Efficacy and Effectiveness of Advanced Hearing Aid Directional and Noise Reduction Technologies for Older Adults With Mild to Moderate Hearing Loss

Objectives: The purpose of the present study was to investigate the laboratory efficacy and real-world effectiveness of advanced directional microphones (DM) and digital noise reduction (NR) algorithms (i.e., premium DM/NR features) relative to basic-level DM/NR features of contemporary hearing aids (HAs). The study also examined the effect of premium HAs relative to basic HAs and the effect of DM/NR features relative to no features. Design: Fifty-four older adults with mild-to-moderate hearing loss completed a single-blinded crossover trial. Two HA models, one a less-expensive, basic-level device (basic HA) and the other a more-expensive, advanced-level device (premium HA), were used. The DM/NR features of the basic HAs (i.e., basic features) were adaptive DMs and gain-reduction NR with fewer channels. In contrast, the DM/NR features of the premium HAs (i.e., premium features) included adaptive DMs and gain-reduction NR with more channels, bilateral beamformers, speech-seeking DMs, pinna-simulation directivity, reverberation reduction, impulse NR, wind NR, and spatial NR. The trial consisted of four conditions, which were factorial combinations of HA model (premium versus basic) and DM/NR feature status (on versus off). To blind participants regarding the HA technology, no technology details were disclosed and minimal training on how to use the features was provided. In each condition, participants wore bilateral HAs for 5 weeks. Outcomes regarding speech understanding, listening effort, sound quality, localization, and HA satisfaction were measured using laboratory tests, retrospective self-reports (i.e., standardized questionnaires), and in-situ self-reports (i.e., self-reports completed in the real world in real time). A smartphone-based ecological momentary assessment system was used to collect in-situ self-reports. Results: Laboratory efficacy data generally supported the benefit of premium DM/NR features relative to basic DM/NR, premium HAs relative to basic HAs, and DM/NR features relative to no DM/NR in improving speech understanding and localization performance. Laboratory data also indicated that DM/NR features could improve listening effort and sound quality compared with no features for both basic- and premium-level HAs. For real-world effectiveness, in-situ self-reports first indicated that noisy or very noisy situations did not occur very often in participants' daily lives (10.9% of the time). Although both retrospective and in-situ self-reports indicated that participants were more satisfied with HAs equipped with DM/NR features than without, there was no strong evidence to support the benefit of premium DM/NR features and premium HAs over basic DM/NR features and basic HAs, respectively. Conclusions: Although premium DM/NR features and premium HAs outperformed their basic-level counterparts in well-controlled laboratory test conditions, the benefits were not observed in the real world. In contrast, the effect of DM/NR features relative to no features was robust both in the laboratory and in the real world. Therefore, the present study suggests that although both premium and basic DM/NR technologies evaluated in the study have the potential to improve HA outcomes, older adults with mild-to-moderate hearing loss are unlikely to perceive the additional benefits provided by the premium DM/NR features in their daily lives. Limitations concerning the study's generalizability (e.g., participant's lifestyle) are discussed. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal's Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: Yu-Hsiang Wu is currently receiving grants from the National Institute on Deafness and Other Communication Disorders, the National Institute on Disability, Independent Living, and Rehabilitation Research, and the Retirement Research Foundation. Octav Chipara is currently receiving grants from the National Institute on Disability, Independent Living, and Rehabilitation Research and the National Science Foundation. Jacob Oleson is currently receiving grants from the National Institute on Deafness and Other Communication Disorders, National Heart, Lung, and Blood Institute, Department of Defense, Centers for Disease Control and Prevention, Fogarty International Center, and the Iowa Department of Public Health. The current research was supported by National Institute on Deafness and Other Communication Disorders (R03DC012551) and the National Institute on Disability, Independent Living, and Rehabilitation Research (90RE5020-01-00). The current research was supported by NIH/NIDCD R03DC012551 (title: Minimal Technologies for Hearing Aid Success in Elderly Adults) and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) 90RE5020-01-00 (title: RERC on Improving the Accessibility, Usability, and Performance of Technology for Individuals Who are Deaf or Hard of Hearing). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this article do not necessarily represent the policy of NIDILRR, ACL, HHS, and the reader should not assume endorsement by the Federal Government. Portions of this paper were presented at the annual conference of the American Auditory Society, March 3, 2016, Scottsdale, AZ. Y.-H.W. designed experiments, interpreted data, and wrote the article; E.S. collected data; O.C. and S.S.H. developed EMA software and processed EMA data; S.D. and J.O. provided statistical analysis. All authors discussed the results and implications and commented on the manuscript at all stages. The authors have no conflicts of interest to declare. Address for correspondence: Yu-Hsiang Wu, 125C SHC, Department of Communication Sciences and Disorders, The University of Iowa, Iowa City, IA 52242, USA. E-mail: yu-hsiang-wu@uiowa.edu Received March 8, 2018; accepted August 29, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Efficacy and Effectiveness of Advanced Hearing Aid Directional and Noise Reduction Technologies for Older Adults With Mild to Moderate Hearing Loss

Objectives: The purpose of the present study was to investigate the laboratory efficacy and real-world effectiveness of advanced directional microphones (DM) and digital noise reduction (NR) algorithms (i.e., premium DM/NR features) relative to basic-level DM/NR features of contemporary hearing aids (HAs). The study also examined the effect of premium HAs relative to basic HAs and the effect of DM/NR features relative to no features. Design: Fifty-four older adults with mild-to-moderate hearing loss completed a single-blinded crossover trial. Two HA models, one a less-expensive, basic-level device (basic HA) and the other a more-expensive, advanced-level device (premium HA), were used. The DM/NR features of the basic HAs (i.e., basic features) were adaptive DMs and gain-reduction NR with fewer channels. In contrast, the DM/NR features of the premium HAs (i.e., premium features) included adaptive DMs and gain-reduction NR with more channels, bilateral beamformers, speech-seeking DMs, pinna-simulation directivity, reverberation reduction, impulse NR, wind NR, and spatial NR. The trial consisted of four conditions, which were factorial combinations of HA model (premium versus basic) and DM/NR feature status (on versus off). To blind participants regarding the HA technology, no technology details were disclosed and minimal training on how to use the features was provided. In each condition, participants wore bilateral HAs for 5 weeks. Outcomes regarding speech understanding, listening effort, sound quality, localization, and HA satisfaction were measured using laboratory tests, retrospective self-reports (i.e., standardized questionnaires), and in-situ self-reports (i.e., self-reports completed in the real world in real time). A smartphone-based ecological momentary assessment system was used to collect in-situ self-reports. Results: Laboratory efficacy data generally supported the benefit of premium DM/NR features relative to basic DM/NR, premium HAs relative to basic HAs, and DM/NR features relative to no DM/NR in improving speech understanding and localization performance. Laboratory data also indicated that DM/NR features could improve listening effort and sound quality compared with no features for both basic- and premium-level HAs. For real-world effectiveness, in-situ self-reports first indicated that noisy or very noisy situations did not occur very often in participants' daily lives (10.9% of the time). Although both retrospective and in-situ self-reports indicated that participants were more satisfied with HAs equipped with DM/NR features than without, there was no strong evidence to support the benefit of premium DM/NR features and premium HAs over basic DM/NR features and basic HAs, respectively. Conclusions: Although premium DM/NR features and premium HAs outperformed their basic-level counterparts in well-controlled laboratory test conditions, the benefits were not observed in the real world. In contrast, the effect of DM/NR features relative to no features was robust both in the laboratory and in the real world. Therefore, the present study suggests that although both premium and basic DM/NR technologies evaluated in the study have the potential to improve HA outcomes, older adults with mild-to-moderate hearing loss are unlikely to perceive the additional benefits provided by the premium DM/NR features in their daily lives. Limitations concerning the study's generalizability (e.g., participant's lifestyle) are discussed. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal's Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: Yu-Hsiang Wu is currently receiving grants from the National Institute on Deafness and Other Communication Disorders, the National Institute on Disability, Independent Living, and Rehabilitation Research, and the Retirement Research Foundation. Octav Chipara is currently receiving grants from the National Institute on Disability, Independent Living, and Rehabilitation Research and the National Science Foundation. Jacob Oleson is currently receiving grants from the National Institute on Deafness and Other Communication Disorders, National Heart, Lung, and Blood Institute, Department of Defense, Centers for Disease Control and Prevention, Fogarty International Center, and the Iowa Department of Public Health. The current research was supported by National Institute on Deafness and Other Communication Disorders (R03DC012551) and the National Institute on Disability, Independent Living, and Rehabilitation Research (90RE5020-01-00). The current research was supported by NIH/NIDCD R03DC012551 (title: Minimal Technologies for Hearing Aid Success in Elderly Adults) and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) 90RE5020-01-00 (title: RERC on Improving the Accessibility, Usability, and Performance of Technology for Individuals Who are Deaf or Hard of Hearing). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this article do not necessarily represent the policy of NIDILRR, ACL, HHS, and the reader should not assume endorsement by the Federal Government. Portions of this paper were presented at the annual conference of the American Auditory Society, March 3, 2016, Scottsdale, AZ. Y.-H.W. designed experiments, interpreted data, and wrote the article; E.S. collected data; O.C. and S.S.H. developed EMA software and processed EMA data; S.D. and J.O. provided statistical analysis. All authors discussed the results and implications and commented on the manuscript at all stages. The authors have no conflicts of interest to declare. Address for correspondence: Yu-Hsiang Wu, 125C SHC, Department of Communication Sciences and Disorders, The University of Iowa, Iowa City, IA 52242, USA. E-mail: yu-hsiang-wu@uiowa.edu Received March 8, 2018; accepted August 29, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Anaphylactic reaction in patient allergic to mango

An allergy to mango is extremely rare. The antigenic composition of the fruit is not fully known. Profilin from mango has a structure similar to birch tree profiling: it is responsible for cross-reactions betw...

