History of Voice Rehabilitation Following Laryngectomy

from Laryngoscope

Introduction: The history of voice rehabilitation following laryngectomy is as long as the history of laryngectomy itself. The multitude of methods which have been employed to reduce the disability associated with the loss of the larynx, illustrate the difficulty of finding an optimal method of reestablishing verbal communication while preserving the ability to breathe and swallow.

Material and Methods: The world literature was reviewed using various Internet and medical search engines and library facilities. Landmark articles were identified and summarized.

Results: A coherent history of voice rehabilitation following laryngectomy was constructed.

Discussion: The methods employed to reestablish voice after extirpation of the larynx may be grouped into the categories of: esophageal speech, surgical methods of creating competent tracheo-pharyngeal shunts to create lung powered voice with and without the use of prosthetic devices to prevent aspiration, “near-total” resection of the larynx with dynamic phonatory shunt, and the use of external pneumatic or electrical devices to create sound which is then transmitted through the oral cavity and pharynx.

Conclusion: For the past two decades, simple shunt devices inserted either primarily, at the time of laryngectomy, or later as a secondary procedure, have mainly supplanted the other methods of voice rehabilitation, with the exception of an occasional patient who has acquired good esophageal speech, or for whom external devices may be the only practical method of voice production.

Direct Electrical Stimulation of Heschl’s Gyrus for Tinnitus Treatment

from Laryngoscope

Objectives/Hypothesis: The purpose of the study was to determine the effect of electrical stimulation of the auditory cortex in patients with tinnitus.

Study Design: Nonrandomized clinical trial.

Methods: Two patients with debilitating tinnitus refractory to conventional therapies were treated. Patients were evaluated with validated questionnaires and psychoacoustic measures to determine the frequency and pitch of their tinnitus. Tones at these frequencies were then presented to the first patient (RP) under magnetoencephalography (MEG) and functional magnetic resonance imaging (fMRI) to determine the tonotopic map for these frequencies in Heschl’s gyrus. These tonotopic sites were targeted for implant with a quadripolar electrode. In the second patient (MV), only the fMRI tonotopic map was performed. These fMRI results detected an area of increased activity, which was selected as the site for the implanted bipolar electrode.

Results: Patient RP (bilateral tinnitus for 2 years) has experienced a sustained reduction to near elimination of tinnitus with intracerebral implanted electrodes, whereas patient MV (unilateral tinnitus for 7 years) had an unsustained reduction in her tinnitus.

Conclusion: These findings suggest that the perception and annoyance of tinnitus may be modulated or reduced through electrical stimulation of the auditory cortex. These unsustained effects for patient MV may have been influenced by the longstanding nature of her tinnitus or by another reason as yet undetermined.

Changes in Speaking Fundamental Frequency Characteristics with Aging

from Folia Phoniatrica et Logopaedica

Changes in speaking fundamental frequency (SFF) associated with aging were studied in a total of 374 healthy normal speakers (187 males and 187 females) from adolescent to older age groups. Participants were asked to read a sample passage aloud, and acoustic analysis was performed. The main results were as follows: (1) Males exhibited no significant trend for SFF changes in aging. However, a slight increase was observed in participants aged 70 years or older. (2) Females in their 30s and 40s showed obviously lower frequencies than those in their 20s. Across all age groups, including the 80s, SFF tended to decrease markedly in association with aging. (3) The degree of SFF change in association with aging was much larger in females than in males. In addition, reference intervals (mean ± 1.96 SD) obtained for males and females in each age group are considered useful for clinical detection of abnormalities of SFF, as well as for detection of laryngeal diseases causing SFF abnormality.

Linguistic Profile of Individuals with Down Syndrome: Comparing the Linguistic Performance of Three Developmental Disorders

from Child Neuropsychology

An increasing number of studies, addressing the linguistic abilities of individuals with Down syndrome (DS) suggest that they exhibit strengths and weaknesses within the linguistic domain. This article critically reviews the literature on the linguistic profile of individuals with DS, with particular emphasis on the expression and reception of vocabulary and grammar, including nonverbal linguistic expression during infant development. In doing so, attention is given to recent comparative studies of the linguistic abilities of individuals with DS, Specific Language Impairment (SLI), and Williams syndrome (WS). The possibility that deficits in one cognitive system may have consequences in another cognitive system, and that these consequences may define the nature of the impairment in each clinical syndrome is further discussed with suggestions for future research.

