[The adaptive Freiburg monosyllabic test in noise : Development of a procedure and comparison of the results with the Oldenburg sentence test]

BACKGROUND

Whereas sentence tests are commonly performed using an adaptive procedure, this method has not yet been transferred to the Freiburg monosyllabic speech test, the most important word test. When using different procedures, a comparison of results between sentence and word tests is not possible. Therefore, an adaptive procedure which has proven itself in sentence tests was transferred to the Freiburg monosyllabic test in noise. The results of the new procedure were compared to the standard of sentence tests, i.e., the Oldenburg sentence test.

METHODS

The adaptive Freiburg monosyllabic speech test and the Oldenburg sentence test were applied in 40 otologically normal subjects in a randomized order. Results were analyzed with respect to time requirements, possible gender differences, the influence of test order, and correlation of test results.

RESULTS

The time required for the adaptive Freiburg monosyllabic speech test was significantly higher than for the Oldenburg sentence test. No significant impact of gender or test order could be shown. The mean signal-to-noise ratio for 50% speech discrimination of the Oldenburg sentence test was significantly smaller than for the adaptive Freiburg monosyllabic speech test. No correlation could be shown between the results of the two tests CONCLUSION: The Freiburg monosyllabic test can not only be used for quantifying discrimination loss in percentage terms, but also to measure the 50% speech recognition threshold with an adaptive algorithm. However, the procedure of the adaptive Freiburg monosyllabic test is more time consuming than that of the Oldenburg sentence test. Concerning a possible missing correlation between the results for 50% speech discrimination, further studies with hearing-impaired persons are needed.

[Management of developmental speech-language disorders in children : Part 1: Diagnosis and underlying comorbid diseases]

Compared to other countries, the prevalence of speech-language disorders among children and also the intervention frequency appear to be much higher in Germany. Since otorhinolaryngologists often initiate speech-language interventions, the first part of this review systematically outlines the guideline-conform diagnostic pathway from examination to therapeutic intervention. The process of first developing a suspected diagnosis which justifies speech-language tests is explained. Beyond this, the rational selection of a set of tests from all those available-some of which the otorhinolaryngologist can perform, some of which require referral-is discussed, as is how these results can be used to assess the severity of the disorder. A special focus of this paper is the differential diagnosis of underlying causes, e. g., hearing disorders and global developmental disorders. A complete set of tests permits a working diagnosis and ICD-10 classification of the case.

[Dependency of APHAB score in the ECu subscale on age, gender and subjective hearing loss : Hearing aid fitting in two subjective hearing loss groups]

OBJECTIVE

The Abbreviated Profile of Hearing Aid Benefit (APHAB) determines subjective impairment by hearing loss in four situations before and after hearing aid fitting. The first part (APHAB_u) of the questionnaire can be used independently of hearing aid fitting. Previous research has demonstrated that the answers in the EC_u subscale for hearing under easy conditions are concentrated in two groups: one with subjectively better, one with subjectively worse hearing. This study aimed to investigate in a large collective whether there are differences between these two groups in terms of age, gender, and individual hearing loss.

PATIENTS AND METHODS

The data of 1755 patients were analyzed, whose APHAB answers and pure-tone thresholds had been collected during hearing aid fitting. Group 1 had an average EC_u score ≤37.5%; in group 2 it was ≥67.5%. The individual hearing losses was determined. Statistical analysis was performed using Mann-Whitney U, χ², Spearman, and Pearson tests.

RESULTS

The 616 members of group 1 were significantly younger (68.7 vs. 73.0 years) and comprised more females (53.9 vs. 46.1%) than the 1139 members of group 2. Hearing was frequency specific in group 1, and hearing loss as classified using standard audiograms and according to the three-frequency table was significantly lower in group 1 than in group 2, CONCLUSION: The distribution with two maximums in the EC_u subscale can be explained by individual differences in terms of age and hearing loss, in part also by gender. The lower absolute number of patients in group 1 could be explained by the still relatively late fitting of hearing aids in general.

