Faculty Bibliography

Complete medical interviews and physical exams were performed on two stimulated patients by a class of medicine interns. These interviews and examinations were videotaped and were then scored using a rating scale developed by the authors. This system of videotaping and rating complete interviews and physical examinations is called the The Northwestern Evaluation & Training System (NETS). Selected findings are presented and discussed. It is shown how the NETS can be used for educational feedback to the individual student and for quality assurance feedback to training programs regarding the effectiveness of their instruction in interview and physical examination skills

One way in which animals localize sounds along the horizon is by detecting the level differences at the 2 ears. Neurons in the lateral superior olive (LSO) encode this cue by integrating the synaptic drive from ipsilateral excitatory and contralateral inhibitory connections. This synaptic integration was analyzed in 400-500-microns brain slices through the gerbil superior olive. Intracellular recordings from LSO neurons were obtained during the application of independent or conjoint electrical stimuli to the excitatory afferent and inhibitory afferent pathways. Stimulation of ascending fibers from the ipsilateral cochlear nucleus reliably evoked EPSPs and action potentials. Stimulation of the medial nucleus of the trapezoid body (MNTB) consistently evoked IPSPs. The evoked postsynaptic potentials differed in that IPSPs were 2 times the duration of EPSPs. An electrophysiological estimate of convergence indicated approximately 10 excitatory and 8 inhibitory afferents per LSO neuron. MNTB stimulation suppressed synaptically evoked action potentials. When stimulus amplitude was increased to the excitatory pathway, it was generally found that a greater MNTB stimulus was necessary to suppress the action potential. A similar commensurate rise in ipsilateral and contralateral acoustic stimulation was also found to be necessary to give the same criterion response. These results confirm that the LSO can integrate evoked action potentials and IPSPs to encode interaural level. Increasing stimulus voltage was found to decrease both action potential and IPSP latency, suggesting that intensity information may be encoded with temporal cues in the nervous system. It was also found that an evoked burst of action potentials could be inhibited in such a way as to yield intermediate discharge rates, dependent on contralateral stimulus level. Taken together, these results suggest that certain properties related to level-difference coding may be available for intracellular analysis using the brain-slice preparation. Several temporal characteristics of the synaptic potentials, including latency and duration, may play a critical role in this simple computation

Nine children received the Nucleus multichannel cochlear prosthesis. The preoperative evaluation consisted of assessments of auditory function, speech recognition, linguistic skills, and speech production. There were no surgical complications, and recovery in all patients was uneventful. The device was programmed 4 to 5 weeks following surgery, and all children were conditioned to the task. Postoperative training began immediately following device stimulation and is ongoing. Auditory skills and speech production scales were devised to monitor each child's progress. All children have shown varying degrees of improvement in auditory skills and speech production using the implant alone

The speech perception abilities of 15 patients were measured preoperatively using hearing aids and postoperatively using the Nucleus 22-channel cochlear implant over a period of 1, 2, or 3 years. Analysis of mean data revealed that, although the greatest amount of improvement in speech perception scores occurred between the preoperative and 3-month poststimulation evaluation, there was also significant improvement in perception of segmental features and open-set speech recognition over the 3-year time period. When individual patient data were examined, however, it was clear that these improvements were due, in large part, to the performance of a subset of patients who had measurable open-set speech recognition abilities at the time of their 3-month, poststimulation evaluation. Subjects who used the processing scheme that included coding of F1 showed significantly more improvement over time than subjects who used the original F0F2 processing scheme exclusively. It was concluded that open-set speech recognition ability at 3 months is an important prognostic indicator of continued improvement in speech perception abilities over time

This article describes the use of principal components analysis to derive a composite score from a battery of 24 audiologic tests. The composite score is being used as the primary outcome variable in a clinical trial comparing the efficacy of three cochlear implant devices for people with bilateral, profound hearing loss. The first principal component from the within-class pooled variance-covariance matrix over four time periods was chosen to establish the coefficients for the composite score. This component accounted for 61% of the total variance of the 24 audiologic tests. The first principal component had its largest coefficients associated with the most difficult audiologic tests. The mean composite score of all patients improved over time; some patients showed dramatic improvement. The changes in the composite score over time were also closely related to subjective impressions of implant performance by the patient, audiologist, and otolaryngologist

The use of preoperative round window stimulation has been advocated for its possible predictive value in cochlear implant patients. We have attempted to correlate cause of deafness, preoperative radiologic study, and postoperative stimulability and performance with preoperative stimulation. Round window stimulation procedures consisted of measurements of electrical thresholds and comfort levels, gap detection, and temporal difference limen. Radiologic studies were performed using high-resolution computerized semi-axial and coronal tomography with 1.5-millimeter overlapping cuts. Patient performance was measured using a standard audiologic test battery. Sixteen postlingually, profoundly deaf adults who received the Nucleus multichannel cochlear implant were studied. All 16 patients who responded to preoperative stimulation had acceptable CT scans for the ear operated on and stimulated postoperatively with the prosthesis. The lowest level at which a patient could reliably detect a gap between two signals ranged from 10 to 150 milliseconds, which was not predictive. For the temporal difference limen task, the patients who could reliably identify the longer of two pulses when the difference was less than 100 milliseconds did achieve varying amounts of open-set speech discrimination postoperatively. In summary, results indicate that the preoperative psychoacoustic electrical stimulation test battery provides useful information in predicting postoperative performance

Homograft materials have been employed to reconstruct the tympanic membrane and ossicular chain since the mid-1960s. Although the use of homograft materials remains somewhat controversial, this technique has been shown to provide excellent long-term results, both anatomically and functionally. This study reports on the long-term results of 477 ears undergoing homograft tympanoplasty and the modification of previously reported surgical techniques