Publication Abstracts - 2000

Storzbach, D., Rohlman D, Anger WK, Binder LM, Campbell K and members of the Portland Environmental Hazards Research Center: Neurobehavioral deficits in Persian Gulf veterans: Further evidence from a population-based study. Environmental Research 85:1-13.

Portland VA Medical Center, Portland, Oregon 97201, USA.

Reports of low-concentration nerve gas exposures during the Gulf War (GW) have spurred concern about possible health consequences and symptoms reported by many returning veterans. The Portland Environmental Hazards Research Center is studying veterans from the northwest United States who report persistent, unexplained "Gulf War" symptoms (cases) and those who do not report those symptoms (controls). An epidemiological survey focused on exposures and symptoms was mailed to a random sample of GW veterans from Oregon and southwestern Washington. Volunteers recruited from survey respondents agreed to undergo a thorough medical examination and psychological and neurobehavioral assessment. Persistent symptoms with no medical explanation associated with Persian Gulf service (e.g., fatigue, muscle pain, memory deficits) beginning during or after the war qualified respondents as cases. The 239 cases with unexplained symptoms and the 112 controls without symptoms were administered a computerized assessment battery of 12 psychosocial and 6 neurobehavioral tests. Replicating and extending previous interim findings, a subgroup of veterans emerged from the initial analysis in the form of extreme outliers which produced a visually and quantitatively obvious bimodal distribution. This led, as it had previously, to analyses of the outliers as a separate group (labeled "slow ODTP"), which confirmed the initial findings of neurobehavioral differences between the outliers and the other cases and controls and provided more convincing evidence that the majority of cases who report neurobehavioral symptoms have no objective evidence of neurobehavioral deficits. However, the larger group of symptomatic veterans do have highly significant and compelling evidence of psychological distress based on scores from 11 separate psychological tests. Whereas the cases differed from the controls by poorer neurobehavioral test performance, extraction of the slow ODTP participants (almost all cases) eliminated neurobehavioral performance differences between the remaining cases and the controls and provided support for the hypothesis that the slow ODTP cases might have been from the unhealthy end of the GW population prior to the war. However, there was no evidence of poor motivation, pre-GW educational differences, or greater association with abnormal psychological function in this group than in other cases or controls. Copyright 2000 Academic Press.

Cienkowski, K.M., Saunders, G.H., (2000). Client-attitude questionnaire provides data that can help shape counseling strategies. Hearing Journal, 53:42-49. 

Recent advances in technology have changed the face of hearing aid fitting.  Digital signal processing, non-linear amplification, and directional microphones are available at the click of a mouse button.  Despite this, acceptance of hearing aids remains poor.  Only 20.4% of hearing impaired adults own hearing aids and 16.2% of owners do not actually use their hearing instrument(s). Only a little over half (54.5%) of owners are satisfied with their hearing aids while 19.4% are dissatisfied.

Hearing impairment is widespread. It is estimated that 27.2 million Americans have a hearing loss. Approximately 30% of people over the age of 65 are affected by hearing impairment, with the figure rising to 35% in those over 75 years.

Psychosocial issues play a major role in the hearing-impaired person's decision not to purchase hearing aids.  The most commonly cited reasons are: "Hearing instruments have a stigma attached to them," "Hearing aids are expensive and/or do not work," "My loss is not serious enough to warrant a hearing aid," and "Only old people wear hearing aids." It therefore seems likely that if some of the psychosocial issues underlying the refusal to acquire hearing aids could be elucidated and altered via counseling, then a greater number of hearing-impaired persons could be expected to wear hearing aids.

Recent studies confirm that hearing aid use has notable advantages.  For instance, the National Council on the Aging found that older adults with hearing loss who do not use amplification are more likely to report feelings of sadness, depression, anxiety, and emotional turmoil.  In contrast, the council found, their aided counterparts experience an overall improvement in quality of life, relationships, and feelings about themselves following acquisition of hearing aids.