Tympanic Membrane Collagen Fibers: A Key to High-Frequency Sound Conduction

from Laryngoscope

Objective: To investigate the significance of tympanic membrane collagen fiber layers in high frequency sound transmission.

Study Design: Human cadaver temporal bone study.

Methods: Laser Doppler vibrometry was used to measure stapes footplate movement in response to acoustic stimulation. The tympanic membrane was altered by creating a series of slits and applying paper patches to isolate the effects of specifically oriented collagen fibers. Three groups of membrane alterations were evaluated: 1) circumferentially oriented slits involving each quadrant to primarily disrupt radial fibers, made sequentially within superior-anterior, inferior-anterior, inferior-posterior, and superior-posterior quadrants; 2) the same slits made in the reverse order; and 3) radially oriented slits from the umbo to the annulus to primarily disrupt circumferential fibers. For each group, measurements of the middle-ear cavity pressure, ear canal pressure, and stapes velocity were made each time the tympanic membrane was altered.

Results: Regardless of the order in which the circumferentially oriented slits were made, there was a consistent decrease in stapes velocity above 4 kHz for the third and fourth cuts compared to the control. The mean decrease in the range of 4 to 12.5 kHz was 11 dB for the third patched slit and 14 dB for the fourth patched slit (P < .01). Radially oriented slits appear to produce smaller effects.

Conclusions: Radial collagen fibers in the tympanic membrane play an important role in the conduction of sound above 4 kHz.

A Guide for Monitoring Child Development in Low- and Middle-Income Countries

from Pediatrics

OBJECTIVE. In low- and middle-income countries, methods for clinicians to address difficulties in language, social-emotional, cognitive, behavioral, or neuromotor development during early childhood are lacking. To fill this gap, we designed, in Turkey, the Guide for Monitoring Child Development, which aims to aid clinicians in monitoring and supporting child development and the early detection and management of developmental difficulties. The Guide for Monitoring Child Development monitoring component is a practical, open-ended interview that catalyzes communication between clinicians and caregivers and obtains a portrayal of the child’s development. We report on the development and psychometric properties of the Guide for Monitoring Child Development monitoring component for children aged 0 to 24 months.

METHODS. We examined the ages of attainment of Guide for Monitoring Child Development milestones and internal consistency in a cross-sectional study of healthy children receiving well-child care (study 1). In 2 clinical samples, we studied the interrater reliability between medical students and a child development specialist administering the guide (study 2), as well as the concurrent validity of the guide administered during a health visit and a comprehensive developmental assessment (study 3).

RESULTS. In study 1 (N = 510), item-total scale correlations ranged from 0.28 to 0.91. An age-dependent attainment pattern was seen in all of the milestones. In study 2 (N = 92), interrater reliability between medical-student pairs and between the child development specialist and students was high (kappa scores were 0.83–0.88). In study 3 (N = 79), the sensitivity, specificity, and positive and negative predictive values were 0.88, 0.93, 0.84, and 0.94, respectively.

CONCLUSIONS. The Guide for Monitoring Child Development is an innovative method for monitoring child development that is designed specifically for use by health care providers in low- and middle-income countries. Studies in Turkey provide preliminary evidence for its reliability and validity.

Ethical, Legal, and Social Concerns About Expanded Newborn Screening: Fragile X Syndrome as a Prototype for Emerging Issues

from Pediatrics

Technology will make it possible to screen for fragile X syndrome and other conditions that do not meet current guidelines for routine newborn screening. This possibility evokes at least 8 broad ethical, legal, and social concerns: (1) early identification of fragile X syndrome, an “untreatable” condition, could lead to heightened anxiety about parenting, oversensitivity to development, alterations in parenting, or disrupted bonding; (2) because fragile X syndrome screening should be voluntary, informed consent could overwhelm parents with information, significantly burden hospitals, and reduce participation in the core screening program; (3) screening will identify some children who are or appear to be phenotypically normal; (4) screening might identify children with other conditions not originally targeted for screening; (5) screening could overwhelm an already limited capacity for genetic counseling and comprehensive care; (6) screening for fragile X syndrome, especially if carrier status is disclosed, increases the likelihood of negative self-concept, societal stigmatization, and insurance or employment discrimination; (7) screening will suggest risk in extended family members, raising ethical and legal issues (because they never consented to screening) and creating a communication burden for parents or expanding the scope of physician responsibility; and (8) screening for fragile X syndrome could heighten discrepancies in how men and women experience genetic risk or decide about testing. To address these concerns we recommend a national newborn screening research network; the development of models for informed decision-making; materials and approaches for helping families understand genetic information and communicating it to others; a national forum to address carrier testing and the disclosure of secondary or incidental findings; and public engagement of scientists, policy makers, ethicists, practitioners, and other citizens to discuss the desired aims of newborn screening and the characteristics of a system needed to achieve those aims.

