Helge S. Johannsen

Stuttering children and the probability of remission—the role of cerebral dominance and speech production

OBJECTIVEnThe identification of critical characteristics which might predict whether childhood stuttering will become chronic. Part of the study investigates the relationship between hearing and central processing of acoustic stimuli, cerebral dominance and the clinical course of the stuttering.nnnMETHODSnA prospective study of 79 stuttering children aged 3-9 years. The subjects were examined with regard to their cerebral dominance in various tests of laterality, their peripheral hearing and their ability to discriminate sound using the dichotic discrimination test according to Uttenweiler (V. Uttenweiler, Dichotischer Diskriminationstest für Kinder, Sprache Stimme Gehör 4 (1980) 107-111). Results were correlated with the probability of remission of stuttering. Comparisons were made with a control group of 18 children of kindergarten age with normal speech. The period of investigation was 18 months.nnnRESULTSnSeventy-two children underwent follow-up examinations. Of these, 36 achieved fluency of speech. The results of the dichotic discrimination test showed no relation to the rate of remission. When the relationship between handedness and stuttering was investigated, it was found that left-handed children had a significantly poorer chance of attaining speech fluency.nnnCONCLUSIONSnThe Uttenweiler test allowed no prognostic evaluation of the future course of stuttering in the age group studied, though auditory dominance was not completely developed in a majority of the 3-6 year-old children. Handedness, however, appears to be related to the probability that stuttering will become chronic.

Visual information processing in the left and right hemispheres during unilateral tachistoscopic stimulation of stutterers

Abstract Tachistoscopy was used to investigate 42 stutterers and a corresponding control group for their speech dominance. A bilateral cortical responsibility for speech was equally frequent in the two groups. However, 2.5 times as many stutterers showed a superiority in the information processing in the right hemisphere than did nonstutterers.

Prognostic indicators for stuttering: the value of computer-based speech analysis

There are currently no known acoustic parameters by which stuttering children can be appraised in order to predict the further course of their speech disfluency. The present study investigates the usefulness of a computer-based speech analysis of fluent utterances. Correlations between acoustic variables, severity, and course of stuttering were sought in a prospective longitudinal study. This analyzed 57 preschool children at 6-month intervals over a period of 4.6 years. The acoustic analyses yielded no clearly distinguishing characteristics. There was, however, one subgroup consisting of children who were still disfluent at study end which showed more variable values at various measurement points for different parameters. Speech control seems to be different in children exhibiting chronic stuttering.

Myoklonus des Mittelohrs

ZusammenfassungBisheriges Wissen zum Thema.nNeben dem Myoklonus der Gaumensegelmuskulatur stellt der Myoklonus des Mittelohrs eine seltene, in ihrer Genese letztendlich unklare Differenzialdiagnose bei Patienten mit objektivem Tinnitus dar. Mittelohrmyokloni zeichnen sich durch abnorme Kontraktionen des M.xa0stapedius und/oder des M.xa0tensor tympani aus.Wissenschaftliche Fragestellung. Unseres Wissens wurde im Kindesalter bisher kein solcher Fall publiziert.Ziele der Arbeit.nBerichtet wird über ein 6-jähriges türkisches Mädchen mit einer beidseitigen mittelgradigen Schallempfindungsschwerhörigkeit und einem beidseitigen hochfrequenten objektiven Tinnitus.Methoden und Arbeitsergebnisse.nGeeignete klinische Untersuchungsmethoden, mögliche Differenzialdiagnosen und therapeutische Optionen werden diskutiert.Schlussfolgerungen.nUm intrazerebrale Veränderungen oder Systemerkrankungen auszuschließen, wie sie bei Patienten mit palatalen Myokloni beschrieben sind, sollte, solange keine größeren Erfahrungen mit dieser Patientengruppe vorliegen, die Diagnostik bei Verdacht auf Mittelohrmyokloni neben einer sorgfältigen Hals-Nasen-Ohren-ärztlichen Untersuchung auch eine neurologische Mitbeurteilung und eine Kernspintomographie des Schädels beinhalten.AbstractPresent state of knowledge.nMyoclonus of the musculature of the soft palate, as well as middle ear myoclonus resulting from abnormal contraction of the stapedius and/or tensor tympani muscles, are two of the rarer causes in the differential diagnose of objective tinnitus.Aim.nHere we describe a childhood case. To our knowledge, no case has previously been described in a child.Methods and results.nOur patient is a six year old girl with a bilateral 40xa0dB sensorineural hearing loss and a high frequency objective tinnitus. The methods of clinical investigation, possible differential diagnoses and therapeutic options are discussed.Conclusion.nBoth intracerebral changes and systemic disorders have been described in some adult patients with palatal myoclonus. Whereas these cases are unlikely to respond to therapy, there is the chance that in some patients with objective tinnitus middle ear myoclonus may be the cause. This should be excluded by appropriate otoneurological investigations.PRESENT STATE OF KNOWLEDGEnMyoclonus of the musculature of the soft palate, as well as middle ear myoclonus resulting from abnormal contraction of the stapedius and/or tensor tympani muscles, are two of the rarer causes in the differential diagnose of objective tinnitus.nnnAIMnHere we describe a childhood case. To our knowledge, no case has previously been described in a child.nnnMETHODS AND RESULTSnOur patient is a six year old girl with a bilateral 40xa0dB sensorineural hearing loss and a high frequency objective tinnitus. The methods of clinical investigation, possible differential diagnoses and therapeutic options are discussed.nnnCONCLUSIONnBoth intracerebral changes and systemic disorders have been described in some adult patients with palatal myoclonus. Whereas these cases are unlikely to respond to therapy, there is the chance that in some patients with objective tinnitus middle ear myoclonus may be the cause. This should be excluded by appropriate otoneurological investigations.

