization on facial, neck, and chest tissues caused by different double source of vibration semioccluded vocal tract exercises (DSV-SOVTEs). Another goal was to inspect the degree of self-perceived sensation of a massage-like sensation. Method Fifty-five participants engaged in a set of several DSV-SOVTEs: (a) phonation with a silicone tube submerged 2 and 8 cm below water surface, (b) Acapella Choice device, (c) lip trills, and (d) tongue trills. A self-perceived massage-like sensation was also assessed. All exercises were performed at three loudness levels. Tissue mobilization signal was captured by four accelerometers placed in four different body regions: (a) over the cheek, (b) over the neck, (c) over the thyroid cartilage, and (d) over the suprasternal notch. Results There is a differential effect of all DSV-SOVTEs on tissue mobilization. All four observed dependent variables from tissue oscillation modulation (frequency, amplitude, jitter, and shimmer) showed significant three-way interactions. In general, amplitude and frequency of tissue oscillation modulation increases with loudness. A self-perceived massage-like sensation showed highly significant differences between DSV-SOVTEs. Conclusions All DSV-SOVTEs do mobilize tissues. Type of exercise, loudness level, and body region produce an effect on all tissue oscillation variables. Acapella device produces the largest amplitude of vibration, lowest frequency, and more regular oscillation of tissue. Water resistance therapy showed the most irregular tissue oscillation. Control of these variables is likely to be relevant to obtain the best outcomes in patients.

Application of loudness level to temporally varying sounds

Most of the environmental noises are temporally varying and include various frequency components. Various methods for evaluating the environmental noises have been proposed. Among them, the method for calculating loudness level was first standardized in 1975 as ISO 532, including Stevens' and Zwicker's methods. Unfortunately, these methods can only be applied to steady state sounds. On the other hand, Aeq (Equivalent Continuous A-weight Sound Pressure Level) is standardized for the evaluation of level fluctuating environmental sounds as ISO 1996. In , the energy mean and A-weighting are used for averaging temporal fluctuation and frequency weighting, respectively. The present authors with their colleagues have conducted many psychological experiments using artificial sounds and actual sounds since 1970's and have being introduced that p (Loudness-based Method), which is a combination of ISO 532 for frequency weighting and ISO 1996 for temporal level fluctuation, is a good method for evaluating various kinds of environmental sounds. ISO 532-1 (Zwicker's method) has been revised including the temporal fluctuation into consideration in 2017, in which p has been adopted as a note. The merit of p will be introduced in this paper presenting many examples.

A Study on the Soundscape Satisfaction Degree of Urban Landscape Garden Parks

Establishing a public response model of soundscape in parks can provide a basis for the optimization of soundscape design. Three representative urban landscape garden parks were selected in Hangzhou, in which a number of evaluation points were chosen along soundwalk paths. Binaural sounds at each evaluation point were sampled by an artificial head and the landscapes of horizontal view and vertical view were obtained by panoramic photos and satellite images, respectively. An evaluation on soundscape of each point was conducted in laboratory based on virtual reality technology, and the correlations between 17 acoustic indicators, 35 landscape indicators and soundscape satisfaction degree were analyzed. The public response model of soundscape satisfaction degree in parks was established. Final indicators entering the model were the loudness level of sound, the aggregation index of water, the largest patch index of water and the landscape shape index of roads, and their standard regression coefficients were -0.666, - 0.561, 0.523 and -0.310, respectively. The impact weights of acoustics and landscape factors on the satisfaction were 32.3% and 67.7%. When the percentage of vegetation area in park exceeds 15%, its contribution to satisfaction degree will be close to a fixed value (reflected in the constant term of the model). The soundscape satisfaction can be effectively improved by reducing the loudness level of sound in parks, increasing the area of the largest water patch with scattered water patches around it, and reducing the shape complexity of road patches.

ANALISIS KINERJA FASILITAS OPERASI PERLINTASAN SEBIDANG (STUDI PADA RESORT 4.6 SMT)

PT Kereta Api Indonesia (KAI) during 2019 and 2018 calculated that there had been 655 accidents at level rail crossings. Accidents often occur in high traffic areas such as the Telecommunication Signal Resort 4.6 SMT. So the researchers conducted research in order to find out the performance of the railway operating facilities under the auspices of the Telecommunication Signal Resort 4.6 SMT as well as public perceptions of its performance. Researchers used a sound level meter to measure the loudness level of the level rail crossings siren sound at the research location. Furthermore, it is compared with the standards stipulated in the Minister of Transportation Regulation Number 44 of 2018. Then tested using Anova to find out whether the population mean will be of the same value using data from each population. Furthermore, an unstructured interview was conducted to hear the perceptions of road users on the performance of the operational facilities at level rail crossings which became the research object. The results showed that the five level rail crossings which were the object of the study had the loudness level of the siren sound below the set standard. In contrast, flat cross lights perform well. Meanwhile, the public perception of the operational facilities at level rail crossings is that they are functioning well.