Sensitivity and specificity of the abbreviated profile of hearing aid benefit (APHAB)

Subjective hearing loss in hearing-impaired patients can be assessed by inventory questionnaires. The abbreviated profile of hearing aid benefit (APHAB) measures subjective hearing loss in four typical hearing situations (subscales). It is used to fit hearing aids in patients with statutory insurance in Germany. In addition, the unaided APHAB (APHAB_u) can be used as a primary diagnostic instrument in audiology. There are no published data regarding the sensitivity and specificity of the unaided APHAB_u. Therefore, we investigated these parameters for detecting hearing loss of at least 25 dB at any frequency between 0.5 and 8.0 kHz. We used the APHAB_u to determine hearing loss in 245 subjects aged 50 years and older without any reported disease of the ears. Due to incomplete answering of the APHAB form, 55 subjects have been excluded. We also measured the pure-tone thresholds by air conduction for all octave frequencies between 0.5 and 8 kHz. Receiver operating characteristic (ROC) curves and the Youden Index were used to determine the diagnostic value of the APHAB_u, particularly sensitivity and specificity, in three different ways: (1) separately for ease of communication (EC_u), background noise (BN_u), and hearing with reverberation (RV_u) subscales; (2) with the mean value of EC_u, BN_u, and RV_u; and (3) with a logistic regression model. The area under the ROC curve was lower for BN only (0.83) and nearly equal for all other methods (0.87–0.89). Depending on how we performed the analyses, the sensitivity of the APHAB_u was 0.70–0.84 (single subscales), 0.76 (mean value of EC_u, BN_u, and RV_u), or 0.85 (logistic regression model). The specificity was 0.79–0.95. The use of single APHAB_u subscales for determining the sensitivity and specificity of the APHAB_u due to confusing results. In comparison, the use of the mean value of EC_u, BN_u, and RV_u and the use of the logistic regression model due to equal values in the ROC curves but a higher sensitivity in the logistic regression model. Therefore, we would recommend the last method for determining the sensitivity and specificity of the APHAB_u.

The influence of frequency-dependent hearing loss to unaided APHAB scores

Hearing loss can be measured by pure-tone and speech audiometry. The subjective hearing impairment can be assessed using questionnaires. The APHAB determines this for four typical hearing situations. It has not been researched previously whether a particular frequency-specific hearing loss leads to a particular unaided APHAB score in one of the subscales or not. Clarification could be helpful using the unaided APHAB as an instrument for primary diagnostics of hearing loss independently of whether hearing aids were subsequently fitted or not. A total of 4546 records from a database were analysed; the average age of the subjects was 69.3 years. Using a multivariant mixed linear model, a possible correlation was examined between a frequency-specific hearing loss (0.5-8.0 kHz) and particular unaided APHAB scores for its subscales. Furthermore, it was determined whether the subject's gender has a corresponding impact. There was no evidence of gender-specific dependence of the unaided APHAB scores. For the EC scale frequencies above 0.5 kHz, for the RV scale all frequencies and for the AV scale the frequencies at 1.0 and 2.0 kHz showed a significant correlation between hearing loss and the APHAB score. For each decibel of hearing loss there was an average rise in the APHAB score for the EC and RV scale of approximately 0.2 percentage points and an average decrease in the AV scale of 0.1 percentage points for each frequency. For the BN scale there was no evidence of this kind of correlation. The very varied possibility between individuals compensating for hearing loss in situations with background noises could be that there is no correlation between frequency-specific hearing loss and an associated unaided APHAB score. The described frequency-specific influence of hearing loss to the EC and RV score could be explained by fewer compensating possibilities for the patients in these specific hearing situations than for the BN scale described. Using the unaided APHAB form in primary diagnostics of hearing impairment is helpful for understanding individual problems.

[Distribution and Scattering of APHAB Answers Before and After Hearing Aid Fitting]

Objective: Questionnaires are an important diagnostic elements in audiology. In Germany the APHAB is regularly used for hearing aid fitting. This study is investigating whether there are any specific questions which are answered more rarely by the subjects than other and whether inverted questions have any influence to this. Methods: Between April 2013 and August 2015 the number of 23 557 APHAB forms by 10 associations of statutory health insurance registered physicians have been collected and evaluated. For all questions the frequency of answers before and after hearing aid fitting have been determined. Results: For the EC scale there was one group of patients without hearing aid which a lot of problems of hearing and a second without. For the BN and RV subscale the majority of the patients addresses problems of understanding. For the AV scale no specific kind of problems found has been found. After successful hearing aid fitting problems of understanding for EC, BN, and RV subscale were reduced on average, for the AV scale no relevant change could be observed. Except for the numbers 11, 18, and 21 all APHAB questions were answered by 93-94% by all subjects. The questions number 11 and 18 were answered by 92%, question number 21 by 87%. Some questions have a similar tendency in deviation from the average (1, 3, 13, 16, and 17). Conclusions: Inverted questions have no influence to the frequency of answers in APHAB questions. The 3 questions which are answered more rarely are describing hearing situations in cinemas, theatres, and at church. Presumably, this hearing situations are not so common for most patients than the other described by the APHAB.

