Monthly Archives: September 2009
Modular MSc in Advanced Audiology Central Auditory Processing: Current Research & Implications for Clinical Practice
Philippa Henderson or Ricky Kemp
Event Tel: Tel: +44 (0)20 7679 8909 / 64
Event Website: Web: www.ucl.ac.uk/ear/training/masterclasses
Event Email: Email: philippa.henderson@ucl.ac.uk
Where:London
When:02 Dec 2009 10:00 – 04 Dec 2009 16:00
from NHS Evidence
The University of Toronto Temporal Bone Course 2009
Event Contact: Contact: Brenda Longo
Event Tel: Tel: +1 416 340 4630
Event Fax: Fax: +1 416 340 3327
Event Email: Email: brenda.longo@uhn.on.ca
Where:Toronto, Canada
When:14 Oct 2009 09:30 – 16 Oct 2009 16:30
from NHS Evidence
Findings at exploratory tympanotomy for conductive hearing loss
Introduction: Despite advances in imaging and other diagnostic tests, it is often impossible to establish with confidence a pre-operative diagnosis in a patient with a conductive hearing loss.
Methods: We studied a series of 340 exploratory tympanotomies for conductive hearing loss carried out by a single surgeon.
Results: The most common operative diagnosis was otosclerosis (n = 164, 48.2 per cent). Ossicular discontinuity was found more commonly than previously reported (n = 103, 30.3 per cent). A small but significant number of patients were found to have cholesteatoma (n = 7.2 per cent).
Conclusions: This information is of value when discussing potential findings at surgery for conductive hearing loss. While otosclerosis is the commonest finding in such cases, a significant number of patients have defects of the ossicular chain.
from the Journal of Laryngology and Otology
Marsupialisation and strap muscle transposition laryngoplasty for vocal cysts with vocal fold atrophy
Objectives: Vocal cysts with fold atrophy often result in more severe glottal incompetence than vocal cysts along during phonation. Although total excision or marsupialisation are reliable treatments for vocal fold cysts, any post-operative vocal deficit with significant glottal gap will need further treatment. This study aimed to evaluate the efficacy of combined treatment consisting of marsupialisation of the cyst immediately followed by strap muscle transposition laryngoplasty.
Method: Under direct laryngomicroscopy, microscissors were used to make a disc-shaped incision encircling the equator of the cyst. After marsupialisation of the cyst, a simultaneous medialisation laryngoplasty with strap muscle transposition was performed.
Results: Seven patients with vocal cysts and marked vocal fold atrophy were included in the study. After surgery, subjective improvement in voice quality was reported by all patients. Patients’ glottal incompetence and vocal performance were markedly improved.
Conclusion: Marsupialisation is a simple and effective surgical technique for vocal fold cysts. For cases of vocal cysts with marked vocal fold atrophy, marsupialisation followed by medialisation laryngoplasty with strap muscle transposition may be considered.
from the Journal of Laryngology and Otology
Mobile, one stage, bilateral ear surgery for chronic otitis media patients in remote areas
Objectives: We evaluated the results of mobile, one stage, bilateral ear surgery conducted in Greenland, where chronic otitis media with and without suppuration is prevalent. The study aimed to increase the number of operations conducted and to reduce the cost of ear surgery in remote areas.
Materials and methods: The study was longitudinal and prospective, with a two-year follow up. Seventeen East Greenlandic patients with bilateral chronic suppurative otitis media or chronic otitis media were selected. Their median age was 16 years; 53 per cent were female and 47 per cent male. Hearing was assessed using median air conduction pure tone average gain, and the ‘take rate’ (i.e. the percentage of total ears with a closed perforation) was evaluated.
Results: All patients attended for follow up. Eighty-two per cent had at least one perforation closed, and the overall take rate was 65 per cent of the 34 ears. The median air conduction pure tone average gain after two years was 18 dB and 13 dB for the right and left ears, respectively. Fourteen patients (82 per cent) obtained an air conduction pure tone average hearing level of ≤25 dB in at least one ear. In total, 71 per cent of the patients were satisfied. There were no hearing hazards.
Conclusions: The results of mobile, one stage, bilateral ear surgery conducted in Greenland for long-lasting chronic suppurative otitis media and chronic otitis media were acceptable and safe, and more ears underwent surgery at reduced cost compared with unilateral ear surgery.
from the Journal of Laryngology and Otology
A Nonword Repetition Task for Speakers With Misarticulations: The Syllable Repetition Task (SRT)
Purpose: Conceptual and methodological confounds occur when non(sense) word repetition tasks are administered to speakers who do not have the target speech sounds in their phonetic inventories or who habitually misarticulate targeted speech sounds. In this article, the authors (a) describe a nonword repetition task, the Syllable Repetiton Task (SRT), that eliminates this confound and (b) report findings from 3 validity studies.
