Gerald Popelka | Stanford University (original) (raw)

Papers by Gerald Popelka

Research paper thumbnail of Comprehensive Measures of Sound Exposures in Cinemas Using Smart Phones

Ear and Hearing, 2014

Objectives: Sensorineural hearing loss from sound overexposure has a considerable prevalence. Ide... more Objectives: Sensorineural hearing loss from sound overexposure has a considerable prevalence. Identification of sound hazards is crucial, as prevention, due to a lack of definitive therapies, is the sole alternative to hearing aids. One subjectively loud, yet little studied, potential sound hazard is movie theaters. This study uses smart phones to evaluate their applicability as a widely available, validated sound pressure level (SPL) meter. Therefore, this study measures sound levels in movie theaters to determine whether sound levels exceed safe occupational noise exposure limits and whether sound levels in movie theaters differ as a function of movie, movie theater, presentation time, and seat location within the theater.

Research paper thumbnail of Distribution characteristics of normal pure-tone thresholds

International Journal of Audiology, 2015

This study examined the statistical properties of normal air-conduction thresholds obtained with ... more This study examined the statistical properties of normal air-conduction thresholds obtained with automated and manual audiometry to test the hypothesis that thresholds are normally distributed and to examine the distributions for evidence of bias in manual testing. Four databases were mined for normal thresholds. One contained audiograms obtained with an automated method. The other three were obtained with manual audiometry. Frequency distributions were examined for four test frequencies (250, 500, 1000, and 2000 Hz). The analysis is based on 317 569 threshold determinations of 80 547 subjects from four clinical databases. Frequency distributions of thresholds obtained with automated audiometry are normal in form. Corrected for age, the mean thresholds are within 1.5 dB of reference equivalent threshold sound pressure levels. Frequency distributions of thresholds obtained by manual audiometry are shifted toward higher thresholds. Two of the three datasets obtained by manual audiometry are positively skewed. The positive shift and skew of the manual audiometry data may result from tester bias. The striking scarcity of thresholds below 0 dB HL suggests that audiologists place less importance on identifying low thresholds than they do for higher-level thresholds. We refer to this as the Good enough bias and suggest that it may be responsible for differences in distributions of thresholds obtained by automated and manual audiometry.

Research paper thumbnail of Comparison of Hearing-Aid Gain Using Functional, Coupler, and Probe-Tube Measurements

Journal of Speech Language and Hearing Research, 1986

Measurements of functional gain were compared first to coupler gain for 57 subjects using one of ... more Measurements of functional gain were compared first to coupler gain for 57 subjects using one of three hearing aid-earmold combinations and second to probe-tube gain for 12 subjects using in-the-ear hearing aids. The average difference between functional and coupler gain plotted as a function of frequency yielded results that were similar to previous reports, with the greatest effects occurring at 3000 and 4000 Hz. Significant differences were seen among hearing aid-earmold combinations at 3000, 4000, and 6000 Hz. Standard deviations for measurements between 750 and 2000 Hz were less than 5 dB and could be explained by variability of functional gain measures associated with test-retest variability of thresholds measured in a sound field. Below 750 Hz and above 2000 Hz, standard deviations exceeded 5 dB. The greater variability may be explained by differences in earmold venting, acoustic characteristics of the ear canal, and stimuli used to measure functional and coupler gain. Neither room nor hearing-aid noise appeared to affect the results significantly. When functional gain was compared to insertion gain measured with a probe-tube system, the average difference across frequencies was less than 1 dB. The variability of the differences at all frequencies, with the exception of 6000 Hz, was within the range reported for functional gain measurements. It was concluded that functional gain can be accurately estimated using probe-tube measurements.

Research paper thumbnail of An Analysis of Malar Fat Volume in Two Age Groups: Implications for Craniofacial Surgery

Craniomaxillofacial Trauma and Reconstruction, 2012

Objective To evaluate how malar fat pad (MFP) volumes vary with age, after controlling for gender... more Objective To evaluate how malar fat pad (MFP) volumes vary with age, after controlling for gender and body mass index (BMI). Study Design A prospective case-control study evaluating volume of the MFP in women of two age groups. Methods Soft tissue dimensions were measured in eight subjects using magnetic resonance imaging. A multiplanar localizing sequence, followed in sagittal and coronal orientations using a turbo spin echo sequence, was performed to define the MFP. Volumetric calculations were then performed using a 3D image analysis application (Dextroscope, Volume Interactions, Republic of Singapore) to circumscribe areas, orient dimensions, and calculate volumes of the MFP. Results These data reveal no significant difference in the mean (standard deviation) right MFP (p = 0.50), left MFP (p = 0.41), or total MFP (p = 0.45) volumes when comparing the two age groups. In addition, these data indicate that there was no correlation between age and total MFP volume (Pearson correlation coefficient 0.27). Moreover, there was no correlation between age and the ratio of total volume/BMI (Pearson correlation coefficient -0.18). Conclusions Although the sample size of this study was small, these data indicate that ptosis of midfacial fat is more important than volume loss in midfacial aging. These data would suggest repositioning as the primary modality for craniofacial reconstruction.