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Perinatal antibiotic exposure alters composition of murine gut microbiota and may influence later responses to peanut antigen

Accumulating evidence suggests that the gut microbiota shapes developmental processes within the immune system. Early life antibiotic use is one factor which may contribute to immune dysfunction and the recent...

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Anaphylactic reaction in patient allergic to mango

An allergy to mango is extremely rare. The antigenic composition of the fruit is not fully known. Profilin from mango has a structure similar to birch tree profiling: it is responsible for cross-reactions betw...

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Imaging of Pediatric Hearing Loss

Temporal bone high-resolution computed tomography (HRCT) and magnetic resonance (MR) imaging are valuable tools in the evaluation of pediatric hearing loss. Computed tomography is important in the evaluation of pediatric conductive hearing loss and is the imaging modality of choice for evaluation of osseous abnormalities. MR imaging is the modality of choice for evaluation of sensorineural hearing loss. A broad spectrum of imaging findings can be seen with hearing loss in children. HRCT and MR imaging provide complementary information and are often used in conjunction in the preoperative evaluation of pediatric candidates for cochlear implantation. (Source: Neuroimaging Clinics)

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Grxcr1 Promotes Hair Bundle Development by Destabilizing the Physical Interaction between Harmonin and Sans Usher Syndrome Proteins

Publication date: 30 October 2018Source: Cell Reports, Volume 25, Issue 5Author(s): Bernardo Blanco-Sánchez, Aurélie Clément, Javier Fierro, Sarah Stednitz, Jennifer B. Phillips, Jeremy Wegner, Jennifer M. Panlilio, Judy L. Peirce, Philip Washbourne, Monte WesterfieldSummaryMorphogenesis and mechanoelectrical transduction of the hair cell mechanoreceptor depend on the correct assembly of Usher syndrome (USH) proteins into highly organized macromolecular complexes. Defects in these proteins lead to deafness and vestibular areflexia in USH patients. Mutations in a non-USH protein, glutaredoxin domain-containing cysteine-rich 1 (GRXCR1), cause non-syndromic sensorineural deafness. To understand the deglutathionylating enzyme function of GRXCR1 in deafness, we generated two grxcr1 zebrafis...

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GRXCR2 Regulates Taperin Localization Critical for Stereocilia Morphology and Hearing

Publication date: 30 October 2018Source: Cell Reports, Volume 25, Issue 5Author(s): Chang Liu, Na Luo, Chun-Yu Tung, Benjamin J. Perrin, Bo ZhaoSummaryMutations in human GRXCR2, which encodes a protein of undetermined function, cause hearing loss by unknown mechanisms. We found that mouse GRXCR2 localizes to the base of the stereocilia, which are actin-based mechanosensing organelles in cochlear hair cells that convert sound-induced vibrations into electrical signals. The stereocilia base also contains taperin, another protein of unknown function required for human hearing. We show that taperin and GRXCR2 form a complex and that taperin is diffused throughout the stereocilia length in Grxcr2-deficient hair cells. Stereocilia lacking GRXCR2 are longer than normal and disorganized due to t...

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Imaging of Pediatric Hearing Loss

Temporal bone high-resolution computed tomography (HRCT) and magnetic resonance (MR) imaging are valuable tools in the evaluation of pediatric hearing loss. Computed tomography is important in the evaluation of pediatric conductive hearing loss and is the imaging modality of choice for evaluation of osseous abnormalities. MR imaging is the modality of choice for evaluation of sensorineural hearing loss. A broad spectrum of imaging findings can be seen with hearing loss in children. HRCT and MR imaging provide complementary information and are often used in conjunction in the preoperative evaluation of pediatric candidates for cochlear implantation. (Source: Neuroimaging Clinics)

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Grxcr1 Promotes Hair Bundle Development by Destabilizing the Physical Interaction between Harmonin and Sans Usher Syndrome Proteins

Publication date: 30 October 2018Source: Cell Reports, Volume 25, Issue 5Author(s): Bernardo Blanco-Sánchez, Aurélie Clément, Javier Fierro, Sarah Stednitz, Jennifer B. Phillips, Jeremy Wegner, Jennifer M. Panlilio, Judy L. Peirce, Philip Washbourne, Monte WesterfieldSummaryMorphogenesis and mechanoelectrical transduction of the hair cell mechanoreceptor depend on the correct assembly of Usher syndrome (USH) proteins into highly organized macromolecular complexes. Defects in these proteins lead to deafness and vestibular areflexia in USH patients. Mutations in a non-USH protein, glutaredoxin domain-containing cysteine-rich 1 (GRXCR1), cause non-syndromic sensorineural deafness. To understand the deglutathionylating enzyme function of GRXCR1 in deafness, we generated two grxcr1 zebrafis...

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GRXCR2 Regulates Taperin Localization Critical for Stereocilia Morphology and Hearing

Publication date: 30 October 2018Source: Cell Reports, Volume 25, Issue 5Author(s): Chang Liu, Na Luo, Chun-Yu Tung, Benjamin J. Perrin, Bo ZhaoSummaryMutations in human GRXCR2, which encodes a protein of undetermined function, cause hearing loss by unknown mechanisms. We found that mouse GRXCR2 localizes to the base of the stereocilia, which are actin-based mechanosensing organelles in cochlear hair cells that convert sound-induced vibrations into electrical signals. The stereocilia base also contains taperin, another protein of unknown function required for human hearing. We show that taperin and GRXCR2 form a complex and that taperin is diffused throughout the stereocilia length in Grxcr2-deficient hair cells. Stereocilia lacking GRXCR2 are longer than normal and disorganized due to t...

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Patient Engagement in Otolaryngology

Patient engagement, which involves incorporating the patient and family as partners in their care, is a growing focus in otolaryngology and surgery. Attention to patient and family centeredness, shared decision making, and patient experience together improves the overall tenor of patient engagement. Patient engagement promotes safety through improving quality of electronic health record data, error detection, and treatment decisions and adherence. In this article, we review specific areas of importance for patient engagement in otolaryngology as well as areas needing more research and development. (Source: Otolaryngologic clinics of North America)

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Clinical Indices to Drive Quality Improvement in Otolaryngology

A Pediatric Tracheostomy Care Index (PTCI) was developed by the authors to standardize care and drive quality improvement efforts at their institution. The PTCI comprises 9 elements deemed essential for safe care of children with a tracheostomy tube. Based on the PTCI scores, the number of missed opportunities per patient was tracked, and interventions through a "Plan-Do-Study-Act" approach were performed. The establishment of the PTCI has been successful at standardizing, quantifying, and monitoring the consistency and documentation of care provided at the authors' institution. (Source: Otolaryngologic clinics of North America)

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Contents

Sujana S. Chandrasekhar (Source: Otolaryngologic clinics of North America)

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Patient Safety and Quality Improvement

OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA (Source: Otolaryngologic clinics of North America)

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Contributors

SUJANA S. CHANDRASEKHAR, MD, FACS, FAAOHNS (Source: Otolaryngologic clinics of North America)

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Copyright

Elsevier (Source: Otolaryngologic clinics of North America)

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CME Accreditation Page

(Source: Otolaryngologic clinics of North America)

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Button Battery Safety

The pediatric button battery (BB) hazard has been recognized for several decades. In 2012, the National Button Battery Task Force was established, and most manufacturers have improved warning labels, more secure packaging, and made BB compartments in products are more secure. Tissue neutralization before BB removal (ie, honey or sucralfate/Carafate ®) is an effective way to reduce the rate of BB injury. In absence of visible perforation, 0.25% sterile acetic acid esophageal tissue irrigation at time of BB removal is recommended as a neutralization strategy to mitigate injury progression. Future BB design changes could eliminate esophageal tis sue injury. (Source: Otolaryngologic clinics of North America)

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Allogeneic Regulatory Dendritic Cell (DCreg) Renal Study

Conditions:   Kidney Transplant;   Renal Transplant Recipients Interventions:   Biological: DCreg: 0.5 million cells/kg+SOC;   Biological: DCreg: 1.2 million cells/kg+SOC;   Biological: DCreg:2.5 to 5.0 million cells/kg+SOC Sponsors:   National Institute of Allergy and Infectious Diseases (NIAID);   University of Pittsburgh Not yet recruiting (Source: ClinicalTrials.gov)

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Post-stroke Immunological Changes in Younger Stroke Patients

Conditions:   Stroke, Ischemic;   Cognitive Decline Intervention:   Other: Analysis of : T-lymphocytes Sponsor:   University Medicine Greifswald Not yet recruiting (Source: ClinicalTrials.gov)

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Clinical Efficacy and Safety of Subcutaneous Immunotherapy With gpASIT+ ™ in Patients With Grass Pollen-induced Allergic Rhinoconjunctivitis

Condition:   Hay Fever Interventions:   Biological: Placebo solution;   Biological: gpASIT+TM Sponsor:   ASIT Biotech S.A. Not yet recruiting (Source: ClinicalTrials.gov)

