Monthly Archives: February 2009
A critical review of King-Kopetzky syndrome: Hearing difficulties, but normal hearing?
Abstract
King-Kopetzky syndrome (KKS) is the condition in which an individual complains of having difficulties understanding speech in background noise but has normal hearing thresholds on pure tone audiometry. KKS is a relatively common condition and recognized as a clinically unique group in the audiological or ENT clinics (about 1-10%). The absence of any abnormal audiometric findings to explain their hearing difficulties leaves the clinicians or audiologists with a diagnostic dilemma and presents difficulties in dealing with the patients. Consequently, in the past they have often simply been reassured or even been recognized as non-organic hearing loss or psychological or neurotic. With developments in audiological technology and in hearing physiology, comprehensive test protocols have been developed to identify the possible pathogenesis underlying patients with KKS. The purpose of this paper is to review the advances in the development of sensitized and objective assessments of subclinical auditory dysfunction in patients with KKS. This should be valuable to provide guidelines on the pathogenesis and consequently lead towards a better understanding of KKS. Appropriate approaches to the process of rehabilitative management of patients with King-Kopetzky syndrome are also discussed.
Treatment outcome in patients undergoing surgery for carcinoma larynx and hypopharynx – a follow-up study
Conclusions: Compared with larynx cancers salvage rates are poorer for hypopharyngeal cancers and the role of primary surgery seems to be significantly higher and more decisive in overall survival (OS). Hypopharyngeal cancers therefore warrant a closer follow-up after an organ preservation protocol, to detect recurrence at the earliest stage and plan for an effective salvage surgery. Objective: To evaluate the survival and morbidity of patients treated by surgery for carcinoma of the larynx and hypopharynx according to site. Patients and methods: All patients who had undergone laryngectomy at the Division of Surgical Oncology Regional Cancer Center (RCC) from June 1995 to December 2005 were included in the study, which retrospectively recorded the age and sex distribution, TNM stage, indication, type of laryngectomy and reconstructive option used. The therapeutic outcome, disease-free survival (DFS), OS, voice preservation and postoperative voice rehabilitation were analysed. Results: Of a total of 167 cases, 123 (74%) had salvage surgery for failed chemoradiotherapy/radical radiotherapy and 44 (26%) had primary surgical treatment. Conservation surgery was undertaken in 4 cases, near total laryngectomy or pharyngectomy (NTL/NTLP) was done in 14 and total laryngectomy (TLPE) with gastric pull up was done in 5. Total laryngectomy (TL) or TL with partial or subtotal pharyngectomy was done in 144 cases. Concomitant neck dissection (ND) was done in 46 cases, 14 posterolateral selective, 15 radical neck dissections (RNDs), 2 extended RNDs, 12 bilateral NDs and 3 modified neck dissections (MNDs). Five patients received platinum-based neoadjuvant chemotherapy and nine had postoperative chemotherapy. In 116 patients the pharyngeal remnant was closed primarily, 21 patients had pectoralis major myocutaneous flap patch reconstruction, 18 had tubed pectoralis major myocutaneous (PMMC) flap reconstruction, 4 had folded (bipaddled) PMMC flap reconstruction, 7 had PMMC and 3 patients had deltopectoral (DP) flap for skin cover. Pathological margin positivity was seen in seven cases and perinodal disease was seen in nine. There was a statistically significant survival difference between salvage and primary surgical cases among cancers of the larynx and hypopharynx. Hypopharyngeal salvage rate was significantly lower in the present study. Sixty-two (37%) patients had postoperative leaks. Five leaks persisted to form pharyngocutaneous fistulae. All of these patients had either wound infection with or without flap necrosis or previous radiation. Two were repaired and in two cases speech prosthesis insertion was possible due its anatomical position. One patient refused further surgical closure after a partially failed repair. Fifty-six (34%) patients recurred locoregionally, 4 (2.3%) patients developed a second primary and 5 (2.9%) had distant metastasis. Thirty patients were voice rehabilitated with an electronic larynx. Seventeen patients had voice prosthesis insertion (6 primary and 10 secondary), 3 patients developed good oesophageal speech and voice preservation was possible in 18 patients. Seventy-nine patients were alive at the time of completing the study.
