Christiane Hey

Immunogenicity of Pneumococcal Vaccination of Patients with Cochlear Implants

BACKGROUND Pneumococcal meningitis is a rare but potentially fatal complication of cochlear implantation. METHODS A prospective study was conducted of the immunogenicity of pneumococcal vaccination in 174 patients with cochlear implants (CIs). The cohort was divided into groups of patients with impaired hearing due to meningitis (P(1)), cranial malformations (P(2)), or an unknown cause (P(3)) and was stratified by age as follows: <2 years (A(1)), 2-5 years (A(2)), and >5 years (A(3)). We determined immunoglobulin (Ig) levels for IgG subclasses 1-4 and serum concentrations of antibodies against pneumococci before and 4-6 weeks after vaccination. Group A(1) received the 7-valent pneumococcal conjugate vaccine (PCV-7), group A(2) received PCV-7 or the 23-valent pneumococcal polysaccharide vaccine (PPV-23), and group A(3) received PPV-23. RESULTS IgG, IgM, and IgG1 levels were significantly lower in group P(1), compared with the other patient groups and with historic data for healthy control subjects, suggesting a decreased antibody response. Group P(1) had lower levels of pneumococcal antibodies, compared with groups P(2) and P(3) before vaccination (P<.05, pneumococcal serotypes 4 and 9V). Irrespective of the underlying condition, all patients showed a sufficient antibody response after 1 dose of vaccine. In children 2-5 years of age, PCV-7 was significantly more immunogenic than PPV-23. CONCLUSIONS PCV-7 should be administered to all CI recipients younger than 6 years and older than 6 years who are at an increased risk for bacterial meningitis. CI recipients with a history of bacterial meningitis should undergo immunological evaluation.

Does the 23-Valent Pneumococcal Vaccine Protect Cochlear Implant Recipients?†

Objectives/Hypothesis: The incidence of meningitis is increased in cochlear implant (CI) recipients. Besides malformations, immunological deficiencies are predisposing factors. Therefore, the immunological background of CI recipients and the immunogenicity of the recommended 23‐valent pneumococcal polysaccharide vaccine (PPV‐23) were investigated.

A Documentation System to Save Time and Ensure Proper Application of the Fiberoptic Endoscopic Evaluation of Swallowing (FEES

A properly performed fiberoptic endoscopic evaluation of swallowing (FEES®) is comprehensive and time-consuming. Editing times of FEES protocols and attempts for efficiency maximization are unknown. Here, the protocol editing times of completed FEES examinations were determined. The present study reports the time savings and quality gains of a newly developed documentation system tailored to the FEES standard of Langmore. Four independent examiners analyzed twelve videos of FEES procedures, six without and six with the documentation system. Effectiveness of the documentation system was evaluated according to the times for total evaluation, interpretation, documentation, report writing, and for report completeness. The documentation system reduced editing times and increased report completeness with large effect sizes. Averaged total evaluation time decreased from 42 to 27 min, report completeness increased from 55 to 80%. The use of the documentation system facilitates and improves the assessment of the swallowing process.

Improved efficiency in swallowing diagnostics using an electronic documentation system

BACKGROUND The aim is to present a German-language electronic documentation system for the fiberoptic endoscopic evaluation of swallowing (FEES) in order to make routine swallowing diagnostics and therapeutic recommendations more effective and as initial confirmation of its suitability for daily use. METHODS Time-efficient, precise, and complete documentation is provided by an interactive findings system via preset text fields and integration of representative frames with automatic report generation. This documentation system (FEED) (Flexible Endoscopic Evaluation of Dysphagia, XION medical GmbH, Berlin) was applied to 301 digitized FEES recordings. RESULTS Of the parameters required by the FEES protocol, 97% were recorded in 9 min on average. Altogether, the application of FEED resulted in a time-saving of more than 50% as compared to free protocols. The use of the Murray and Rosenbek scales enabled a graded evaluation of swallowing disorders. CONCLUSIONS FEED shortens documentation time, improves report quality and has proven to be a practical instrument in making routine swallowing diagnostics and therapy more effective.

High Prevalence of Hearing Loss at the Special Olympics: Is This Representative of People with Intellectual Disability?

BACKGROUND The Healthy Hearing (HH) programme at the Special Olympics (SO) revealed hearing disorders in between 16 and 40% of athletes. However, it is not clear whether these prevalence represents the entire population with intellectual disability. Therefore, this study compares the hearing status of SO athletes with an intellectual disability (ID) to students with ID at a special needs school. MATERIALS AND METHODS The HH screening was performed in 637 athletes (mean age 27.1 years, range 9.7-70.6 years) during the 2008 German SO Summer Games - and in 198 special needs students (mean age 12.7 years, range 6.7-20.0 years). RESULTS Twenty-two per cent of athletes and 18% of students failed the HH screening. Approximately 60% of the total participants received recommendations for further follow-up and treatment without between-group differences. CONCLUSIONS The results of the HH screening at SO events are assumed to be representative of children and adolescents with ID in special needs schools.