In 1996, we published a paper describing the development of the Attitudes Toward Hearing Loss Questionnaire (ALHQ).  This 24-item questionnaire consisted of five subscales that evaluated some of the psychosocial factors involved in the use and acquisition of hearing aids.  Three of the five subscales were considered to be statistically reliable, but two were not.  The aim of the study reported here was to revise the questionnaire to improve its statistical reliability, while at the same time investigating the possibility of adding or replacing subscales.  This paper describes the outcome of the refinement of the ALHQ, and reports some of the relationships seen between ALHQ subscales and other subjective measures of hearing aid satisfaction/benefit.

Dirks, D., Takayanagi, S., Moshfegh, A., Fausti, S. A., & Noffsinger, D. (2000).  Lexical factors affecting spoken word recognition.  Audiology, (Journal of the Audiological Society of  Australia and New Zealand), 22:1-12. 

Dirks, D., Takayanagi, S., Moshfegh, A., Noffsinger, D., & Fausti, S. A. (2000). Examination of the neighborhood activation theory in normal and hearing-impaired listeners. Ear and Hearing, 22:1-13. .

National Center for Rehabilitative Auditory Research, Veterans Administration Medical Center, Portland, Oregon, USA.

OBJECTIVE: Experiments were conducted to examine the effects of lexical information on word recognition among normal hearing listeners and individuals with sensorineural hearing loss. The lexical factors of interest were incorporated in the Neighborhood Activation Model (NAM). Central to this model is the concept that words are recognized relationally in the context of other phonemically similar words. NAM suggests that words in the mental lexicon are organized into similarity neighborhoods and the listener is required to select the target word from competing lexical items. Two structural characteristics of similarity neighborhoods that influence word recognition have been identified; "neighborhood density" or the number of phonemically similar words (neighbors) for a particular target item and "neighborhood frequency" or the average frequency of occurrence of all the items within a neighborhood. A third lexical factor, "word frequency" or the frequency of occurrence of a target word in the language, is assumed to optimize the word recognition process by biasing the system toward choosing a high frequency over a low frequency word. DESIGN: Three experiments were performed. In the initial experiments, word recognition for consonant-vowel-consonant (CVC) monosyllables was assessed in young normal hearing listeners by systematically partitioning the items into the eight possible lexical conditions that could be created by two levels of the three lexical factors, word frequency (high and low), neighborhood density (high and low), and average neighborhood frequency (high and low). Neighborhood structure and word frequency were estimated computationally using a large, on-line lexicon-based Webster's Pocket Dictionary. From this program 400 highly familiar, monosyllables were selected and partitioned into eight orthogonal lexical groups (50 words/group). The 400 words were presented randomly to normal hearing listeners in speech-shaped noise (Experiment 1) and "in quiet" (Experiment 2) as well as to an elderly group of listeners with sensorineural hearing loss in the speech-shaped noise (Experiment 3). RESULTS: The results of three experiments verified predictions of NAM in both normal hearing and hearing-impaired listeners. In each experiment, words from low density neighborhoods were recognized more accurately than those from high density neighborhoods. The presence of high frequency neighbors (average neighborhood frequency) produced poorer recognition performance than comparable conditions with low frequency neighbors. Word frequency was found to have a highly significant effect on word recognition. Lexical conditions with high word frequencies produced higher performance scores than conditions with low frequency words. CONCLUSION: The results supported the basic tenets of NAM theory and identified both neighborhood structural properties and word frequency as significant lexical factors affecting word recognition when listening in noise and "in quiet." The results of the third experiment permit extension of NAM theory to individuals with sensorineural hearing loss. Future development of speech recognition tests should allow for the effects of higher level cognitive (lexical) factors on lower level phonemic processing.

Folmer, R. L., & Griest, S. E. (2000). Tinnitus and insomnia. American Journal of Otolaryngology, 21:287-293. 

Tinnitus Clinic, Oregon Hearing Research Center, Department of Otolaryngology, Oregon Health Sciences University, Portland 97201-3098, USA.