Die Aussagekraft einer akustischen Sprachanalyse für die prognostische Einschätzung des kindlichen Stotterns Teilergebnisse einer prospektiven Längsschnittstudie

ZusammenfassungBisheriges Wissen. Es sind bisher keine akustischen Parameter bekannt, die eine Hilfestellung bei der Einschätzung bezüglich des weiteren Verlaufs des Stotterns erlauben.nn Fragestellung. Untersucht wurde die Aussagekraft einer computergestützten Sprachanalyse flüssig gesprochener Äußerungen hinsichtlich der Wahrscheinlichkeit für eine Stotterremission im Vorschulalter. Dabei wurden mögliche Einflüsse mundmotorischer bzw. linguistischer Störungen besonders berücksichtigt.nn Ziele der Arbeit. Die Bedeutung der Bedingungen für die Aufrechterhaltung des Stotterns und deren Gewichtung untereinander sollte geklärt werden. Dazu wurden die Ergebnisse aus der akustischen Analyse mit klinischen Stottermaßen in Beziehung gesetzt.nn Methoden und Ergebnisse. Prospektiv wurde bei 58 stotternden Vorschulkindern nach Zusammenhängen zwischen akustischen Variablen zu Schweregrad und Verlauf des Stotterns gesucht. Als Vergleich dienten 19 gleichaltrige, normalsprechende Kontrollkinder. Die Projektdauer betrug 1,5 Jahre und berücksichtigt einen Zeitraum, in dem die Remission des kindlichen Stotterns besonders häufig zu beobachten ist und der daher gut geeignet scheint, zwischen Entwicklungsunflüssigkeiten und beginnendem bzw. bereits chronischem Verlauf des Stotterns zu unterscheiden. Die meisten Kinder, deren Stottern gleichzeitig mit einer Sprachentwicklungsverzögerung einherging, hatten eine höhere Remissionswahrscheinlichkeit. Diese höhere Remissionsrate war nicht auf Therapieeffekte zurückzuführen. Statistische Zusammenhänge einzelner Variablen zu mundmotorischen und/oder linguistischen Defiziten ergaben sich anhand der akustischen Analyse nicht.nn Schlussfolgerungen. Es kann angenommen werden, dass Stottersymptome bei den Studienkindern mit zusätzlichen linguistischen Einschränkungen vermehrt im Rahmen von Wortfindungs- und Satzplanungsdefiziten aufgetreten sind. Das Stottern remittierte bei diesen Kindern innerhalb von 18 Monaten durch die Verbesserung der sprachlichen Kompetenz. Aus der akustischen Analyse lassen sich für die Routinediagnostik des kindlichen Stotterns bisher keine prognostischen Marker ableiten. Wenn ein stotterndes Kind Gefahrenmomente zeigt, die einen Übergang in einen chronischen Verlauf vermuten lassen, müssen im Rahmen einer therapiesteuernden Diagnostik die individuell wirksamen Faktoren gefunden werden, die für dieses Kind bestimmend sind.AbstractPresent state of knowledge. There are currently no known acoustic parameters by which stuttering children can be appraised which will predict their subsequent speech fluency.nn Aim. To explain the significance of factors which perpetuate stuttering by using computer-based speech analysis of fluent speech for a 1 1/2 year period and to relate acoustic analysis with clinical measurements of stuttering. Special attention was given to motor-oral and/or linguistic deficits.nn Method and results. A prospective study of 58 pre-school children who stutter. Correlations were sought between acoustic variables in the severity and course of the stuttering with the influence of motor-oral and linguistic disturbances. 19 age-matched, normal-speaking children served as controls. A subdivision of the study group into different subgroups with particular motor-oral and/or linguistic problems showed that children whose stuttering coincides with a delayed speech development have a distinctly better prognosis for early remission. In most of these children the stuttering remitted to such a degree as the deficits causing the stuttering could be reappraised, which means simultaneous improvement of the linguistic competence.nn Conclusion. It was apparent that remission rate was much higher in those children who showed linguistic disturbances at the same time with stuttering. Within the stuttering group, subgroups showed a few correlations in several acoustic parameters, but these could not, as yet, be shown to give any prognostic markers in the routine diagnosis of children who stutter. If a child shows any danger-signs of acquiring stuttering on a more permanent basis, a careful diagnosis is necessary in order to find the individually underlying factors before any therapeutical procedure.