Research paper thumbnail of Reliability of airway obstruction analyses from Sleep MRI sequences

Otolaryngology - Head and Neck Surgery, 2010

OBJECTIVE: A real-time MRI "movie" during natural sleep ("Sleep MRI") allows observation of dynam... more OBJECTIVE: A real-time MRI "movie" during natural sleep ("Sleep MRI") allows observation of dynamic airway obstructions in obstructive sleep apnea syndrome (OSAS) patients. The purpose of this article was to determine the reliability of assessing these obstructions. STUDY DESIGN: Cross-sectional diagnostic test evaluation. SETTING: Academic referral center. SUBJECTS AND METHODS: A total of 23 Sleep MRI sequences randomly selected from 20 consecutive OSAS patients were analyzed by two experienced sleep surgeons on two separate occasions separated by at least two weeks. Five dimensions were assessed: presence or absence of any obstruction, presence or absence of a retropalatal obstruction, presence or absence of a retroglossal obstruction, presence or absence of a swallow, and duration of an obstructive event. RESULTS: For all dimensions measured, intra-rater reliability coefficients ranged from a low of 0.95 to a high of 1.0 for each rater. Inter-rater reliability coefficients ranged from a low of 0.85 to a high of 1.0. On two separate evaluations separated by at least two weeks, rater 1 identified a retropalatal obstruction in 100 percent of sequences, whereas rater 2 did so in 91 percent and 96 percent of the sequences, respectively. Retroglossal obstruction was identified in 57 percent (rater 1) and 65 percent (rater 2) of sequences. CONCLUSION: Intra-rater and inter-rater reliability coefficients are very high for determination of presence or absence of any obstruction, presence or absence of a retropalatal obstruction, presence or absence of a retroglossal obstruction, presence or absence of a swallow, and duration of obstruction from Sleep MRI sequences in OSAS patients.

Research paper thumbnail of The Significance of “The Significant Asymmetrical Tympanogram”: A Reply to Pearlman and Graber

Journal of Speech Language and Hearing Research, 1978

Research paper thumbnail of Static and Dynamic Acoustic Impedance Measurements in Infant Ears

Journal of Speech Language and Hearing Research, 1975

Tympanometry and acoustic reflex threshold data are reported for a series of presumable normal in... more Tympanometry and acoustic reflex threshold data are reported for a series of presumable normal infants ranging in age from 55 to 132 days. In general, tympanograms displayed single peaks between +/- 50 mm H2O. Susceptance tympanograms with a 660-Hz probe frequency were sometimes characterized by monotonically increasing susceptance as ear canal pressure was changed from -200 to +200 mm H2O. Static values of acoustic conductance, susceptance, admittance, resistance, reactance, impedance, and phase angle were computed from tympanograms using the values of ambient and +200 mm H2O (0/+200 procedure) and maximum and minimum tympanometric values (MAX/MIN procedure). Comparison of the data from the two computational procedures suggested that the MAX/MIN procedure produces means and standard deviations of static values which are more manageable for establishing confidence limits with which to evaluate potentially pathological subjects. The MAX/MIN procedure resulted in lower mean values of conductance and susceptance for infant subjects relative to previously reported adult data using a similar computational procedure. Acoustic reflex thresholds were clearly present in all testable infants at coupler sound pressure levels similar to adult data, suggesting that the relations between reflex thresholds and hearing sensitivity demonstrated in adult subjects are similarly applicable to infant subjects. Mild sedation to induce sleep without altering the reflex would make acoustic reflex threshold measurement a useful procedure for screening large numbers of infants.

Research paper thumbnail of The effect of continuous positive airway pressure on middle ear pressure

The Laryngoscope, 2012

Objectives/Hypothesis: While continuous positive airway pressure (CPAP) is commonly used for obst... more Objectives/Hypothesis: While continuous positive airway pressure (CPAP) is commonly used for obstructive sleep apnea treatment, its effect on middle ear pressure is unknown. The purpose of this study was to measure the effect of CPAP on middle ear pressure and describe the correlation between CPAP levels and middle ear pressures.

Research paper thumbnail of BASIC LABORATORY INSTRUMENTATION FOR SPEECH AND HEARING

The Laryngoscope, 1986

An academic directory and search engine.

Research paper thumbnail of Stimulus Frequency Otoacoustic Emissions in Wild-Type and TECTA Mice

... in Wild-Type and TECTA Mice Karina N. Pikhart ??? , Gerald R. Popelka???, Arturo Moleti ?????... more ... in Wild-Type and TECTA Mice Karina N. Pikhart ??? , Gerald R. Popelka???, Arturo Moleti ?????? , Renata Sisto???, ... Abstract. Stimulus-frequency otoacoustic emissions (SFOAEs) were measured in wild-type and TectaC1509/+ mice from 8???13 kHz via the two-tone suppression method. ...

Research paper thumbnail of A Tribute to Max Aaron Goldstein, MD

Research paper thumbnail of Hearing Levels of Railroad Trainmen

The Laryngoscope, 1989

The hearing sensitivity of 9427 railroad train crew members, determined during the first year of ... more The hearing sensitivity of 9427 railroad train crew members, determined during the first year of a company-wide hearing conservation program, was compared with hearing sensitivity in a control population not exposed to occupational noise. The hearing sensitivity of the trainmen did not differ significantly from that of the control population. Multiple regression analysis, which considered separately the effects of age and years of service, showed significant differences in hearing levels due to age, but no differences in hearing levels due to years of service. Evaluation of the data by risk categories developed by the National Institute for Occupational Safety and Health indicate that this group of trainmen had no risk of occupational noise-induced hearing loss. These analyses, combined with studies of locomotive cab noise, show clearly that trainmen are not typically exposed to hazardous occupational noise.

