Next-generation hearing aids emulate fly’s ability to pinpoint sound

ere is a fly that can locate a cricket from the sound it makes, despite other noises in the background. Yet the hearing mechanism that helps the fly do this spans only 1.5 mm, which is 50 times smaller than the wavelength of the cricket’s chirp. Now, engineers have found a way to mimic the fly’s super-hearing in a tiny device that does not require a bulky battery.

A paper describing the work is published in the journal Applied Physics Letters.

The engineers, from the Cockrell School of Engineering at the University of Texas at Austin, say the new device could be used in a new generation of hypersensitive hearing aids that use intelligent microphones to select only those sounds or conversations that the wearer wants to hear.

Fly’s sophisticated hearing can locate a cricket with remarkable accuracy

Neal Hall, an assistant professor in the Cockrell School’s Department of Electrical and Computer Engineering, and his team of graduate students, drew their inspiration from pioneering work by Ronald Miles at Binghamton University, NY, and Ronald Hoy at Cornell University, Ithaca, NY.

 

They were the first to describe the technological potential of emulating the super-hearing mechanism of the yellow-colored parasitoid flyOrmia ochracea, which stalks and locates male field crickets from their chirps and lays live larvae on and around them.

The fly can locate the cricket with remarkable accuracy because it has a sophisticated sound processing mechanism that determines the direction of the sound within an angle of 2 degrees.

Using the fly’s super-evolved hearing structure as a model, Prof. Hall and colleagues made a tiny pressure-sensing device out of silicon. With a span of only 2 mm, the device is nearly the same size as the fly’s hearing organ.

Unlike many insects, the reason humans and other mammals can pinpoint the source of a sound is because we have a much larger distance between our ears. The sound processing mechanism in our brains uses the time difference in the arrival of the sound at the two ears to locate the source.

But insects’ bodies are generally too small to do this – the sound waves effectively hit both sides almost at the same time.

That is, except for insects like O. ochracea – it can locate the direction of a cricket’s chirp even though its ears are less than 2 mm apart. Its highly evolved hearing mechanism can sense the 4 millisecond gap between the sound entering one ear and the other. It also amplifies this time difference using a “teeter-totter” or “see-saw” mechanism that allows it to locate the cricket with remarkable accuracy.

Engineers emulated fly’s hearing mechanism using a flexible beam

To replicate the fly’s hearing mechanism, the team made a flexible beam incorporating piezoelectric materials that allowed them to use the flexing and rotation of the beam as a way to measure sound pressure and pressure gradient at the same time.

While other teams have already tried to build hearing devices that emulate the fly’s super-hearing, Prof. Neal and colleagues are the first to use piezoelectric materials, which convert mechanical pressure into electrical signals and allow the device to work with very little power.

“Because hearing aids rely on batteries, minimizing power consumption is a critical consideration in moving hearing-aid device technology forward,” says Prof. Hall.

He sees this technology being attractive to people with hearing problems in the future. While as many as 1 in 10 Americans could benefit from a hearing aid, currently only a fifth of this number use one, he adds.

He says many believe the main reason for the gap is hearing aid wearers’ dissatisfaction with the devices:

“Turning up the volume to hear someone across from you also amplifies all of the surrounding background noise – resembling the sound of a cocktail party.”

As well as taking hearing aid technology to a new level, the device could also be useful in military and defense applications. For example, in dark environments where visual cues are absent.

Funds from the Defense Advanced Research Projects Agency (DARPA) helped finance the study.

In February 2014, Medical News Today reported how researchers have developed a new low-powered chip that offers the prospect of cochlear implants without external hardware.

Written by Catharine Paddock PhD

http://www.medicalnewstoday.com/articles/280000.php

 

 

 

Tinnitus affects processing of emotions

Patients with persistent ringing in the ears – a condition known as tinnitus – process emotions differently in the brain from those with normal hearing, researchers report in the journal Brain Research.

Tinnitus afflicts 50 million people in the United States, according to the American Tinnitus Association, and causes those with the condition to hear noises that aren’t really there. These phantom sounds are not speech, but rather whooshing noises, train whistles, cricket noises or whines. Their severity often varies day to day.