Arytenoid cartilage necrosis: a rare complication of prolonged endotracheal intubation.

A s reviewed by Burns et al. (l), prolonged endotracheal intubation (in excess of 24 hours) was first described in 1880 by William MacEwen. Subsequent voice disorders and/or respiratory distress has been well documented. In most cases, injuries can be verified by microlaryngoscopy and microstroboscopy. For microstroboscopic examinations of laryngeal function, an electrically triggered intermittent discharge tube is used as the standard light source which analyzes sound from a laryngeal lowpass microphone. The method enables the viewer to see an apparently slowed sequence of vocal fold movements (the mucosal wave). Less commonly, electromyography or computed tomography (CT) is required (2,3). The following case presentations describe arytenoid cartilage necrosis in two patients as a result of prolonged endotracheal intubation. An axial CT cut at the level of the upper portion of the arytenoid cartilages (Fig. 1) demonstrates normal anatomy in this region.

Qualitätskontrolle audiologischer Befunde einer universitären phoniatrisch/pädaudiologischen Einrichtung@@@Quality control in a university phoniatric/pediatric audiology department: Am Beispiel der Begutachtung der beruflichen Lärmschwerhörigkeit@@@Expert versus community measurement of occupational noise induced hearing loss

AIMnAn investigation was made to reveal whether suspicion of occupational hearing loss can be satisfactorily determined by an otolaryngologist or workplace audiological measurement. These were compared with a formal audiometrical assessment at a university clinic.nnnMETHODS AND RESULTSnA retrospective study was made of 95 cases of noise induced hearing loss. A total of 78 individuals were investigated by an otolaryngologist and 70 by workplace audiometry. Using workplace audiometry, 27% of the tests showed a reduction in working capacity of at least 20%. In only five of these was a specialist opinion sought within a year. In 50%, this took longer than 5 years. A comparison of audiometric data from expert opinion revealed that there was conformity in only 47% with workplace audiometry and 48% with otolaryngologist testing. In some cases (27% workplace and 33% ENT practice), the measured hearing loss and calculation of disability exceeded that determined by the experts.nnnCONCLUSIONSnThe results of workplace audiometry demonstrated that hearing loss was frequently reported only after the workers had received a disability of at least 20%. Possible reasons for discrepancies in audiological testing might be the exaggeration of hearing loss by the worker, insufficient recovery time after noise exposure, or inexperienced audiologists. Our data show that audiometric testing in workplace audiometry, as well as in ENT practice, often reveal a higher disability rating compared to formal audiological (university) assessment, even if these discrepancies do not reach statistical significance.ZusammenfassungZiele der ArbeitZur Klärung, ob den Berufsgenossenschaften der Verdacht einer beruflichen Lärmschwerhörigkeit rechtzeitig gemeldet wird und ob die Qualität audiometrischer Voruntersuchungen mit der gutachterlichen Untersuchung übereinstimmt, wurde ein Qualitätsvergleich audiologischer Befunde einer universitären phoniatrisch/pädaudiologischen Einrichtung mit niedergelassenen HNO-Ärzten bzw. dem arbeitsmedizinischen Dienst durchgeführt.Methoden/ErgebnisseRetrospektiv wurde anhand von 95 Lärmgutachten festgestellt, dass 78 Personen von einem HNO-Arzt und 70 beim AMD audiologisch voruntersucht worden waren. Bei 26 durch den AMD untersuchten Personen (27%) errechnete sich eine MdE von mindestens 20%. Davon wurde nur in 5 Fällen eine gutachterliche Untersuchung innerhalb eines