Anterior fracture dislocation of the odontoid peg in ankylosing spondylitis as a cause for rhinolalia clausa: a case study

from the Journal of Laryngology and Otology

We present an unusual cause of rhinolalia clausa secondary to an oropharyngeal mass. A 69-year-old male presented to the otorhinolaryngology clinic with a one year history of a ‘plummy’ voice. He had a longstanding history of severe ankylosing spondylitis. Examination revealed an obvious hyponasal voice and a smooth hard mass in the midline of the posterior nasopharyngeal and oropharyngeal walls. Subsequent computed tomography scans and lateral plain neck X-ray showed a fracture dislocation of the odontoid peg, secondary to ankylosing spondylitis, which had eroded through the body of the C1 vertebra to lie anteriorly, resulting in the aforementioned impression into the pharyngeal mucosa. The radiological images, the role of the nasal airways in phonation and the causes of hyponasal speech are discussed.

Botulinum toxin A injection under electromyographic guidance for treatment of spasmodic dysphonia

from the Journal of Laryngology and Otology

Spasmodic dysphonia is a disabling voice condition caused by a chronic neurological disorder of central motor processing. Present therapy is directed at relief of symptoms rather than cure. Botulinum toxin type A injection into the thyroarytenoid muscle has become the pre-eminent approach for treatment of adductor spasmodic dysphonia. Botulinum toxin A injections can be performed in an out-patient setting under electromyographic guidance. We present our experience with 153 injections in 14 patients with adductor spasmodic dysphonia over a 10-year period. We demonstrate that the electromyography signal is a reliable prognostic indicator in terms of efficacy, and that patients’ subjective opinion is a valid indicator of treatment success and future treatment strategy.

Epstein–Barr virus-associated smooth muscle tumour mimicking bilateral vocal process granuloma

from the Journal of Laryngology and Otology

A case is presented of a 36-year-old Chinese woman with a renal transplant for end-stage renal failure due to Goodpasture’s syndrome. She presented with a year’s history of throat discomfort and acid regurgitation into her throat. Videolaryngoscopy revealed bilateral vocal process granuloma, presumed to be due to gastroesophageal reflux. A four-week course of high dose omeprazole was prescribed. On follow up a month later, the granulomas had enlarged, and laser excision was undertaken. Histological and immunohistochemical staining was consistent with Epstein–Barr virus-associated smooth muscle tumour. This is believed to be the first reported case in the English literature of such a tumour affecting the vocal process. The aim of this paper is to present the pathogenesis, clinical behaviour and treatment of Epstein–Barr virus-associated smooth muscle tumour, and to review the literature concerning the differential diagnosis of polypoid vocal process lesions.

Management of granular myringitis: A systematic review

from the Journal of Laryngology and Otology

Introduction: Granular myringitis is a chronic disorder characterised by lateral squamous de-epithelialisation and granulation of the tympanic membrane. Untreated, granular myringitis can lead to post-inflammatory medial external auditory canal fibrosis, acquired canal atresia and inflammatory infiltration of the deep canal.

Aim: This study aimed to establish optimal management strategies which could be applied to clinical practice, through systematic review of the current literature.

Methods: Current literature was obtained by searching evidence-based medical databases, the Cochrane database, the Database of Abstracts of Reviews of Effects, the Cochrane controlled trials register, Ovid Medline, the various British Medical Journal imprint journals, individual journal websites and citation indexes, and by hand-searching current journals. Detailed inclusion criteria were set. Data were retrieved from the selected studies and checked for accuracy and consistency. The primary outcome measured was the effect of the proposed intervention on recurrence of granular myringitis, compared with empirical antibiotic therapy.

Results: Fifty-eight publications were identified, dating from 1964 to 2005; 46 of these were potentially relevant. After assessment using the preset inclusion criteria, only two studies remained. El-Seifi and Fouad (2000) found that surgical excision of granulation tissue resulted in an 80 per cent reduction in recurrence of granular myringitis when compared with conventional antibiotic therapy. However, Jung et al. (2002) demonstrated a 96 per cent reduction in granular myringitis recurrence when managed with dilute vinegar solution.