Method: Ninety-five preschool children with speech delay and 63 with typical speech completed an assessment battery that included the Nonword Repetition Task (NRT; C. Dollaghan & T. F. Campbell, 1998) and the SRT. SRT stimuli include only 4 of the earliest occurring consonants and 1 early occurring vowel.
Results: Study 1 findings indicated that the SRT eliminated the speech confound in nonword testing with speakers who misarticulate. Study 2 findings indicated that the accuracy of the SRT to identify expressive language impairment was comparable to findings for the NRT. Study 3 findings illustrated the SRT’s potential to interrogate speech processing constraints underlying poor nonword repetition accuracy. Results supported both memorial and auditory–perceptual encoding constraints underlying nonword repetition errors in children with speech-language impairment.
Conclusion: The SRT appears to be a psychometrically stable and substantively informative nonword repetition task for emerging genetic research and other research with speakers who misarticulate.
Behavior Predictors of Language Development Over 2 Years in Children With Autism Spectrum Disorders
Purpose: This exploratory study examined predictive relationships between 5 types of behaviors and the trajectories of vocabulary and language development in young children with autism over 2 years.
Method: Participants were 69 children with autism assessed using standardized measures prior to the initiation of early intervention (T1) and 6 months (T2), 12 months (T3), and 24 months (T4) later. Growth curve modeling examined the extent to which behaviors at T1 and changes in behaviors between T1 and T2 predicted changes in development from T1 to T4.
Results: Regardless of T1 nonverbal IQ and autism severity, high scores for inattentive behaviors at T1 predicted lower rates of change in vocabulary production and language comprehension over 2 years. High scores for social unresponsiveness at T1 predicted lower rates of change in vocabulary comprehension and production and in language comprehension over 2 years. Scores for insistence on sameness behaviors, repetitive stereotypic motor behaviors, and acting-out behaviors at T1 did not predict the rate of change of any child measure over 2 years beyond differences accounted for by T1 autism severity and nonverbal IQ status.
Directional Effects on Infants and Young Children in Real Life: Implications for Amplification
Method: Twenty-seven children (11 with normal hearing, 16 with impaired hearing) between 11 and 78 months of age were video recorded in naturalistic settings for analyses of head orientation. Reports on daily activities were obtained from caregivers. The effect of directionality in different environments was quantified by measuring the Speech Transmission Index (STI; H. J. M. Steeneken & T. Houtgast, 1980).
Results: Averaged across 4 scenarios, children looked in the direction of a talker for 40% of the time when speech was present. Head orientation was not affected by age or hearing status. The STI measurements revealed a directional advantage of 3 dB when a child looked at a talker but a deficit of 2.8 dB when the talker was sideways or behind the child. The overall directional effect in real life was between –0.4 and 0.2 dB.
Conclusions: The findings suggest that directional microphones in personal hearing devices for young children are not detrimental and have much potential for benefits in real life. The benefits may be enhanced by fitting directionality early and by counseling caregivers on ways to maximize benefits in everyday situations.
Effects of It Takes Two to Talk—The Hanen Program for Parents of Preschool Children With Cerebral Palsy: Findings From an Exploratory Study
Purpose: To investigate whether It Takes Two to Talk—The Hanen Program for Parents of Preschool Children With Cerebral Palsy is associated with change in interaction between children who have motor disorders and their parents.
Method: Eleven children aged 19–36 months who had nonprogressive motor disorders that affected their communication, and their mothers, were observed 4 months and 1 month before mothers attended It Takes Two to Talk training, and 1 month and 4 months after its completion.
Results: Interaction patterns were stable prior to training. After training, mothers initiated less and produced more responses and fewer requests. Children produced more initiations, as well as more requests and provisions of information, after training. Mothers’ linguistic input did not change in amount or complexity. Changes were maintained 4 months later. Mothers’ views of parenting did not change.
Conclusions: It Takes Two to Talk may be associated with positive communication change for this group. Further investigation of its clinical effectiveness is warranted.
Epidemiology of Speech and Language Impairment in a Nationally Representative Sample of 4- to 5-Year-Old Children
Results: Parent-reported prevalence: 25.2% had concerns about how their child talked and made speech sounds (11.8% “concerned”; 13.4% “a little concerned”), and 9.5% had concerns about how their child understood language (4.4% “concerned”; 5.1% “a little concerned”). Parents who reported concerns identified “speech not clear to others” as the most frequent area of difficulty (12.0%). Teacher-reported prevalence: 22.3% of children were considered to be less competent than others in their expressive language ability (6.7% “much less competent”; 15.6% “less competent”); 16.9% were considered to be less competent than others in their receptive language ability (4.0% “much less competent”; 12.9% “less competent”). The match between parent and teacher identification was higher for expressive speech and language concern than for receptive language. Direct assessment: 13.0% of children were 1–2 SDs below the mean on the Adapted Peabody Picture Vocabulary Test–III (S. Rothman, 2003), and a further 1.7% were > 2 SDs below the mean. Parent and teacher reports were significantly correlated with scores obtained via direct assessment. Period prevalence: Parents and teachers reported that 14.5% of children had accessed speech-language pathologist (SLP) services. 2.2% indicated that they needed but could not access an SLP.