Research paper thumbnail of Long-Term Safety and Benefit of a New Intraoral Device for Single-Sided Deafness

Otology & Neurotology, 2011

To determine the long-term safety and benefit of a new intraoral bone conduction device (SoundBit... more To determine the long-term safety and benefit of a new intraoral bone conduction device (SoundBite Hearing System by Sonitus Medical) for single-sided deafness (SSD). A multi-center, controlled, nonrandomized, prospective unblinded study of SSD patients wearing the device over a 6-month period. Ambulatory care centers typical of those where SSD patients are diagnosed and treated. Adults (N = 22) with acquired, permanent SSD and no current use of any other SSD device. Continual daily wear of the new device for 6 months. Comprehensive medical, audiologic, and dental measures; aided thresholds; Abbreviated Profile of Hearing Aid Benefit scores, and an SSD questionnaire. There were no related adverse events or changes in the medical or audiologic findings at the end of the trial compared with the beginning. There were no significant changes in the mean aided thresholds (p > 0.01) or the mean dental measures (p > 0.05) at 3 or 6 months compared with pretrial measures. The mean Abbreviated Profile of Hearing Aid Benefit benefit scores showed improvement (p < 0.01) for the Background Noise, Reverberation, and Ease of Communication subscales and the Global scale at 3 and 6 months. The results of the SSD questionnaire indicated that the vast majority (>90%) of the subjects reported satisfaction and improvement in a variety of areas after wearing the device long term. The SoundBite system is safe and continues to provide substantial benefit for SSD patients with continual daily use over a 6-month period.

Research paper thumbnail of In Vivo Imaging of Mammalian Cochlear Blood Flow Using Fluorescence Microendoscopy

Otology & Neurotology, 2006

Aims: We sought to develop techniques for visualizing cochlear blood flow in live mammalian subje... more Aims: We sought to develop techniques for visualizing cochlear blood flow in live mammalian subjects using fluorescence microendoscopy. Background: Inner ear microcirculation appears to be intimately involved in cochlear function. Blood velocity measurements suggest that intense sounds can alter cochlear blood flow. Disruption of cochlear blood flow may be a significant cause of hearing impairment, including sudden sensorineural hearing loss. However, inability to image cochlear blood flow in a nondestructive manner has limited investigation of the role of inner ear microcirculation in hearing function. Present techniques for imaging cochlear microcirculation using intravital light microscopy involve extensive perturbations to cochlear structure, precluding application in human patients. The few previous endoscopy studies of the cochlea have suffered from optical resolution insufficient for visualizing cochlear microvasculature. Fluorescence microendoscopy is an emerging minimally invasive imaging modality that provides micron-scale resolution in tissues inaccessible to light microscopy. In this article, we describe the use of fluorescence microendoscopy in live guinea pigs to image capillary blood flow and movements of individual red blood cells within the basal turn of the cochlea.

Research paper thumbnail of Efficacy and Safety of an In-the-Mouth Bone Conduction Device for Single-Sided Deafness

Otology & Neurotology, 2011

To determine the efficacy, benefit, and safety of a new in-the-mouth bone conduction device (Soun... more To determine the efficacy, benefit, and safety of a new in-the-mouth bone conduction device (SoundBite Hearing System) for single-sided deafness (SSD). A multicenter, controlled, nonrandomized prospective unblinded study of SSD patients wearing the device. Ambulatory care centers typical of those where SSD patients are diagnosed and treated. Adults (ages >18 and <80 yr) with acquired, permanent SSD (N=28) and no current use of any SSD device. Continual daily wear of the new device over a 30-day trial period. The Hearing in Noise Test (HINT), the Abbreviated Profile of Hearing Aid Benefit (APHAB), comprehensive pretrial and posttrial medical, audiologic, and dental examinations and an SSD questionnaire. The Hearing in Noise Test scores improved an average of -2.5 dB after 30 days, compared with wearing no device (p<0.001). The Abbreviated Profile of Hearing Aid Benefit scores improved (p<0.05) for all subjects for the Global and Background Noise subscales and for all but 1 subject for the Reverberation and Ease of Communication subscales. There were no medical, audiologic, or dental complications. The SoundBite system is safe and effective and provides substantial benefit for SSD patients with continual daily use over a 30-day period.