Conclusions: There was a reduced recurrence of granular myringitis in both studies’ intervention groups, although neither study was randomised or blinded, making it difficult to assess the clinical relevance of the results. However, the following conclusions can be inferred. (1) Conventional topical antibiotic and steroid drops appear to be less efficacious and more likely to lead to recurrence of symptoms, compared with other proposed treatment modalities. (2) Treatment with dilute vinegar solution presents a logical, unharmful alternative to conventional antibiotic drops. Further research of high value is needed.

Optimising outcome assessment of voice interventions, II: sensitivity to change of self-reported and observer-rated measures

from the Journal of Laryngology and Otology

Objectives: A wide range of well validated instruments is now available to assess voice quality and voice-related quality of life, but comparative studies of the responsiveness to change of these measures are lacking. The aim of this study was to assess the responsiveness to change of a range of different measures, following voice therapy and surgery.

Design: Longitudinal, cohort comparison study.

Setting: Two UK voice clinics.

Participants: One hundred and forty-four patients referred for treatment of benign voice disorders, 90 undergoing voice therapy and 54 undergoing laryngeal microsurgery.

Main outcome measures: Three measures of self-reported voice quality (the vocal performance questionnaire, the voice handicap index and the voice symptom scale), plus the short form 36 (SF 36) general health status measure and the hospital anxiety and depression score. Perceptual, observer-rated analysis of voice quality was performed using the grade–roughness–breathiness–asthenia–strain scale. We compared the effect sizes (i.e. responsiveness to change) of the principal subscales of all measures before and after voice therapy or phonosurgery.

Results: All three self-reported voice measures had large effect sizes following either voice therapy or surgery. Outcomes were similar in both treatment groups. The effect sizes for the observer-rated grade–roughness–breathiness–asthenia–strain scale scores were smaller, although still moderate. The roughness subscale in particular showed little change after therapy or surgery. Only small effects were observed in general health and mood measures.

Conclusion: The results suggest that the use of a voice-specific questionnaire is essential for assessing the effectiveness of voice interventions. All three self-reported measures tested were capable of detecting change, and scores were highly correlated. On the basis of this evaluation of different measures’ sensitivities to change, there is no strong evidence to favour either the vocal performance questionnaire, the voice handicap index or the voice symptom scale.

Tinnitus rehabilitation: a mindfulness meditation cognitive behavioural therapy approach

from the Journal of Laryngology and Otology

Background: Chronic tinnitus is a frequent symptom presentation in clinical practice. No drug treatment to date has shown itself to be effective. The aim of the present study was to investigate the effects of cognitive behavioural therapy and meditation in tinnitus sufferers.

Methodology: Patients were selected from a dedicated tinnitus clinic in the Welsh Hearing Institute. A waiting list control design was used. Twenty-five chronic tinnitus sufferers were consecutively allocated to two groups, one receiving a cognitive behavioural therapy/meditation intervention of four one hour sessions with the other group waiting three months and subsequently treated in the same way, thereby acting as their own control. The main outcome was measured using the Hallam tinnitus questionnaire. A four to six month follow up was conducted.

Results: These showed significant statistical reductions in tinnitus variables both in the active and also in the control group. Post-therapy, no significant change was found after the waiting list period. The improvement was maintained at the four to six month period.

Conclusion: The positive findings give support for the use of cognitive behavioural therapy/meditation for chronic tinnitus sufferers.

22nd Century

from PBS.org

Website for the pilot episode of a 2007 PBS program about technology and innovation. Features video of stories about cochlear implants, “eyetap” (“glasses that continuously record what you see and have the ability to interject new information into what you are watching”), an electrode implanted in the brain of a man to restore communication abilities lost in an accident, and related topics. Also includes interviews, writings, and links to related resources. (synopsis from Librarians Internet Index)

Schools suffer lack of speech therapists

from Topix.net

“This is an absolute national crisis, the shortage of speech pathologists, because we have many students, children in and out of schools – you’re talking about some 2- or 3-year-olds – that have communication disorders,” said Miriam Podrazik, a personnel development director at the state Department of Education. “They are needing help learning to talk, and they are on waiting lists.”

Bone-Anchored Hearing Aid System Application for Unilateral Congenital Conductive Hearing Impairment: Audiometric Results

from Otology & Neurotology

Objective: To study the audiologic outcome of bone-anchored hearing aid (BAHA) application in patients with congenital unilateral conductive hearing impairment.

Study Design: Prospective audiometric evaluation on 20 patients.

Setting: Tertiary referral center.

