Faculty Bibliography

The evidence for the existence of secondary endolymphatic hydrops in patients with perilymphatic fistulas is reviewed and the indications for treatment of such hydrops in patients with fistulas are discussed. The indications for and results of combined fistula repair by middle ear exploration and endolymphatic sac surgery in fifteen patients are presented. The preliminary results in these patients appear encouraging. Patients with recurrent perilymphatic fistulas, or with symptoms of attacks of spinning vertigo after fistula repair, and those who present with severe imbalance with findings of a perilymphatic fistula appear to be candidates for combined fistula and sac surgery.

Paired-comparison judgments of intelligibility of speech in noise were obtained from eight hearing-impaired subjects on a large number of hearing aids simulated by a digital master hearing aid. The hearing aids which comprised a 5 X 5 matrix differed systematically in the amount of low-frequency and high-frequency gain provided. A comparison of three adaptive strategies for determining optimum hearing aid frequency-gain characteristics (an iterative round robin, a double elimination tournament, and a modified simplex procedure) revealed convergence on the same or similar hearing aids for most subjects. Analysis revealed that subjects for whom all three procedures converged on the same hearing aid showed a single pronounced peak in the response surface, while a broader peak was evident for the subjects for whom the three procedures identified similar hearing aids. The modified simplex procedure was found to be most efficient and the iterative round robin least efficient

Electromyographic (EMG) feedback has been proposed to enhance rehabilitation following hypoglossal-facial nerve anastomosis. Sixteen of 25 patients who underwent hypoglossal-facial nerve anastomosis with and without postoperative EMG rehabilitation were videotaped for evaluation of facial movement by four observers unaware of these patients' rehabilitation therapy. Using a House Facial Nerve Grading System and intragroup comparison, a trend discernible in this preliminary study indicates a chance for better facial function with EMG feedback rehabilitation