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Endocrine Immunology in Early Stage ER+ Breast Cancer Patients

Conditions:   Breast Cancer;   Estrogen Receptor-positive Breast Cancer;   Healthy Intervention:   Sponsors:   Duke University;   United States Department of Defense Not yet recruiting (Source: ClinicalTrials.gov)

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Investigational Therapeutics for the Treatment of People With Ebola Virus Disease

Condition:   Ebola Virus Interventions:   Drug: ZMapp;   Drug: Remdesivir;   Drug: MAb114 Sponsor:   National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)

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Patient Engagement in Otolaryngology

Patient engagement, which involves incorporating the patient and family as partners in their care, is a growing focus in otolaryngology and surgery. Attention to patient and family centeredness, shared decision making, and patient experience together improves the overall tenor of patient engagement. Patient engagement promotes safety through improving quality of electronic health record data, error detection, and treatment decisions and adherence. In this article, we review specific areas of importance for patient engagement in otolaryngology as well as areas needing more research and development. (Source: Otolaryngologic clinics of North America)

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Clinical Indices to Drive Quality Improvement in Otolaryngology

A Pediatric Tracheostomy Care Index (PTCI) was developed by the authors to standardize care and drive quality improvement efforts at their institution. The PTCI comprises 9 elements deemed essential for safe care of children with a tracheostomy tube. Based on the PTCI scores, the number of missed opportunities per patient was tracked, and interventions through a "Plan-Do-Study-Act" approach were performed. The establishment of the PTCI has been successful at standardizing, quantifying, and monitoring the consistency and documentation of care provided at the authors' institution. (Source: Otolaryngologic clinics of North America)

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Contents

Sujana S. Chandrasekhar (Source: Otolaryngologic clinics of North America)

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Patient Safety and Quality Improvement

OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA (Source: Otolaryngologic clinics of North America)

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Contributors

SUJANA S. CHANDRASEKHAR, MD, FACS, FAAOHNS (Source: Otolaryngologic clinics of North America)

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Copyright

Elsevier (Source: Otolaryngologic clinics of North America)

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Forthcoming Issues

Implantable Auditory Devices (Source: Otolaryngologic clinics of North America)

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CME Accreditation Page

(Source: Otolaryngologic clinics of North America)

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Button Battery Safety

The pediatric button battery (BB) hazard has been recognized for several decades. In 2012, the National Button Battery Task Force was established, and most manufacturers have improved warning labels, more secure packaging, and made BB compartments in products are more secure. Tissue neutralization before BB removal (ie, honey or sucralfate/Carafate ®) is an effective way to reduce the rate of BB injury. In absence of visible perforation, 0.25% sterile acetic acid esophageal tissue irrigation at time of BB removal is recommended as a neutralization strategy to mitigate injury progression. Future BB design changes could eliminate esophageal tis sue injury. (Source: Otolaryngologic clinics of North America)

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Allogeneic Regulatory Dendritic Cell (DCreg) Renal Study

Conditions:   Kidney Transplant;   Renal Transplant Recipients Interventions:   Biological: DCreg: 0.5 million cells/kg+SOC;   Biological: DCreg: 1.2 million cells/kg+SOC;   Biological: DCreg:2.5 to 5.0 million cells/kg+SOC Sponsors:   National Institute of Allergy and Infectious Diseases (NIAID);   University of Pittsburgh Not yet recruiting (Source: ClinicalTrials.gov)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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Post-stroke Immunological Changes in Younger Stroke Patients

Conditions:   Stroke, Ischemic;   Cognitive Decline Intervention:   Other: Analysis of : T-lymphocytes Sponsor:   University Medicine Greifswald Not yet recruiting (Source: ClinicalTrials.gov)

MedWorm Message: If you are looking to buy something in the January Sales please visit TheJanuarySales.com for a directory of all the best sales in the UK. Any income gained via affiliate links keeps MedWorm running.

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Clinical Efficacy and Safety of Subcutaneous Immunotherapy With gpASIT+ ™ in Patients With Grass Pollen-induced Allergic Rhinoconjunctivitis

Condition:   Hay Fever Interventions:   Biological: Placebo solution;   Biological: gpASIT+TM Sponsor:   ASIT Biotech S.A. Not yet recruiting (Source: ClinicalTrials.gov)

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Endocrine Immunology in Early Stage ER+ Breast Cancer Patients

Conditions:   Breast Cancer;   Estrogen Receptor-positive Breast Cancer;   Healthy Intervention:   Sponsors:   Duke University;   United States Department of Defense Not yet recruiting (Source: ClinicalTrials.gov)

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Investigational Therapeutics for the Treatment of People With Ebola Virus Disease

Condition:   Ebola Virus Interventions:   Drug: ZMapp;   Drug: Remdesivir;   Drug: MAb114 Sponsor:   National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)

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Plasmodium and Other Parasites in Pregnant Women and Children Around Margibi and Montserrado Counties, Liberia

Condition:   Malaria Intervention:   Sponsor:   National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)

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Satisfaction level in dental-phobic patients with implant-supported rehabilitation performed under general anaesthesia: a prospective study

Abstract

Background

Phobic patients avoid dental treatment impairing their oral health and making it challenging to offer them prosthetic rehabilitation. This study evaluated patients' experience of implant-supported prosthetic treatment after implantation performed under general anaesthesia due to dental phobia and severe pharyngeal reflexes (SPR). The effect of gender, age and location of implantation on patient satisfaction was tested.

Methods

Two hundred five patients underwent implantation under general anesthesia both in maxilla and mandible, respectively. After a trans-gingival healing period of 6–8 weeks, fixed implant bridges were inserted. Patients completed oral health impact profile questionnaire (OHIP-14). An additional set of six special questions was also developed and considered. Analysis of the OHIP-14 total score was made using logistics regression. Wald chi-square test was used to analyse the effect of age, gender and location of implantation. Effect sizes were estimated as odds-ratios and associated 95% Wald confidence intervals.

Results

Eighty two of 205 patients were included after prosthetic treatment. After start, 38 patients were excluded (4 died and 34 couldn't be reached). OHIP-14-analyses were made by 43 patients (30–90 years). 67% of patients were totally satisfied with the whole implant rehabilitation (scoring 0). Mean of total score was 2.5. Only age affected significantly (p = 0.014) patients satisfaction. The obtained data indicate that younger patients (30–64 years) especially women are less satisfied (4.95) than older patients (0.3) for age group (65–90 years).Special questions' data showed that 94.5% were satisfied with their treatment. 77.3% continued regular check-up after treatment and 96.9% would undergo the same treatment again. 95.5% would recommend implants to a friend of colleague.

Conclusion

Gender and location of implantation have no significant influence on patient satisfaction. Younger patients especially women are less satisfied than older patients. Phobic patients are totally satisfied with implant rehabilitation under general anaesthesia which means that this treatment can be considered as a treatment of choice giving these patients the same opportunity like others to improve their oral health and well-being.

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Factors associated with future dental care utilization among low-income smokers overdue for dental visits

Abstract

Background

Smokers are at increased risk of oral disease. While routine dental care can help prevent and treat oral health problems, smokers have far lower rates of dental care utilization compared with non-smokers. We sought to better understand which factors may facilitate or hinder dental care utilization among low-income smokers participating in a randomized intervention trial in order to inform future intervention planning.

Methods

This is a secondary analysis of data collected between 2015 and 2017 as part of the OralHealth4Life trial. Participants were eligible callers to the Louisiana, Nebraska, and Oregon state tobacco quitlines who had no dental appointment in the prior or upcoming six months. We examined the association between participants' baseline characteristics and their receiving professional dental care between baseline and the 6-month follow-up survey.

Results

Participants were racially diverse (42% non-White) and two-thirds had an annual household income under $20,000. Most (86.7%) had not had a dental cleaning in more than one year. Commonly cited barriers to dental care included cost (83.7%) and no dental insurance (78.1%). Those with dental insurance were more likely to see a dentist at follow-up (RR 1.66). Similarly, those reporting a dental insurance barrier to care were less likely to see a dentist at follow-up (RR 0.69); however, there was no significant utilization difference between those reporting a cost barrier vs. those who did not. After controlling for these financial factors, the following baseline characteristics were significantly associated with a higher likelihood of dental care utilization at 6 months: higher motivation (RR 2.16) and self-efficacy (RR 1.80) to visit the dentist, having a disability (RR 1.63), having a higher education level (RR 1.52), and having perceived gum disease (RR 1.49). Factors significantly associated with a lower likelihood of dental care utilization included being married (RR 0.68) and not having a last dental cleaning within the past year (RR 0.47).

Conclusions

Our findings provide important insight into factors that may facilitate or deter use of professional dental care among low-income smokers. This information could inform the development of future interventions to promote dental care utilization.

Trial registration

ClinicalTrials.gov: NCT02347124; registered 27 January 2015.

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Satisfaction level in dental-phobic patients with implant-supported rehabilitation performed under general anaesthesia: a prospective study

Abstract

Background

Phobic patients avoid dental treatment impairing their oral health and making it challenging to offer them prosthetic rehabilitation. This study evaluated patients' experience of implant-supported prosthetic treatment after implantation performed under general anaesthesia due to dental phobia and severe pharyngeal reflexes (SPR). The effect of gender, age and location of implantation on patient satisfaction was tested.