[Botulinum Toxin in Functional Hypersalivation--All about Dosage?]

BACKGROUND

The use of botulinum toxin injection in the salivary gland, is taking an increasing significance in the treatment of functional hypersalivation today. With due regard to the off -label use and the prospect of success, dosage levels are not yet standardized.

MATERIAL AND METHODS

In a retrospective study, 54 patients resp. 117 treatments were analysed over a period of 5 years according to their dosage levels of botulinum toxin, outcome and side effects.

RESULTS

In 90% of the cases, a reduction of saliva after botulinum toxin injections was reported, although a significant number of patients wished for an even greater effect. Compared to the first botulinum toxin injection, we therefore used a higher dosage plan in the following treatment in order to achieve better clinical results. Besides not enough saliva reduction, the main side effects were swallowing problems and thick or sticky saliva in patients with a tracheal cannula. With the exception of insufficient saliva reduction, the other described side effects were irrespective to the dosage level.

CONCLUSIONS

Botulinum toxin injection as a treatment of hypersalivation is an effective method with only minor side effects, even in increased dosage levels. Nevertheless, certain modifications according to each individual treatment are required. Possible side effects such as swallowing problems or non-responding situations should always be part of informed consent, especially as the latter is even possible for higher dosage levels.

Results in using the Freiburger monosyllabic speech test in noise without and with hearing aids

The Freiburger Speech Test (FST) has been the gold standard in speech testing by word recognition score in Germany for many years. Recently, it has been demonstrated that for an amount of 104 test-persons there is no significant deviation within the lists. The objective of this study was to determine the percentiles of the distinct measuring situations in quiet and with noise (e.g. applied in hearing aid fitting) and the average benefit using hearing aids. In this prospective study, 623 patients with SNHL and equipped with hearing aids for at least 3 months have been investigated by means of the Freiburger monosyllabic test (FBE) without and with hearing aids and in quiet or with noise (CCITT noise, 65/60 dB signal-noise ratio) in free field conditions at 65 dB to determine the ratio of intelligibility. To investigate the different diagnostic conditions a linear mixed model was applied. The dependent binary variable corresponds to the number of understood syllables. The average age of all subjects was about 72.6 years. The average rate of understanding in the FBE without hearing aids and in quiet was 38.5 %, with hearing aids and in quiet 67.7 %, without hearing aids and with noise 22.4 %, and with hearing aids and with noise 39.8 %. All results were presented with the depending confidence intervals. The extent of hearing loss and the quality of hearing aid fitting can be successfully measured using the FST in quiet and with background noise (CCITT noise). In quiet, an average hearing improving gain of 29.2 % points and with noise a gain of 17.4 % points could be estimated with a successful hearing aid fitting.

[Hypersalivation - inauguration of the S2k Guideline (AWMF) in short form]

Hypersalivation describes a relatively excessive salivary flow, which wets the patient himself and his surroundings. It may result because of insufficient oro-motor function, dysphagia, decreased central control and coordination. This reduces social interaction chances and burdens daily care. Multidisciplinary diagnostic and treatment evaluation is recommended already at early stage and focus on dysphagia, and saliva aspiration. Therefore, a multidisciplinary S2k guideline was developed. Diagnostic tools such as fiberoptic endoscopic evaluation of swallowing and videofluoroscopic swallowing studies generate important data on therapy selection and control. Especially traumatic and oncologic cases profit from swallowing therapy programmes in order to activate compensation mechanisms. In children with hypotonic oral muscles, oralstimulation plates can induce a relevant symptom release because of the improved lip closure. In acute hypersalivation, the pharmacologic treatment with glycopyrrolate and scopolamine in various applications is useful but its value in long-term usage critical. The injection of botulinum toxin into the salivary glands has shown safe and effective results with long lasting saliva reduction. Surgical treatment should be reserved for isolated cases. External radiation is judged as ultima ratio. Therapy effects and symptom severity has to be followed, especially in neurodegenerative cases. The resulting xerostomia should be critically evaluated by the responsible physician regarding oral and dental hygiene.

