B Rajashekhar

Word retrieval ability on semantic fluency task in typically developing Malayalam-speaking children

Word-retrieval abilities in children can be assessed using word generation or verbal fluency task. The ability to retrieve is related to the individual’s ability to retrieve associated words from the mental lexicon in an organized manner. The present study focuses on the developmental aspects of semantic fluency in 1,015 Malayalam-speaking children in the age range of 5 years to 15 years across both genders. The study revealed a developmental trend in the mean total number of correct word scores, number of clusters generated, and switching scores; however, mean cluster size did not show any statistically significant variation. Further, the scores did not vary across genders. Overall, the study indicated a linear developmental trend during verbal fluency with the increase in complexity of strategy use.

Follow-up in newborn hearing screening – A systematic review

INTRODUCTION The quality and efficiency of newborn hearing screening programs (NHS) rely heavily on appropriate follow-up. The Joint Committee on Infant Hearing recommends a follow-up rate of more than 95% of infants who fail the initial hearing screening. However, a 70% benchmark is considered to be more feasible. This high loss to follow-up (LTF) rate acts as a threat to the overall success of NHS programs. The objective of the study was to identify and examine the reported rates of LTF, attributed reasons for LTF and strategies undertaken to reduce LTF. METHODS Using a systematic search, articles published between 2005 to December 2015 were identified from PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Educational Resources Information Center (ERIC), Scopus, Ovid, ProQuest, and Cochrane Library. To be included in the review, the study should be exploring the loss to follow-up or drop-out rate in newborn hearing screening programs and be published in an indexed peer-reviewed journal in the English language. The main outcome measures were overall rate of LTF, factors leading to LTF and measures adopted to overcome LTF. RESULTS 53 articles were short-listed for data extraction. Out of these, 27 were single-centre studies, 19 were multi-centre, 3 compared multiple databases, and 4 used survey-based methods. Overall LTF rates of 20% in single-centre and 21% in multiple-centre studies were observed. Educational disparity and lack of adequate knowledge among parents were associated with LTF. The most commonly used strategy to overcome LTF suggested by studies was the use of an adequate data management system. CONCLUSION This review is a novel attempt to explore the LTF among NHS studies, reasons for LTF and strategies to reduce LTF. This review can act as a basis for planning and execution of effective NHS programs.

Knowledge and attitude (KA) survey regarding infant hearing loss in Karnataka, India

INTRODUCTION The support provided and the decisions taken by mothers determine the success of Universal Newborn Hearing Screening (UNHS). Attempts at exploring the existing knowledge-attitude among mothers is crucial to create/modify the existing screening programs. The present study attempts to explore the knowledge and attitude toward infant hearing loss (HL) among mothers of newborns in the Indian state of Karnataka. METHOD A cross-sectional survey was conducted among 219 mothers of newborns in Karnataka, India. The questionnaire was framed from existing literature and consisted of 19 questions assessing knowledge and attitude toward infant HL to be rated on a three-point scale (no, not sure, yes). Descriptive statistics and Cronbachs α were used to analyze the data. RESULTS Mothers exhibited good knowledge of risk factors; noise (70.3%) and ear discharge (54.3%). More than 75% agreed that treatment for HL is available and that these children can attend school. The questions of superstitions and cultural beliefs yielded mixed responses. A large number of mothers expressed desire to have their children tested at birth (84.9%) and were concerned about their childrens hearing (87.7%). Yet only 54.3% stated that they would allow their children to wear hearing aids. SUMMARY AND CONCLUSION The present study is an attempt to understand the knowledge and attitude of mothers toward infant HL in Karnataka and facilitate identification of potential areas of less knowledge as a reference for endeavors of enhancement. It further highlights the need for implementing public awareness programs to improve knowledge and attitude of mothers toward infant HL for better implementation of UNHS.