University of Illinois speech and hearing science professor Fatima Husain, who led the study, said previous studies showed that tinnitus is associated with increased stress, anxiety, irritability and depression, all of which are affiliated with the brain’s emotional processing systems.

“Obviously, when you hear annoying noises constantly that you can’t control, it may affect your emotional processing systems,” Husain said. “But when I looked at experimental work done on tinnitus and emotional processing, especially brain imaging work, there hadn’t been much research published.”

She decided to use functional magnetic resonance imaging (fMRI) brain scans to better understand how tinnitus affects the brain’s ability to process emotions. These scans show the areas of the brain that are active in response to stimulation, based upon blood flow to those areas.

Three groups of participants were used in the study: people with mild-to-moderate hearing loss and mild tinnitus; people with mild-to-moderate hearing loss without tinnitus; and a control group of age-matched people without hearing loss or tinnitus. Each person was put in an fMRI machine and listened to a standardized set of 30 pleasant, 30 unpleasant and 30 emotionally neutral sounds (for example, a baby laughing, a woman screaming and a water bottle opening). The participants pressed a button to categorize each sound as pleasant, unpleasant or neutral.

The tinnitus and normal-hearing groups responded more quickly to emotion-inducing sounds than to neutral sounds, while patients with hearing loss had a similar response time to each category of sound. Over all, the tinnitus group’s reaction times were slower than the reaction times of those with normal hearing.

Activity in the amygdala, a brain region associated with emotional processing, was lower in the tinnitus and hearing-loss patients than in people with normal hearing. Tinnitus patients also showed more activity than normal-hearing people in two other brain regions associated with emotion, the parahippocampus and the insula. The findings surprised Husain.

“We thought that because people with tinnitus constantly hear a bothersome, unpleasant stimulus, they would have an even higher amount of activity in the amygdala when hearing these sounds, but it was lesser,” she said. “Because they’ve had to adjust to the sound, some plasticity in the brain has occurred. They have had to reduce this amygdala activity and reroute it to other parts of the brain because the amygdala cannot be active all the time due to this annoying sound.”

Because of the sheer number of people who suffer from tinnitus in the United States, a group that includes many combat veterans, Husain hopes her group’s future research will be able to increase tinnitus patients’ quality of life.

“It’s a communication issue and a quality-of-life issue,” she said. “We want to know how we can get better in the clinical realm. Audiologists and clinicians are aware that tinnitus affects emotional aspects, too, and we want to make them aware that these effects are occurring so they can better help their patients.”

http://www.medicalnewstoday.com/releases/278846.php

Picture courtesy of tinnitusart.com

 

 

 

Study identifies ‘new risks’ for mouth and throat cancers

Poor oral health and irregular dental checks can increase the risk of oral cancer, a new study has found.

The International Agency for Research on Cancer report also found excessive use of mouthwash – more than three times a day – can also increase risk.

Smoking, heavy drinking and “low socio-economic status” are established risk indicators of mouth and throat cancers.

The study covered 1,962 cancer patients and a further 1,993 control subjects across nine countries in Europe.

The study was led by the Leibniz Institute for Prevention Research and Epidemiology in Bremen, Germany, (Bips) and backed by researchers from Glasgow University Dental School.

‘Really important’

Prof Wolfgang Ahrens, deputy director of Bips, described the study findings as “really important”.

“Up until now, it was not really known if these dental risk factors were independent of the well known risks for mouth and throat cancers – smoking, alcohol and low socio-economic status,” he said.

Prof Ahrens said the report findings were highly “nuanced” and there was an interconnectedness of many of the risk factors.

The definition of poor oral health included people who had complete or part dentures and people with persistently bleeding gums.

Dr David Conway, clinical senior lecturer at Glasgow University Dental School, said: “People should not assume that if they wear dentures and have none of their own teeth left, they have no need to see a dentist.

“On the contrary, even if you have got dentures, you should make sure you go for regular check-ups.”

People with poor dental care were defined as those who hardly ever or never brushed their teeth or visited the dentist.

Dr Conway said the frequency of dental visits should be determined by a dentist’s risk assessment and if people fell into the low-risk category it could be once a year or even every two years.

“It is not a case of one size fits all,” he added.

“Visits could be six-monthly, but certainly not five-yearly.”

Mouthwash ‘risk’

The research team said the possible role of mouthwash as a risk factor would require further research.

