Abstract There is a growing body of evidence demonstrating self-reported hearing difficulties (HD; i.e., substantial difficulty in understanding speech in complex listening situations) in adults with normal pure-tone sensitivity. Anecdotally, some audiologists have tried personal mild-gain amplification as a treatment option for adults with HD. In 2008, Kuk and colleagues reported positive results of a mild-gain hearing aid trial for children with auditory processing disorders. To date, however, there have been no studies investigating the benefit of mild-gain amplification to treat HD in adults with normal audiograms. The effectiveness of a four-week trial with mild-gain amplification for adults with self-reported HD and clinically normal hearing sensitivity was investigated. Two participant groups with normal pure-tone audiograms (thresholds ≤20 dB HL 250–8000 Hz) were recruited to study the effects of self-reported HD on hearing handicap, self-perceived auditory processing difficulties, and performance on a speech-in-noise task. Furthermore, the benefit of mild-gain amplification was examined after a four-week hearing aid trial on self-perceived hearing handicap and auditory processing difficulties, and performance on an aided speech-in-noise task. Effects were analyzed using a mixed-model repeated measures analysis of variance. Posthoc analyses were performed for each significant main effect. Thirty-nine participants participated in two groups. Twenty normal hearing adults (19–27 yr) without complaints of HD were recruited as a control group. Nineteen normal hearing adults (18–58 yr) with self-reported HD were recruited for the mild-gain hearing aid trial. Subjective complaints of HD were assessed with two questionnaires (the Hearing Handicap Inventory for Adults [HHIA] and the Auditory Processing Questionnaire [APQ]) and an auditory processing test battery (SCAN:3-A, dichotic digit recognition, gaps-in-noise test, and the 500-Hz masking level difference). Speech-in-noise abilities were assessed before and after hearing aid trial using the Revised Speech Perception in Noise Test (R-SPIN) at multiple signal-to-noise ratios. Hearing aid use and impressions during the hearing aid trial were recorded. Results demonstrated that participants with HD perceived significantly greater hearing handicap (HHIA) and greater self-perceived auditory processing difficulties (APQ) than the control group. Participants with HD performed significantly poorer on the R-SPIN relative to controls, especially for low-predictability items. Results of the hearing aid trial for participants with HD revealed significant improvements in hearing handicap, self-perceived auditory processing difficulties, and speech-in-noise performance relative to prehearing aid trial measures. The hearing aids were well tolerated by the majority of participants with HD , with most of them wearing the hearing aids an average of 1–4 h per day. The results from the present study suggest that adults who present with complaints of HD even in the presence of normal hearing sensitivity represent a unique population that warrants further evaluation beyond the standard hearing test. Furthermore, results from the hearing aid trial suggest that mild-gain amplification is a viable treatment option for at least some individuals with HD.
The hypothalamic-pituitary-gonadal axis was evaluated in two groups of age-matched men with documented biochemical and histologic liver disease and compared to that of age-matched normal controls. Basal testosterone levels (p < 0.05), spermatozoa concentrations (p < 0.01), and seminal plasma volume (p < 0.01) were reduced in the alcoholics studied with liver disease, but not the hemophiliacs with liver disease when compared to the normal controls. No difference in estradiol levels was noted between groups. Basal follicle-stimulating hormone and luteinizing hormone (LH) concentrations were increased (both p < 0.01) in the alcoholics while only LH concentrations were increased (p < 0.01) in the hemophiliacs compared to the normal controls. Gonadotropins (folliclestimulating hormone and LH) and testosterone responses to clomiphene and to luteinizing hormone-releasing factor (LH only) in the alcoholic population studied, further distinguished the alcoholics from the hemophiliacs and the normal controls. The basal levels of the other anterior pituitary hormones (growth hormone and thyroid-stimulating hormone) as well as their provocative responses to thyrotropin-releasing hormone also distinguished the alcoholics from the hemophiliac population. Based upon these results, we propose that factors other than the liver disease per se are responsible for the disturbances of hypothalamic-pituitary-gonadal function observed in men with biochemically as well as histologically advanced stable liver disease.
Two unrelated patients had a congenital, probably familial, hemorrhagic disorder associated with a prolonged “prothrombin time.” Laboratory examination showed that this prolongation was not due to deficiency of prothrombin, proaccelerin, or fibrinogen, nor to excess of inhibitors. The diagnosis of hypoproconvertinemia was established by the findings of a low “proconvertin index.” by Owren's test, and by the ability of added proconvertin to restore normal prothrombin conversion in vitro. Prothrombin, consumption tests in both cases showed a: moderate but significant decrease.
Abstract This report describes three patients with factor (F) VII deficiency: two adult siblings and an unrelated 5½‐month‐old child who succumbed after several central nervous system (CNS) hemorrhages. This event prompted a review of the literature concerning the incidence and characteristics of intracranial hemorrhage in congenital F VII deficiency. Of 138 patients reported to have F VII deficiency, only 75 were considered to have a true deficiency. There was a 1:1 sex distribution with a 19% incidence of consanguinity in the 63 families which these 75 patients represented. CNS hemorrhage occurred in 12 of the 75 proven factor‐deficient patients – an incidence of 16.0%. There was a 1.4:1 female predominance in this group, with a 44.4% incidence of consanguinity in their nine families. Except for one patient with hypertension, there was no history of preceding trauma or previous underlying CNS abnormality, though head trauma with a difficult vaginal delivery may have occurred in five infants. Diagnostic lumbar puncture or ventricular tap revealed bloody, xanthochromic cerebrospinal fluid in five. Five patients with F VII deficiency developed a CNS hemorrhage prior to 1 week of age, and none survived. Seven patients older than 1 week of age suffered such an event, and four of these survived. It is concluded that the greatest risk factor for development of CNS hemorrhage is trauma related to the birth process.