Research paper thumbnail of Preliminary Evaluation of a Novel Bone-Conduction Device for Single-Sided Deafness

Otology & Neurotology, 2010

A new intraoral bone-conduction device has advantages over existing bone-conduction devices for r... more A new intraoral bone-conduction device has advantages over existing bone-conduction devices for reducing the auditory deficits associated with single-sided deafness (SSD). Existing bone-conduction devices effectively mitigate auditory deficits from single-sided deafness but have suboptimal microphone locations, limited frequency range, and/or require invasive surgery. A new device has been designed to improve microphone placement (in the ear canal of the deaf ear), provide a wider frequency range, and eliminate surgery by delivering bone-conduction signals to the teeth via a removable oral appliance. Forces applied by the oral appliance were compared with forces typically experienced by the teeth from normal functions such as mastication or from other appliances. Tooth surface changes were measured on extracted teeth, and transducer temperature was measured under typical use conditions. Dynamic operating range, including gain, bandwidth, and maximum output limits, were determined from uncomfortable loudness levels and vibrotactile thresholds, and speech recognition scores were measured using normal-hearing subjects. Auditory performance in noise (Hearing in Noise Test) was measured in a limited sample of SSD subjects. Overall comfort, ease of insertion, and removal and visibility of the oral appliance in comparison with traditional hearing aids were measured using a rating scale. The oral appliance produces forces that are far below those experienced by the teeth from normal functions or conventional dental appliances. The bone-conduction signal level can be adjusted to prevent tactile perception yet provide sufficient gain and output at frequencies from 250 to 12,000 Hz. The device does not damage tooth surfaces nor produce heat, can be inserted and removed easily, and is as comfortable to wear as traditional hearing aids. The new microphone location has advantages for reducing the auditory deficits caused by SSD, including the potential to provide spatial cues introduced by reflections from the pinna, compared with microphone locations for existing devices. A new approach for SSD has been proposed that optimizes microphone location and delivers sound by bone conduction through a removable oral appliance. Measures in the laboratory using normal-hearing subjects indicate that the device provides useful gain and output for SSD patients, is comfortable, does not seem to have detrimental effects on oral function or oral health, and has several advantages over existing devices. Specifically, microphone placement is optimized for reducing the auditory deficit caused by SSD, frequency bandwidth is much greater, and the system does not require surgical placement. Auditory performance in a small sample of SSD subjects indicated a substantial advantage compared with not wearing the device. Future studies will involve performance measures on SSD patients wearing the device for longer periods.

Research paper thumbnail of Sleep MRI: Novel technique to identify airway obstruction in obstructive sleep apnea

Otolaryngology - Head and Neck Surgery, 2009

We describe a new tool, “Sleep MRI,” a real-time device that detects and characterizes the anatom... more We describe a new tool, “Sleep MRI,” a real-time device that detects and characterizes the anatomic site, magnitude, and duration of airway obstruction simultaneously with MRI-compatible physiologic measures of peripheral arterial tone, hemoglobin oxygen saturation, and pulse rate in ...

Research paper thumbnail of Reliability of airway obstruction analysis from sleep MRI

Otolaryngology - Head and Neck Surgery, 2009

Assessment of obstructions from dynamic real-time MRI is very different from assessment of static... more Assessment of obstructions from dynamic real-time MRI is very different from assessment of static images. Differences include differentiating a true obstruction and a swallow. A total of 23 MRI sequences selected randomly were rated by two experienced sleep surgeons (authors of ...

Research paper thumbnail of Newborn Hearing Screening with Combined Otoacoustic Emissions and Auditory Brainstem Responses

Journal of the American Academy of Audiology, 2004

Accurate assessment of neonatal hearing screening performance is impossible without knowledge of ... more Accurate assessment of neonatal hearing screening performance is impossible without knowledge of the true status of hearing, a prohibitive requirement that necessitates a complete diagnostic evaluation on all babies screened. The purpose of this study was to circumvent this limitation by integrating two types of screening measures obtained near simultaneously on every baby. Peripheral auditory function was defined by otoacoustic emission results. A complete diagnostic evaluation was performed on every baby who received a "Refer" outcome for auditory brainstem response screening. The integrated results for auditory brainstem response screening in an unselected group of 300 newborns estimated sensitivity at 100%, specificity at 99.7%, overall referral rate at 2.0%, and a positive predictive value of 83.3%. Conductive loss associated with amniotic fluid in the middle ear can persist several weeks after birth; conductive loss can produce a "Refer" outcome for auditory brainstem response screening; and auditory neuropathy can be detected with screening measures. Prevalence results were consistent with the published literature. The implications of this study are that otoacoustic emissions and auditory brainstem measures provide much more information than either alone and that both are needed for a comprehensive…

Research paper thumbnail of Preliminary comparison of bone-anchored hearing instruments and a dental device as treatments for unilateral hearing loss

International Journal of Audiology, 2013

To compare the effectiveness of two types of treatment for unilateral hearing loss (UHL), bone-an... more To compare the effectiveness of two types of treatment for unilateral hearing loss (UHL), bone-anchored hearing instruments (BAHI) and a dental device (SoundBite). Either BAHI or SoundBite were worn for 30 days, and then the devices were swapped and the second device was worn for 30 days. Measures included unaided and aided sound-field thresholds, sound localization, and perception of speech in babble. The APHAB questionnaire was administered for each trial period. Nine adult BAHI wearers with UHL. Mid-frequency aided thresholds were lower for SoundBite than for BAHI. Both devices gave benefits for localization after 30 days, but there was no difference between devices. Speech perception was better for both devices than for unaided listening when the target speech came from the poorer hearing side or in front, and the interfering babble came from the better-hearing side. There was no consistent difference between devices. APHAB scores were better for SoundBite than for BAHI. Speech perception and sound localization were similar for the two types of device, but the SoundBite led to lower aided thresholds and better APHAB scores than the BAHI.