Effektivierung der Schluckdiagnostik durch ein elektronisches Dokumentationssystem

BACKGROUND The aim is to present a German-language electronic documentation system for the fiberoptic endoscopic evaluation of swallowing (FEES) in order to make routine swallowing diagnostics and therapeutic recommendations more effective and as initial confirmation of its suitability for daily use. METHODS Time-efficient, precise, and complete documentation is provided by an interactive findings system via preset text fields and integration of representative frames with automatic report generation. This documentation system (FEED) (Flexible Endoscopic Evaluation of Dysphagia, XION medical GmbH, Berlin) was applied to 301 digitized FEES recordings. RESULTS Of the parameters required by the FEES protocol, 97% were recorded in 9 min on average. Altogether, the application of FEED resulted in a time-saving of more than 50% as compared to free protocols. The use of the Murray and Rosenbek scales enabled a graded evaluation of swallowing disorders. CONCLUSIONS FEED shortens documentation time, improves report quality and has proven to be a practical instrument in making routine swallowing diagnostics and therapy more effective.

Validierung der deutschen Kurzversion der Sekretbeurteilungsskala nach Murray

OBJECTIVE Accumulation of secretions in hypopharynx, aditus vestibule, and trachea is often found in cases of severe dysphagia and is considered a cardinal trait of high clinical and therapeutic importance. For the graduation of the severity level of accumulated secretions, a short version of the 4-point Murray secretion scale is available, which is also integrated into the protocol of the fiberoptic endoscopic evaluation of swallowing (FEES) according to the Langmore standard. This study aimed at the validation of the German translation of this short version in order to facilitate a uniform, standardized evaluation of the accumulation of secretions in dysphagic patients in the German language area. MATERIAL AND METHODS For the examination of reliability and validity, a reference standard was defined by 2 dysphagia experts on the basis of 40 video files of the FEES examination, 10 videos for each of the severity grades. Afterwards, these videos were rated independently by 4 raters and re-rated in a new randomized order 2 weeks later. RESULTS Both the intra-rater reliability (τ>0,830***) and the inter-rater reliability (Kendalls W>0,890***) were highly significant and can be considered good. The same is valid for the correlation of ratings with the reference standard (τ=0,969***). CONCLUSIONS The German translation of the short version of the 4-point Murray secretion scale is recommendable as a reliable and valid instrument for the graduation of the cardinal trait of oropharyngeal dysphagia and also as an evidence-based instrument for standardized use in the German language area.

Tongue Contour Reconstruction from Optical and Electrical Palatography

Tongue shape reconstruction based on safe and convenient measurement techniques is of great interest for speech research and speech therapy. Two potentially useful and related measurement techniques for this purpose are electropalatography (EPG) and optopalatography (OPG). While EPG measures the time-varying contact pattern between the hard palate and the tongue, OPG measures distances between the two. Here, we examined the potential of EPG, OPG, and their combination for predicting the whole tongue contour using a multiple linear regression model. The model was trained and tested with tongue shapes and virtual sensor data obtained from Magnetic Resonance Images of sustained articulations of two speakers. When the model was trained and tested with the same speaker, the error of tongue contour reconstruction was significantly lower for predictions based on OPG data than for predictions based on EPG data. When the model was trained with one speaker and tested with the other, the error pattern was less consistent and the overall error was higher. Hence, especially OPG is well suited for tongue contour prediction, but an adaptation method is needed to transfer the model to a new speaker.

Validierung der deutschen Version des Eating Assessment Tool bei Kopf-Hals-Tumor-Patienten

OBJECTIVE The assessment of subjective swallowing complaints constitutes an important element in a multidimensional, modern management of head and neck cancer patients suffering from dysphagia. For this purpose, an internationally recognized and validated 10-item questionnaire EAT-10 is used that was developed and validated by Belafski et al. in 2008. The purpose of the present study is the translation of EAT-10 into the German language and its validation for head and neck cancer patients. MATERIAL AND METHODS After the translation of EAT-10 into German according to the guidelines for the translation of foreign measuring instruments, a validation of gEAT-10 was carried out on the basis of the sample of 210 head and neck cancer patients. The reliability was determined by means of the internal consistency (Cronbachs Alpha) and item-total correlations (Spearman). The construct validity was verified by the uni- and multivariate analyses of the distribution of gEAT-10 total scores depending on gender, age, BMI, tumor stage and localization as well as type of the oncological therapy. RESULTS The internal consistency amounted to α = .94, the item-total correlations varied between ρ = .59 and ρ = .85. No significant associations between gEAT-10 total scores and gender as well as age were identified in univariate calculations. Such associations were found for BMI, tumor stage and localization as well as type of the oncological therapy. However, only the tumor stage yielded a significant result in a regression. CONCLUSIONS The gEAT-10 was shown to be a reliable and construct valid questionnaire for the assessment of subjective swallowing complaints in patients with head and neck cancer.

Effektivierung der Schluckdiagnostik durch ein elektronisches Dokumentationssystem@@@Improved efficiency in swallowing diagnostics using an electronic documentation system

BACKGROUND The aim is to present a German-language electronic documentation system for the fiberoptic endoscopic evaluation of swallowing (FEES) in order to make routine swallowing diagnostics and therapeutic recommendations more effective and as initial confirmation of its suitability for daily use. METHODS Time-efficient, precise, and complete documentation is provided by an interactive findings system via preset text fields and integration of representative frames with automatic report generation. This documentation system (FEED) (Flexible Endoscopic Evaluation of Dysphagia, XION medical GmbH, Berlin) was applied to 301 digitized FEES recordings. RESULTS Of the parameters required by the FEES protocol, 97% were recorded in 9 min on average. Altogether, the application of FEED resulted in a time-saving of more than 50% as compared to free protocols. The use of the Murray and Rosenbek scales enabled a graded evaluation of swallowing disorders. CONCLUSIONS FEED shortens documentation time, improves report quality and has proven to be a practical instrument in making routine swallowing diagnostics and therapy more effective.