The document provides information about cochlear implants, including:
1) Cochlear implants bypass damaged parts of the inner ear to electrically stimulate the auditory nerve. They allow access to sound and can help develop speech recognition and communication.
2) The history of cochlear implants dates back to the 18th century but modern multi-channel implants were developed in the 1980s and have improved performance.
3) Over 100,000 people worldwide have received cochlear implants, including over 6,000 procedures annually in the US. The number of recipients is growing as criteria have expanded to include milder and unilateral hearing losses.
Opportunities for kids with Hearing loss dougbackous
This is a short review of new opportunities for children with hearing loss aimed at primary care doctors. Parents can learn from it as well. Presented at the Swedish Pediatric education 1/21/11.
Opportunities for kids with Hearing lossdougbackous
This is a short review of new opportunities for children with hearing loss aimed at primary care doctors. Parents can learn from it as well. Presented at the Swedish Pediatric education 1/21/11.
• Hearing loss is widely recognized as one of the most common human disorders. (Nipalko J.K., 2002). Hearing loss affects up to 10% of the population. The prevalence increases with age and over one third of people older than 65 years have a significant hearing loss. Only approximately 20% of people with hearing loss seek assistance from hearing aids, of these, as many as 16.2% do not wear their devices.
• It has been reported that 5 of 10,000 infants less than 2 years of age are profoundly hearing impaired. They are unable to hear any sound from the outside world.
• The problem is critical for adults and dramatic for children. Early onset profound hearing loss has been shown to have devastating consequences for the development of language that is essential for learning almost anything. It allows us to participate, to understand, to interact with the world around us, and to avoid social isolation. (Moeller, 1998)
• Sensorineural hearing loss is caused by defect of the inner ear or central auditory pathways. Treatment is dependent on the degree of hearing impairment. Hearing aids are indicated for mild to severe sensorineural hearing loss. In patients with severe to profound hearing loss due to cochlear defects or any abnormalities will result in severe handicap. To overcome this severe handicap, application of implantable hearing aids is indicated.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
1. Cochlear Implants
Chih-Hung Wang, MD, PhD
Department of Otolaryngology-Head & Neck Surgery
Tri-Service General Hospital, National Defense Medical Center
王智弘
三軍總醫院耳鼻喉部 國防醫學院耳鼻喉學科
13. What Is A Cochlear Implant?
A surgically implanted medical device that
bypasses the damaged part of the inner ear
to electrically stimulate the remaining neural
fibers of the auditory nerve
Electrical current stimulates the remaining
auditory nerve fibers in the damaged inner
ear to generate sensations of hearing
14. What are the potential
benefits of CI?
Access to sound
Environmental sounds
Speech sounds
High frequency sounds
Soft sounds
Development of speech
recognition and speech
communication
15. History of
Cochlear Implants
1790, when Alessandro Volta (the developer of the electric battery)
placed metal rods in his own ears and connected them to a 50-volt
circuit, experiencing a jolt and hearing
a noise "like a thick boiling soup".
Djourno and Eyries(1957) - direct stimulation by placing a wire on the
auditory nerve
House and Doyle(1961) – approaching the auditory nerve through scala
tympani electrode implantation tympani approach
( hearing sensation that were “pleasant and useful”)
Simmons(1964) - modiolar stimulation
House and Michelson - implantation of electrodes driven by implantable
receiver-stimulators
16. History of
Cochlear Implants (cont.)
House(1972) - first speech processor was developed to interface with the
House 3M single-electrode implant, 1972~1980: > 1000 implanted,
In 1980, age criteria were lowered form 18 to 2 years )
1984 – multiple-channel devices, enhanced spectral perception and speech
recognition capabilities (Australia, Nucleus)
1990s – changes in implant technology and in clinical approaches, speech
processor designs have evolved to produce higher performance levels strategies
1995 - Clarion CI, ABC applied in USA
1998 – MedEl, Austria entered the US market
17. How many people are
implanted?