Conclusion: Multiple indicators of speech and language impairment in diverse contexts confirmed the high prevalence of this condition in early childhood and a concomitant need for SLP services.
Facilitating the participation of people with aphasia in research: a description of strategies
Aim: To suggest strategies and techniques for research in people with aphasia based upon experiences in conducting research in this group of people.
Methods: We conducted a qualitative study and a quantitative study in people with aphasia concerning their social participation. In these studies different strategies were developed based upon the literature, conversations with people with aphasia and speech and language therapists, to facilitate the inclusion of people with aphasia, even those with severe communication problems. Several strategies were evaluated. The strategies used and our experiences are outlined in this report.
Main contribution: It is possible to conduct research in this group. Several strategies were helpful to make this mission possible: the use of pre-structured diaries, the use of in-depth interviews with attention to non-verbal communication, the use of existing measurements, adjusted for people with aphasia by: using pictograms, placing one question per page, bolding the key concepts in the question, using large font, visualizing the answering possibilities in words and in pictures, reducing the question length, and excluding negatives in the question.
Conclusion: Research in people with aphasia is possible when using strategies adjusted to the communicative impairment.
Language Features in a Mother and Daughter of a Chromosome 7;13 Translocation Involving FOXP2
Purpose: The aims of this study were (a) to locate the breakpoints of a balanced translocation (7;13) within a mother (B) and daughter (T); (b) to describe the language and cognitive skills of B and T; and (c) to compare this profile with affected family members of the KE family who have a mutation within FOXP2.
Method: The breakpoint locations for T and B were identified by use of fluorescent in situ hybridization analysis followed by DNA sequencing using long-range polymer chain reaction amplification methods. The cognitive and language characteristics were obtained via the use of standardized tests of intelligence, receptive and expressive vocabulary and sentence use, and a spontaneous language sample.
Results: The translocation breakpoints in T and B were found in FOXP2 on chromosome 7 and in RFC3 on chromosome 13. T and B’s pattern of relative strengths and weaknesses across their cognitive and language performance was found to be similar to descriptions of the affected KE family members.
Conclusions: Prior reports of individuals with chromosomal rearrangements of FOXP2 have emphasized their speech impairment. This study provides additional evidence that language—in particular, grammar—is likely to be influenced by abnormalities of FOXP2 function.
Objective Measures of Listening Effort: Effects of Background Noise and Noise Reduction
Purpose: This work is aimed at addressing a seeming contradiction related to the use of noise-reduction (NR) algorithms in hearing aids. The problem is that although some listeners claim a subjective improvement from NR, it has not been shown to improve speech intelligibility, often even making it worse.
Method: To address this, the hypothesis tested here is that the positive effects of NR might be to reduce cognitive effort directed toward speech reception, making it available for other tasks. Normal-hearing individuals participated in 2 dual-task experiments, in which 1 task was to report sentences or words in noise set to various signal-to-noise ratios. Secondary tasks involved either holding words in short-term memory or responding in a complex visual reaction-time task.
Results: At low values of signal-to-noise ratio, although NR had no positive effect on speech reception thresholds, it led to better performance on the word-memory task and quicker responses in visual reaction times.
Conclusions: Results from both dual tasks support the hypothesis that NR reduces listening effort and frees up cognitive resources for other tasks. Future hearing aid research should incorporate objective measurements of cognitive benefits.
Tongue Movements During Water Swallowing in Healthy Young and Older Adults
Purpose: The purpose of this study was to explore the nature and extent of variability in tongue movement during healthy swallowing as a function of aging and gender. In addition, changes were quantified in healthy tongue movements in response to specific differences in the nature of the swallowing task (discrete vs. sequential swallows).
Method: Electromagnetic midsagittal articulography (EMMA) was used to study the swallowing-related movements of markers located in midline on the anterior (blade), middle (body), and posterior (dorsum) tongue in a sample of 34 healthy adults in 2 age groups (under vs. over 50 years of age). Participants performed a series of reiterated water swallows, in either a discrete or a sequential manner.
Results: This study shows that age-related changes in tongue movements during swallowing are restricted to the domain of movement duration. The authors confirm that different tongue regions can be selectively modulated during swallowing tasks and that both functional and anatomical constraints influence the manner in which tongue movement modulation occurs. Sequential swallowing, in comparison to discrete swallowing, elicits simplification or down-scaling of several kinematic parameters.
Conclusion: The data illustrate task-specific stereotyped patterns of tongue movement in swallowing, which are robust to the effects of healthy aging in all aspects other than movement duration.