[Drooling in neuropediatric patients]

Drooling is defined as an anterior salivary flow which can be insufficiently controlled due to dysphagia und orofacial motoric deficits. It leads to moistened lips, chin, hands and surrounding in diverse extent. Drooling can severely interfere social contacts and requires more nursing facilities. A multidisciplinary approach in diagnostics and therapy is essential. Key points are the evaluation of inhibited swallowing and of orofacial motoric deficits. In the therapy of drooling, scopolamine patches and oral stimulation plates are useful but within the last few years, the injection of botulinum toxin into the salivary glands produced positive effects, as this therapy is an effective, well tolerated and safe option in these children. Surgical corrections of the salivary glands are more and more reserved for isolated cases.

[Unilateral extended medialization thyroplasty. Treatment for total aspiration after laser surgery and radiotherapy of laryngeal cancer]

BACKGROUND

Total aspiration is a rare complication after extended laser surgery for laryngeal cancer with adjuvant radiotherapy.

PATIENTS AND METHODS

Two patients with long-standing total aspiration after laser surgery with radiotherapy despite intensified swallowing therapy were treated with an extended medialization thyroplasty.

RESULTS

Postoperatively, both patients were able to swallow food and liquids without aspiration. One patient no longer has a gastrostomy tube and has been free from aspiration with normal oral food intake for 3 years. The second patient, with a tiny mucosal scar perforation, developed an abscess 2 months after surgery and needed revision surgery, with a subsequent return of aspiration.

DISCUSSION

The second patient's complication stresses the significance of an intact endolaryngeal scar because of the well-known prolonged healing of mucosa in the irradiated larynx. In our opinion, the potential benefits of medialization thyroplasty outweigh the risk of significant complications, especially after irradiation.

[Notched-noise-BERA: methods and diagnostic use]

BACKGROUND

As Picton demonstrated with case reports in 1978, thresholds of click-evoked potentials do not match to pure tone thresholds if hearing loss differs across the test frequencies. Thus, he developed a stimulation with brief tone pips masked by a notched noise that over the years became the standard method for frequency specific threshold estimation. Currently, new technologies like auditory steady-state responses and Chirp-evoked potentials promise to overcome some disadvantages of the NN-BERA.

METHODS

Thus, a systematic review about the NN-BERA was needed to further compare the competitive technologies. Literature research was performed according to the present guidelines for evidence based medicine. It was found that a meta-analysis with data pooling was impossible because of massive discrepancies of methods and subjects across the retrieved publications.

RESULTS

The differences of means between pure tone thresholds and NN-BERA-thresholds were up to 12 dB. Standard deviations were 2 to 16 dB and generally higher at 0.5 und 1 kHz compared to 2 and 4 kHz. Correlations were r = 0.84 to r = 0.97.

CONCLUSIONS

The NN-BERA faces a growing competition by auditory steady state potentials, chirp-evoked potentials, and distortion product otoacoustic emissions but serves still as the standard for an objective threshold estimation since it's accuracy is well evaluated and the interpretation is independent from statistical tests which accuracy is not sufficiently evaluated at present.

Integration des aktiven Mittelohrimplantates in die plastische Ohrmuschelrekonstruktion

BACKGROUND

Patients with high-grade microtia and atresia require a sophisticated and specific treatment. Apart from the plastic reconstruction of the auricle, in some cases hearing rehabilitation is medically indicated or is desired by the patients. The long-term results of simultaneous middle ear reconstruction with tympanoplasty are often inadequate owing to a persisting air-bone gap, and new techniques in hearing rehabilitation are needed for these patients.

METHODS

We present three cases of unilateral atresia to illustrate a combined approach integrating hearing rehabilitation using the active middle ear implant Vibrant Soundbridge (VSB) into plastic auricular reconstruction. The VSB was attached to the stapes suprastructure via the titanium clip in two of these cases and in the third case a subfacial approach was used to attach it directly to the membrane of the round window.