They were unable to analyse the types of mouthwash used many years ago by participants in the study.

Dr Conway added: “I would not advise routine use of mouthwash, full stop.

“There are occasions and conditions for which a dentist could prescribe a mouthwash – it could be that a patient has a low salivary flow because of a particular condition or medicine they are taking.

“But for me, all that’s necessary, in general, is good regular brushing with a fluoride toothpaste and flossing combined with regular check-ups by a dentist.”

The findings of the study have been published in Oral Oncology.

http://www.bbc.com/news/uk-scotland-glasgow-west-26875793

 

 

 

Voice-Care®: a new low-cost device developed for voice monitoring

A new device to monitor voice professionals as well as to track vocal changes that are due to chronic diseases and physical or psychological stress

Functional dysphonia is the nightmare of professional singers and even more so of amateur actors, but also of teachers and call-centre operators, to mention only a few of the workers exposed to the risk of vocal damage due to an excessive effort or misuse of the voice. This problem is much more common than people realize and the intervention of specialists, such as speech therapists or phoniatricians, often takes place when the dysphonia is already chronic and the risk of compromising the use of the voice even permanently is very high. Among the occupational categories most at risk to voice diseases, teachers is one of the most affected, followed by performers (singers and actors). In the U.S. it is estimated that up to 20% of teachers and 11% of the singers have clinical voice disorders.

Voice-Care® can be used to monitor voice professionals as well as to track vocal changes that are due to chronic diseases and physical or psychological stress. How can technology help in solve these problems? The Voice-Care® device is essentially made up of a contact microphone and a small data-processing unit. It has been developed at the Politecnico di Torino thanks to a joint project between Prof. Alessio Carullo (Department of Electronics and Telecommunications) and Prof. Arianna Astolfi (Department of Energy). Alessio Carullo is an expert in the field of electrical and electronic measurements, while Arianna Astolfi works in the field of applied acoustics.

It is a simple low-cost device with sophisticated functionalities, which is able to store a large amount of reliable data and provide an objective estimation of the stress the vocal folds are subjected to. It is a useful tool to prevent damage from dysphonia and to highlight bad acoustic conditions that are responsible for this damage. Specific tests have shown the effectiveness of the device in highlighting improvements in the use of voice by teachers after an acoustic intervention in school environments.

The Voice-Care® device is easy to wear and does not interfere with the patient’s normal activities. It gives the possibility of analysing time intervals over a range of tens of seconds to several hours, up to the whole working day. A particular feature is the traceability assurance of the obtained measurements, thanks to the implementation of suitable calibration procedures for each of the estimated parameters. Furthermore, its low cost (some hundreds of euros for an industrial production) could offer the possibility of performing extensive experimental campaigns.

A first experimental test that has involved 30 primary-school teachers has been performed. This test has allowed the bad acoustic conditions of the investigated classroom to be identified and then corrected. In some cases, the reduction of the vocal effort and vocal load of teachers has been confirmed by repeating the test after an acoustic intervention.

Another possible application of the Voice-Care® device is the diagnosis of vocal apparatus diseases. A cooperation has been set up between the present research group and the group of Ear Nose and Throat specialists of the Dept. of Surgical Sciences at the University of Turin, which is coordinated by prof. Giancarlo Pecorari. The device is available to public and private organizations for possible collaborations with the aim of conducting experimental campaigns that involve categories at risk to vocal diseases.

 

http://www.medicalnewstoday.com/releases/276633.php

 

Researchers transplant regenerated oesophagus

Tissue engineering has been used to construct natural oesophagi, which in combination with bone marrow stem cellshave been safely and effectively transplanted in rats. The study, published in Nature Communications, shows that the transplanted organs remain patent and display regeneration of nerves, muscles, epithelial cells and blood vessels.

The new method has been developed by researchers at Karolinska Institutet in Sweden, within an international collaboration lead by Professor Paolo Macchiarini. The technique to grow human tissues and organs, so called tissue engineering, has been employed so far to produce urinary bladder, trachea and blood vessels, which have also been used clinically. However, despite several attempts, it has been proven difficult to grow tissue to replace a damaged oesophagus.