Methods

Two hundred five patients underwent implantation under general anesthesia both in maxilla and mandible, respectively. After a trans-gingival healing period of 6–8 weeks, fixed implant bridges were inserted. Patients completed oral health impact profile questionnaire (OHIP-14). An additional set of six special questions was also developed and considered. Analysis of the OHIP-14 total score was made using logistics regression. Wald chi-square test was used to analyse the effect of age, gender and location of implantation. Effect sizes were estimated as odds-ratios and associated 95% Wald confidence intervals.

Results

Eighty two of 205 patients were included after prosthetic treatment. After start, 38 patients were excluded (4 died and 34 couldn't be reached). OHIP-14-analyses were made by 43 patients (30–90 years). 67% of patients were totally satisfied with the whole implant rehabilitation (scoring 0). Mean of total score was 2.5. Only age affected significantly (p = 0.014) patients satisfaction. The obtained data indicate that younger patients (30–64 years) especially women are less satisfied (4.95) than older patients (0.3) for age group (65–90 years).Special questions' data showed that 94.5% were satisfied with their treatment. 77.3% continued regular check-up after treatment and 96.9% would undergo the same treatment again. 95.5% would recommend implants to a friend of colleague.

Conclusion

Gender and location of implantation have no significant influence on patient satisfaction. Younger patients especially women are less satisfied than older patients. Phobic patients are totally satisfied with implant rehabilitation under general anaesthesia which means that this treatment can be considered as a treatment of choice giving these patients the same opportunity like others to improve their oral health and well-being.

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Factors associated with future dental care utilization among low-income smokers overdue for dental visits

Abstract

Background

Smokers are at increased risk of oral disease. While routine dental care can help prevent and treat oral health problems, smokers have far lower rates of dental care utilization compared with non-smokers. We sought to better understand which factors may facilitate or hinder dental care utilization among low-income smokers participating in a randomized intervention trial in order to inform future intervention planning.

Methods

This is a secondary analysis of data collected between 2015 and 2017 as part of the OralHealth4Life trial. Participants were eligible callers to the Louisiana, Nebraska, and Oregon state tobacco quitlines who had no dental appointment in the prior or upcoming six months. We examined the association between participants' baseline characteristics and their receiving professional dental care between baseline and the 6-month follow-up survey.

Results

Participants were racially diverse (42% non-White) and two-thirds had an annual household income under $20,000. Most (86.7%) had not had a dental cleaning in more than one year. Commonly cited barriers to dental care included cost (83.7%) and no dental insurance (78.1%). Those with dental insurance were more likely to see a dentist at follow-up (RR 1.66). Similarly, those reporting a dental insurance barrier to care were less likely to see a dentist at follow-up (RR 0.69); however, there was no significant utilization difference between those reporting a cost barrier vs. those who did not. After controlling for these financial factors, the following baseline characteristics were significantly associated with a higher likelihood of dental care utilization at 6 months: higher motivation (RR 2.16) and self-efficacy (RR 1.80) to visit the dentist, having a disability (RR 1.63), having a higher education level (RR 1.52), and having perceived gum disease (RR 1.49). Factors significantly associated with a lower likelihood of dental care utilization included being married (RR 0.68) and not having a last dental cleaning within the past year (RR 0.47).

Conclusions

Our findings provide important insight into factors that may facilitate or deter use of professional dental care among low-income smokers. This information could inform the development of future interventions to promote dental care utilization.

Trial registration

ClinicalTrials.gov: NCT02347124; registered 27 January 2015.

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Morphological study of the changes after sagittal split ramus osteotomy in patients with facial asymmetry: measurements of 3-dimensional modelling

The effects of bilateral sagittal split ramus osteotomy (BSSRO) on the temporomandibular joint (TMJ) are still not well understood. The aim of this study was to compare the morphological differences among unaffected subjects on the one hand, and patients with facial asymmetry before and after BSSRO on the other. Ten Chinese patients (preoperative and postoperative groups, mean (SD) age 25 (5) years) diagnosed with facial asymmetry and 10 unaffected subjects (control group, mean (SD) age 27 (5) years) were recruited prospectively. (Source: The British Journal of Oral and Maxillofacial Surgery)

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The burden of serious fungal disease in the UK – infections with “rare” organisms

In the absence of mandatory surveillance programs for individual fungal organisms, attempts to determine the burden of fungal disease commonly rely upon methods that estimate infection rates based on incidence data for specific at-risk populations, coupled with anecdotal data from mycology referral centres.1-3 A recent study published in this journal provided crude estimates of the annual incidence of Pneumocystis pneumonia, cryptococcal disease, invasive aspergillosis, chronic pulmonary aspergillosis, allergic bronchopulmonary aspergillosis, severe asthma with fungal sensitisation, candidemia, oesophageal candidosis, Candida peritonitis and mucoromycosis in the United Kingdom (UK) using such approaches. (Source: Journal of Infection)

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Clinical Indices to Drive Quality Improvement in Otolaryngology

A Pediatric Tracheostomy Care Index (PTCI) was developed by the authors to standardize care and drive quality improvement efforts at their institution. The PTCI comprises 9 elements deemed essential for safe care of children with a tracheostomy tube. Based on the PTCI scores, the number of missed opportunities per patient was tracked, and interventions through a "Plan-Do-Study-Act" approach were performed. The establishment of the PTCI has been successful at standardizing, quantifying, and monitoring the consistency and documentation of care provided at the authors' institution.

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Patient Engagement in Otolaryngology

Patient engagement, which involves incorporating the patient and family as partners in their care, is a growing focus in otolaryngology and surgery. Attention to patient and family centeredness, shared decision making, and patient experience together improves the overall tenor of patient engagement. Patient engagement promotes safety through improving quality of electronic health record data, error detection, and treatment decisions and adherence. In this article, we review specific areas of importance for patient engagement in otolaryngology as well as areas needing more research and development.

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Forthcoming Issues

Implantable Auditory Devices

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Copyright

Elsevier

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CME Accreditation Page

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Contributors

SUJANA S. CHANDRASEKHAR, MD, FACS, FAAOHNS

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Patient Safety and Quality Improvement

OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA

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Three-dimensional soft tissue prediction in orthognathic surgery: a clinical comparison of Dolphin, ProPlan CMF, and probabilistic finite element modelling

Three-dimensional surgical planning is used widely in orthognathic surgery. Although numerous computer programs exist, the accuracy of soft tissue prediction remains uncertain. The purpose of this study was to compare the prediction accuracy of Dolphin, ProPlan CMF, and a probabilistic finite element method (PFEM). Seven patients (mean age 18years; five female) who had undergone Le Fort I osteotomy with preoperative and 1-year postoperative cone beam computed tomography (CBCT) were included. The three programs were used for soft tissue prediction using planned and postoperative maxillary position, and these were compared to postoperative CBCT. (Source: International Journal of Oral and Maxillofacial Surgery)

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Clinical Indices to Drive Quality Improvement in Otolaryngology

A Pediatric Tracheostomy Care Index (PTCI) was developed by the authors to standardize care and drive quality improvement efforts at their institution. The PTCI comprises 9 elements deemed essential for safe care of children with a tracheostomy tube. Based on the PTCI scores, the number of missed opportunities per patient was tracked, and interventions through a "Plan-Do-Study-Act" approach were performed. The establishment of the PTCI has been successful at standardizing, quantifying, and monitoring the consistency and documentation of care provided at the authors' institution.

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Forthcoming Issues

Implantable Auditory Devices

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Copyright

Elsevier

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CME Accreditation Page

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Contents

Sujana S. Chandrasekhar

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Contributors

SUJANA S. CHANDRASEKHAR, MD, FACS, FAAOHNS

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Patient Safety and Quality Improvement

OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA

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Three-dimensional soft tissue prediction in orthognathic surgery: a clinical comparison of Dolphin, ProPlan CMF, and probabilistic finite element modelling

Three-dimensional surgical planning is used widely in orthognathic surgery. Although numerous computer programs exist, the accuracy of soft tissue prediction remains uncertain. The purpose of this study was to compare the prediction accuracy of Dolphin, ProPlan CMF, and a probabilistic finite element method (PFEM). Seven patients (mean age 18years; five female) who had undergone Le Fort I osteotomy with preoperative and 1-year postoperative cone beam computed tomography (CBCT) were included. The three programs were used for soft tissue prediction using planned and postoperative maxillary position, and these were compared to postoperative CBCT. (Source: International Journal of Oral and Maxillofacial Surgery)

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Contact Dermatitis

This article discusses the most noteworthy trends within the field, organized by allergen category, with particular attention to newer and/or controversial allergens. (Source: Dermatologic Clinics)

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Contact Dermatitis

This article discusses the most noteworthy trends within the field, organized by allergen category, with particular attention to newer and/or controversial allergens. (Source: Dermatologic Clinics)

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A prospective clinical study to evaluate the performance of zirconium dioxide dental implants in single-tooth edentulous area: 3-year follow-up

Abstract

Background

Traditionally, dental implants have been made from titanium or titanium alloys. Alternatively, zirconia-based ceramic implants have been developed with similar characteristics of functional strength and osseointegration. Ceramic implants offer advantages in certain settings, e.g. in patients who object to metal dental implants. The aim of this study was to investigate the mid-term (36 months) clinical performance of a ceramic monotype implant in single-tooth edentulous area.