Research paper thumbnail of Comprehensive Measures of Sound Exposures in Cinemas Using Smart Phones

Ear and Hearing, 2014

Objectives: Sensorineural hearing loss from sound overexposure has a considerable prevalence. Ide... more Objectives: Sensorineural hearing loss from sound overexposure has a considerable prevalence. Identification of sound hazards is crucial, as prevention, due to a lack of definitive therapies, is the sole alternative to hearing aids. One subjectively loud, yet little studied, potential sound hazard is movie theaters. This study uses smart phones to evaluate their applicability as a widely available, validated sound pressure level (SPL) meter. Therefore, this study measures sound levels in movie theaters to determine whether sound levels exceed safe occupational noise exposure limits and whether sound levels in movie theaters differ as a function of movie, movie theater, presentation time, and seat location within the theater.

Research paper thumbnail of Distribution characteristics of normal pure-tone thresholds

International Journal of Audiology, 2015

This study examined the statistical properties of normal air-conduction thresholds obtained with ... more This study examined the statistical properties of normal air-conduction thresholds obtained with automated and manual audiometry to test the hypothesis that thresholds are normally distributed and to examine the distributions for evidence of bias in manual testing. Four databases were mined for normal thresholds. One contained audiograms obtained with an automated method. The other three were obtained with manual audiometry. Frequency distributions were examined for four test frequencies (250, 500, 1000, and 2000 Hz). The analysis is based on 317 569 threshold determinations of 80 547 subjects from four clinical databases. Frequency distributions of thresholds obtained with automated audiometry are normal in form. Corrected for age, the mean thresholds are within 1.5 dB of reference equivalent threshold sound pressure levels. Frequency distributions of thresholds obtained by manual audiometry are shifted toward higher thresholds. Two of the three datasets obtained by manual audiometry are positively skewed. The positive shift and skew of the manual audiometry data may result from tester bias. The striking scarcity of thresholds below 0 dB HL suggests that audiologists place less importance on identifying low thresholds than they do for higher-level thresholds. We refer to this as the Good enough bias and suggest that it may be responsible for differences in distributions of thresholds obtained by automated and manual audiometry.

Research paper thumbnail of Comparison of Hearing-Aid Gain Using Functional, Coupler, and Probe-Tube Measurements

Journal of Speech Language and Hearing Research, 1986

Measurements of functional gain were compared first to coupler gain for 57 subjects using one of ... more Measurements of functional gain were compared first to coupler gain for 57 subjects using one of three hearing aid-earmold combinations and second to probe-tube gain for 12 subjects using in-the-ear hearing aids. The average difference between functional and coupler gain plotted as a function of frequency yielded results that were similar to previous reports, with the greatest effects occurring at 3000 and 4000 Hz. Significant differences were seen among hearing aid-earmold combinations at 3000, 4000, and 6000 Hz. Standard deviations for measurements between 750 and 2000 Hz were less than 5 dB and could be explained by variability of functional gain measures associated with test-retest variability of thresholds measured in a sound field. Below 750 Hz and above 2000 Hz, standard deviations exceeded 5 dB. The greater variability may be explained by differences in earmold venting, acoustic characteristics of the ear canal, and stimuli used to measure functional and coupler gain. Neither room nor hearing-aid noise appeared to affect the results significantly. When functional gain was compared to insertion gain measured with a probe-tube system, the average difference across frequencies was less than 1 dB. The variability of the differences at all frequencies, with the exception of 6000 Hz, was within the range reported for functional gain measurements. It was concluded that functional gain can be accurately estimated using probe-tube measurements.

Research paper thumbnail of An Analysis of Malar Fat Volume in Two Age Groups: Implications for Craniofacial Surgery

Craniomaxillofacial Trauma and Reconstruction, 2012

Objective To evaluate how malar fat pad (MFP) volumes vary with age, after controlling for gender... more Objective To evaluate how malar fat pad (MFP) volumes vary with age, after controlling for gender and body mass index (BMI). Study Design A prospective case-control study evaluating volume of the MFP in women of two age groups. Methods Soft tissue dimensions were measured in eight subjects using magnetic resonance imaging. A multiplanar localizing sequence, followed in sagittal and coronal orientations using a turbo spin echo sequence, was performed to define the MFP. Volumetric calculations were then performed using a 3D image analysis application (Dextroscope, Volume Interactions, Republic of Singapore) to circumscribe areas, orient dimensions, and calculate volumes of the MFP. Results These data reveal no significant difference in the mean (standard deviation) right MFP (p = 0.50), left MFP (p = 0.41), or total MFP (p = 0.45) volumes when comparing the two age groups. In addition, these data indicate that there was no correlation between age and total MFP volume (Pearson correlation coefficient 0.27). Moreover, there was no correlation between age and the ratio of total volume/BMI (Pearson correlation coefficient -0.18). Conclusions Although the sample size of this study was small, these data indicate that ptosis of midfacial fat is more important than volume loss in midfacial aging. These data would suggest repositioning as the primary modality for craniofacial reconstruction.