In this new study, the researchers created the bioengineered organs by using oesophagi from rats and removing all the cells. With the cells gone, a scaffold remains in which the structure as well as mechanical and chemical properties of the organ are preserved. The produced scaffolds were then reseeded with cells from the bone marrow. The adhering cells have low immunogenicity which minimizes the risk of immune reaction and graft rejection and also eliminates the need for immunosuppressive drugs. The cells adhered to the biological scaffold and started to show organ-specific characteristics within three weeks.

The cultured tissues were used to replace segments of the oesophagus in rats. All rats survived and after two weeks the researchers found indications of the major components in the regenerated graft: epithelium, muscle cells, blood vessels and nerves.

“We believe that these very promising findings represent major advances towards the clinical translation of tissue engineered esophagi”, says Paolo Macchiarini, Director of Advanced center for translational regenerative medicine (ACTREM) at Karolinska Institutet.

Tissue engineered organs could improve survival and quality of life for the hundreds of thousands of patients yearly diagnosed with oesophageal disorders such as cancer, congenital anomalies or trauma. Today the patients’ own intestine or stomach is used for esophageal replacements, but satisfactory function rarely achieved. Cultured tissue might eliminate this current need and likely improve surgery-related mortality, morbidity and functional outcome.

The current study was conducted in collaboration with the Texas Heart Institute in the U.S., as well as universities in Italy, Russia, and Germany. It was supported financially by, among others, the Swedish Research Council, the Stockholm County Council through the ALF agreement, and the European Union’s Seventh Framework Programme. The equipment used in the study was developed by the company Harvard Apparatus Regenerative Technology.

Picture courtesy of www.sciencedaily.com

http://www.medicalnewstoday.com/releases/275511.php

Two breath compounds could be associated with larynx cancer

Researchers at the Rey Juan Carlos University and the Alcorcón Hospital (Madrid) have compared the volatile substances exhaled by eleven people with cancer of larynx, with those of another twenty healthy people. The results show that the concentrations of certain molecules, mainly ethanol and 2-butanone, are higher in individuals with carcinoma, therefore they act as potential markers of the disease.

Human breath contains thousands of volatile organic compounds (VOC) and some of them can be used as non-invasive biomarkers for various types of head and neck cancers as well as cancer of the larynx.

This was shown in the experiment carried out by scientists from the Rey Juan Carlos University (URJC) with 31 volunteers: 20 healthy subjects (half of which are smokers) and 11 with cancer of the larynx in various phases of the disease and who are being treated in the Alcorcón Hospital in Madrid.

The results, published in the journal Chromatographia, reveal that the air exhaled by the more seriously ill patients – in a stage called T3 – contains different concentrations of seven compounds compared with the levels of healthy people or even those with a less developed tumour (T1).

Specifically, in the graphics of individuals with advanced cancer, the peaks that represent ethanol (C2H6O) and 2-butanone (C4H8O) are particularly significant. These two compounds therefore become potential markers of laryngeal carcinoma.

“At the moment it is still a preliminary study and a wider sample has to be obtained,” Rafael García, professor of Chemical Engineering at the URJC and co-author of the study told SINC, “but it is a step in the right direction, an alternative with regard to identifying biomarkers, not only for this type of cancer but for other more prevalent and serious ones such as lung cancer, where early detection is key”.

As part of the experiment, the researchers asked the participants to breathe into tedlar bags after fasting for at least eight hours so there was no leftover food or drink on their breath.

The samples were then analysed with solid phase micro-extraction, gas chromatography and mass spectrometry techniques, which enable very small amounts of a substance to be separated and identified. The concentrations are around or slightly above the equipment’s detection limits (40 nanograms/mL), which is equivalent to 40 ppb or parts per billion.

The ultimate aim of the research is to “create an electronic nose that can be used in hospitals and health centres for the early detection of these types of diseases,” concluded Rafael García. This team, together with other Spanish and foreign research groups, is working hard to develop sensors capable of detecting diseases through breath analysis.

Head and neck cancers represent between 5% and 10% of all malignant tumours currently diagnosed in Spain. Every year nearly half a million new cases are detected worldwide, mainly attributed to tobacco and alcohol use and approximately 90% are laryngeal cancer. The study also identified four markers in the exhaled breath that are typical of smokers, such as benzene and furfural.

http://www.medicalnewstoday.com/releases/276057.php

 

Hearing loss affects old people’s personality

As people approach old age, they generally become less outgoing. New research from the University of Gothenburg shows that this change in personality is amplified among people with impaired hearing. The findings emphasise the importance of acknowledging and treating hearing loss in the elderly population.