Emotional speech in Parkinson’s disease

from Movement Disorders

Patients with Parkinson’s disease (PD) tend to speak monotonously with minor modulation of pitch and intensity. The goal of this study was to find out whether these speech changes can be explained mainly by motor impairment, i.e. akinesia and rigidity of the articulatory apparatus, or whether alterations of emotional processing play an additional role. Sixteen patients with mild PD and 16 healthy controls (HC) were compared. Fundamental frequencies (pitch) and intensities (loudness) were determined as (1) maximal upper and lower values achieved in nonemotional speech (phonation capacity), (2) upper and lower values used when speaking Anna in emotional intonation (neutral, sad, happy) as requested (production task), or (3) when imitating a professional speaker (imitation task). Although groups did not significantly differ in their phonation capacity, patients showed a significantly smaller pitch and intensity range than HC in the production task. In the imitation task, however, ranges were again similar. These results suggest that alterations of emotional processing contribute to speech changes in PD, especially regarding emotional prosody, in addition to motor impairment. © 2008 Movement Disorder Society

Fine structure of distortion product otoacoustic emissions: its dependence on age and hearing threshold and clinical implications

from the European Archives of Oto-Rhino-Laryngology

Abstract Distortion product otoacoustic emissions (DPOAE) are routinely used in audiological diagnostics. When the stimulus frequencies f1 and f2 are varied in small steps, distinct non-monotonicities (peaks and valleys) in DPOAE level versus frequency functions can be observed. This so-called DPOAE fine structure (FS) is supposed to be the result of physiological interferences between two different cochlear sources which generate the DPOAE signal. Although FS can complicate interpretations with respect to cochlear functional status at the primary source near f2, its presence might also be relevant in clinical audiological diagnostics. It is therefore of interest to determine FS prevalence and its dependence on age, frequency and hearing threshold. First, it was screened for FS using two tone stimulation (L1/L2 = 55/45 dB SPL, f2/f1 = 1.22) and frequency steps of 40 Hz in the frequency range of 1.8–4.2 kHz. DPOAE (2f1 − f2) were then recorded in 1/3 octave-bands centered around f2 = 2, 3 and 4 kHz with a frequency resolution of 12.5, 20 and 25 Hz, respectively, both with and without a third stimulus (L3 = 45 dB SPL, f3 = 2f1 − f2 + 25 Hz) which was supposed to act as a suppressor of FS. Results of measurements in 102 human individuals from a mixed patient population are reported. Prevalence of DPOAE and FS in a specific frequency range, (i.e. 2, 3, or 4 kHz) was classified into five categories: I) distinct FS within the respective frequency range, II) “single dip” in DP-gram, III) “flat” DP-gram well above noise floor but no distinct FS, IV) DPOAE near noise floor with “irregular responses”, and V) no DPOAE measurable. The prevalence of the categories was set in relation to the subject’s age and the audiometric threshold at the corresponding center frequency. The estimated probability for a FS (category I and II) was 50–80% if hearing threshold was better than 10 dB HL at the corresponding center frequency. FS prevalence strongly decreased with increasing hearing loss (P < 0.0001). There was no statistically significant age effect (P = 0.088). In more than 50% of the subjects with a behavioral hearing threshold of 10 dB HL or better, a distinct FS near the according frequency was detected, given the presented measurement conditions. While further research is directed at optimal suppression of the second cochlear source of DPOAE and thereby of FS in order to obtain information about the cochlear status near f2 only, the evaluation of FS itself may be clinically useful for monitoring subtle cochlear changes, e.g. during exposure to ototoxic substances or noise.

Situating language production within the matrix of human cognition: The state of the art in language production research

from Language and Cognitive Processes

A summary of recent work in language production is presented, focusing on the Third International Workshop on Language Production (Chicago, USA, August 2006). The articles included in this special issue focus on three overlapping themes: language production in dialogue (Arnold; Costa, Pickering, & Sorace); multilingual language production (Costa et al.; Abutalebi & Green); and control processes in production (Abutalebi & Green; Dell, Oppenheim, & Kittredge). Points of convergence and divergence between these contributions are discussed.