RESULTS

The air-bone gap was reduced to 17 dB, 14 dB and 0.25 dB HL. In free-field speech recognition tests at 65 dB SPL the patients achieved 100%, 90% and 100% recognition with the activated implant. No postoperative complications such as facial nerve paresis, vertigo or inner ear damage were found.

CONCLUSIONS

The integration of active middle ear implants in auricular reconstruction opens up a new approach in complete hearing rehabilitation. The additional implantation of the VSB does not have any negative effect on the healing process or the cosmetic outcome of the auricular reconstruction.

Auditive Verarbeitungs- und Wahrnehmungsstörungen

The consensus statement published by the German Society for Phoniatry and Paedaudiology in the year 2000 has been revised and actualized. The revised version takes into account current scientific and clinical findings. Aspects of the definition of auditory processing disorders (APD) are described extensively. These include symptoms, anamnestic information and diagnostic steps (preliminary examinations, subjective and objective audiological procedures). APD can appear in different forms, some of which can be classified within subtypes. Furthermore, factors which need to be considered in order to differentiate between APD and other diseases are specified. Therapeutic intervention possibilities which are rated according to their prognostic values conclude the article.

Tonfrequenzevozierte Potenziale

Auditory evoked responses to tone-pips in notched-noise provide frequency specific estimations of thresholds. Most often, test frequencies are 0.5-4 kHz. Thresholds are expected to match with a high degree to behavioral thresholds. However, only few studies are available containing data on stimulus and averaging parameters, especially at a test frequency of 0.25 kHz. In order to find "optimal" parameters for a widely used device (Nicolet Spirit Version 1.6), we designed five experiments on stimulus polarity (Exp.I), sweep frequency (Exp.II), stimulus duration (Exp.III), notched noise level (Exp.IV), and threshold estimation (Exp.V). The experiments also included a low test frequency of 0.25 kHz. These experiments were applied to 29 healthy volunteers (n=29, aged 20-41 years with normal hearing and no history of illness of the ear). We found that alternating stimulus polarity and a sweep frequency of 43.5/s evoked responses that were highest with respect to amplitudes (0.2-0.4 mV) and correlations (0.49-0.91). A novel finding of the study was that the highest amplitudes and correlations could be achieved if stimulus durations and notched-noise-levels were specifically adjusted to the test frequencies (stimulus durations 0.25 kHz: 4 ms, 0.5 Hz: 2 ms, 1-4 kHz: 1 ms, notched-noise-levels 0.25-0.5 Hz: +10 dB, 1-4 kHz: +/-0 dB). Deviations from behavioral thresholds did not exceed +/-5 dB in 93% of the measures. The results indicate that frequency specific auditory evoked responses provide reliable threshold estimations. Future experiments are required to confirm the threshold deviations for hard of hearing individuals.

[The management of Dysphagia. Part 1: diagnostics]

Patients with chronic dysphagia are often in need of artificial nutrition; though being well balanced in terms of energy and vitamins, patients are at a high risk for the loss of resistance and body weight. Dysphagia also causes a severe drawback of the overall quality of life. This paper gives an overview of the present management of dysphagia from the point of view of otolaryngologists, head-neck-surgeons, phoniatricians, and medical speech-language-voice-pathologists. The physiology of swallowing and typical symptoms of dysphagia are first explained. Then the current most important diagnostic procedures as orofacial and laryngeal function analysis, video-endoscopy, and quantitative assessments, are discussed (part 1). This also includes considerations on bolus viscosity variation, postures, swallowing maneuvers, and sensory enhancement procedures, while actual options like botulinum toxin, passy-muir speaking valve, electromyographic biofeedback, and electrostimulation are also mentioned (part 2).

Zusammenhänge zwischen „Anamnesebogen für Auditive Verarbeitungs- und Wahrnehmungsstörungen” und „Heidelberger Lautdifferenzierungstest”

BACKGROUND

A standardized anamnestic questionnaire of central auditory processing disorders ("Anamnestischer Erhebungs- und Beobachtungsbogen für auditive Verarbeitungs- und Wahrnehmungsstörungen") (FB-AVWS) was developed by German paedaudiologists. The present study examined the relations between this questionnaire and the results of selected auditory-perceptual tests to evaluate the validity of the FB-AVWS.

SUBJECTS AND METHOD

As part of a multicentric study, 113 pupils in primary schools were examined by the "Heidelberger Lautdifferenzierungstest", a test of phonemic discrimination and identification (HLAD). Additionally, the parents answered the FB-AVWS. Sensitivity, specificity and correlations with the FB-AVWS were determined referred to the HLAD.