Liuzijue qigong versus traditional breathing training for patients with post-stroke dysarthria complicated by abnormal respiratory control: Results of a single-center randomized controlled trial

Objective: The aim of the study was to investigate whether liuzijue qigong could improve the ability of respiratory control and comprehensive speech in patients with stroke dysarthria. Design: A randomized controlled trial. Setting: The research was carried out in the department of rehabilitation. Participants: Altogether, a total of 98 stroke patients with dysarthria participated in the study. Interventions: Patients were randomly divided into two groups (the experimental group: basic articulation + liuzijue qigong, 48 patients or the control group: basic articulation + traditional breathing training, 50 patients). All therapies were conducted once a day, five times a week for three weeks. Main measures: Primary outcome measure: Speech breathing level of the modified Frenchay Dysarthria Assessment. Secondary outcome measures: the modified Frenchay Dysarthria Assessment, maximum phonation time, maximal counting ability, /s/, /z/, s/z ratio, and the loudness level. All outcome measures were assessed twice (at baseline and after three weeks). Results: At three weeks, There were significant difference between the two groups in the change of speech breathing level (81% vs 66%, P = 0.011), the modified Frenchay Dysarthria Assessment (5.54 (4.68–6.40) vs 3.66 (2.92–4.40), P = 0.001), maximum phonation time (5.55 (4.92–6.18) vs 3.01(2.31–3.71), P < 0.01), maximal counting ability (3.08(2.45–3.71) vs 2.10 (1.53–2.67), P = 0.018), and /s/ (3.08 (2.39–3.78) vs 1.87 (1.23–2.51), P = 0.004), while no significant differences were found in the change of /z/ (3.08 (2.31–3.86) vs 2.10 (1.5–2.64), P = 0.08), s/ z ratio (1.26 (0.96–1.55) vs 1.03 (0.97–1.09), P = 0.714), and the change of loudness level (69% vs 60%, P = 0.562). Conclusions: Liuzijue qigong, combined with basic articulation training, could improve the respiratory control ability, as well as the comprehensive speech ability of stroke patients with dysarthria. Trial registration: ChiCTR-INR-16010215.

Effects of rumble strip parameters on acoustics, vibration, and perception

Rumble strips aim to alert the driver of dangerous situations via acoustic and tactile stimulation. They can, however, also lead to increased noise in the surroundings. Strip parameters and the vehicle type determines the size of these acoustic and vibratory effects. In our work, 16 rumble strip types (including strips with irregular spacing) were evaluated with respect to their effects on acoustics, vibration, and perception. Interior and exterior emissions caused by controlled pass-overs of a car and a truck were recorded. Annoyance, urgency, and reaction time of 16 listeners were tested in a laboratory experiment and models mapping acoustics to perception were developed. Steering wheel and seat vibrations were acquired. Our results show a high correlation of interior and exterior noise. The loudness level was the best predictor of perceived annoyance and urgency. Irregular spacing reduced the tonality at the cost of a difficult production process. While a large variety of strip types produced a sufficient acoustic effect in the passenger car, the acoustic response was lower in the truck. Combined with the low vibration levels found in the truck, an identification of an optimal strip type for both vehicle types turns out to be difficult.

EFFECT OF AUDITORY DISTRACTION ON HAND AND FOOT REACTION TIME AMONG AGEING MALAYSIAN AUTOMOBILE DRIVERS

The involvement of ageing drivers in traffic accidents were reported but little cited on the severity of auditory driving distractions. Driving distraction contributes to increases in reaction time which can lead to safety traffic risks. Thus, in this study, hand and foot reaction times were measured in response to different distractions within the identical simulated driving route. The task varies in a controlled setting where soundless distractions were present, Comfortable Loudness Level (CLL), Uncomfortable Loudness Level (ULL) auditory distractions, and phone call distraction. Participants were among 40 Malaysian driving license holders consists of 57.5% males and 42.5% females with age mean, (M=51.83, SD=14.058). Results indicated that both hand and foot reaction time were shortest for CLL and longest during phone call. Ageing male scored shortest hand reaction time of 1.15s during CLL distraction. For foot reaction time, ageing male scores shortest of 0.92s for both CLL and no distractions. Pearson’s coefficient of correlation shows r>0.5. The results indicated hand reaction time was affected by foot reaction time (r=0.665), was significantly more for foot when compared with hand, could be because of difference in nerve conduction velocity and movement time of the hand when compared with that of foot.

Prediction of Software-Based Sentence-in-Noise Recognition Thresholds of Hearing-Impaired Listeners

Purpose: Although hearing-impaired (HI) listeners often have difficulty understanding in noise as their primary complaints, the speech-in-noise intelligibility test is not conducted as a standard audiologic test battery. This study investigated whether the speech audiometry in quiet accurately reflects the sentence-in-noise intelligibility of HI listeners. Methods: Sixty-two HI listeners participated. All the HI listeners had symmetrical high-frequency hearing loss and bilaterally worn hearing aids. Twenty-five normal-hearing (NH) listeners also participated as a control group. The unaided word and sentence recognition scores (WRS and SRS) were obtained in quiet at individually determined most comfortable loudness level. With bilateral hearing aids, the aided WRS and SRS were evaluated at a normal conversational level. The software-based Korean Matrix sentence in noise test was administered at a fixed level (65 dB SPL) of noise while adjusting the sentence level adaptively based on the listener’s response. The signal-to-noise ratio (SNR) required to achieve 50% intelligibility (speech recognition thresholds, SRTs) was obtained. Results: On average, the aided SRT of HI listeners was 0.1 dB SNR, and the mean SRT of NH adults was -8.91 dB SNR. The Matrix sentence-in-noise intelligibility was not sufficiently explained by the unaided WRS or unaided SRS. Conclusion: A traditional measure of the unaided speech-in-quiet recognition cannot accurately predict the aided speech-innoise intelligibility. Clinically, a software-based sentence-in-noise intelligibility test is recommended to directly confirm the actual benefits of hearing aid in noisy situations.