Central timing deficits in subtypes of primary speech disorders

from Clinical Linguistics and Phonetics

Childhood apraxia of speech (CAS) is a proposed speech disorder subtype that interferes with motor planning and/or programming, affecting prosody in many cases. Pilot data (Peter & Stoel-Gammon, 2005) were consistent with the notion that deficits in timing accuracy in speech and music-related tasks may be associated with CAS. This study replicated and expanded earlier findings. Eleven children with speech disorders and age-and gender-matched controls participated in non-word imitation, clapped rhythm imitation, and paced repetitive tapping tasks. Results suggest a central timing deficit, expressed in both the oral and the limb modality, and observable in two different types of timing measures, overall rhythmic structures and small-scale durations. Associations among timing measures were strongest in the participants with speech disorders, who also showed lower timing accuracy than the controls in all measures. The number of observed CAS characteristics was associated with timing deficits.

An investigation of voice quality in individuals with inherited elastin gene abnormalities

from Clinical Linguistics and Phonetics

The human elastin gene (ELN) is responsible for the generation of elastic fibres in the extracellular matrix of connective tissue throughout the body, including the vocal folds. Individuals with Supravalvular aortic stenosis (SVAS) and Williams syndrome (WS) lack one normal ELN allele due to heterozygous ELN abnormalities, resulting in a haploinsufficiency. We measured perceptual and acoustic characteristics of voice quality in individuals with SVAS and WS to investigate the consequences to vocal function secondary to ELN haploinsufficiency. Results indicated that the voice quality of individuals with SVAS/WS was rated as significantly more abnormal, rough, and hoarse compared to normal controls, and that adults with SVAS/WS were rated as significantly lower in pitch. Acoustic measures indicated that individuals with SVAS/WS produced greater instability of fundamental frequency during phonation (as reflected via increased pitch sigma and increased jitter). These findings support the possibility that heterozygous ELN abnormalities negatively influence vocal fold biomechanics and the resulting sound produced by the vibrating glottis.

Fortition and lenition patterns in the acquisition of obstruents by children with cochlear implants

from Clinical Linguistics and Phonetics

This paper investigates patterns of error production in 10 children who use cochlear implants, focusing specifically on the acquisition of obstruents. Two broad patterns of production errors are investigated, fortition (or strengthening) errors and lenition (or weakening) errors. It is proposed that fortition error patterns tend to be related to the process of phonological development, because they are involved with universal implications and notions of markedness. Lenition error patterns, on the other hand, show more context-sensitive effects and reflect properties related to minimization of articulatory effort. The relationship between fortition and markedness is demonstrated in an optimality theoretic analysis, and it is further demonstrated that the observed characteristics of phonological development in children with cochlear implants are similar to those exhibited by children with normal hearing.

Prosodic boundaries in alaryngeal speech

from Clinical Linguistics and Phonetics

Alaryngeal speakers (speakers in whom the larynx has been removed) have inconsistent control over acoustic parameters such as F0 and duration. This study investigated whether proficient tracheoesophageal and oesophageal speakers consistently convey phrase boundaries. It was further investigated if these alaryngeal speakers used the same hierarchy of acoustic boundary cues that is found in normal speakers. A perception experiment revealed that listeners identified prosodic boundaries less accurately in oesophageal speakers. Acoustic analyses showed that laryngeal speakers used pre-boundary lengthening and pitch movements at phrase boundaries, as expected. Tracheoesophageal speakers used pre-boundary-lengthening and pauses and oesophageal speakers used pauses to convey phrase boundaries. Two oesophageal speakers also paused inappropriately, within phrases. Although these two speakers differentiated between air-injection and prosodic pauses, listeners were unable to tell the two types of pauses apart. Alaryngeal speakers might benefit from therapy that specifically teaches them how to optimize their prosodic abilities.

A comparison between the feeling of ear fullness and tinnitus in acute sensorineural hearing loss

from the International Journal of Audiology

The feeling of ear fullness (FEF) occurs frequently in patients with acute sensorineural hearing loss; the same is true for tinnitus (TIN). However, the cause of FEF in these patients is unclear. This study included 171 ears of patients admitted with unilateral sudden deafness to the ENT division of Fukuoka University Hospital between January 2001 and December 2004. The results showed TIN was mainly associated with worse high-frequency hearing thresholds, where hearing loss was relatively severe, and this association became stronger after the hearing threshold stabilized. FEF was associated with the low-frequency region, where hearing loss was relatively mild, and this association disappeared after the hearing threshold stabilized. In conclusion, TIN is thought to originate in the region where hair cells are impaired; in contrast, FEF may originate from some functional factor rather than an organic lesion of the cochlea.