RESULTS

We found significant, though moderate correlations, between the scale "auditory discrimination" of the FB-AVWS and the subtests "kinaesthetic/phonemic identification" and "phonemic analysis" of the HLAD. The other subscales of the FB-AVWS showed no significant correlations with the HLAD and its several subtests. The values for the sensitivity of the FB-AVWS were relatively high (93 and 100 %) as where the negatively predictive values for the HLAD as a whole and the subscale 1B (98 and 100 %), referred to HLAD. The specificity and the positive values were relatively low for the HLAD as a whole and for several of its subtests.

CONCLUSION

The FB-AVWS is a useful supplementation for the complementary clinical evaluation of central auditory disorders. It allows an assessment of the child's auditory perception and processing skills compared to the general population of primary school children. However, it is not valid as a screening or diagnostic instrument.

Dosierung von Botulinumtoxin Typ�B bei spasmodischer Dysphonie vom Adduktortyp

Today, most patients with severe adductor type spasmodic dysphonia are treated with repeated injections of botulinum toxin type A (BTA). It is known that patients who have been treated for many years and have received a high cumulative dosage may develop antibodies against BTA, making them "resistant" to further injections. For these patients, botulinum toxin type B (BTB, NeuroBloc) is considered to be a new chance to continue the treatment. When changing to BTB, one has to find an "equivalent dosage" which is estimated for cervical dystonia to be 25-33-fold of the previous Botox dosage and the 10-13-fold for the previous Dysport dosage. We report on a 62 year old female patient with antibodies against BTA. For maximum care, the first injection of BTB was performed with the sixfold of the previous Dysport dosage, which was almost the half of the needed dosage predicted from experience with cervical dystonia. The relief only lasted 3 weeks and was therefore disappointing. For the subsequent injections, we consulted Sataloff who also had one patient with antibodies treated with BTB. Based on his personnel advice, we chose the 30-fold dosage, which was effective for 3 months, resulting in improvements to voice quality (both psychoacoustic rating and acoustic measures), voice "quantity" (voice range profiles), aerodynamics (maximum phonation time, phonation quotient), and voice handicap. As with Sataloff et al. (2002), we found that the dosage of BTB probably has to be much higher than in cervical dystonia.

[The management of dysphagia -- part 2: therapy]

In the first part of the article we described diagnostic methods aiming to resolve the individual underlying pathomechanism of chronic swallowing disorders (dysphagia). From these, we deducted different therapeutic measures that can be applied either alone or in combination. Weakening of the upper esophageal sphincter with botulinum toxin is reserved for patients with structural stenosis or a relative hyperfunction of the sphincter. It can be tried to use the "Passy-Muir Valve" for tracheostomized patients that aspirate. Most cases benefit from a therapy that consists of specific exercises. "Restitution" relies on exercises to practice new movement patterns as well as improvement of muscle strength. "Compensation" is based on exercises to counteract structural and/or functional deficits. Through "adaptation" residual, therapy resistant disease can be alleviated through dietary planning of consistency, temperature, and nutrient content of food. In many cases it is necessary to combine "restitution", "compensation", and "adaptation".

Altersabh�ngigkeit sp�ter auditorischer Potenziale (NC-ERP) bei Kindern

BACKGROUND

Neutral condition event related potentials (NC-ERP) are not suitable for differentiating between children suffering from auditory processing disorders (APD) alone and APD-children with attention deficit disorder. Other factors beside severity of APD may cause "pathological" NC-ERP. Here we raise the question of whether maturational factors may be responsible for disordered NC-ERP.

METHODS

NC-ERP data from 142 APD children (range 5.4-17.2 years; mean 9.8 years) were analysed. Data were grouped according to age of children (I: <7.11 years n=34; II: 8.0-9.11 years n=46; III: 10.0-11.11 years n=39; IV: >12.0 years n=23).

RESULTS

Pathological NC-ERP were found in 82.3% (group I), 56.6% (group II), 46.2% (group III) and 8.8% (group IV). Additional analyses confirmed no correlation with ADHD.