PURPOSE: To investigate the effects of insomnia on tinnitus severity and to determine how this relationship may evolve with the passage of time. MATERIALS AND METHODS: Questionnaires were mailed to patients before their initial appointment at the Oregon Health Sciences University Tinnitus Clinic between 1994 and 1997. These questionnaires requested information pertaining to insomnia, tinnitus severity, and loudness. During their initial appointment, patients received counseling, education, and reassurance about tinnitus; audiometric and tinnitus evaluations; and treatment recommendations. Follow-up questionnaires were mailed to 350 patients 1 to 4 years (mean = 2.3 yr) after their initial appointment at the clinic. RESULTS: One hundred seventy-four patients (130 men, 44 women; mean age 55.9 yr) returned follow-up questionnaires. Although many of these patients improved in both sleep interference and tinnitus severity, a significant number (43) reported on the follow-up questionnaire that they continued to have difficulty sleeping. Reported loudness and severity of tinnitus were significantly greater for this group than for groups of patients who reported that they never or only sometimes have difficulty sleeping. The relationship between sleep disturbance and tinnitus severity became more pronounced with the passage of time. CONCLUSIONS: Insomnia is associated with greater perceived loudness and severity of tinnitus. These findings underscore the importance of identification and successful treatment of insomnia for patients with tinnitus.

Henry, J. A., & Meikle, M. B. (2000). Psychoacoustical measures of tinnitus. American Journal of Audiology, 11:138-155. 

VA RR&D National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Oregon 97207, USA.

This report reviews research from the 1930s to the present that has extended our understanding by investigating the characteristics of tinnitus that can be studied using psychoacoustic techniques. Studies of tinnitus masking and residual inhibition began in the 1970s, leading to the therapeutic use of tinnitus masking and a consequent increase in research devoted to tinnitus measurement. In 1981, the CIBA Foundation symposium on tinnitus advocated general adoption of four tinnitus measures: (1) pitch, (2) loudness, (3) maskability, and (4) residual inhibition. Since then, psychoacoustic research into all four topics has proliferated, yielding many valuable insights and controversies concerning the details of measurement techniques. A consensus has emerged that neither the loudness nor other psychoacoustic measures of tinnitus bear a consistent relation to the severity or perceived loudness of tinnitus. Nevertheless, quantification is needed in clinical trials of proposed treatments and in a variety of other types of tinnitus research. Standardization of techniques for specifying the acoustic parameters of tinnitus thus continues to be an important research goal.

Henry, J. A., Fausti, S. A., Flick, C. L., Helt, W. J., & Ellingson, R. M. (2000). Computer-automated clinical technique for tinnitus quantification. American Journal of Audiology, 9:1-14. 

Veterans Affairs RR&D National Center for Rehabilitative Auditory Research, Portland VA Medical Center, OR, USA. henryj@ohsu.edu

This study addresses the need for uniformity in techniques for clinical quantification of tinnitus. Because automation can be an effective means to achieve standardization, this laboratory is developing techniques to perform computer-automated tinnitus testing. The present study was conducted to demonstrate the feasibility of obtaining reliable tinnitus measures using a fully automated system. A computer-controlled psychoacoustical system was developed to quantify tinnitus loudness and pitch using a tone-matching technique. Hearing thresholds were also obtained as part of the procedure. The system generated test stimuli and simultaneously controlled a notebook computer positioned in the sound chamber facing the patient. The notebook computer displayed instructions for responding and relayed response choices through on-screen "buttons" that the patient touched with a pen device. Twenty individuals with tinnitus were evaluated with the technique over two sessions, and responses were analyzed for test-retest reliability. Analyses revealed good reliability of thresholds, loudness matches, and pitch matches. These results demonstrate that use of a fully automated system to obtain reliable measurements of tinnitus loudness and pitch is feasible for clinical application.

Henry, J. A., Fausti, S. A., Kempton, J. B., & Trune, D. R. (2000). Twenty-stimulus train for rapid acquisition of auditory brainstem responses in humans. Journal of the American Academy of Audiology, 11:103-113. 

National Center for Rehabilitative Auditory Research, Department of Veterans Affairs Medical Center, Portland, Oregon 97207, USA.