1980 - 1,000
1990 - 5,000, 90% adults
1997 - 20,000
2002 - 45,000, 50% children
2006 - >100,000
2009 - >188,000
approximately 6,000 procedures take place annually in the
United States. (adult/child: 41,500/25,500)
Approximately 100 cases annually in Taiwan
18. Van Naarden et al:
An overall prevalence rate of serious hearing impairment of 1.1
cases per 1000 children aged 3-10 years.
By age 75 years, 360 of 1000 adults have a disabling hearing
loss.
1996, National Institute on Deafness and Other
Communications Disorders survey
More than 28 million Americans are deaf or hearing impaired.
This statistic may reach 40 million by the year 2020.
21. The indication for cochlear
implantation
Congenital hearing loss and prelingual
deafness
Acquired hearing loss and postlingual
deafness
Severe hearing loss that can be aided and
that deteriorates to profound loss in
childhood, adolescence, or adulthood
(perilingual) and coexists with various
degrees of language development
22. The contraindication for
cochlear implantation
deafness due to lesions of the eighth cranial nerve or brain stem
chronic infections of the middle ear and mastoid cavity or tympanic
membrane perforation
The absence of cochlear development as demonstrated on CT scans
remains an absolute contraindication
Certain medical conditions that preclude surgery (eg, specific
hematologic, pulmonary, and cardiac conditions) also may be
contraindications
The lack of realistic expectations regarding the benefits of cochlear
implantation and/or a lack of strong desire to develop enhanced oral
communication skills poses a strong contraindication for implant
surgery
23. Evolving Audiologic Criteria
May, 1995 NIH Consensus Development Conference on Cochlear Implants
Profound bilateral sensorineural hearing loss (>90dB)
Minimal speech perception under best aided conditions.
April, 2001: Balkany T, et al: Cochlear Implants in Children.
Otolaryngologic Clinics of North America 34:455-62.
Severe (70-90dB) or profound bilateral sensorineural hearing loss
Those with some residual amplified hearing are still candidates
24. Expanding Age Criteria
May, 1995 NIH Consensus Development Conference on Cochlear Implants
Minimum age of 2 years
April, 2001: Balkany T, et al: Cochlear Implants in Children.
Otolaryngologic Clinics of North America 34:455-62.
Recommend minimum age to be 12 months.
Provides child with auditory input during critical period of language
development
25. Candidacy- ADULTS
Health adult over 18 Y/O
Severe to profound hearing loss in both ears
(PTA 70 dBHL)
Post-lingual onset of severe to profound hearing loss
(after age 6 y/o)
Limited benefit from hearing aids
(SDS 50%)
Desire to improve hearing and realistic expectations
No medical contraindications
26. Candidacy- CHILDREN
12 months to 17 years of age
Bilateral profound hearing loss
(PTA 90 dBHL)
Negligible functional hearing aid benefit
(6 months at least)
In USA
Children 4 y/o
PBK word score 0-12% or HINT-C score 30%
Children 4 y/o
MLNT word score 20% or IT-MAIS score 2 on questions 3, 5, 6
27. January 2005
Medicare guidelines as of January 2005 allow
for cochlear implantation in patients with
50% aided sentence discrimination scores
and allow for 60% sentence scores in clinical
trials.
Clearly, the trend over time is that relaxed
guidelines are better, and better implant
performance and outcome have been
demonstrated.
28. How to evaluate the candidate
Measures the patient's hearing with and without hearing aids.
Evaluation with pure-tone audiometry (PTA) and auditory brainstem
response (ABR) testing (in the case of children) often is performed.
Otoacoustic emission (OAE) testing complements these studies; OAE
results often indicate the need for a trial of newer and sometimes
stronger hearing aids.
A CT scan is obtained to evaluate the status of the cochlea and to
establish the presence of a patent (nonossified) cochlea or to identify a
common cavity, Mondini dysplasia, enlarged vestibular aqueduct, or an
ossified cochlea.
In children and young adults, speech and language evaluation and
educational placement discussions are performed next.