DISCUSSION

Although there is a whole body of evidence that late auditory evoked potential may mature with age, it is not known if NC-ERP are also age dependent. Our results that NC-ERP mature with age are consistent with data for other late auditory evoked potentials. Since normative date of NC-ERP for different age groups are still lacking, NC-ERP results in children should be interpreted very cautiously.

Sp�te auditorische Potenziale (NC-ERP) bei Kindern mit Symptomen einer auditiven Verarbeitungs- und Wahrnehmungsst�rung

BACKGROUND

Auditory processing disorders (APD) result from dysfunctions of processes dedicated to audition and affect processing of information in the auditory modality. Children with APD exhibit symptoms similar to those with attention deficit disorders (ADHD). With regard to therapeutic strategies it seems mandatory to employ diagnostic procedures able to differentiate between APD and ADHD. Recently it was found that auditory evoked neutral condition event-related potentials (NC-ERP) correlate with results from psychoacoustic measures suitable to unveil dysfunctions of auditory processing, thus confirming APD. Here we investigated whether NC-ERP may be used as a tool to differentiate between APD and ADHD.

METHODS

In a retrospective analysis, NC-ERP data from 99 children with (+ADHD) and 43 without ADHD symptoms (-ADHD) were examined. All patients suffered from symptoms consistent with information processing deficits in the auditory modality. Analysis of variance was applied.

RESULTS

+ADHD children and -ADHD children did not show a significantly different distribution pattern of pathological NC-ERP.

DISCUSSION

Since the probability of pathological NC-ERP is equally distributed in children with or without ADHD, all of whom suffered from auditory processing deficits, it seems fair to conclude that NC-ERP are not suitable to differentiate between APD and ADHD. This may be due to methodological limitations. Alternatively, APD and ADHD may indeed be overlapping entities with a common yet unidentified origin.

Search for deletion 22q11.2 in interphase nuclei of buccal mucosa of patients ascertained by isolated cleft palate: a new diagnostic approach

A new approach for the detection of chromosome deletion 22q11.2 in interphase nuclei from buccal mucosa cells obtained by a non-invasive procedure is described. FISH analysis has been performed on samples from a group of 101 patients that presented consecutively for speech therapy and/or surgical correction of cleft palate. A normal result has been obtained in 98 patients; a deletion 22q11.2 was present in three patients (2.8%) with cleft palate.

[Normal nasalance for the German language. Nasometric values for clinical use in patients with cleft lip and palate]

OBJECTIVE

Rhinophonia is often present in patients with cleft lip and palate (CLP) many years after palatoplasty. It may be caused either by organic deficits, functional disorders, or both. NasalView is known as an instrument for the objective assessment of nasalance in cases of velopharyngeal insufficiency or incompetence.However,normative values for the German language are not yet available. In order to overcome this problem, this study evaluated such norms using NasalView.

METHODS

A total of 50 individuals with normal speech development were examined with NasalView. The median age was 14 years (range 11-20 years). The tone material used comprised the vowels /a:/, /e:/, /i:/, /o:/, /u:/, the sentences S(1): "Die Schokolade ist sehr lecker."("This chocolate is very tasty.") and S(2): "Nenne meine Mamma Mimmi."("Call my mummy Mimmi."), and the text passages of LT(1): "Nordwind und Sonne"("Northwind and sun"), LT(2): "Kindergeburtstag"("A child's birthday party") and LT(3): "Der grosse Gesang"("A famous song").

RESULTS

The mean nasalance for the vowels was 35.9% (+/-8.4), for S(1) (containing no nasal consonants) 24.9% (+/-5.3), and for S(2) 69.6% (+/-5.5) (with many nasal sounds). The results for the text passages were 42.1% (+/-4.2) for LT(1), 36.9% (+/-4.3) for LT(2) and 38.2% (+/-4.4) for LT(3).

CONCLUSION

The norms of nasalance for the German language presented here may be useful in measuring the long-term outcome of cleft lip and palate.

[Hearing screening with automatic evaluation of TEOAE and a new method of automatic evaluation of early auditory evoked potentials. Optimization and field trial]

BACKGROUND AND OBJECTIVE

To make a rational decision as to which screening test might be adequate as a universal newborn hearing screening, different methods have to be tested under "real-life" conditions. In addition, a good reference is required as "golden standard."