Frequency distribution of synchronized spontaneous otoacoustic emissions showing sex-dependent differences and asymmetry between ears in 2- to 4-day-old neonates
Conclusions
The overall distribution of frequency of SSOAEs in 2- to 4-day-old neonates had the similar mature ‘peak-valley-peak’ distribution pattern seen in adults. Significant sex-dependent differences of the SSOAEs frequency distributions have been found. However, only slight ear asymmetries of the SSOAEs frequency distributions can observed in this age group.
from the International Journal of Pediatric Otorhinolaryngology
Original Study Comparison of the use of tympanic and extratympanic electrodes for electrocochleography
Conclusions:
Both electrodes were effective for EchoG evaluation, but the extratympanic one was easier to insert and did not cause discomfort. However, the tympanic electrode produced tracings of greater amplitude and of better reproducibility. Laryngoscope, 119:563-566, 2009
from Laryngoscope
Language in Isolation, and Its Implications for Variation and Change
ABSTRACT
This article discusses some approaches to the conceptualization of isolation in sociolinguistic research. It argues that isolation is a multifaceted phenomenon with geographic, social and attitudinal implications. Based on evidence from geographically isolated speech communities (mostly islands) and socially isolated ones (so-called Sprachinseln) from around the world, it discusses their potential for variation and change studies, both in terms of synchrony (contact phenomena, language obsolescence or revival and intensification, language and identity, etc.) and diachrony, because they provide showcase scenarios to look into and reconstruct mechanisms of contact linguistics (e.g. new-dialect formation), founder effects, colonial lag, etc
Weighting of vowel cues explains patterns of word–object associative learning
ABSTRACT
Previous research has demonstrated that infants under 17 months have difficulty learning novel words in the laboratory when the words differ by only one consonant sound, irrespective of the magnitude of that difference. The current study explored whether 15-month-old infants can learn novel words that differ in only one vowel sound. The rich acoustic/phonetic properties of vowels allow for a detailed analysis of the contribution of acoustic/phonetic cues to infants’ performance with similar-sounding words. Infants succeeded with the vowel pair /i/–/I/, but failed with vowel pairs /i/–/u/ and /I/–/u/. These results suggest that infants initially use the most salient acoustic cues for vowels and that this staged use of acoustic cues both predicts and explains why infants can learn some words that differ in only a single vowel.
Speech-perception-in-noise deficits in dyslexia
ABSTRACT
Speech perception deficits in developmental dyslexia were investigated in quiet and various noise conditions. Dyslexics exhibited clear speech perception deficits in noise but not in silence. Place-of-articulation was more affected than voicing or manner-of-articulation. Speech-perception-in-noise deficits persisted when performance of dyslexics was compared to that of much younger children matched on reading age, underscoring the fundamental nature of speech-perception-in-noise deficits. The deficits were not due to poor spectral or temporal resolution because dyslexics exhibited normal ‘masking release’ effects (i.e. better performance in fluctuating than in stationary noise). Moreover, speech-perception-in-noise predicted significant unique variance in reading even after controlling for low-level auditory, attentional, speech output, short-term memory and phonological awareness processes. Finally, the presence of external noise did not seem to be a necessary condition for speech perception deficits to occur because similar deficits were obtained when speech was degraded by eliminating temporal fine-structure cues without using external noise. In conclusion, the core deficit of dyslexics seems to be a lack of speech robustness in the presence of external or internal noise.
Alexia With and Without Agraphia: An Assessment of Two Classical Syndromes
Conclusion: Some cases of pure alexia may be a perceptual word-form agnosia, with loss of internal representations of letters and words, while the angular gyral syndrome of alexia with agraphia is a linguistic deep dyslexia. The presence or absence of agraphia does not always distinguish between the two; rather, writing can mirror the reading deficits, being more obvious and profound in the case of an angular gyral syndrome.
Unusual complication following trauma to a bone-anchored hearing aid: case report and literature review
Abstract
Objective: We report the second published case of a child with a serious traumatic injury involving the fixture and abutment of their bone-anchored hearing aid.
Method: Case reports and review of the world literature concerning unusual complications following trauma to bone-anchored hearing aids.
Results: A nine-year-old girl with Dubowitz syndrome sustained an intrusion injury of her bone-anchored hearing aid fixture and abutment following a fall. No other injury was sustained, and there was no neurological complication. The patient underwent immediate removal of the implant and subsequently made a full recovery. Such serious and unusual complications are fortunately very rare. On review of the literature, four cases of similar complications were identified. Only one involved a traumatic injury in a child.
Conclusion: Provision of bone-anchored hearing aids involves many clinicians. All clinicians involved in this procedure must be aware of the need to monitor their patients carefully, and to remember that unusual and unexpected complications, although rare, do happen. The patient’s need for care continues long after the surgery is complete.
(Accepted April 07 2008)
from the Journal of Laryngology and Otology
Sudden hearing loss due to fibromuscular dysplasia
Abstract
Objective: This case is reported in order to demonstrate the importance of detailed clinical analysis, including evaluation of personal and family history, in the differential diagnosis of sudden sensorineural hearing loss.