Methods

This was a prospective, open-label, single-arm study in patients requiring implant rehabilitation in single-tooth edentulous area. Ceramic implants (PURE Ceramic Implant, Institut Straumann AG, Basel, Switzerland) with a diameter of 4.1 mm were placed following standard procedure and loaded with provisional and final prostheses after 3 and 6 months, respectively. Implant survival rate and implant success rate were evaluated and crestal bone levels were measured by analysing standardized radiographs during implant surgery and at 6, 12, 24 and 36 months.

Results

Forty-four patients received a study implant, of whom one patient withdrew consent after 3 months. With one implant lost during the first 6 months after surgery, the implant survival rate was 97.7% at 6 months. No further implants were lost over the following 30 months, and 3 patients were lost to follow-up during this time frame. This led to a survival rate of 97.5% at 36 months.

Six months after implant surgery 93.0% of the implants were considered "successful", increasing to 97.6% at 12 months and remaining at this level at 24 months (95.1%) and 36 months (97.5%).

Bone loss was most pronounced in the first half-year after implant surgery (0.88 ± 0.86 mm). By contrast, between 12 and 36 months the mean bone level remained stable (minimal gain of 0.06 [± 0.60] mm). Hence, the overall bone loss from implant surgery to 36 months was 0.97 (± 0.88) mm.

Conclusions

In the follow-up period ceramic implants can achieve favourable clinical outcomes on a par with titanium implants. For instance, these implants can be recommended for patients who object to metal dental implants. However, longer term studies with different edentulous morphology need to confirm the present data.

Trial registration

Registered on www.clinicaltrials.gov: NCT02163395.

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Combining virtual model and cone beam computed tomography to assess periodontal changes after anterior tooth movement

Abstract

Background

Orthodontic force may affect not only periodontal ligaments, but also the alveoloar bone and the gingiva according to the type of tooth movements. The authors assessed changes in gingival thickness (GT) and alveolar bone thickness (ABT) after orthodontic treatment using a new method.

Methods

This study included 408 teeth (208 central incisors, 200 lateral incisors) from the upper and lower 4 anterior teeth of 52 patients who had completed orthodontic treatment. GT and ABT were measured using virtual casts fabricated from impressions and cone beam computed tomography (CBCT). Two sectioned images of every tooth axis were acquired by partitioning each tooth with a line connecting the midpoint of the incisal edge to the midpoint of the cementoenamel junction in the virtual models and the root apex in CBCT images. After superimposing the two sectioned images, GT and ABT were measured before and after orthodontic tooth movement. Correlations between GT and ABT before and after treatment, and changes in GT and ABT associated with sex, tooth arch, tooth position, orthognathic surgery, and tooth inclination and rotation were assessed.

Results

Before orthodontic treatment, GT and ABT were significantly correlated. Patients who underwent orthognathic surgery exhibited an increase in GT thickness compared with those who did not. ABT was significantly decreased in proclined teeth and in rotated teeth.

Conclusions

GT and ABT can be affected by the nature of tooth movement and can be accurately assessed by comparing sectioned CBCT images and virtual models.

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What factors affect the severity of permanent tooth impaction?

Abstract

Background

The aim of this study was to investigate the association between the severity of permanent tooth impaction and a number of predefined factors, including tooth type, age, gender, tooth agenesis, microdontia of maxillary lateral incisor, and retained deciduous predecessors.

Methods

A sample of 2979 dental patients, aged 15 to 40 years, was surveyed by two calibrated examiners for permanent tooth impaction (excluding third molars). On panoramic radiographs, the impacted teeth were initially ranked based on their vertical, horizontal, and angular positions, and the ranking was then analysed for distribution by the predefined factors. To test the age factor, patients were divided into younger (15 to 25 yr) and older (between 25 and 40 yr) age groups. The statistical significance of the ranked vertical, horizontal, and angular positions of impacted teeth by the investigated factors was determined using the Wilcoxon-Mann-Whitney U test.

Results

The angular position of the impacted teeth was more severe in the older age group (P = 0.012) and in females (P = 0.018). The maxillary canine had more severe horizontal (P = 0.001) and angular (P = 0.003) impactions in females. Tooth agenesis was associated with less severe horizontal impaction (P = 0.041) in the mandibular second premolar. In addition, microdontia of the maxillary lateral incisor was associated with more severe horizontal impaction in general, and more severe horizontal (P = 0.024) and angular (P = 0.010) impaction of the mandibular second premolar in particular. Finally, our results showed that a retained deciduous predecessor was linked to a less severe vertical impaction of the mandibular second premolar (P = 0.030) and horizontal impaction of the maxillary second premolar (P = 0.037) but more severe angular impaction of the mandibular canine.

Conclusions

This study suggests that the more delayed the treatment, being a female, the presence of maxillary lateral incisor with microdontia, and retained lower deciduous canines might be associated with more severe position of the impacted teeth. Because the severity of tooth impaction would follow different patterns when considering the investigated factors, it is mandatory to include such factors during dental diagnoses and the planning of preventive or interceptive interventions for young patients.

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A prospective clinical study to evaluate the performance of zirconium dioxide dental implants in single-tooth edentulous area: 3-year follow-up

Abstract

Background

Traditionally, dental implants have been made from titanium or titanium alloys. Alternatively, zirconia-based ceramic implants have been developed with similar characteristics of functional strength and osseointegration. Ceramic implants offer advantages in certain settings, e.g. in patients who object to metal dental implants. The aim of this study was to investigate the mid-term (36 months) clinical performance of a ceramic monotype implant in single-tooth edentulous area.

Methods

This was a prospective, open-label, single-arm study in patients requiring implant rehabilitation in single-tooth edentulous area. Ceramic implants (PURE Ceramic Implant, Institut Straumann AG, Basel, Switzerland) with a diameter of 4.1 mm were placed following standard procedure and loaded with provisional and final prostheses after 3 and 6 months, respectively. Implant survival rate and implant success rate were evaluated and crestal bone levels were measured by analysing standardized radiographs during implant surgery and at 6, 12, 24 and 36 months.

Results

Forty-four patients received a study implant, of whom one patient withdrew consent after 3 months. With one implant lost during the first 6 months after surgery, the implant survival rate was 97.7% at 6 months. No further implants were lost over the following 30 months, and 3 patients were lost to follow-up during this time frame. This led to a survival rate of 97.5% at 36 months.

Six months after implant surgery 93.0% of the implants were considered "successful", increasing to 97.6% at 12 months and remaining at this level at 24 months (95.1%) and 36 months (97.5%).

Bone loss was most pronounced in the first half-year after implant surgery (0.88 ± 0.86 mm). By contrast, between 12 and 36 months the mean bone level remained stable (minimal gain of 0.06 [± 0.60] mm). Hence, the overall bone loss from implant surgery to 36 months was 0.97 (± 0.88) mm.

Conclusions

In the follow-up period ceramic implants can achieve favourable clinical outcomes on a par with titanium implants. For instance, these implants can be recommended for patients who object to metal dental implants. However, longer term studies with different edentulous morphology need to confirm the present data.

Trial registration

Registered on www.clinicaltrials.gov: NCT02163395.

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Combining virtual model and cone beam computed tomography to assess periodontal changes after anterior tooth movement

Abstract

Background

Orthodontic force may affect not only periodontal ligaments, but also the alveoloar bone and the gingiva according to the type of tooth movements. The authors assessed changes in gingival thickness (GT) and alveolar bone thickness (ABT) after orthodontic treatment using a new method.

Methods

This study included 408 teeth (208 central incisors, 200 lateral incisors) from the upper and lower 4 anterior teeth of 52 patients who had completed orthodontic treatment. GT and ABT were measured using virtual casts fabricated from impressions and cone beam computed tomography (CBCT). Two sectioned images of every tooth axis were acquired by partitioning each tooth with a line connecting the midpoint of the incisal edge to the midpoint of the cementoenamel junction in the virtual models and the root apex in CBCT images. After superimposing the two sectioned images, GT and ABT were measured before and after orthodontic tooth movement. Correlations between GT and ABT before and after treatment, and changes in GT and ABT associated with sex, tooth arch, tooth position, orthognathic surgery, and tooth inclination and rotation were assessed.

Results

Before orthodontic treatment, GT and ABT were significantly correlated. Patients who underwent orthognathic surgery exhibited an increase in GT thickness compared with those who did not. ABT was significantly decreased in proclined teeth and in rotated teeth.

Conclusions

GT and ABT can be affected by the nature of tooth movement and can be accurately assessed by comparing sectioned CBCT images and virtual models.

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Perinatal antibiotic exposure alters composition of murine gut microbiota and may influence later responses to peanut antigen

Abstract

Background

Accumulating evidence suggests that the gut microbiota shapes developmental processes within the immune system. Early life antibiotic use is one factor which may contribute to immune dysfunction and the recent surge in allergies by virtue of its effects on gut microbiota.

Objective and methods

As a first step towards determining whether a relationship exists between perinatal antibiotic induced changes in the gut microbiota and the later development of a peanut allergy, we exposed newborn mice to either the broad-spectrum antibiotic vancomycin or to a vehicle for 6 weeks and then used a novel murine model of peanut allergy.

Results

Early-life treatment with vancomycin resulted in a significant shift in the gut microbiota community characterized by a reduction in the abundance of firmicutes and preponderance of inflammatory proteobacteria. Mice with an antibiotic-altered microbiota, showed a localized allergic-like response characterized by ear swelling and scratching following intra-dermal peanut antigen challenge. Likewise, circulating IgE levels were increased in antibiotic-treated mice, but no evidence of a systemic allergic or anaphylactic-like response was observed. Importantly, we utilized the naturally occurring pro-inflammatory cytokine, tumor necrosis factor-α (TNF-α), rather than the more commonly used cholera toxin, as an adjuvant together with the peanut antigen.