Effectiveness of hearing protector devices in impulse noise verified with transiently evoked and distortion product otoacoustic emissions

from the International Journal of Audiology

This study aimed to evaluate the effect of impulse noise on otoacoustic emissions (OAEs) while a passive non-linear earplug or an active level-dependent earmuff was worn.

Since none of the standardized attenuation measurement techniques, REAT (real ear at threshold), ATF (acoustic test fixture), or MIRE (microphone in real ear), is designed to test both types in real-wearing condition, OAEs, suitable for detecting subtle changes in the functional integrity of the cochlear outer hair cells, are used.

First, DPOAEs (distortion product) and TEOAEs (transiently evoked) of 24 subjects were compared before, immediately after gunfire practice, and after one hour of non-exposure. Secondly, both types of OAEs were evaluated in 31 subjects before and after exposure during a five-day military practice.

Significant differences existed between the ears in most cases; the emissions from the right ear had a tendency to be more robust. There were no significant changes in OAEs either before and after exposure, or in the second experiment over multiple days. These findings suggest that the HPDs are able to prevent cochlear damage.

Iris pigmentation and susceptibility to noise-induced hearing loss

from the International Journal of Audiology

The purpose of this retrospective study is to examine the possible association between iris pigmentation and susceptibility to noise-induced hearing loss in 2407 noise-exposed workers. The workers were between 16 to 65 years of age and were exposed to 2 to 42 years of work-related noise. Results demonstrated that dark-eyed workers presented a greater percentage of normal pure-tone thresholds than fair-eyed workers. Fair-eyed workers had threshold averages of 25.1 dB (right ear) and 26.0 dB (left ear) at 3, 4, and 6 kHz, which were significantly worse than workers with dark irises, with threshold averages of 15.8 dB and 17.2 dB in the right and left ear, respectively (p<0.01). Fair-eyed workers with less than 10 years of noise exposure had the same audiometric pattern as the dark-eyed workers exposed for more than 10 years. Workers not exposed to noise did not present significant differences in their audiometric pattern as a function of eye colour. These results suggest that iris pigmentation may be an additional indication of susceptibility to noise-induced hearing loss.

Is the relation of social class to change in hearing threshold levels from childhood to middle age explained by noise, smoking, and drinking behaviour?

from the International Journal of Audiology

Recent work shows that variation in adult hearing function is related both to social class of origin and current social class. This study examines how much of this relationship after adjustment for childhood hearing impairment is explicable by occupational noise, current smoking, and alcohol consumption. A cohort of 9023 persons born in the UK during one week in 1958 was followed periodically, and hearing threshold levels (HTLs) were measured at 1 kHz and 4 kHz at age 45 years. Most (71% and 68%, at 1 kHz and 4 kHz respectively) of the relation to social class of origin of adult HTLs remains after adjustment for these other factors. For the relation to current social class, corresponding values are 64% and 44% (though varying by gender). The magnitude of social class effect is comparable to that of occupational noise. Susceptibility to hearing impairment is likely to be appreciably determined in early childhood.

The effect of hearing impairment in older people on the spouse

from the International Journal of Audiology

The prevalence of hearing impairment (HI) in older people and its detrimental effects on their quality of life and well-being is well known. To date however, there have been few studies investigating the impact on the person’s spouse. To investigate this topic, a qualitative study consisting of in-depth interviews was conducted with five female and five male spouses of older people with HI. The aims of the study were: (1) to describe the spouses’ experiences of living with someone with a HI; (2) to describe the effect of HI on the couples’ communication and relationship; and (3) to identify coping strategies adopted by spouses. An interpretive analysis revealed four themes that described the experience of spouses of older people with HI: (1) the broad ranging effects of the HI on the spouses’ everyday lives; (2) the spouses’ need to constantly adapt to their partners’ HI; (3) the effect of acceptance of the HI on the spouse; and (4) the impact of ageing and retirement. Spouses in this study experienced a wide range of effects as a result of their partners’ HI. Implications for audiological rehabilitation are discussed.