This study addressed the clinical need to obtain frequency-specific auditory brainstem responses (ABRs) more rapidly than is currently possible. ABRs were obtained from 20 subjects using two different methods: a conventional method with tone bursts presented singly and a multiple-stimulus method using a train of 20 tone bursts. For both methods, tone bursts were presented at frequencies 1, 2, 4, and 8 kHz, shaped with a Blackman-Harris window and having intensity levels up to 105 dB peak equivalent sound pressure level (peSPL). The single tone bursts were presented at a 17.2/sec repetition rate. The 20 tone-burst train used the four frequencies at five intensities each and a repetition rate of 3.7/sec (separations between tone bursts of 9-12 msec, with 77 msec off-time between trains). Mean latencies and mean amplitudes for wave V were compared using t-tests for each of 12 conditions (four frequencies, each at the three highest output levels). For latency, only one comparison was significantly different (2 kHz, 77 dB peSPL). Similarly, only one comparison was significant for amplitude (2 kHz, 97 dB peSPL). There was, however, a trend for the tone bursts presented in trains to have longer latencies and reduced amplitudes compared to the respective responses for the single tone-burst condition. These results indicate the presence of some response adaptation when tone bursts are presented in a train. The use of a properly designed stimulus train can result in a significant time savings for obtaining frequency-specific ABRs as compared with single tone-burst presentations.

Khan, D. C., DeGagne, J. M., & Trune, D. R. (2000). Abnormal cochlear connective tissue mineralization in the Palmerston North autoimmune mouse. Hearing Research, 142:12-22. 

Oregon Hearing Research Center, NRC04, Department of Otolaryngology- Head and Neck Surgery, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.

Inner ear fibrosis and osteogenesis are common features of human autoimmune disease, although the cellular mechanisms are unknown. The Palmerston North (PN) autoimmune strain mouse has been shown to develop modiolar sclerotic lesions with progression of its systemic disease. Therefore, lesion development was studied in the cochleas of PN mice to gain insight into potential autoimmune osteogenic processes in the human ear. Cochleas from PN mice were examined with electron microscopy to characterize the cellular and extracellular matrix changes that lead to abnormal mineralization. Initially, activated fibroblasts produced extracellular matrix fibers, ranging in size from fine fibrils to larger collagen-like fibers. These proliferating fibers appeared to 'seed' the mineralizing lesions by serving as the framework for mineral deposition. As mineralization continued, the foci grew in size and fused to form large sclerotic masses within the connective tissue. However, the lesions never invaded nor degraded the normal modiolar bone. These observations of abnormal mineralization of cochlear connective tissue fibers show some parallels with human cochlear autoimmune osteogenesis, suggesting similar molecular processes may be involved.

Larson, V., Williams, D., Henderson, W. G., Luethke, L. E., Beck, L. B., Noffsinger, D., Wilson, R. H., Dobie, R. A., Haskell, G., Bratt, G. W., Shanks, J. E., Stelmachowicz, P., Studebaker, G. A., Boysen, A. E., Donahue, A., Canalis, R., Fausti, S. A., & Rappaport, B. Z. (2000). Efficacy of 3 commonly used hearing aid circuits: A crossover trial.  NIDCD/VA Hearing Aid Clinical Trial Group. Journal of American Medical Association, 284:1806-13. 

Howard Leight Industries, 7828 Waterville Rd, San Diego, CA 92154, USA. vlarson@howardleight.com