Conclusion

Our data suggest that early antibiotic exposure promotes a shift in the gut microbiota community that may in turn, influence how mice later respond to a TNF-α + antigen challenge. However, further studies verifying the capacity of microbiota restoration to protect against allergic responses will be needed to confirm a causal role of antibiotic-induced microbiota variations in promoting allergic disease phenotypes.

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Increased expression of the membrane-bound CD40 ligand on peripheral CD4+ T cells in the acute phase of AQP4-IgG-seropositive neuromyelitis optica spectrum disorders

Currently, no data are available regarding the expression levels of CD40L on CD4+ T cells in patients with neuromyelitis optica spectrum disorders (NMOSD). The percentage of circulating CD40L+CD4+ T cells was measured by flow cytometry in 23 NMOSD patients and 10 healthy controls. The ratio of CD40L+CD4+ to CD4+ T cells in patients at acute phase (18.28  ± 15.56%) was significantly higher than that in healthy controls (7.23 ± 5.94%, P = .032) and was positively correlated with disease severity (r = 0.532, P = .041). (Source: Journal of Neuroimmunology)

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Effect of IL-33 on de novo synthesized mediators from human mast cells

In their recent interesting review, Olivera et  al1 stress the importance of mast cells as targets not only of allergic stimuli but also of many environmental and cationic molecules. The authors then focus on the role of the cytokine IL-33 in allergen-induced mast cell responses. (Source: Journal of Allergy and Clinical Immunology)

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Reply

We thank Theoharides and Leeman1 for their positive comments on our review,2 which focused on recent developments in the understanding of human mast cell biology. It is gratifying to see this large number of recent scientific reports from which we selected only a portion of many interesting and novel experimental approaches and observations. The understanding of mast cell biology has lagged somewhat behind studies on other effector cells because mast cells do not normally occur in blood, there is no human condition characterized by the absence of mast cells in all tissues, and there is no pharmacologic therapy that specifically and only silences mast cell function. (Source: Journal of Allergy and Clinical Immunology)

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Newborn Screening for Severe Combined Immunodeficiency in the United States

In the United States, significant improvement in diagnosis and outcomes for children affected with severe combined immunodeficiency has followed institution of newborn screening using an assay to measure T-cell receptor excision circles in newborn dried blood spot specimens. Key to this outcome is the avoidance of infectious complications in infants with severe combined immunodeficiency. (Source: Immunology and Allergy Clinics of North America)

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Hereditary Autoinflammatory Disorders

This article focuses on the clinical presentation of IL-1 and interferon-driven autoinflammatory disorders, and discusses novel diseases with features of immunodeficiency. Approaches to the clinical diagnosis, genetic testing, and treatment of these disorders are addressed. (Source: Immunology and Allergy Clinics of North America)

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Update on Advances in Hematopoietic Cell Transplantation for Primary Immunodeficiency Disorders

Hematopoietic stem cell transplantation (HSCT) in patients with primary immunodeficiency disorders (PIDDs) is being increasingly used as a curative option. Understanding the critical components, such as disease 's nature and activity and pre-HSCT and post-HSCT patient care is key to a successful outcome. HSCT should be tailored to the underlying PIDD, as different PIDDs, such as severe combined immune deficiency, Treg dysfunction, and phagocytic disorders, have different transplant approaches. Therefore, successful HSCT in patients with PIDDs requires teamwork between immunologists and transplant physicians. In this article, the authors elaborate on various aspects of PIDD-HSCT and highlight recent advances. (Source: Immunology and Allergy Clinics of North America)

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Increased expression of the membrane-bound CD40 ligand on peripheral CD4+ T cells in the acute phase of AQP4-IgG-seropositive neuromyelitis optica spectrum disorders

Currently, no data are available regarding the expression levels of CD40L on CD4+ T cells in patients with neuromyelitis optica spectrum disorders (NMOSD). The percentage of circulating CD40L+CD4+ T cells was measured by flow cytometry in 23 NMOSD patients and 10 healthy controls. The ratio of CD40L+CD4+ to CD4+ T cells in patients at acute phase (18.28  ± 15.56%) was significantly higher than that in healthy controls (7.23 ± 5.94%, P = .032) and was positively correlated with disease severity (r = 0.532, P = .041). (Source: Journal of Neuroimmunology)

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Effect of IL-33 on de novo synthesized mediators from human mast cells

In their recent interesting review, Olivera et  al1 stress the importance of mast cells as targets not only of allergic stimuli but also of many environmental and cationic molecules. The authors then focus on the role of the cytokine IL-33 in allergen-induced mast cell responses. (Source: Journal of Allergy and Clinical Immunology)

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Reply

We thank Theoharides and Leeman1 for their positive comments on our review,2 which focused on recent developments in the understanding of human mast cell biology. It is gratifying to see this large number of recent scientific reports from which we selected only a portion of many interesting and novel experimental approaches and observations. The understanding of mast cell biology has lagged somewhat behind studies on other effector cells because mast cells do not normally occur in blood, there is no human condition characterized by the absence of mast cells in all tissues, and there is no pharmacologic therapy that specifically and only silences mast cell function. (Source: Journal of Allergy and Clinical Immunology)

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Newborn Screening for Severe Combined Immunodeficiency in the United States

In the United States, significant improvement in diagnosis and outcomes for children affected with severe combined immunodeficiency has followed institution of newborn screening using an assay to measure T-cell receptor excision circles in newborn dried blood spot specimens. Key to this outcome is the avoidance of infectious complications in infants with severe combined immunodeficiency. (Source: Immunology and Allergy Clinics of North America)

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Primary Immunodeficiency Disorders

This issue on primary immunodeficiency disorders (PIDD) builds upon a previous set of reviews in the Immunology and Allergy Clinics of North America. The field of Clinical Immunology continues to expand at a rapid rate, so this issue updates readers on new diagnoses and new therapies and highlights some of the exciting developments in our field. Many of our well-known colleagues have contributed their expertise and time to educate us about important advances, which will benefit our patients with PIDD. (Source: Immunology and Allergy Clinics of North America)

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Hereditary Autoinflammatory Disorders

This article focuses on the clinical presentation of IL-1 and interferon-driven autoinflammatory disorders, and discusses novel diseases with features of immunodeficiency. Approaches to the clinical diagnosis, genetic testing, and treatment of these disorders are addressed. (Source: Immunology and Allergy Clinics of North America)

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Update on Advances in Hematopoietic Cell Transplantation for Primary Immunodeficiency Disorders

Hematopoietic stem cell transplantation (HSCT) in patients with primary immunodeficiency disorders (PIDDs) is being increasingly used as a curative option. Understanding the critical components, such as disease 's nature and activity and pre-HSCT and post-HSCT patient care is key to a successful outcome. HSCT should be tailored to the underlying PIDD, as different PIDDs, such as severe combined immune deficiency, Treg dysfunction, and phagocytic disorders, have different transplant approaches. Therefore, successful HSCT in patients with PIDDs requires teamwork between immunologists and transplant physicians. In this article, the authors elaborate on various aspects of PIDD-HSCT and highlight recent advances. (Source: Immunology and Allergy Clinics of North America)

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Comparisons of IQ in Children With and Without Cochlear Implants: Longitudinal Findings and Associations With Language

Conclusion: These results suggest that children using cochlear implants perform similarly to hearing peers on measures of intelligence, but those with severe comorbidities are at-risk for cognitive deficits. Despite the strong link between socioeconomic status and intelligence, this association was no longer significant once spoken language performance was accounted for. These results reveal the important contributions that early intervention programs, which emphasize language and parent training, contribute to cognitive functioning in school-age children with CIs. For families from economically disadvantaged backgrounds, who are at-risk for suboptimal outcomes, these early intervention programs are critical to improve overall functioning. (Source: Ear and Hearing)

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Development of a Novel Bone Conduction Verification Tool Using a Surface Microphone: Validation With Percutaneous Bone Conduction Users

Conclusions: Models of bone conduction devices that have intact skin cannot be measured with the skull simulator. This study is the first to present and evaluate a new tool for bone conduction verification. The surface microphone is capable of yielding equivalent audibility measurements as the skull simulator for percutaneous bone conduction users at multiple input levels. This device holds potential for measuring other bone conduction devices (Sentio, BoneBridge, Attract, Soft headband devices) that do not have a percutaneous implant. (Source: Ear and Hearing)

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Tinnitus, Depression, Anxiety, and Suicide in Recent Veterans: A Retrospective Analysis

Conclusions: The study results do not confirm clinical and anecdotal reports that tinnitus could be related to suicide among Veterans. However, tenets from rehabilitation psychology suggest that the onset of chronic impairment or disability does not predict an individual's subsequent psychological states; other personal attributes may be more influential. Health care professionals, such as audiologists and psychologists, should be cognizant of the associations between tinnitus and mental health issues and be prepared to address the psychological needs of individuals who have tinnitus. (Source: Ear and Hearing)

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Response Changes During Insertion of a Cochlear Implant Using Extracochlear Electrocochleography

Objectives: Electrocochleography is increasingly being utilized as an intraoperative monitor of cochlear function during cochlear implantation (CI). Intracochlear recordings from the advancing electrode can be obtained through the device by on-board capabilities. However, such recordings may not be ideal as a monitor because the recording electrode moves in relation to the neural and hair cell generators producing the responses. The purposes of this study were to compare two extracochlear recording locations in terms of signal strength and feasibility as intraoperative monitoring sites and to characterize changes in cochlear physiology during CI insertion. Design: In 83 human subjects, responses to 90 dB nHL tone bursts were recorded both at the round window (RW) and then at an extrac...

