Download Effects of Infrared Light Treatment on Impaired Auditory

Effects of Infrared Light Treatment
on Impaired Auditory Function
DEE ADAMS NIKJEH, PH.D.
JENNIFER J. LISTER, PH.D.
STEPHANIE M. TRACIE, B.S.
UNIVERSITY OF SOUTH FLORIDA
TAMPA, FLORIDA
2009 ASHA CONVENTION
NEW ORLEANS, LA
RESEARCH ISSUE
What we know so far…
¾Current available treatments for sensorineural
hearing loss amplify and acoustically modify
sound
¾ Hearing aids
¾ Cochlear implants
¾ Assistive listening devices
¾Light therapy systems have been shown to
increase blood flow and modulate cellular function
¾Current literature supports a connection between
improved circulation and potential for improved
hearing
RATIONALE
¾ Numerous inner ear pathologies such as sudden
deafness, noise-induced HL, Meniere’s disease &
sensorineural HL are associated with reduction or
alteration of blood flow to cochlea
¾ Light energy influences localized production of nitric
oxide (NO) Æstimulates vasodilation Æincreases
blood flow
RATIONALE
¾ Pulsed photo-energy is noninvasive therapeutic
agent for treating soft tissue injuries, severe wounds,
and chronic pain due to peripheral neuropathy
¾ Effectiveness depends on absorption by targeted
tissue based on wavelength, skin contact, and
perpendicular delivery of pulsed light
QUESTION
¾Does pulsed infrared light improve hearing
among adults with sensorineural hearing
loss?
¾Specifically, does performance improve on
any objective or subjective component of a
comprehensive auditory assessment
battery?
METHODS
¾ Clinical trial feasibility study in collaboration with
Anodyne Therapy System LLC
¾ Anodyne Therapy is a form of Monochromatic
Infrared Photo-Thermal Energy (MIRE TM)
¾
¾
¾
¾
U.S. patented and FDA-approved medical device to increase
circulation & reduce pain, stiffness & muscle spasm
Delivers near infrared (890 nm) photo energy
60 luminous diodes on a flexible pad
Placed in direct skin contact to maximize absorption
PARTICIPANTS
¾ 30 English speaking adults (ages 55-80)
¾ Bilaterally-symmetrical, high-frequency, sloping, adultonset sensorineural hearing loss
¾ Word recognition scores 70% or less each ear in quiet, 60
dB HL
¾ Negative history
¾ Chronic middle ear disease
¾ Neurological disorder
¾ Cognitive impairment
¾ Hemophilia
¾ Exposure to excessive noise
¾ Exposure to ototoxic agents
¾ Necrotic skin over mastoid processes
PROCEDURE – Screening for inclusion
¾ Mini Mental State Examination (MMSE) – Score > 27
¾ Otoscopic Exam – cursory exam of outer ear and skin
behind ear
¾ Pure tone air conduction & bone conduction - 250 to
8000 Hz including 3000 and 6000 Hz
¾ Left ear, right ear, & binaural monosyllabic word
recognition in quiet - 50-word NU6 lists, 60 dB HL
PROCEDURE – Pre & Post
Standard Audiometric Evaluation
¾ Tympanometry & Acoustic Reflex Thresholds
¾ Ipsilateral & contralateral
¾ 500, 1k, & 2k Hz
¾ Speech Reception Threshold (SRT)
¾ Left ear, right ear, & binaural
¾ 50% correct threshold for speech measured using recorded
spondee words
¾ Monosyllabic Word Recognition (WRS) in quiet
¾ Left ear, right ear, & binaural
¾ 50-word NU6 lists, 84 dB HL
PROCEDURE – Pre & Post
Standard Audiometric Evaluation
¾ Monosyllabic word recognition in noise (WIN)
¾ Left ear, right ear, & binaural
¾ Words in Noise (WIN) test
¾ Otoacoustic Emissions
¾ Distortion Product (DPOAEs)
¾ Transient Evoked (TEOAEs)
¾ Patient self-report of communication problems
¾ Abbreviated Profile of Hearing Aid Benefit (APHAB)
¾ Tinnitus Handicap Inventory (THI)
PROCEDURE – Treatment Protocol
Anodyne Therapy System
¾ Infrared pulsed light treatment
¾ Nine, 30-minute sessions
¾ 3 times/week, 3 weeks
¾ After 4th treatment
¾ NU-6 monosyllabic wd list - word recognition in quiet at 60 dB
HL
¾ WIN – words in noise test
¾ After 9th treatment – Repeat audiometric evaluation
ANODYNE THERAPY SYSTEM
Word
Recognition
(WRS) Quiet
– 60 and 80
dB HL
Significant
improvement:
Right 60 dB (p=0.002)
Left 60 dB (p=0.005)
No Significant
improvement:
Binaural 60 dB (p=0.217)
All 80 dB conditions
(p>0.05)
Speech
Reception
Threshold
(SRT)
Significant
improvement:
Left ear (p=0.003)
Binaural (p=0.05)
No Significant
improvement:
Right ear (p=0.354)
Words in
Noise (WIN)
Significant
improvement:
Right ear (p=0.002)
No Significant
improvement:
Left ear (p=0.055)
Binaural (p=0.166)
Self-Report
Measures
APHAB & THI
Significant
improvement:
APHAB-EC (p<0.001)
APHAB-BN (p=0.002)
APHAB-RV (p=0.002)
THI (p=0.02)
No Significant
improvement:
APHAB-AV (p=0.83)
Clinical
Significance
Word recognition
in Quiet:
Relative to pre-test
performance (Carney
& Schlauch, 2007)
Test
WRS at 60
dB HL
Words in Noise
test:
SNR improvement of
3.2 or more (Wilson,
McArdle, & Smith,
2007)
WIN
Ear
Number of
Participants
Right
8
Left
4
Binaural
3
Right
4
Left
1
Binaural
3
SUMMARY
¾ Statistically significant treatment effects for several
measures of word recognition.
¾ Clinically significant improvement for word
recognition in quiet and in noise.
¾
30% of the participants in at least one ear condition.
¾ Self-reported improvements in ease of
communication, even in background noise and
reverberation.
¾ Self-reported improvement in tinnitus symptoms
¾ Pulsed infrared light treatment warrants
further research