CONTEXT: Numerous studies have demonstrated that hearing aids provide significant benefit for a wide range of sensorineural hearing loss, but no carefully controlled, multicenter clinical trials comparing hearing aid efficacy have been conducted. OBJECTIVE: To compare the benefits provided to patients with sensorineural hearing loss by 3 commonly used hearing aid circuits. DESIGN: Double-blind, 3-period, 3-treatment crossover trial conducted from May 1996 to February 1998. SETTING: Eight audiology laboratories at Department of Veterans Affairs medical centers across the United States. PATIENTS: A sample of 360 patients with bilateral sensorineural hearing loss (mean age, 67.2 years; 57% male; 78.6% white). INTERVENTION: Patients were randomly assigned to 1 of 6 sequences of linear peak clipper (PC), compression limiter (CL), and wide dynamic range compressor (WDRC) hearing aid circuits. All patients wore each of the 3 hearing aids, which were installed in identical casements, for 3 months. MAIN OUTCOME MEASURES: Results of tests of speech recognition, sound quality, and subjective hearing aid benefit, administered at baseline and after each 3-month intervention with and without a hearing aid. At the end of the experiment, patients ranked the 3 hearing aid circuits. RESULTS: Each circuit markedly improved speech recognition, with greater improvement observed for soft and conversationally loud speech (all 52-dB and 62-dB conditions, P</=.001). All 3 circuits significantly reduced the frequency of problems encountered in verbal communication. Some test results suggested that CL and WDRC circuits provided a significantly better listening experience than PC circuits in word recognition (P =.002), loudness (P =.003), overall liking (P =.001), aversiveness of environmental sounds (P =.02), and distortion (P =.02). In the rank-order ratings, patients preferred the CL hearing aid circuits more frequently (41.6%) than the WDRC (29.8%) and the PC (28.6%) (P =.001 for CL vs both WDRC and PC). CONCLUSIONS: Each circuit provided significant benefit in quiet and noisy listening situations. The CL and WDRC circuits appeared to provide superior benefits compared with the PC, although the differences between them were much less than the differences between the aided vs unaided conditions. JAMA. 2000;284:1806-1813.

McCall, A. L. (2000). Glucose Transport and Stress.. In G. Fink (Ed.), Encyclopedia of Stress (pp. 270-275). 

Glucose transport supplies fuel needed for energy metabolism by all mammalian cells. The supply of glucose is especially important for cells, such as the neurons of the brain, which have a high metabolic rate supported by an obligate consumption of glucose as fuel. Transport is regulated by a variety of factors, including those associated with stress. The transport proteins that accomplish glucose transport are modulated in their expression, cellular distribution, synthesis, and half-lives by stress-related factors.  Such factors include stress hormones, metabolic stress such as cellular energy demand, and stress-related kinase signaling. The net effect of such regulation may be to ensure appropriate distribution of glucose fuel to tissues during stress that most require this particular fuel.

Meikle, M. B. (2000). Tinnitus caused by sudden intense change in pressure. Tinnitus Today.  American Tinnitus Association, 25:17. 

Parthasarathi, A. A., Grosh, K., & Nuttall, A. L. (2000). Three-dimensional numerical modeling for global cochlear dynamics. Journal of the Acoustical Society of America, 107:474-85. 

Department of Biomedical Engineering, University of Michigan, Ann Arbor 48109, USA.

A hybrid analytical-numerical model using Galerkin approximation to variational equations has been developed for predicting global cochlear responses. The formulation provides a flexible framework capable of incorporating morphologically based mechanical models of the cochlear partition and realistic geometry. The framework is applied for a simplified model with an emphasis on application of hybrid methods for three-dimensional modeling. The resulting formulation is modular, where matrices representing fluid and cochlear partition are constructed independently. Computational cost is reduced using two methods, a modal-finite-element method and a boundary element-finite-element method. The first uses a cross-mode expansion of fluid pressure (2.5D model) and the second uses a waveguide Green's-function-based boundary element method (BEM). A novel wave number approach to the boundary element formulation for interior problem results in efficient computation of the finite-element matrix. For the two methods a convergence study is undertaken using a simplified passive structural model of cochlear partition. It is shown that basilar membrane velocity close to best place is influenced by fluid and structural discretization. Cochlear duct pressure fields are also shown demonstrating the 3D nature of pressure near best place.

Reagan, L. P., Magarinos, A. M., Yee, D. K., Swzeda, L. I., Van Buren, A., McCall, A. L., & McEwen, B. S. (2000). Oxidative stress and HNE conjugation of GLUT3 are increased in the hippocampus of diabetic rats subjected to stress. Brain Research, 862:292-300. 

Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, The Rockefeller University, Box 165, 1230 York Avenue, New York, NY, USA. reaganl@rockvax.rockefeller.edu

Recent studies demonstrate that cellular, molecular and morphological changes induced by stress in rats are accelerated when there is a pre-existing strain upon their already compromised adaptive responses to internal or external stimuli, such as may occur with uncontrolled diabetes mellitus. The deleterious actions of diabetes and stress may increase oxidative stress in the brain, leading to increases in neuronal vulnerability. In an attempt to determine if stress, diabetes or stress+diabetes increases oxidative stress in the hippocampus, radioimmunocytochemistry was performed using polyclonal antisera that recognize proteins conjugated by the lipid peroxidation product 4-hydroxy-2-nonenal (HNE). Radioimmunocytochemistry revealed that HNE protein conjugation is increased in all subregions of the hippocampus of streptozotocin (STZ) diabetic rats, rats subjected to restraint stress and STZ diabetic rats subjected to stress. Such increases were not significant in the cortex. Because increases in oxidative stress may contribute to stress- and diabetes-mediated decreases in hippocampal neuronal glucose utilization, we examined the stress/diabetes mediated HNE protein conjugation of the neuron specific glucose transporter, GLUT3. GLUT3 immunoprecipitated from hippocampal membranes of diabetic rats subjected to stress exhibited significant increases in HNE immunolabeling compared to control rats, suggesting that HNE protein conjugation of GLUT3 contributes to decreases in neuronal glucose utilization observed during diabetes and exposure to stress. Collectively, these results demonstrate that the hippocampus is vulnerable to increases in oxidative stress produced by diabetes and stress. In addition, increases in HNE protein conjugation of GLUT3 provide a potential mechanism for stress- and diabetes-mediated decreases in hippocampal neuronal glucose utilization.

Ren, T., & Nuttall, A. L. (2000). Fine structure and multicomponents of the electrically evoked otoacoustic emission in gerbil. Hearing Research, 143:58-68. 

Oregon Hearing Research Center (NRC04), Department of Otolaryngology and Head and Neck Surgery, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97201-3098, USA. rent@ohsu.edu

Like the acoustically evoked distortion product otoacoustic emissions (DPOAE), the amplitude spectrum of the extracochlear electrically evoked otoacoustic emission (EEOAE) also shows peaks and valleys, which are termed the fine structure (FS) of the EEOAE. The hypothesis that the FS of the EEOAE is generated by multiple wave interactions in the cochlea is investigated by examining the relationship between the FS and the multiple-delay components of the EEOAE. The bulla of the gerbil was exposed using a ventral surgical approach. One pole of a bipolar electrode was placed in the round window niche, and the other pole on the surface of the first cochlear turn. A microphone was used to measure electrically evoked sound pressure change in the ear canal. A recently developed multicomponent analysis method was used to detect the EEOAE multiple delays. It was found that the FS is the spectral representation of the multiple-delay components. The relative power of a prominent long delay component (LDC) shows a negative relationship to the electrical stimulus level. Both the FS and the LDC were abolished by intravenous furosemide. Reconstructed signals showed that mathematical removal of the EEOAE LDC also completely eliminated the FS. These data demonstrate that the FS and the EEOAE multicomponents are properties of normal cochlear mechanics in a healthy ear and that the FS is a manifestation of the multicomponents. The findings in this study strongly indicate that the FS of the EEOAE evoked by extracochlear electrical stimulation is generated by wave interaction in the cochlea. The similarity between the EEOAE FS and the DPOAE FS suggests that they may share the same mechanism.

Ren, T., Nuttall, A. L., & Parthasarathi, A. A. (2000). Quantitative measure of multicomponents of otoacoustic emission. Journal of Neuroscience Methods, 96:97-104.

Oregon Hearing Research Center, Department of Otolaryngology, Head and Neck Surgery, Oregon Health Sciences University, Portland, OR 97201-3098, USA. rent@ohsu.edu

A method for quantitatively measuring measuring multicomponents of otoacoustic emissions (OAE) was developed in this study. The method is based on the rationale that, if the acoustic emission is a vector sum of multicomponents coming from different locations in the cochlea, each component will show a delay. The proposed method consists of the following steps: (1) the amplitude and phase of the emission is measured when the emission frequency is swept; (2) the real part of the spectrum is obtained based on the amplitude and phase spectra; and (3) the real part of the emission spectrum is then analyzed using a Fourier transform to extract the multiple components. The theoretical basis and practical procedure of this method are described, and in vitro and in vivo tests are used to demonstrate the validity of the method. Preliminary data demonstrate the multicomponents of the extracochlear electrically evoked otoacoustic emission (EEOAE). 