Speech and Swallowing Outcomes in Buccal Mucosa Carcinoma

Buccal carcinoma is one of the most common malignant neoplasms among all oral cancers in India. Understanding the role of speech language pathologists (SLPs) in the domains of evaluation and management strategies of this condition is limited, especially in the Indian context. This is a case report of a young adult with recurrent squamous cell carcinoma of the buccal mucosa with no deleterious habits usually associated with buccal mucosa carcinoma. Following composite resection, pectoralis major myocutaneous flap reconstruction, he developed severe oral dysphagia and demonstrated unintelligible speech. This case report focuses on the issues of swallowing and speech deficits in buccal mucosa carcinoma that need to be addressed by SLPs, and the outcomes of speech and swallowing rehabilitation and prognostic issues.

A national survey of knowledge, attitude and practices among pediatricians towards newborn hearing screening in India

INTRODUCTION Pediatricians have a key role in ensuring that infant has undergone hearing screening and required follow-up. Attempts in various countries and centers have been made at exploring their knowledge, attitude and practices towards universal newborn hearing screening. In India, such a program is at its preliminary stage, and hence a need was felt to study this aspect in pediatricians working in India. METHOD A cross-sectional online survey was carried out among 112 pediatricians working in India. The questionnaire was framed after reviewing the existing questionnaires. Descriptive statistics was used to summarize the findings. RESULTS A response rate of 7.99% (112/1402) was obtained of which only 20.5% reported of availability of screening program in their work set-up. The majority of the pediatricians (95%) were aware of the newborn hearing screening while 98.3% were affirmative about the importance of screening of all infants. Very few pediatricians reported of a screening program in their set-up or in their close locality. Overall the pediatricians were confident about their knowledge on this topic yet expressed a need to know more about several intricacies about hearing screening. The pediatricians also provided an input on the most preferred method of receiving more information. SUMMARY AND CONCLUSION The success of the universal newborn hearing screening program lies in the support and cooperation of health care providers such as pediatricians. The present study draws attention to the positive attitude and practices exhibited by them. It also sheds light on the knowledge gaps that are present and need the due attention of the policy makers. Further, it highlights the need for having more continuing medical education program and awareness drives for ensuring a better implementation of UNHS.

Knowledge and attitude of parents/caregivers towards hearing loss and screening in newborns – a systematic review

Abstract Objective: The parents/caregivers of a newborn play a pivotal role in the process of hearing screening and intervention. The decisions taken by them depend on their knowledge and attitude. The purpose of this study was to review the literature systematically on knowledge and attitude of parents/caregivers towards infant hearing loss and newborn hearing screening. Design: A systematic search was conducted using electronic databases for the periods from 1990 to March 2016. Two authors scrutinized the studies and extracted the data based on predetermined criteria. Study sample: Ten studies. Results: Ear discharge was correctly identified as a risk factor for hearing loss along with measles, drugs/medication, family history, congenital causes and noise exposure. The studies revealed mixed results for knowledge about newborn hearing screening. Overall, the parents/caregivers showed positive attitudes towards hearing screening and intervention options. However, due to heterogeneity in the studies, it’s hard to derive a conclusion. Conclusions: The present review sheds light on the common areas of misconception among parents/caregivers about risk factors of infant hearing loss and newborn hearing screening. The review also draws attention to the need to have more studies exploring this knowledge and attitude of parents/caregivers among diverse populations.

CORTICAL AUDITORY EVOKED POTENTIALS IN TWO PRELINGUALLY DEAFENED ADULTS

Background: It has been reported that in prelingually deafened adults there is maturation of the late latency response (LLR) after rehabilitation using cochlear implants. Other evidence suggests that the auditory system, like any other sensory system, receives multimodal stimulation, a factor which could help the auditory system mature even in the absence of any auditory input. The current study was done on two prelingually deaf adults who had not received rehabilitation, and their latencies were within the normal mature range, suggesting their auditory cortex responses were maturely developed prior to rehabilitation. Material and methods: Two male participants took part in the study: one was 21 years old and the other was 36, and both had congenital profound hearing loss. Using pure tone thresholds obtained earlier, a strong class hearing aid (Siemens Infiniti Pro SP) was programmed using NOAH software and fitted to the right ear using the NALNL-1 fitting formula. As an objective measure of verification of hearing aid effect, auditory P1, N1, P2, and N2 were recorded using the free-field facility available in the IHS SmartEP system: a 1000 Hz pure tone was presented at 70 dB SPL (30 dB SL) and 50 dB SPL (10 dB SL) from a loudspeaker at a distance of 1 m and 45° angle. Results: The latencies of P1, N1, P2, and N2 for both participants were recorded for 70 and 90 dB HL; all latencies were well within normal limits. Conclusions: The results indicate that, with adequate amplification, a mature response from the auditory cortex can be obtained even in adults who have profound hearing loss and who have been deprived of auditory stimuli since a prelingual age.