The risk of tinnitus following occupational noise exposure in workers with hearing loss or normal hearing

from the International Journal of Audiology

The purpose was to investigate the relationship between noise exposure and tinnitus among workers with normal hearing and hearing loss, respectively. We conducted a cross-sectional survey of 752 workers employed at 91 workplaces, that were investigated by means of full work-shift noise levels, questionnaire data, and bilateral pure-tone audiometry. Tinnitus was not associated with the present noise level, the duration of noise exposure, or the cumulative noise exposure if participants had normal hearing. As expected, such trends were demonstrated if participants had a hearing handicap. Based on these data, we will be cautious in ascribing tinnitus to noise exposure in our patients’ workplaces if they have a normal audiogram. Furthermore our data indicates no risk of noise-induced tinnitus at exposure levels where no hearing loss would be expected, e.g. as usually encountered in non-industrial workplaces.

Cataract Prevalence, Alternative Glaucoma Therapies Online, Seatbelts Vs. Airbags, And Hearing Loss In Glaucoma Patients

from Medical News Today.com

An Eye Disease or Systemic Disorder? Hearing Loss Study Adds to the Evidence Shahin Yazdani, MD, and his research team evaluated whether patients with ocular pseudoexfoliation syndrome—the most common cause worldwide of the form of glaucoma known as “secondary open angle”—had a higher incidence of hearing loss. In ocular pseudoexfoliation (also called “exfoliation”) syndrome, fibrous white deposits aggregate on the iris, lens and other parts of the eye and can block fluid drainage; this blockage increases intraocular pressure, which can damage the optic nerve. Similar fibrillar deposits have been found in the heart, blood vessels, lung, liver, kidneys and skin of patients with ocular pseudoexfoliation. In addition, pseudoexfoliation has been associated with ischemic heart disease. systemic hypertension, aneurysms, Alzheimer’s disease, and age-related macular degeneration (AMD). The researchers hypothesized that the hearing organs might also be affected after noticing hearing disability in many pseudoexfoliation patients.

Chimp and human communication trace to same brain region

from EurekAlert.org

An area of the brain involved in the planning and production of spoken and signed language in humans plays a similar role in chimpanzee communication, researchers report online on February 28th in the journal Current Biology, a publication of Cell Press.

Impact of early hearing screening and treatment on language development and education level: Evaluation of 6 years of universal newborn hearing screening (ALGO((R))) in Flanders, Belgium

from the International Journal of Pediatric Otorhinolaryngology

OBJECTIVES: Early intervention in hearing-impaired children may improve language outcomes and subsequent school and occupational performance. The objective of this study was to retrospectively analyze over 6 years the educational outcome and language development of a first cohort of children, detected by the Flemish universal newborn hearing screening (UNHS) program based on automated auditory brainstem response (AABR), with the oldest children being in primary school. METHODS: We studied 229 hearing-impaired children from 1998 till 2003. The following variables were considered: the age during the school year 2005-2006, the degree of hearing loss, additional impairments including presence of intellectual disability, school placement and early intervention. RESULTS: Analysis showed that 85.4% of the children with moderate, severe or profound hearing loss and no additional disability, older than 5.5 years, reach mainstream education. Further detailed description was provided for the outcomes of children with uni- and bilateral cochlear implants. Overall results stress that 46% of all children with a cochlear implant obtain mainstream education. Of all cochlear implant (CI) children above 5.5 years, without additional handicaps, 78.9% of children attend primary mainstream school. Data on language development show that up to 45% of the children with unilateral cochlear implant and no additional disabilities had normal to slight delay on language development. These data are fulfilling the goals stated by the JCIH and the American Academy of Pediatrics (AAP) in 2000. The role and impact of additional handicaps is discussed. The importance of early hearing loss identification and hearing therapy for appropriate language development is highlighted. Finally our preliminary results on children with bilateral cochlear implants without additional handicaps present an improved language development in comparison to unilateral CI-children. CONCLUSION: A vast majority of the children detected by the UNHS program, with moderate, severe or profound hearing loss and no additional disability, older than 5.5 years, reach mainstream education. Additional disabilities have a major influence.