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A Dynamically Focusing Cochlear Implant Strategy Can Improve Vowel Identification in Noise

Conclusions: These initial results suggest that further exploration of dynamic focusing is warranted. Specifically, optimizing such strategies on an individual basis may lead to improvements in speech perception for more adult listeners and improve how CIs are tailored. Some listeners may also need a longer period of time to acclimate to a new program. (Source: Ear and Hearing)

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Evaluation of Speed and Accuracy of Next-Generation Auditory Steady State Response and Auditory Brainstem Response Audiometry in Children With Normal Hearing and Hearing Loss

Objectives: The first objective of this study was to compare the predicted audiometric thresholds obtained by auditory steady state response (ASSR) and auditory brainstem response (ABR) in infants and toddlers when both techniques use optimal stimuli and detection algorithms. This information will aid in determining the basis for large discrepancies in ABR and ASSR measures found in past studies. The hypothesis was that advancements in ASSR response detection would improve (lower) thresholds and decrease discrepancies between the thresholds produced by the two techniques. The second objective was to determine and compare test times required by the two techniques to predict thresholds for both ears at the 4 basic audiometric frequencies of 500, 1000, 2000, and 4000 Hz. Design: A multic...

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How to Optimally Fit a Hearing Aid for Bimodal Cochlear Implant Users: A Systematic Review

Conclusions: Although a bimodal benefit was found in most studies, there is no clear evidence how certain choices in HA fitting contribute to optimal bimodal performance. A generally accepted HA prescription rule is an essential part of most fitting procedures used in the studies. Current evidence suggests that frequency lowering or transposition is not beneficial. Individual fine tuning based on loudness or general preference is often applied, but its additional value for auditory performance should be investigated more thoroughly. Good quality comparative studies are needed to further develop evidence-based fitting procedures in case of bimodal listening. (Source: Ear and Hearing)

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Head Movements Allow Listeners Bilaterally Implanted With Cochlear Implants to Resolve Front-Back Confusions

Conclusions: Bilateral implantation can offer CI listeners the ability to track dynamic auditory spatial difference cues and compare these changes to changes in their own head position, resulting in a reduced rate of front-back confusions. This suggests that, for these patients, estimates of auditory acuity based solely on static laboratory settings may underestimate their real-world localization abilities. (Source: Ear and Hearing)

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The Effect of the MicroRNA-183 Family on Hair Cell-Specific Markers of Human Bone Marrow-Derived Mesenchymal Stem Cells

Hearing loss is considered the most common sensory disorder across the world. Nowadays, a cochlear implant can be an effective treatment for patients. Moreover, it is often believed that sensorineural hearing loss in humans is caused by loss or disruption of the function of hair cells in the cochlea. In this respect, mesenchymal cells can be a good candidate for cell-based therapeutic approaches. To this end, the potential of human bone marrow-derived mesenchymal stem cells to differentiate into hair cells with the help of transfection of microRNA in vitro was investigated. MicroRNA mimics (miRNA-96, 182, and 183) were transfected to human bone marrow-derived mesenchymal stem cells using Lipofec ­tamine as a common transfection reagent following the manufacturer's instructions at 50 nM ...

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Comparison of Two Different Treatment Protocols Using Systemic and Intratympanic Steroids with and without Hyperbaric Oxygen Therapy in Patients with Severe to Profound Idiopathic Sudden Sensorineural Hearing Loss: A Randomized Controlled Trial

Conclusion: These results demonstrate that the addition of HBOT to steroid combination therapy does not improve the average PTA values in severe to profound ISSNHL; however, it was associated with a better outcome at 500 Hz 1 month after treatment and, at 1 kHz, WDS 3 months after treatment. The sum of complete and partial hearing recovery was significantly higher for the study group than for the control group.Audiol Neurotol 2018;23:199 –207 (Source: Audiology and Neurotology)

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Comparisons of IQ in Children With and Without Cochlear Implants: Longitudinal Findings and Associations With Language

Conclusion: These results suggest that children using cochlear implants perform similarly to hearing peers on measures of intelligence, but those with severe comorbidities are at-risk for cognitive deficits. Despite the strong link between socioeconomic status and intelligence, this association was no longer significant once spoken language performance was accounted for. These results reveal the important contributions that early intervention programs, which emphasize language and parent training, contribute to cognitive functioning in school-age children with CIs. For families from economically disadvantaged backgrounds, who are at-risk for suboptimal outcomes, these early intervention programs are critical to improve overall functioning. (Source: Ear and Hearing)

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Development of a Novel Bone Conduction Verification Tool Using a Surface Microphone: Validation With Percutaneous Bone Conduction Users

Conclusions: Models of bone conduction devices that have intact skin cannot be measured with the skull simulator. This study is the first to present and evaluate a new tool for bone conduction verification. The surface microphone is capable of yielding equivalent audibility measurements as the skull simulator for percutaneous bone conduction users at multiple input levels. This device holds potential for measuring other bone conduction devices (Sentio, BoneBridge, Attract, Soft headband devices) that do not have a percutaneous implant. (Source: Ear and Hearing)

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Tinnitus, Depression, Anxiety, and Suicide in Recent Veterans: A Retrospective Analysis

Conclusions: The study results do not confirm clinical and anecdotal reports that tinnitus could be related to suicide among Veterans. However, tenets from rehabilitation psychology suggest that the onset of chronic impairment or disability does not predict an individual's subsequent psychological states; other personal attributes may be more influential. Health care professionals, such as audiologists and psychologists, should be cognizant of the associations between tinnitus and mental health issues and be prepared to address the psychological needs of individuals who have tinnitus. (Source: Ear and Hearing)

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Response Changes During Insertion of a Cochlear Implant Using Extracochlear Electrocochleography

Objectives: Electrocochleography is increasingly being utilized as an intraoperative monitor of cochlear function during cochlear implantation (CI). Intracochlear recordings from the advancing electrode can be obtained through the device by on-board capabilities. However, such recordings may not be ideal as a monitor because the recording electrode moves in relation to the neural and hair cell generators producing the responses. The purposes of this study were to compare two extracochlear recording locations in terms of signal strength and feasibility as intraoperative monitoring sites and to characterize changes in cochlear physiology during CI insertion. Design: In 83 human subjects, responses to 90 dB nHL tone bursts were recorded both at the round window (RW) and then at an extrac...

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A Dynamically Focusing Cochlear Implant Strategy Can Improve Vowel Identification in Noise

Conclusions: These initial results suggest that further exploration of dynamic focusing is warranted. Specifically, optimizing such strategies on an individual basis may lead to improvements in speech perception for more adult listeners and improve how CIs are tailored. Some listeners may also need a longer period of time to acclimate to a new program. (Source: Ear and Hearing)

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Using Objective Metrics to Measure Hearing Aid Performance

Conclusions: The results presented in this article represent a first step in applying the HASPI and HASQI metrics to commercial hearing aids. Modern hearing aids often use several different processing strategies operating simultaneously. The proposed metrics provide a way to predict the total effect of this processing, including algorithm interactions that may be missed by conventional measurement procedures. The measurements in this article show significant differences between manufacturers, processing settings, and adjustment for different hearing losses. No significant differences were found between basic and premium hearing aid models. Further research will be needed to determine the clinical relevance of these measurements and to provide target values appropriate for successful fitt...

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Evaluation of Speed and Accuracy of Next-Generation Auditory Steady State Response and Auditory Brainstem Response Audiometry in Children With Normal Hearing and Hearing Loss

Objectives: The first objective of this study was to compare the predicted audiometric thresholds obtained by auditory steady state response (ASSR) and auditory brainstem response (ABR) in infants and toddlers when both techniques use optimal stimuli and detection algorithms. This information will aid in determining the basis for large discrepancies in ABR and ASSR measures found in past studies. The hypothesis was that advancements in ASSR response detection would improve (lower) thresholds and decrease discrepancies between the thresholds produced by the two techniques. The second objective was to determine and compare test times required by the two techniques to predict thresholds for both ears at the 4 basic audiometric frequencies of 500, 1000, 2000, and 4000 Hz. Design: A multic...