Storzbach, D., Binder, L. M., Salinsky, M., Campbell, B. R., & Mueller, R. M. (2000).  Improved prediction of nonepileptic seizure using combined MMPI and EEG measures, Epilepsia, 41:332-337. 

Oregon Health Sciences, University Epilepsy Center and Portland Veteran's Affairs Medical Center, USA. daniel.storzbach@va.gov

PURPOSE: Nonepileptic seizures (NESs) are frequently mistaken for epileptic seizures (ESs). Improved detection of patients with NESs could lead to more appropriate treatment and medical cost savings. Previous studies have shown the MMPI/MMPI-2 to be a useful predictor of NES. We hypothesized that combining the MMPI-2 with a physiologic predictor of epilepsy (routine EEG; rEEG) would result in enhanced prediction of NES. METHODS: Consecutive patients undergoing CCTV-EEG monitoring underwent rEEG evaluation and completed an MMPI-2. Patients were subsequently classified as having epilepsy (n = 91) or NESs (n = 76) by using standardized criteria. Logistic regression was used to predict seizure type classification. RESULTS: Overall classification accuracy was 74% for rEEG, 71% for MMPI-2 Hs scale, and 77% for MMPI-2 Hy scale. The model that best predicted diagnosis included rEEG, MMPI-2, and number of years since the first spell, resulting in an overall classification accuracy of 86%. CONCLUSIONS: The high accuracy achieved by the model suggests that it may be useful for screening candidates for diagnostic telemetry.

Storzbach, D., Campbell, K., Anger, W. K., Binder, L. M., Rohlman, D., & McCauley, S. (2000).  Members of the Portland Environmental Hazards Research Center; Psychological differences between veterans with and without Gulf War unexplained symptoms.  Psychosomatic Medicine, 62:726-735.

Portland VA Medical Center and the Center for Research on Occupational and Environmental Toxicology, Oregon Health Sciences University, 97201, USA. daniel.storzbach@va.gov

OBJECTIVE: The objective of this study was to assess measures of psychological and neurobehavioral functioning to determine their association with unexplained symptoms in Gulf War veterans. METHODS: An epidemiological survey focusing on exposures and symptoms was mailed to a random sample of Gulf War veterans from Oregon and southwestern Washington. Volunteers were recruited from survey respondents who agreed to undergo a thorough medical examination and psychological and neurobehavioral assessment. Persistent symptoms with no medical explanation associated with service in the Persian Gulf (eg, fatigue, muscle pain, and memory deficits) that began during or after the war qualified respondents as cases. The 241 veterans with unexplained symptoms were classified as case subjects, and the 113 veterans without symptoms were classified as control subjects. All veterans completed a battery of computerized assessment tests consisting of 12 psychosocial and 6 neurobehavioral tests. Differences between case and control subjects on neurobehavioral and psychological variables were assessed with univariate and multivariate statistical comparisons. RESULTS: Case subjects differed substantially and consistently from control subjects on diverse psychological tests in the direction of increased distress and psychiatric symptoms. Case subjects had small but statistically significant deficits relative to control subjects on some neurobehavioral tests of memory, attention, and response speed. A logistic regression model consisting of four psychological variables but no neurobehavioral variables classified case and control subjects with 86% accuracy. CONCLUSIONS: Our results revealed that Gulf War veterans who report symptoms associated with that conflict differed on multiple psychological measures in the direction of increased distress and performed more poorly on neurobehavioral measures when compared with control subjects who did not report symptoms. This suggests that psychological differences have a prominent role in investigation of possible explanations of Gulf War symptoms. 

Trune, D. R., Kempton, J. B., & Kessi, M. (2000). Aldosterone (mineralocorticoid) equivalent to prednisolone (glucocorticoid) in reversing hearing loss in autoimmune mice. Laryngoscope, 110:1902-1906. 