Patients: The experimental group comprised 20 consecutive patients with congenital unilateral conductive hearing impairment, with a mean air-bone gap of 50 dB.

Methods: Aided and unaided hearing was assessed using sound localization and speech recognition-in-noise tests.

Results: Aided hearing thresholds and aided speech perception thresholds were measured to verify the effect of the BAHA system on the hearing acuity. All patients fulfilled the criteria that the aided speech reception thresholds or the mean aided sound field thresholds were 25 dB or better in the aided situation. Most patients were still using the BAHA almost every day. Sound localization scores varied widely in the unaided and aided situations. Many patients showed unexpectedly good unaided performance. However, nonsignificant improvements of 3.0 (500 Hz) and 6.9 degrees (3,000 Hz) were observed in favor of the BAHA. Speech recognition in noise with spatially separated speech and noise sources also improved after BAHA implantation, but not significantly.

Conclusion: Some patients with congenital unilateral conductive hearing impairment had such good directional hearing and speech-in-noise scores in the unaided situation that no overall significant improvement occurred after BAHA fitting in our setup. Of the 18 patients with a complete data set, 6 did not show any significant improvement at all. However, compliance with BAHA use in this patient group was remarkably high. Observations of consistent use of the device are highly suggestive of patient benefit. Further research is recommended to get more insight into these findings.

Dialogic reading and morphology training in Chinese children: Effects on language and literacy

from Developmental Psychology

This study investigates the effects of parent-child shared book reading and metalinguistic training on the language and literacy skills of 148 kindergartners in Hong Kong. Children were pretested on Chinese character recognition, vocabulary, morphological awareness, and reading interest and then assigned randomly to 1 of 4 conditions: the dialogic reading with morphology training (DR + MT), dialogic reading (DR), typical reading, or control condition. After a 12-week intervention period, the DR intervention yielded greater gains in vocabulary, and the DR + MT intervention yielded greater improvement in character recognition and morphological awareness. Both interventions enhanced children’s reading interest. Results confirm that different home literacy approaches influence children’s oral and written language skills differently: Shared book reading promotes language development, whereas parents’ explicit metalinguistic training within a shared book reading context better prepares children for learning to read. (PsycINFO Database Record (c) 2008 APA, all rights reserved) This study investigates the effects of parent-child shared book reading and metalinguistic training on the language and literacy skills of 148 kindergartners in Hong Kong. Children were pretested on Chinese character recognition, vocabulary, morphological awareness, and reading interest and then assigned randomly to 1 of 4 conditions: the dialogic reading with morphology training (DR + MT), dialogic reading (DR), typical reading, or control condition. After a 12-week intervention period, the DR intervention yielded greater gains in vocabulary, and the DR + MT intervention yielded greater improvement in character recognition and morphological awareness. Both interventions enhanced children’s reading interest. Results confirm that different home literacy approaches influence children’s oral and written language skills differently: Shared book reading promotes language development, whereas parents’ explicit metalinguistic training within a shared book reading context better prepares children for learning to read. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Social risk and protective factors for African American children’s academic achievement and adjustment during the transition to middle school

from Developmental Psychology

The transition to middle school is often marked by decreased academic achievement and increased emotional stress, and African American children exposed to social risk may be especially vulnerable during this transition. To identify mediators and protective factors, the authors related severity and timing of risk exposure to academic achievement and adjustment between 4th and 6th grade in 74 African American children. Longitudinal analyses indicated that severity more than timing of risk exposure was negatively related to all outcomes and that language skills mediated the pathway from risk for most outcomes. Transition to middle school was related to lower math scores and to more externalizing problems when children experienced higher levels of social risk. Language skills and parenting served as protective factors, whereas expectations of racial discrimination was a vulnerability factor. Results imply that promoting parenting and, especially, language skills, and decreasing expectations of racial discrimination provide pathways to academic success for African American children during the transition from elementary to middle school, especially those exposed to adversity. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Congenital Absence of the Oval Window: Diagnosis, Surgery, and Audiometric Outcomes

from Otology & Neurotology

Objective: To review the surgical management and outcomes of patients with congenital absence of the oval window (CAOW) undergoing the oval window drill-out (OWD) procedure.

Study Design and Setting: A retrospective chart review of patients with CAOW seen in a tertiary care otologic practice between 1991 and 2006.

Patients/Intervention: Patients with CAOW undergoing OWD procedure.