Research paper thumbnail of Reliability of airway obstruction analyses from Sleep MRI sequences

Otolaryngology - Head and Neck Surgery, 2010

OBJECTIVE: A real-time MRI "movie" during natural sleep ("Sleep MRI") allows observation of dynam... more OBJECTIVE: A real-time MRI "movie" during natural sleep ("Sleep MRI") allows observation of dynamic airway obstructions in obstructive sleep apnea syndrome (OSAS) patients. The purpose of this article was to determine the reliability of assessing these obstructions. STUDY DESIGN: Cross-sectional diagnostic test evaluation. SETTING: Academic referral center. SUBJECTS AND METHODS: A total of 23 Sleep MRI sequences randomly selected from 20 consecutive OSAS patients were analyzed by two experienced sleep surgeons on two separate occasions separated by at least two weeks. Five dimensions were assessed: presence or absence of any obstruction, presence or absence of a retropalatal obstruction, presence or absence of a retroglossal obstruction, presence or absence of a swallow, and duration of an obstructive event. RESULTS: For all dimensions measured, intra-rater reliability coefficients ranged from a low of 0.95 to a high of 1.0 for each rater. Inter-rater reliability coefficients ranged from a low of 0.85 to a high of 1.0. On two separate evaluations separated by at least two weeks, rater 1 identified a retropalatal obstruction in 100 percent of sequences, whereas rater 2 did so in 91 percent and 96 percent of the sequences, respectively. Retroglossal obstruction was identified in 57 percent (rater 1) and 65 percent (rater 2) of sequences. CONCLUSION: Intra-rater and inter-rater reliability coefficients are very high for determination of presence or absence of any obstruction, presence or absence of a retropalatal obstruction, presence or absence of a retroglossal obstruction, presence or absence of a swallow, and duration of obstruction from Sleep MRI sequences in OSAS patients.

Research paper thumbnail of The Significance of “The Significant Asymmetrical Tympanogram”: A Reply to Pearlman and Graber

Journal of Speech Language and Hearing Research, 1978

Research paper thumbnail of Static and Dynamic Acoustic Impedance Measurements in Infant Ears

Journal of Speech Language and Hearing Research, 1975

Tympanometry and acoustic reflex threshold data are reported for a series of presumable normal in... more Tympanometry and acoustic reflex threshold data are reported for a series of presumable normal infants ranging in age from 55 to 132 days. In general, tympanograms displayed single peaks between +/- 50 mm H2O. Susceptance tympanograms with a 660-Hz probe frequency were sometimes characterized by monotonically increasing susceptance as ear canal pressure was changed from -200 to +200 mm H2O. Static values of acoustic conductance, susceptance, admittance, resistance, reactance, impedance, and phase angle were computed from tympanograms using the values of ambient and +200 mm H2O (0/+200 procedure) and maximum and minimum tympanometric values (MAX/MIN procedure). Comparison of the data from the two computational procedures suggested that the MAX/MIN procedure produces means and standard deviations of static values which are more manageable for establishing confidence limits with which to evaluate potentially pathological subjects. The MAX/MIN procedure resulted in lower mean values of conductance and susceptance for infant subjects relative to previously reported adult data using a similar computational procedure. Acoustic reflex thresholds were clearly present in all testable infants at coupler sound pressure levels similar to adult data, suggesting that the relations between reflex thresholds and hearing sensitivity demonstrated in adult subjects are similarly applicable to infant subjects. Mild sedation to induce sleep without altering the reflex would make acoustic reflex threshold measurement a useful procedure for screening large numbers of infants.

Research paper thumbnail of The effect of continuous positive airway pressure on middle ear pressure

The Laryngoscope, 2012

Objectives/Hypothesis: While continuous positive airway pressure (CPAP) is commonly used for obst... more Objectives/Hypothesis: While continuous positive airway pressure (CPAP) is commonly used for obstructive sleep apnea treatment, its effect on middle ear pressure is unknown. The purpose of this study was to measure the effect of CPAP on middle ear pressure and describe the correlation between CPAP levels and middle ear pressures.

Research paper thumbnail of BASIC LABORATORY INSTRUMENTATION FOR SPEECH AND HEARING

The Laryngoscope, 1986

An academic directory and search engine.

Research paper thumbnail of Stimulus Frequency Otoacoustic Emissions in Wild-Type and TECTA Mice

... in Wild-Type and TECTA Mice Karina N. Pikhart ??? , Gerald R. Popelka???, Arturo Moleti ?????... more ... in Wild-Type and TECTA Mice Karina N. Pikhart ??? , Gerald R. Popelka???, Arturo Moleti ?????? , Renata Sisto???, ... Abstract. Stimulus-frequency otoacoustic emissions (SFOAEs) were measured in wild-type and TectaC1509/+ mice from 8???13 kHz via the two-tone suppression method. ...

Research paper thumbnail of A Tribute to Max Aaron Goldstein, MD

Research paper thumbnail of Hearing Levels of Railroad Trainmen

The Laryngoscope, 1989

The hearing sensitivity of 9427 railroad train crew members, determined during the first year of ... more The hearing sensitivity of 9427 railroad train crew members, determined during the first year of a company-wide hearing conservation program, was compared with hearing sensitivity in a control population not exposed to occupational noise. The hearing sensitivity of the trainmen did not differ significantly from that of the control population. Multiple regression analysis, which considered separately the effects of age and years of service, showed significant differences in hearing levels due to age, but no differences in hearing levels due to years of service. Evaluation of the data by risk categories developed by the National Institute for Occupational Safety and Health indicate that this group of trainmen had no risk of occupational noise-induced hearing loss. These analyses, combined with studies of locomotive cab noise, show clearly that trainmen are not typically exposed to hazardous occupational noise.