Oregon Hearing Research Center, Department of Otolaryngology--Head and Neck Surgery, Oregon Health Sciences University, Portland 97201-3998, USA.

HYPOTHESIS: Although the glucocorticoid prednisone is the standard therapy for autoimmune sensorineural hearing loss, what this hormone does in the ear to restore hearing is not known. MRL/MpJ-Fas(lPr) autoimmune mice consistently have shown only stria vascularis disease, implying that abnormal ion balances in the endolymph underlie cochlear dysfunction. Previously we have shown that hearing loss in these mice is reversed with prednisolone treatment. This, coupled with the complete lack of cochlear inflammation, suggests that the restoration of hearing with prednisolone is due to its sodium transport function and not to its anti-inflammatory or immune suppression effects. Therefore the hypothesis of this study was that the mineralocorticoid aldosterone, which only increases sodium transport, would be as effective as prednisolone in reversing autoimmune hearing loss. STUDY DESIGN: MRL/MpJ-Fas(lPr) autoimmune mice were treated with either prednisolone or aldosterone to compare steroid effects on auditory brainstem response (ABR) thresholds and stria morphology. METHODS: After baseline ABR audiometry, autoimmune mice were given prednisolone (5 mg/kg per day), aldosterone (15 microg/kg per day), or water in their drinking bottles. After 2 months of treatment the ABR thresholds were remeasured, and ears collected for histological examination. RESULTS: The untreated controls showed continued elevation of ABR thresholds and edematous stria. However, thresholds in most steroid mice were improved or unchanged and their stria morphology improved, particularly with aldosterone treatment. CONCLUSIONS: Restoration of hearing with steroid treatment is due to increased sodium transport to re-establish cochlear ionic balances. Aldosterone therapy may offer advantages over prednisone for long-term management of not only autoimmune hearing loss, but also other forms of nonimmune-related deafness for which steroids are currently prescribed.

Trune, D. R., Kempton, J. B., & Kessi, M. (2000). Aldosterone (mineralocorticoid) equivalent to prednisolone (glucocorticoid) in reversing hearing loss in autoimmune mice. Laryngoscope, 110:103-13. 

Oregon Hearing Research Center, Department of Otolaryngology--Head and Neck Surgery, Oregon Health Sciences University, Portland 97201-3998, USA.

HYPOTHESIS: Although the glucocorticoid prednisone is the standard therapy for autoimmune sensorineural hearing loss, what this hormone does in the ear to restore hearing is not known. MRL/MpJ-Fas(lPr) autoimmune mice consistently have shown only stria vascularis disease, implying that abnormal ion balances in the endolymph underlie cochlear dysfunction. Previously we have shown that hearing loss in these mice is reversed with prednisolone treatment. This, coupled with the complete lack of cochlear inflammation, suggests that the restoration of hearing with prednisolone is due to its sodium transport function and not to its anti-inflammatory or immune suppression effects. Therefore the hypothesis of this study was that the mineralocorticoid aldosterone, which only increases sodium transport, would be as effective as prednisolone in reversing autoimmune hearing loss. STUDY DESIGN: MRL/MpJ-Fas(lPr) autoimmune mice were treated with either prednisolone or aldosterone to compare steroid effects on auditory brainstem response (ABR) thresholds and stria morphology. METHODS: After baseline ABR audiometry, autoimmune mice were given prednisolone (5 mg/kg per day), aldosterone (15 microg/kg per day), or water in their drinking bottles. After 2 months of treatment the ABR thresholds were remeasured, and ears collected for histological examination. RESULTS: The untreated controls showed continued elevation of ABR thresholds and edematous stria. However, thresholds in most steroid mice were improved or unchanged and their stria morphology improved, particularly with aldosterone treatment. CONCLUSIONS: Restoration of hearing with steroid treatment is due to increased sodium transport to re-establish cochlear ionic balances. Aldosterone therapy may offer advantages over prednisone for long-term management of not only autoimmune hearing loss, but also other forms of nonimmune-related deafness for which steroids are currently prescribed.