Main Outcome Measures: Findings at surgery and preoperative and postoperative audiometric outcomes (air and bone conduction thresholds; speech reception threshold).

Results: Seventeen ears underwent OWD for CAOW. Four cases were aborted. For the 13 subject ears, average 1-month postoperative 4-tone air conduction and speech reception thresholds were significantly lower than preoperative thresholds. Long-term follow-up (average, 20 months) air conduction and speech reception thresholds were also significantly lower but showed a slight worsening of thresholds compared with the 1-month postoperative results. Speech discrimination scores and bone conduction thresholds remained stable.

Conclusion: OWD may be a viable operation for patients with CAOW, although longer follow-up is needed. Given the mixed hearing results in the current patient series, we have tempered our enthusiasm for this operation. Technically challenging, this procedure nevertheless can improve patients’ hearing with minimal morbidity. Revision surgery did not result in improved outcome.

Examination of the Larynx and Pharynx

from the New England Journal of Medicine

This is a video of the procedures involved.

Visualization of the larynx and pharynx is an essential part of a complete head and neck examination. Although the location of these structures often precludes direct visualization, simple techniques can be used to evaluate these anatomic structures in the clinical setting. Indirect laryngoscopy can be performed with either a simple dental mirror or with a flexible fiberoptic endoscope. These procedures can be performed on patients who are awake and cooperative, and are usually well tolerated. Patients with symptoms such as chronic cough, dysphonia, chronic throat pain, dysphagia, voice changes, and symptoms of aspiration should all undergo careful laryngoscopy.

Implementing Visually Cued Imitation Training With Children With Autism Spectrum Disorders and Developmental Delays

from the Journal of Positive Behavior Interventions

Clearly, imitation is linked to a variety of skill areas. As a result, children with autism and developmental delays are less likely than their typical peers to perform well in many areas of development, including play and speech. The purpose of this study was to determine if a simple, teacher-friendly strategy could be implemented that would affect peer imitation skills in children with autism spectrum and developmental disorders. A single-subject multiple baseline design was applied across four participants to determine the impact of a multicomponent visually cued imitation strategy. Results indicated that participants’ imitation skills increased and reliance on physical prompts decreased. The results are discussed in terms of the amount of imitation that occurred, the level of prompts used, and the activities engaged in.

Transient reduction of tinnitus intensity is marked by concomitant reductions of delta band power

from BMC Biology

Background
Tinnitus is an auditory phantom phenomenon, characterized by the sensation of sounds without objectively identifiable sound sources. So far its causes are not well understood. Previous research found altered patterns of spontaneous brain activity in chronic tinnitus sufferers compared to healthy controls, yet it is unknown whether these abnormal oscillatory patterns are causally related to the tinnitus sensation. Partial support for this notion comes from a neurofeedback approach developed by our group in which significant reductions in tinnitus loudness could be achieved in patients who successfully normalized their patterns of spontaneous brain activity. The current work attempts to complement these studies by scrutinizing how modulations of tinnitus intensity alter ongoing oscillatory activity.

Results
In the present study the relation between tinnitus sensation and spontaneous brain activity was investigated using residual inhibition (RI) to reduce tinnitus intensity and source-space projected magnetencephalographic (MEG) data to index brain activity. RI is the sustained reduction (criteria here: 50% for at least 30 seconds) in tinnitus loudness after cessation of a tonal tinnitus masker. A pilot study (n = 38) identified ten patients who showed RI. A significant reduction of power in the delta (1.3 – 4.0 Hz) frequency band was observed in temporal regions during RI (p [less than or equal to] 0.001).

Conclusions
The current results suggest that changes of tinnitus intensity induced by RI are mediated by alterations in the pathological patterns of spontaneous brain activity, specifically a reduction of delta activity. Delta activity is a characteristic oscillatory activity generated by deafferented/deprived neuronal networks. This implies that RI effects might reflect the transient reestablishment of balance between excitatory and inhibitory neuronal assemblies via reafferentation, that has been perturbed (in most tinnitus individuals) by a hearing damage. Since enhancements have been reported in the delta frequency band for tinnitus at rest, this result conforms to our assumption that a normalization of oscillatory properties of cortical networks is a prerequisite for attenuating the tinnitus sensation. For RI to have therapeutic significance however, this normalization would have to be stabilized.