Performance benefits for adults using a cochlear implant with adaptive dynamic range optimization (ADRO): a comparative study

from Cochlear Implants Internations

The aim of this study was to assess the qualitative and quantitative benefits for speech-recognition ability of a preprocessing strategy known as adaptive dynamic range optimization (ADRO), used in conjunction with the subject’s standard MAP, in comparison with the subject’s standard MAP alone, for a group of experienced German-speaking adults using the Nucleus® 24 Cochlear implant.
In a prospective, single-subject, comparative study design, experienced adult CI-users were asked to trial and compare both their standard MAP and the newly fitted ADRO MAP (ADRO MAP fitting - week 0) following a take-home trial period of 5 weeks. Assessment of speech recognition ability performed in quiet (at 50, 60 and 70 dB SPL) and adaptively in noise was carried out repeatedly in two test sessions in weeks 5 and 7 (ADRO MAP postfitting) using both MAPs. The order of speech tests and MAPs tested was counterbalanced across the test sessions to control for potential learning effects during the study. Subjective assessments were performed at week 0 to assess details of current usage. Comparative subjective assessments were carried out at weeks 5 and 7 to obtain impressions of loudness of environmental sounds and speech understanding in a variety of conversational situations with both MAPs and finally MAP preference judgements.
Fifteen adult, German-speaking, experienced implant users wearing their body-worn SPrint processor for a minimum of six hours and up to 16 hours per day were enrolled in the study across three university clinic hospitals in Germany.
On average, speech-reception thresholds (SRT) were significantly improved with the ADRO MAP compared to using the standard MAP for all speech materials in quiet. The mean advantage for SRT values with the ADRO MAP was 2.9 dB, ± 2.8 dB (p = 0.002) for the Freiburger Numbers test and 3.3 dB, ± 3.2 dB (p = 0.008) for the Freiburger Monosyllabic Words test. In noise, the ADRO MAP led to a significant improvement for the group for the mean signal-to-noise ratio required for a 50% speech recognition score (SNR 50) for the Oldenburger sentences of 1.74 dB, ± 3.2 dB (p = 0.048). Comparison of subjective impressions of loudness of environmental sounds revealed no significant difference in the ratings observed with either MAP. For speech understanding in a variety of listening situations, 35% of subjects preferred the ADRO MAP, 29% preferred the standard MAP whereas 36% reported no difference. Statistically the MAP preferences for the groups were not significant, however a significant MAP preference was noted in four subjects for the ADRO MAP and in two subjects for the standard MAP.
Our study results demonstrate significant benefits of ADRO for speech recognition ability in quiet and in noise for both soft and conversational levels of speech. For the majority of subjects, both the ADRO and standard MAPs were found to be useful on a daily basis. No reductions in performance were noted for speech recognition or loudness scaling judgements of environmental sounds when using the newly fitted ADRO MAP, suggesting a smooth transition to the use of the preprocessing algorithm. It is recommended that an ADRO MAP be provided for all CI users as an additional program option to offer potential added benefit in select environments. Copyright © 2008 John Wiley & Sons, Ltd.

The influence of syllable onset complexity and syllable frequency on speech motor control

from Brain and Language

Functional imaging studies have delineated a “minimal network for overt speech production”, encompassing mesiofrontal structures (supplementary motor area, anterior cingulate gyrus), bilateral pre- and postcentral convolutions, extending rostrally into posterior parts of the inferior frontal gyrus (IFG) of the language-dominant hemisphere, left anterior insula as well as bilateral components of the basal ganglia, the cerebellum, and the thalamus. In order to further elucidate the specific contribution of these cerebral regions to speech motor planning, subjects were asked to read aloud visually presented bisyllabic pseudowords during functional magnetic resonance imaging (fMRI). The test stimuli systematically varied in onset complexity (CCV versus CV) and frequency of occurrence (high-frequency, HF versus low-frequency, LF) of the initial syllable. A cognitive subtraction approach revealed a significant main effect of syllable onset complexity (CCV versus CV) at the level of left posterior IFG, left anterior insula, and both cerebellar hemispheres. Conceivably, these areas closely cooperate in the sequencing of subsyllabic aspects of the sound structure of verbal utterances. A significant main effect of syllable frequency (LF versus HF), by contrast, did not emerge. However, calculation of the time series of hemodynamic activation within the various cerebral structures engaged in speech motor control revealed this factor to enhance functional connectivity between Broca’s area and ipsilateral anterior insula.

Cochlear Implant Supports an Author’s Active Life

from the New York Times

Josh Swiller was 22 and profoundly deaf when he applied to the Peace Corps in search of adventure. And indeed, adventure he found. His experiences in Zambia are eloquently recounted in his hard-to-put-down memoir of deafness and Africa, “The Unheard” (Holt, 2007). . . .

Functional outcome after total and subtotal glossectomy with free flap reconstruction

from Head and Neck

Background
The aim of this study was to evaluate postoperative oral functions of patients who had undergone total or subtotal (75%) glossectomy with preservation of the larynx for oral squamous cell carcinomas.