Research paper thumbnail of Long-Term Safety and Benefit of a New Intraoral Device for Single-Sided Deafness

Otology & Neurotology, 2011

To determine the long-term safety and benefit of a new intraoral bone conduction device (SoundBit... more To determine the long-term safety and benefit of a new intraoral bone conduction device (SoundBite Hearing System by Sonitus Medical) for single-sided deafness (SSD). A multi-center, controlled, nonrandomized, prospective unblinded study of SSD patients wearing the device over a 6-month period. Ambulatory care centers typical of those where SSD patients are diagnosed and treated. Adults (N = 22) with acquired, permanent SSD and no current use of any other SSD device. Continual daily wear of the new device for 6 months. Comprehensive medical, audiologic, and dental measures; aided thresholds; Abbreviated Profile of Hearing Aid Benefit scores, and an SSD questionnaire. There were no related adverse events or changes in the medical or audiologic findings at the end of the trial compared with the beginning. There were no significant changes in the mean aided thresholds (p > 0.01) or the mean dental measures (p > 0.05) at 3 or 6 months compared with pretrial measures. The mean Abbreviated Profile of Hearing Aid Benefit benefit scores showed improvement (p < 0.01) for the Background Noise, Reverberation, and Ease of Communication subscales and the Global scale at 3 and 6 months. The results of the SSD questionnaire indicated that the vast majority (>90%) of the subjects reported satisfaction and improvement in a variety of areas after wearing the device long term. The SoundBite system is safe and continues to provide substantial benefit for SSD patients with continual daily use over a 6-month period.

Research paper thumbnail of In Vivo Imaging of Mammalian Cochlear Blood Flow Using Fluorescence Microendoscopy

Otology & Neurotology, 2006

Aims: We sought to develop techniques for visualizing cochlear blood flow in live mammalian subje... more Aims: We sought to develop techniques for visualizing cochlear blood flow in live mammalian subjects using fluorescence microendoscopy. Background: Inner ear microcirculation appears to be intimately involved in cochlear function. Blood velocity measurements suggest that intense sounds can alter cochlear blood flow. Disruption of cochlear blood flow may be a significant cause of hearing impairment, including sudden sensorineural hearing loss. However, inability to image cochlear blood flow in a nondestructive manner has limited investigation of the role of inner ear microcirculation in hearing function. Present techniques for imaging cochlear microcirculation using intravital light microscopy involve extensive perturbations to cochlear structure, precluding application in human patients. The few previous endoscopy studies of the cochlea have suffered from optical resolution insufficient for visualizing cochlear microvasculature. Fluorescence microendoscopy is an emerging minimally invasive imaging modality that provides micron-scale resolution in tissues inaccessible to light microscopy. In this article, we describe the use of fluorescence microendoscopy in live guinea pigs to image capillary blood flow and movements of individual red blood cells within the basal turn of the cochlea.

Research paper thumbnail of Efficacy and Safety of an In-the-Mouth Bone Conduction Device for Single-Sided Deafness

Otology & Neurotology, 2011

To determine the efficacy, benefit, and safety of a new in-the-mouth bone conduction device (Soun... more To determine the efficacy, benefit, and safety of a new in-the-mouth bone conduction device (SoundBite Hearing System) for single-sided deafness (SSD). A multicenter, controlled, nonrandomized prospective unblinded study of SSD patients wearing the device. Ambulatory care centers typical of those where SSD patients are diagnosed and treated. Adults (ages >18 and <80 yr) with acquired, permanent SSD (N=28) and no current use of any SSD device. Continual daily wear of the new device over a 30-day trial period. The Hearing in Noise Test (HINT), the Abbreviated Profile of Hearing Aid Benefit (APHAB), comprehensive pretrial and posttrial medical, audiologic, and dental examinations and an SSD questionnaire. The Hearing in Noise Test scores improved an average of -2.5 dB after 30 days, compared with wearing no device (p<0.001). The Abbreviated Profile of Hearing Aid Benefit scores improved (p<0.05) for all subjects for the Global and Background Noise subscales and for all but 1 subject for the Reverberation and Ease of Communication subscales. There were no medical, audiologic, or dental complications. The SoundBite system is safe and effective and provides substantial benefit for SSD patients with continual daily use over a 30-day period.