Case report: A 50-year-old woman presented with a sudden onset of sensorineural hearing loss in her right ear. She had experienced three previous episodes of sudden sensorineural hearing loss in her left ear, at the ages of 35, 48 and 50 years. She also reported suffering two strokes with left hemiparesis due to fibromuscular dysplasia of her right internal carotid artery. A positive family history of stroke among maternal relatives suggested autosomal dominant inheritance. The patient’s personal and family history suggested a rare cause of sudden sensorineural hearing loss, for which alternative therapeutic modalities may be applicable in selected cases.
Conclusions: Careful follow up of any patient with sudden sensorineural hearing loss and evaluation of their personal and family history is essential, in order to uncover evidence of rare underlying causes of sudden sensorineural hearing loss. For patients with such rare diagnoses, alternative therapy and surveillance modalities may be useful in disease management, depending on pre-existing pathology. Those patients should be managed via a multidisciplinary approach, including genetic counselling, in order to achieve the best possible outcome.
from the Journal of Laryngology and Otology
Long-term outcome of children undergoing surgery for suspected perilymph fistula
Abstract
A number of authors have suggested that surgery for suspected perilymph fistula is effective in preventing deterioration of hearing and in improving hearing in some cases in the short term. We present long-term hearing outcome data from 35 children who underwent exploration for presumed perilymph fistula at The Children’s Hospital, Sydney, Australia, between 1985 and 1992.
Methods: The pre-operative audiological data (mean of 500, 1000, 2000 and 4000 Hz results) were compared with the most recently available data (range two to 15 years) and the six-month post-operative data.
Results: The short-term results showed no significant change in hearing at six months, with a subsequent, statistically significant progression of hearing loss in both operated and non-operated ears (Wilcoxon signed rank test: operated ear, p < 0.017; non-operated ear, p < 0.009).
Conclusion: In this case series, exploratory surgery for correction of suspected perilymph fistula did not prevent progression of long-term hearing loss.
from the Journal of Laryngology and Otology
Incidence and quality of vertigo symptoms after cochlear implantation
Conclusion: Exposing patients to the risk of possible balance disorders associated with cochlear implantation is justified in view of the hearing rehabilitation achieved, even with today’s broader indications for cochlear implantation. However, patients should in any case be informed about the possibility and quality of post-operative vertigo symptoms.
from the Journal of Laryngology and Otology
High frequency of heterozygosity in GJB2 mutations among patients with non-syndromic hearing loss
Abstract
Objective: To determine the prevalence of GJB2 mutations among subjects with congenital, non-syndromic, sensorineural hearing loss, within a north Indian population.
Materials and methods: This was a case–control study in which the frequencies of the three most prevalent GJB2 mutations (35delG, W24X and 167delT) were studied. Polymerase chain reaction restriction fragment length polymorphism assays were performed to detect these mutations. The entire coding region of the GJB2 gene was sequenced in all patients, and also in any of their family members who showed GJB2 mutations.
Results: The 35delG mutation was found to be the most prevalent mutation (21 per cent), followed by the W24X mutation (7 per cent). This is the first report of the 35delG mutation in an Indian population. One patient was a compound heterozygote for 35delG/W24X. The 167delT mutation was not observed in any patient.
Conclusions: These findings challenge the classical view that the W24X variant of the GJB2 gene represents a single ‘founder’ mutation.
from the Journal of Laryngology and Otology
‘Isn’t it enough to be a Chinese speaker’: Language ideology and migrant identity construction in a public primary school in Beijing
Abstract
This paper explores the establishment of migrant identities through linguistic and sociolinguistic exchanges in a Beijing public school. Drawing on the data from ethnographic observation and interviews, the research demonstrates how small features of language become emblematic of individual and group identities, and how such identities have an impact on the appraisal of migrant pupils’ performance at school as well as in wider frames of macro-political order which often invoke homogeneism within the dominant language ideologies, emphasizing linguistic uniformity and homogeneity.
Twisting tongues and memories: Explorations of the relationship between language production and verbal working memory
Abstract
Many accounts of working memory posit specialized storage mechanisms for the maintenance of serial order. We explore an alternative, that maintenance is achieved through temporary activation in the language production architecture. Four experiments examined the extent to which the phonological similarity effect can be explained as a sublexical speech error. Phonologically similar nonword stimuli were ordered to create tongue twister or control materials used in four tasks: reading aloud, immediate spoken recall, immediate typed recall, and serial recognition. Dependent measures from working memory (recall accuracy) and language production (speech errors) fields were used. Even though lists were identical except for item order, robust effects of tongue twisters were observed. Speech error analyses showed that errors were better described as phoneme rather than item ordering errors. The distribution of speech errors was comparable across all experiments and exhibited syllable-position effects, suggesting an important role for production processes. Implications for working memory and language production are discussed.
from the Journal of Memory and Language