Cepstral Peak Prominence of Blom-Singer ‘Non-Indwelling Low Pressure’ and ‘Classic Indwelling’ Voice Prosthesis in Male Tracheo-oesophageal Speakers

Introduction: Tracheo-oesophageal (TE) speech is one of the most commonly used alaryngeal voice restoration options for individuals who have undergone a total laryngectomy. Cepstral Peak Prominence (CPP) implies the overall voice quality objectively. Aim: To compare the CPP between Blom-Singer non-indwelling low pressure and classic indwelling voice prosthesis across vowel phonation /a/ and text-reading tasks in male TE speakers. Materials and Methods: The study included 10 male TE speakers in the age range of 45-75 years. Dr. Hillenbrand’s ‘Speech Tool’ software was used to measure CPP. Two types of speech prosthesis used were Blom-Singer non-indwelling low pressure and classic indwelling voice prosthesis (both of 16 French diameter) and the tasks vowel phonation and text-reading were considered. The SPSS software, version 15.0 (SPSS Inc., Chicago, IL) was used for data analysis. The parametric paired t-test was applied to compare CPP between two types of voice prostheses across speech tasks. Results: There was no significant difference between Blom-Singer non-indwelling low pressure voice prosthesis and classic indwelling voice prosthesis for CPP during vowel phonation/a/task {t(9)=0.74, p=0.516} and text-reading task {t(9)=0.72, p=0.947)}. Similarly, there was no significant difference for CPP between speech tasks for Blom-Singer non-indwelling low pressure voice prosthesis {t(9)=1.11, p=0.347)} and Blom-Singer classic indwelling voice prosthesis {t(9)=0.51, p=0.644)}. Conclusion: In TE speakers, CPP is not influenced by prosthesis type in terms of mode of fitting, prosthesis design and valve opening pressure across speech tasks, implying no difference in the objective measure of overall voice quality.

Current Status of Voice Restoration Following Total Laryngopharyngoesophagectomy: A Case Report

Hypopharyngeal carcinoma is one of the common head and neck cancers and also more common in men in India. Understanding of the role of the speech-language pathologist (SLP) in the area of assessment and management of this condition is limited. This is a case report of an adult male with recurrent squamous cell carcinoma of hypopharynx, spread to larynx and esophagus. Following total laryngopharyngoesophagectomy (TLPE) with gastric transposition, the patient was aphonic. This case report focuses on the voice restoration options available, that SLP needs to be aware right during pre-operative counselling and his/her role in rehabilitating TLPE patient with gastric transposition reconstruction.

Neurogenic speech sequelae following suicide attempt by hanging: a case report.

Abstract Background: Attempting suicide by hanging has become one of the most preferred means among adolescents. Individuals who survive a suicide attempt by hanging have a range of deficits, including neuropsychological, neuropsychiatric, pulmonary and even speech and language deficits. Literature regarding speech and language deficits in cases of near hanging is especially limited. Objective: This study aimed to demonstrate the sequelae of neurogenic speech deficits following a suicide attempt by hanging, the treatment strategies, and prognostic issues in one such case. Methods: We report of Patient X who attempted suicide by hanging. The patient was admitted and a detailed speech and language evaluation was completed. Results: Patient X was diagnosed with hypoxic-ischemic encephalopathy with organic amnesic syndrome. Consequent to the neurogenic insult, the patient demonstrated speech deficits that were characterized by moderate flaccid dysarthria and neurogenic stuttering. Patient X underwent a week of treatment, subsequent to which there was an improvement in certain speech subsystems. However, the neurogenic stuttering symptoms did not resolve completely even post therapy. Conclusion: Individuals who survive a suicide attempt by hanging have a range of deficits, including speech deficits that need to be addressed by a speech language pathologist. This case report is an eye opener for speech language pathologists regarding their role in such cases.