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How to Optimally Fit a Hearing Aid for Bimodal Cochlear Implant Users: A Systematic Review

Conclusions: Although a bimodal benefit was found in most studies, there is no clear evidence how certain choices in HA fitting contribute to optimal bimodal performance. A generally accepted HA prescription rule is an essential part of most fitting procedures used in the studies. Current evidence suggests that frequency lowering or transposition is not beneficial. Individual fine tuning based on loudness or general preference is often applied, but its additional value for auditory performance should be investigated more thoroughly. Good quality comparative studies are needed to further develop evidence-based fitting procedures in case of bimodal listening. (Source: Ear and Hearing)

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Head Movements Allow Listeners Bilaterally Implanted With Cochlear Implants to Resolve Front-Back Confusions

Conclusions: Bilateral implantation can offer CI listeners the ability to track dynamic auditory spatial difference cues and compare these changes to changes in their own head position, resulting in a reduced rate of front-back confusions. This suggests that, for these patients, estimates of auditory acuity based solely on static laboratory settings may underestimate their real-world localization abilities. (Source: Ear and Hearing)

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The Effect of the MicroRNA-183 Family on Hair Cell-Specific Markers of Human Bone Marrow-Derived Mesenchymal Stem Cells

Hearing loss is considered the most common sensory disorder across the world. Nowadays, a cochlear implant can be an effective treatment for patients. Moreover, it is often believed that sensorineural hearing loss in humans is caused by loss or disruption of the function of hair cells in the cochlea. In this respect, mesenchymal cells can be a good candidate for cell-based therapeutic approaches. To this end, the potential of human bone marrow-derived mesenchymal stem cells to differentiate into hair cells with the help of transfection of microRNA in vitro was investigated. MicroRNA mimics (miRNA-96, 182, and 183) were transfected to human bone marrow-derived mesenchymal stem cells using Lipofec ­tamine as a common transfection reagent following the manufacturer's instructions at 50 nM ...

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Comparison of Two Different Treatment Protocols Using Systemic and Intratympanic Steroids with and without Hyperbaric Oxygen Therapy in Patients with Severe to Profound Idiopathic Sudden Sensorineural Hearing Loss: A Randomized Controlled Trial

Conclusion: These results demonstrate that the addition of HBOT to steroid combination therapy does not improve the average PTA values in severe to profound ISSNHL; however, it was associated with a better outcome at 500 Hz 1 month after treatment and, at 1 kHz, WDS 3 months after treatment. The sum of complete and partial hearing recovery was significantly higher for the study group than for the control group.Audiol Neurotol 2018;23:199 –207 (Source: Audiology and Neurotology)

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Ideas to Build Your Brand With Colleagues and Clients, SLPs

The job of a speech-language pathologist continues to expand. And as demand for our expertise increases, so does our workload. Awareness about our profession seems not to grow as much, however. New SLPs, for example, might quickly learn about others' sometimes-limited understanding about our scope of practice. It can be frustrating when others don't understand what an SLP does, but we can teach them by advocating for ourselves. As a school-based SLP, I educate many of my co-workers about the extent of my skills and expertise. Let's learn to represent our brand, fellow SLPs. I hope these strategies work as well for you—whatever your setting—as they did for me: Create and deliver a brief presentation to co-workers about speech-language pathology: Include audiologists, occupati...

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Ideas to Build Your Brand With Colleagues and Clients, SLPs

The job of a speech-language pathologist continues to expand. And as demand for our expertise increases, so does our workload. Awareness about our profession seems not to grow as much, however. New SLPs, for example, might quickly learn about others' sometimes-limited understanding about our scope of practice. It can be frustrating when others don't understand what an SLP does, but we can teach them by advocating for ourselves. As a school-based SLP, I educate many of my co-workers about the extent of my skills and expertise. Let's learn to represent our brand, fellow SLPs. I hope these strategies work as well for you—whatever your setting—as they did for me: Create and deliver a brief presentation to co-workers about speech-language pathology: Include audiologists, occupati...

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Deictic and desubjectivizing meaning in advertising discourse: The usage of Spanish te and se clitics

This study aims to contribute to a better understanding of oral and written Spanish advertising discourse by analyzing variation between the second-person object clitic te ['you'] and the clitic se ['one'] from a cognitive viewpoint. The variable choice of te or se strongly conditions the interpretation of advertisements and their meanings. The main cognitive explanatory notion will be salience; both clitics, te and se, imply different degrees of referent salience. Second-person te is more salient than se; therefore, the meanings conveyed by each one in media discourse will be notably different. Results indicate that the distribution and usage of the clitics te and se reveal different persuasion strategies in advertising discourse. In general terms, te is used when a special deicti...

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Green synthesis of manganese nanoparticles: Applications and future perspective–A review

Publication date: Available online 31 October 2018Source: Journal of Photochemistry and Photobiology B: BiologyAuthor(s): Vahid Hoseinpour, Nasser GhaemiAbstractNanobiotechnology is a promising and appearing field of nanotechnology. In recent years, the necessity of making biocompatible materials for different applications in various area such as health, medicine, water treatment and purification, etc. caused more attention to this area. Today, green synthesis of different nanoparticles (NPs) has been extensively studied. However, less attention has been paid to manganese as a high-performance metal in various applications such as medicine, biomedicine, biosensors, water treatment and purification, electronics, electrochemistry, photoelectronics, catalysis, and etc. Manganese oxides (Mn-ox...

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SLP-Perceived Technical and Patient-Centered Factors Associated with Pharyngeal High-Resolution Manometry

AbstractHigh-resolution manometry (HRM) objectively measures swallowing-related pressures in the pharynx and esophagus. It has been used in many research applications, but it is unclear how HRM is perceived amongst speech-language pathologists (SLP) as it enters into clinical practice. The purpose of this study was to explore SLP perceptions of clinical HRM use. Based on qualitative data collected at four focus groups held at two national conferences and a survey based on open-ended questions, we found broad consensus among those queried regarding how HRM 's objective and targeted data could enhance diagnosis and drive treatments. However, we found less consensus among SLPs regarding which patients may and may not benefit, as well as when in the clinical process HRM would best supplement...

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Is the Location of White Matter Lesions Important in the Swallowing Function of Older Patients with Mild Stroke?

AbstractOlder patients with stroke have poor functional prognosis compared to younger patients. Patients with stroke who have severe white matter (WM) lesions have been reported to have swallowing problems. The aim of this study was to determine whether the location of WM lesions affects swallowing function in older patients with mild stroke. We conducted a retrospective analysis of 88 patients aged  >  65 years who had a National Institutes of Health Stroke Scale score  of ≤ 5 and who underwent videofluoroscopic swallowing examination after their first stroke. Participants were divided into three groups according to the involvement of corticobulbar tract (CBT) as follows: group I, no inv olvement of CBT; group II, involvement of CBT in one hemisphere; and group III, involvem...

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Photodynamic therapy: Toward a systemic computational model

Publication date: Available online 30 October 2018Source: Journal of Photochemistry and Photobiology B: BiologyAuthor(s): N. López-Marína, R. Mulet, R. RodríguezAbstractWe have designed a systemic model to understand the effect of Photodynamic Therapy (PDT) on long time scales. The model takes into account cell necrosis due to oxygen reactive species, cell apoptosis through the caspase pathway and the competition between healthy and tumor cells. We attempted to describe the system using state of the art computational techniques (necrosis and apoptosis) and simple models that allow a deeper understanding of the long time scale processes involved (healing and tumor growth). We analyzed the influence of the surface and tumor depth on the effectiveness of different treatment plans and we pr...

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Acquiring and visualizing 3D/4D ultrasound recordings of tongue motion

Publication date: November 2018Source: Journal of Phonetics, Volume 71Author(s): Steven M. Lulich, Kelly H. Berkson, Kenneth de JongAbstractUltrasound is increasingly common in speech and phonetics research as technology continues to improve. The first digital 3D/4D ultrasound system was utilized for speech research nearly a decade ago, but data access, processing, and visualization were limited to (non-speech) clinical imaging applications. Access to the raw (pulse-echo or scan-converted) image data is a critical step toward making 3D/4D ultrasound an effective tool for speech research. In addition, there is a need for technical characterization of 3D/4D ultrasound systems together with a presentation of their strengths and limitations for research. This paper gives a general technical de...

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A modified multimodal communication treatment for individuals with traumatic brain injury.

In this study, the researchers measured the effectiveness of a modified Multimodal Communication Treatment designed to increase communication breakdown resolution and use of AAC strategies by two individuals with TBI. A multiple baseline, single-case design was used to measure outcomes for the two participants who had motor speech disorders and cognitive-communication impairments. They completed four pre-treatment sessions, 20 treatment sessions, and three post-treatment sessions. Dependent variables included the number of AAC strategies produced during a modality probe task and two measures of communication breakdown resolution during a structured, functional task. Both participants increased use of AAC strategies during modality probes, but demonstrated minimal changes in communication b...

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Responsiveness of a parent-reported outcome measure to evaluate AAC interventions for children and youth with complex communication needs.

This study provides initial support for the ability of the FIATS-AAC to detect functional changes in children and youth and their families after receiving a graphic-based SGD. PMID: 30369273 [PubMed - as supplied by publisher] (Source: Augmentative and Alternative Communication)

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Construct validity of the family impact of assistive technology scale for augmentative and alternative communication.

This study provides evidence for the emerging construct validity of the FIATS-AAC as a measure linked to psychosocial aspects of quality-of-life in children with AAC needs between the ages of 6- and 12-years. PMID: 30369255 [PubMed - as supplied by publisher] (Source: Augmentative and Alternative Communication)

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The complexities of AAC intervention research: emerging trends to consider.

Authors: Romski M, Sevcik RA Abstract Augmentative and alternative communication (AAC) is always about intervening and the subsequent effects of the interventions (e.g., on the AAC user, family perspectives, educational outcomes, and vocational outcomes). AAC intervention research is about generating new knowledge by studying some aspect of AAC delivery in a planned manner so that it can be replicated and then translated into clinical/educational practice. This commentary on AAC intervention research highlights the complexities inherent in this type of research and the range of components that contribute to it, and reflects on emerging trends that we must consider as we continue to develop and enhance intervention research. Conducting AAC intervention research is a commitment to un...

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