The researchers studied 400 individuals 80-98 years old over a six-year period. Every two years, the subjects were assessed in terms of physical and mental measures as well as personality aspects such as extraversion, which reflects the inclination to be outgoing, and emotional stability. The results show that even if the emotional stability remained constant over the period, the participants became less outgoing.

Interestingly, the researchers were not able to connect the observed changes to physical and cognitive impairments or to age-related difficulties finding social activities. The only factor that could be linked to reduced extraversion was hearing loss.

‘To our knowledge, this is the first time a link between hearing and personality changes has been established in longitudinal studies. Surprisingly, we did not find that declining overall health and functional capacity make people less outgoing. But hearing loss directly affects the quality of social situations. If the perceived quality of social interaction goes down, it may eventually affect whether and how we relate to others,’ says Anne Ingeborg Berg, PhD, licensed psychologist and researcher at the Department of Psychology, University of Gothenburg.

The study yields interesting knowledge about personality development late in life, and also points to the importance of acknowledging and treating hearing loss among the elderly.

The utilisation of hearing aids did not affect the correlation found, which suggests that there is a need for support in the use of aids such as hearing devices.

‘Our previous studies have shown that outgoing individuals are happier with their lives. It is hypothesised that an outgoing personality reflects a positive approach to life, but it also probably shows how important it is for most people to share both joy and sadness with others. Even if we can’t conclude anything about causal relationships, we can guess that the link between hearing loss and social withdrawal forms a potential threat to older people’s wellbeing,’ says Berg.

The study, conducted by Anne Ingeborg Berg and Boo Johansson from the ADA – Gero Group, Department of Psychology, University of Gothenburg, was published in Journal of Personality.

http://www.medicalnewstoday.com/releases/274847.php

Picture courtesy of www.dailymail.co.uk

 

Human sniff range exceeds 1 trillion odors

 

A new study published in the journal Science finds that the human sense of smell can detect more than 1 trillion odors, far exceeding the number previous studies have indicated.

Humans can discriminate several million different colors and nearly half a million sounds or tones, so by showing we can discriminate over 1 trillion odors, the study places the human sense of smell in a different league altogether.

The authors write that the study “demonstrates that the human olfactory system, with its hundreds of different olfactory receptors, far outperforms the other senses in the number of physically different stimuli it can discriminate.”

Study leader Dr. Andreas Keller, of the Laboratory of Neurogenetics and Behavior at Rockerfeller University in New York, NY, says even 1 trillion may be an underestimate:

“The message here is that we have more sensitivity in our sense of smell than for which we give ourselves credit. We just don’t pay attention to it and don’t use it in everyday life.”

Head of the Lab, Prof. Leslie Vosshall, says it was generally believed that the range of the human sense of smell was around 10,000, and adds:

“Everyone in the field had the general sense that this number was ludicrously small, but Andreas was the first to put the number to a real scientific test.”

The quality of an odor is a complex thing. The smells we come across in everyday life actually comprise many different molecules, of which we sense only a few. For example a rose scent has 275 molecules, but we only sense a small proportion of them.

Sense of smell is more complicated to study

This means studying sense of smell is not as straightforward as examining sight or hearing. It is multidimensional in comparison.

For the study, Dr. Keller and colleagues invited volunteers to sniff vials of odors that held different mixes of 128 odor molecules responsible for scents ranging from spearmint to orange to anise.

The vials contained combinations of 10, 20 and 30 of the 128 odor molecules with different proportions of them in common.

The volunteers were presented with three vials at a time. Two of them contained identical mixtures of odor molecules, and the third one was different. They were asked to pick the odd one out.

The researchers found that while some volunteers were much better at picking the odd one out than others, on average they could distinguish between mixtures that shared as much as 51% of the same components. Above this proportion, most volunteers struggled to pick the odd one out. This was the case regardless of whether the mixtures contained 10, 20 or 30 odors.

Even 1 trillion may be an underestimate

From these results, the researchers extrapolated an estimate of the total number of distinguishable mixtures, arriving at the 1 trillion figure.