Research paper thumbnail of Preliminary Evaluation of a Novel Bone-Conduction Device for Single-Sided Deafness

Otology & Neurotology, 2010

A new intraoral bone-conduction device has advantages over existing bone-conduction devices for r... more A new intraoral bone-conduction device has advantages over existing bone-conduction devices for reducing the auditory deficits associated with single-sided deafness (SSD). Existing bone-conduction devices effectively mitigate auditory deficits from single-sided deafness but have suboptimal microphone locations, limited frequency range, and/or require invasive surgery. A new device has been designed to improve microphone placement (in the ear canal of the deaf ear), provide a wider frequency range, and eliminate surgery by delivering bone-conduction signals to the teeth via a removable oral appliance. Forces applied by the oral appliance were compared with forces typically experienced by the teeth from normal functions such as mastication or from other appliances. Tooth surface changes were measured on extracted teeth, and transducer temperature was measured under typical use conditions. Dynamic operating range, including gain, bandwidth, and maximum output limits, were determined from uncomfortable loudness levels and vibrotactile thresholds, and speech recognition scores were measured using normal-hearing subjects. Auditory performance in noise (Hearing in Noise Test) was measured in a limited sample of SSD subjects. Overall comfort, ease of insertion, and removal and visibility of the oral appliance in comparison with traditional hearing aids were measured using a rating scale. The oral appliance produces forces that are far below those experienced by the teeth from normal functions or conventional dental appliances. The bone-conduction signal level can be adjusted to prevent tactile perception yet provide sufficient gain and output at frequencies from 250 to 12,000 Hz. The device does not damage tooth surfaces nor produce heat, can be inserted and removed easily, and is as comfortable to wear as traditional hearing aids. The new microphone location has advantages for reducing the auditory deficits caused by SSD, including the potential to provide spatial cues introduced by reflections from the pinna, compared with microphone locations for existing devices. A new approach for SSD has been proposed that optimizes microphone location and delivers sound by bone conduction through a removable oral appliance. Measures in the laboratory using normal-hearing subjects indicate that the device provides useful gain and output for SSD patients, is comfortable, does not seem to have detrimental effects on oral function or oral health, and has several advantages over existing devices. Specifically, microphone placement is optimized for reducing the auditory deficit caused by SSD, frequency bandwidth is much greater, and the system does not require surgical placement. Auditory performance in a small sample of SSD subjects indicated a substantial advantage compared with not wearing the device. Future studies will involve performance measures on SSD patients wearing the device for longer periods.

Research paper thumbnail of Sleep MRI: Novel technique to identify airway obstruction in obstructive sleep apnea

Otolaryngology - Head and Neck Surgery, 2009

We describe a new tool, “Sleep MRI,” a real-time device that detects and characterizes the anatom... more We describe a new tool, “Sleep MRI,” a real-time device that detects and characterizes the anatomic site, magnitude, and duration of airway obstruction simultaneously with MRI-compatible physiologic measures of peripheral arterial tone, hemoglobin oxygen saturation, and pulse rate in ...

Research paper thumbnail of Reliability of airway obstruction analysis from sleep MRI

Otolaryngology - Head and Neck Surgery, 2009

Assessment of obstructions from dynamic real-time MRI is very different from assessment of static... more Assessment of obstructions from dynamic real-time MRI is very different from assessment of static images. Differences include differentiating a true obstruction and a swallow. A total of 23 MRI sequences selected randomly were rated by two experienced sleep surgeons (authors of ...

Research paper thumbnail of Newborn Hearing Screening with Combined Otoacoustic Emissions and Auditory Brainstem Responses

Journal of the American Academy of Audiology, 2004

Accurate assessment of neonatal hearing screening performance is impossible without knowledge of ... more Accurate assessment of neonatal hearing screening performance is impossible without knowledge of the true status of hearing, a prohibitive requirement that necessitates a complete diagnostic evaluation on all babies screened. The purpose of this study was to circumvent this limitation by integrating two types of screening measures obtained near simultaneously on every baby. Peripheral auditory function was defined by otoacoustic emission results. A complete diagnostic evaluation was performed on every baby who received a "Refer" outcome for auditory brainstem response screening. The integrated results for auditory brainstem response screening in an unselected group of 300 newborns estimated sensitivity at 100%, specificity at 99.7%, overall referral rate at 2.0%, and a positive predictive value of 83.3%. Conductive loss associated with amniotic fluid in the middle ear can persist several weeks after birth; conductive loss can produce a "Refer" outcome for auditory brainstem response screening; and auditory neuropathy can be detected with screening measures. Prevalence results were consistent with the published literature. The implications of this study are that otoacoustic emissions and auditory brainstem measures provide much more information than either alone and that both are needed for a comprehensive…

Research paper thumbnail of Preliminary comparison of bone-anchored hearing instruments and a dental device as treatments for unilateral hearing loss

International Journal of Audiology, 2013

To compare the effectiveness of two types of treatment for unilateral hearing loss (UHL), bone-an... more To compare the effectiveness of two types of treatment for unilateral hearing loss (UHL), bone-anchored hearing instruments (BAHI) and a dental device (SoundBite). Either BAHI or SoundBite were worn for 30 days, and then the devices were swapped and the second device was worn for 30 days. Measures included unaided and aided sound-field thresholds, sound localization, and perception of speech in babble. The APHAB questionnaire was administered for each trial period. Nine adult BAHI wearers with UHL. Mid-frequency aided thresholds were lower for SoundBite than for BAHI. Both devices gave benefits for localization after 30 days, but there was no difference between devices. Speech perception was better for both devices than for unaided listening when the target speech came from the poorer hearing side or in front, and the interfering babble came from the better-hearing side. There was no consistent difference between devices. APHAB scores were better for SoundBite than for BAHI. Speech perception and sound localization were similar for the two types of device, but the SoundBite led to lower aided thresholds and better APHAB scores than the BAHI.