Methods
Speech intelligibility and swallowing capacity of 17 patients who had been treated between 1992 and 2002 were scored and classified using standard protocols 6 to 36 months postoperatively. The outcomes were finally rated as good, acceptable, or poor.

Results
The 4-year disease-specific survival rate was 64%. Speech intelligibility and swallowing capacity were satisfactory (acceptable or good) in 82.3%. Only 3 patients were still dependent on tube feeding. Good speech perceptibility did not always go together with normal diet tolerance, however.

Conclusions
Our satisfactory results are attributable to the use of large, voluminous soft tissue flaps for reconstruction, and to the instigation of postoperative swallowing and speech therapy on a routine basis and at an early juncture. © 2008 Wiley Periodicals, Inc. Head Neck, 2008

Speech Handicap Index in patients with oral and pharyngeal cancer: Better understanding of patients’ complaints

from Head and Neck

Background
A Speech Handicap Index (SHI) questionnaire with 30 items on speech problems was developed and validated in 92 patients with cancer of the oral cavity or pharynx and 110 healthy subjects.

Methods
All subjects completed the SHI and the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Head & Neck module (QLQ-H&N35). Twenty-nine patients completed the SHI twice to assess test-retest reliability.

Results
Factor analysis identified 2 well-defined subscales, assessing speech function and psychosocial functioning related to speech. Internal consistency and test-retest reliability were high. Construct validity was evidenced by its ability to distinguish between patient subgroups formed on the basis of tumor grade. A cut-off score of 6 points was defined to identify patients with speech problems.

Conclusions
Results of this initial psychometric study indicate that the SHI is a reliable and valid questionnaire for assessing speech problems. Additional research is needed to evaluate responsiveness of the questionnaire to changes in speech-related problems over time. © 2008 Wiley Periodicals, Inc. Head Neck, 2008

Aphasia during the Acute Phase in Ischemic Stroke

from Cerebrovascular Diseases

Objectives: We investigated the incidence, clinical characteristics, outcome and factors associated with aphasia and early improvement in acute ischemic stroke. Methods: We consecutively studied 855 patients with acute ischemic stroke who were admitted to our hospital within 48 h after onset and who were not comatose on admission. Assessment of aphasia was performed on admission (day 0) and day 10. We examined the incidence, severity, and subtypes of aphasia, and compared the clinical background of patients with and without aphasia on admission, and also those with and without early improvement by day 10. In addition, we investigated the independent factors associated with the presence of aphasia on admission and with early improvement. Results: Of the 855 patients, 130 (15.2%) had aphasia on admission. The National Institutes of Health Stroke Scale (NIHSS) on admission (OR 1.21; 95% CI 1.17-1.26) was a significant and independent factor associated with the presence of aphasia on admission. Early improvement was seen in 56 of 121 aphasic patients (46.3%) who were still alive on day 10. A history of hypercholesterolemia (OR 3.27; 95% CI 1.14-9.39) was a significant and independent factor associated with early improvement in aphasia during the acute phase and NIHSS on admission (OR 0.95; 95% CI 0.90-0.99) was marginally significant. Conclusion: It is difficult to predict the outcome of aphasia within the first few days after the onset of ischemic stroke.

Development of word reading fluency and spelling in a consistent orthography: An 8-year follow-up

from the Journal of Educational Psychology

In a longitudinal study, development of word reading fluency and spelling were followed for almost 8 years. In a group of 115 students (65 girls, 50 boys) acquiring the phonologically transparent German orthography, prediction measures (letter knowledge, phonological short-term memory, phonological awareness, rapid automatized naming, and nonverbal IQ) were assessed at the beginning of Grade 1; reading fluency and spelling were tested at the end of Grade 1 as well as in Grades 4 and 8. Reading accuracy was close to ceiling in all reading assessments, such that reading fluency was not heavily influenced by differences in reading accuracy. High stability was observed for word reading fluency development. Of the dysfluent readers in Grade 1, 70% were still poor readers in Grade 8. For spelling, children who at the end of Grade 1 still had problems translating spoken words into phonologically plausible letter sequences developed problems with orthographic spelling later on. The strongest specific predictors were rapid automatized naming for reading fluency and phonological awareness for spelling. Word recognition speed was a relevant and highly stable indicator of reading skills and the only indicator that discriminated reading skill levels in consistent orthographies. Its long-term development was more strongly influenced by early naming speed than by phonological awareness. (PsycINFO Database Record (c) 2008 APA, all rights reserved)