PATIENTS/METHODS

In the study presented here, an ABR with a novel algorithm for threshold-estimation was optimized and compared to TEOAE (Echoscreen) and DPOAE (GSI 60) in a three-step protocol using a standard click-evoked ABR (Evoselect) as reference of sensitivity and specificity.

RESULTS

26 ears were found to be hearing-impaired. All of them were also detected by each of the screening method (sensitivity 100%). Specificity in the final "step 2" of the study was around 87.7/92.3% for Echoscreen, 82.4/84.4% for DPOAE and 82.4/89.1 for Evoflash (left/right, respectively). Differences were not at all significant (X2-test, p > > 0.05). In summary, results were somewhat inferior to those found by other authors, probably due to more difficult conditions in the "real-life" setting.

CONCLUSIONS

A higher rate of false-alarm shows that a two-step screening is necessary. Therefore, increased resources for diagnostic procedures are required.

Suggestion for orthodontic and speech improving measures in CLP patients

The objective of the present paper is to describe a soft palate level device, the veloretractor, which is a combination of orthodontic appliance and therapeutic aid in speech therapy. Its use is demonstrated in a case report of a child with complete bilateral cleft lip and palate. Both orthodontic and phoniatric/pedaudiologic treatment needs during the course are demonstrated along with the treatment results.

[Botulinum toxin type A-induced "rebalancing" in bilateral vocal cord paralysis?]

BACKGROUND

Upper airway obstruction due to bilateral vocal cord paralysis in an 80-year-old female patient was successfully relieved by injection of botulinum toxin A (BTA) into the laryngeal adductor muscles. The patient achieved satisfactory airway ventilation. Spirograms obtained preoperatively and postoperatively documented improved peak flow rates and 1-s forced expiratory volume values. Voice quality was breathy after the injection; however, neither aspiration nor dysphagia developed. Surprisingly, the maximum phonation time increased.

PATIENTS AND METHODS

During a follow-up check 4 months later, the patient still reported less dyspnea although the vocal cords were closer together than initially after the injection. The decrease in dyspnea as reported by the patient lasted approximately 2 years.

RESULTS

The improvement in breathing following injection of BTA can be interpreted as a paralysis or weakening of the laryngeal adductors. However, it remains unclear why the maximum phonation time increased. Comparable findings, i.e., improvement in overall laryngeal function, are described in the literature as BTA-mediated laryngeal rebalancing.

[Cochlear hearing loss following Mycoplasma pneumoniae infection]

BACKGROUND

A sudden unilateral hearing loss in childhood is commonly regarded as an unusual event.

CASE-REPORT

In this paper, we report of a 10 year old girl suffering from a unilateral right-sided sudden hearing loss following an acute infection with Mycoplasma pneumoniae, which is also rarely observed. Maximum hearing loss was estimated around 30 dB (0.25-6 kHz), which resolved after infusions using plasma expanders. Both transitory and distortion product otoacoustic emissions remained absent, while latencies of acoustically evoked potentials were normal.

DISCUSSION

This suggests a damage of outer hair cell function as an explanation for the observed hearing loss. The coincidence of two rare events for children such as a spontaneous sudden unilateral hearing loss combined with an infection with Mycoplasma pneumoniae gives rise to the hypothesis of a causal relationship that is discussed according to the literature.

[Psychoacoustic scaling of acoustic voice parameters by multicenter voice ratings]

BACKGROUND

The purpose of the study was to analyze if perceptual voice quality ratings of the well-known RBH rating procedure (a 4-point scale of roughness, breathiness, and hoarseness) covary with acoustical voice parameters.

METHODS

120 voice samples from subjects with healthy and hoarse voices were rated on the RBH-index in a multicenter study with 31 raters. Multivariate regression tree analysis classified the perceptual ratings as "gold standard". Voice samples were acoustically analyzed with a feature extraction method. Feedforward-networks were trained to selected acoustical parameters having highest "relative importance" in the regression trees. Based on the best classifier, a computer program consisting of 50 simultaneous working networks was developed.

RESULTS

Mean probabilities for correct classifications were found at 0.65-0.85, implying a significance level over chance (0.25). Classifications of the program matched in 40% with a priori values in the categories roughness combined with breathiness, and in 65% in at least one domain.

CONCLUSIONS

The new method described here provides a psychoacoustically based "objective" classification of hoarse voices, which seems to enable future analysis of new parameters (like GNE), which may even improve the present results.