However, the team believes even 1 trillion may be an underestimate, because the real world contains many more odors that can be mixed in many more different ways.

Dr. Keller suggests our ancestors made more use of their sense of smell. We now hold our noses high above the ground, and by having daily showers and storing our food in a refrigerator we have effectively cut ourselves off from many of the odor encounters much valued by our forebears.

“This could explain our attitude that smell is unimportant, compared to hearing and vision,” he adds.

In December 2013 Medical News Today reported a study that suggested we each live in a unique odor world. There, the researchers found as much as 30% of the large array of human smell receptors differs between any two individuals.

Written byCatharine Paddock PhD

http://www.medicalnewstoday.com/articles/274351.php

otolaryngology, otolaryngologist, otolaryngology news, ent news, ENT

Genes bring music to your ears

Multiple regions in the human genome are reported to be linked to musical aptitude, according to a study published inMolecular Psychiatry. The function of the candidate genes implicated in the study ranges from inner-ear development to auditory neurocognitive processes, suggesting that musical aptitude is affected by a combination of genes involved in the auditory pathway. The research was funded by the Academy of Finland.

The perception of music starts with specialised hair cells in the inner ear, which transmit sounds as electronic signals through the auditory pathway to the auditory cortex, where sounds are primarily recognised. In addition to simple sensory perception, the processing of music has been shown to affect multiple other regions of the brain that play a role in emotion, learning and memory.

The genomes of 767 people, belonging to 76 families characterised by the ability to discriminate pitch, duration and sound patterns, were analysed for single nucleotide polymorphisms (SNP). The best association was found at chromosome 3 close to the GATA2 gene that regulates the development of cochlear hair cells and the inferior colliculus (IC) in the auditory pathway. The best linkage results were obtained on chromosome 4, which contains five genes, PCHD7, PDGFRA, KCTD8, CHRNA9 and PHOX2B, that all affect inner-ear development and are expressed in amydala or hippocampus. The highest probability of linkage was obtained for pitch perception accuracy next to the protocadherin 7 gene, PCDH7, known to be expressed in cochlear and amygdaloid complexes. Amygdala is the emotional center of the human brain and is reported to be affected by music.

The researchers note that musical aptitude is a complex behavioural trait not fully captured by the sound perception tests used in this study, and that environmental factors, such as culture and music education, likely play an important role here. The findings provide a valuable background for molecular studies and research on the interplay of genes and the environment with respect to musical ability.

The study (A genome-wide linkage and association study of musical aptitude identifies genetic loci containing variants related to inner-ear development and neurocognitive functions) was published in Molecular Psychiatry on 24 February 2014. The principal investigator is Jaana Oikkonen in collaboration with Assistant Professor Päivi Onkamo, University of Helsinki, and Professor Veronica Vieland’s group from Columbus University. The experts in musical aptitude are Professor Kai Karma and MuD Pirre Raijas. The responsible researcher of the project is Assistant Professor Irma Järvelä, University of Helsinki.

http://www.medicalnewstoday.com/releases/273948.php

Picture courtesy to www.sciencedaily.com

 

Patients Blame H&N Therapy for Lasting Speech Issues

SCOTTSDALE, Ariz. — Patients with oropharyngeal cancer reported significant voice and speech impairment for up to 2 years after chemoradiation therapy, but most of their doctors saw no evidence of it, data from a prospective study showed.

Two years after treatment, a fourth of patients said their voice and speech remained below baseline levels, whereas none of their clinicians noted any impairment. At no time did as many as 10% of clinicians report patients with speech and voice issues, whereas the proportion of patients reporting problems ranged as high as 56%.

The likelihood of patient-reported difficulties with oral communication increased with the radiation dose to the glottic larynx, reported Jeffrey M. Vainshtein, MD, and colleagues at theMultidisciplinary Head and Neck Cancer Symposium.

“Our findings highlight the critical role of patient-reported outcomes in identifying areas of improvement of our current therapies, which may ultimately translate into improvements in quality of life for our patients,” Vainshtein, of the University of Michigan in Ann Arbor, said during a press briefing.

Dysphagia and xerostomia are recognized adverse effects of chemoradiation for head and neck cancer and have been studied extensively in recent years. In contrast, a paucity of information exists relative to the effects of chemoradiation on voice and speech quality, Vainshtein said.