Finally, a psychosocial evaluation is completed. Once a patient has
been evaluated, a team meeting commences to recommend
implantation advice.
If the patient is cleared for implantation, the patient proceeds with
preoperative medical clearance, chooses an implant device, and
proceeds with surgery
29. How many surviving neuron
should be left
The number of surviving neuron populations
needed for successful implantation remains unclear.
In 1991, Linthicum et al:
successful speech understanding in a patient who
demonstrated less than 10% of the normal
complement of neurons via a temporal bone study
30. Speech Audiometry
1950, USA: Speech sound , words or sentences
Speech reception threshold (SRT):
spondee words: 50% repeat
SRT-PTA< 6~8 dB, if >12 dB, repeat SRT or PTA
SRT-speech detection threshold< 8 dB
Speech discrimination score(SDS):
phonetically balanced words:
SRT + 40 dB=PB-MAX
32. The Cochlear Implantation
Team
Interdisciplinary team
Otologist
Audiologist
Aural rehabilitation specialist
Speech pathologist
Clinical psychologist
33. Age & Outcomes
Younger age at implantation is generally
associated with better outcomes.
Children implanted after age 5 show
improvement over those with hearing aids, but
less improvement than children implanted under
age 5.
Children over age 10 should be screened
carefully, as they are more likely to have poorer
outcomes.
34. Central Neural Plasticity
Children older than 7 y/o with
prelingual hearing loss are typically not
considered as good candidates for CI
35. Radiologic Evaluation
Computed tomography of the temporal
bones
Mastoid aeration
Facial nerve position
Patency of cochlea
Middle ear status
Evaluate IAC
37. Radiologic Evaluation
Indications for Magnetic Resonance Imaging
IAC <1.5mm on CT
Evaluate presence of cochlear nerve
Hx of Meningitic Deafness
Evaluate degree of cochlear ossification
Cochlear aplasia or auditory nerve aplasia are
contraindications to cochlear implantation
High-resolution T2-weighted fast spin echo
MRI is complementing and even replacing CT
scanning because of its increased ability to
reveal cochlear ossification
39. Psychosocial Factors
Patient and family motivation are critical
Must be prepared for extensive period
of aural rehabilitation
Initial postoperative rehabilitation may
require daily sessions for up to two weeks.
Realistic expectations
40. Cochlear Implantation Procedure
2-3 hours under general anesthesia
The internal device is placed under the skin
behind the ear into a well created in the mastoid
bone
The electrode array is inserted into the cochlea
Patient usually discharged the following day
Device is activated 4 weeks later
41. Determine the side of the
implant
Implanting the better-hearing ear, allows for
a greater population of surviving spiral
ganglion cells to receive electrical stimulation
and, hence, potentially results in a better
outcome.
However, some patients, especially those
who have progressive bilateral sensorineural
hearing loss and are experiencing
asymmetric deafness bilaterally , the
poorer-hearing ear may be implanted
42.
43.
44. Components of All Cochlear Implant Systems
• Headpiece (HP) with HP
Microphone (and Transmitter
Antenna), Cable SP
• Speech Processor (SP)
• Internal Cochlear Stimulator HP
(ICS) Package (with Receiver
Antenna) SP
• Electrode Array
ICS
ICS
45. Cochlear Implant Components
Internal Device
Surgically implanted under the
skin
Electronics package (receiver-
stimulator) with magnet
Electrode array placed inside the
cochlea
External Device
Worn on the body or at ear level
Sound/speech processor
Microphone
Coil with magnet
46.
47. The external components of the CI
system pick up sounds, analyze
them, and convert them into an
electrical signal that is sent to the
internal device located under the
skin
Internal and external components
are held close to each other by a
pair of magnets and communicate
via transcutaneous transmission of
a radio-frequency signal
48. The internal device decodes the
signal and sends electrical current
to each electrode
When the electrodes stimulate the
nerve fibers of the auditory nerve,
the signal is received by the brain
and interpreted as sound