To examine the issue, investigators assessed voice and speech outcomes in 93 patients who underwent chemoradiation for oropharyngeal cancer, using intensity-modulated radiation therapy (IMRT). At baseline, and then every 3 to 6 months after finishing treatment, patients completed two validated questionnaires: Head and Neck Quality of Life (HNQOL) and University of Washington Quality of Life (UWQOL).

At the same intervals, the patients’ physicians reported their assessments in accordance with the Common Terminology Criteria for Adverse Events.

All of the patients had locally advanced stage III/IV oropharyngeal cancer and received treatment in two clinical trials of organ-sparing IMRT. Radiation therapy protocols were designed to minimize the radiation dose to the pharyngeal constrictors, salivary glands, oral cavity, glottic larynx, supraglottic larynx, and esophagus.

Vainshtein and colleagues analyzed patient questionnaires to identify factors associated with voice and speech impairment, in addition to the frequency of impairment.

By the HNQOL communication domain and speech impairment domain of the UWQOL, radiotherapy-induced speech impairment reached a maximum in the first month after treatment. Impairment then decreased in subsequent assessments, stabilizing at 12 to 18 months.

The proportion of patients reporting post-treatment speech and voice impairment followed a time pattern consistent with speech impairment reflected in answers to the questionnaires. By the HNQOL, 68% of patients said their voice and speech quality were impaired versus baseline, decreasing to 56% at 3 months, 46% at 6 months, 33% at 12 months, 31% at 18 months, and 24% at 24 months.

By the UWQOL, the proportion of patients reporting worsening of voice and speech quality after treatment was 41%, 26%, 29%, 28%, 15%, and 22% at the assessments from 1 to 24 months after finishing therapy.

In contrast, few physicians included voice and speech impairment in their adverse event reports. Vainshtein said 7% of physicians reported grade 1 toxicity with respect to worsening of voice and speech at 3 months, 5% at 6 months, and 0% thereafter.

Comparing treatment characteristics and patient-reported voice quality worsening, investigators found an association between radiation dose to the larynx and patient-reported impairment at 6 and 12 months. Reported impairment at 6 months increased from 25% with a cumulative radiation dose of <20 Gy to 59% at >30-40 Gy, 50% at 40-50 Gy, and 64% with laryngeal doses >50 Gy (P=0.02).

A similar pattern emerged from the analysis of 12-month outcomes, as the proportion of patients reporting worsening of voice quality from baseline increased from 10% for laryngeal radiation doses <20 Gy to 63% of patients for cumulative doses >50 Gy (P=0.011).

“We observed similar findings for patient-reported voice quality worsening and speech impairment,” Vainshtein said. “The results were independent of other patient and treatment factors.”

Press briefing moderator Mitchell Machtay, MD, said he found the study eye opening.

“If you looked at radiation dose to larynx, not the area where the tumor was, I was struck by how doses of 20 to 30 Gy, which we don’t normally consider as very toxic high doses that can damage the voicebox, still caused a fair amount of damage,” said Machtay, of University Hospitals Case Medical Center in Cleveland.

The magnitude of disconnect between patient and physician assessments was one of the more surprising findings in the study.

“I don’t think it’s unique to head and neck cancer. I don’t think it’s unique to our study. I don’t think it’s unique to medicine,” Vainshtein said. “I think physicians tend to underestimate the effect of their treatment — whatever it is — on our patients.”

Some adverse effects can be subtle and do not become apparent during conversations with physicians, he continued. When the patients express their sentiments in a more formal manner, such as a questionnaire, the effects do emerge.

Some of the disconnect reflects differences in patients’ approaches to their illness and adverse effects of treatment, said Wade Thorstad, MD, of Washington University in St. Louis.

“There’s a group of patients, when you’re interviewing them about their symptoms, will tell it like it is and really explain things well,” said Thorstad, another participant in the press briefing. “There’s another group that is stoic, and they really underplay their issues before [their physician]. However, when they are filling out a questionnaire about their feelings about quality of life, I think you get a more honest assessment.”

Vainshtein and co-authors reported no relevant relationships with industry.

http://www.medpagetoday.com/MeetingCoverage/MHNCS/44439