Jahres veranlasst. Bei 50% lag eine zeitliche Frist von >5 Jahren vor. Ein Vergleich der gutachterlich festgestellten MdE-Bewertungen ergab in 47% eine Übereinstimmung zum AMD und in 48% zu den HNO-Praxen. In 27% (AMD) bzw. 33% (HNO-Ärzte) errechnete sich ein höherer MdE Wert im Vergleich zur gutachterlichen Untersuchung.FazitDie Auswertung ergab, dass der AMD die Hörstörung häufig erst dann an die BG gemeldet hat, wenn der Hörverlust bereits eine entschädigungspflichtige MdE von mindestens 20% bedingte.Die audiometrischen Messungen beim AMD ebenso wie in der HNO-ärztlichen Praxis führten häufig zu höheren MdE-Bewertungen als die in einer universitären Einrichtung—allerdings ohne statistische Signifikanz.AbstractAimAn investigation was made to reveal whether suspicion of occupational hearing loss can be satisfactorily determined by an otolaryngologist or workplace audiological measurement. These were compared with a formal audiometrical assessment at a university clinic.Methods and resultsA retrospective study was made of 95 cases of noise induced hearing loss. A total of 78 individuals were investigated by an otolaryngologist and 70 by workplace audiometry. Using workplace audiometry, 27% of the tests showed a reduction in working capacity of at least 20%. In only five of these was a specialist opinion sought within a year. In 50%, this took longer than 5xa0years. A comparison of audiometric data from expert opinion revealed that there was conformity in only 47% with workplace audiometry and 48% with otolaryngologist testing. In some cases (27% workplace and 33% ENT practice), the measured hearing loss and calculation of disability exceeded that determined by the experts.ConclusionsThe results of workplace audiometry demonstrated that hearing loss was frequently reported only after the workers had received a disability of at least 20%. Possible reasons for discrepancies in audiological testing might be the exaggeration of hearing loss by the worker, insufficient recovery time after noise exposure, or inexperienced audiologists. Our data show that audiometric testing in workplace audiometry, as well as in ENT practice, often reveal a higher disability rating compared to formal audiological (university) assessment, even if these discrepancies do not reach statistical significance.

Qualitätskontrolle audiologischer Befunde einer universitären phoniatrisch/pädaudiologischen Einrichtung

AIMnAn investigation was made to reveal whether suspicion of occupational hearing loss can be satisfactorily determined by an otolaryngologist or workplace audiological measurement. These were compared with a formal audiometrical assessment at a university clinic.nnnMETHODS AND RESULTSnA retrospective study was made of 95 cases of noise induced hearing loss. A total of 78 individuals were investigated by an otolaryngologist and 70 by workplace audiometry. Using workplace audiometry, 27% of the tests showed a reduction in working capacity of at least 20%. In only five of these was a specialist opinion sought within a year. In 50%, this took longer than 5 years. A comparison of audiometric data from expert opinion revealed that there was conformity in only 47% with workplace audiometry and 48% with otolaryngologist testing. In some cases (27% workplace and 33% ENT practice), the measured hearing loss and calculation of disability exceeded that determined by the experts.nnnCONCLUSIONSnThe results of workplace audiometry demonstrated that hearing loss was frequently reported only after the workers had received a disability of at least 20%. Possible reasons for discrepancies in audiological testing might be the exaggeration of hearing loss by the worker, insufficient recovery time after noise exposure, or inexperienced audiologists. Our data show that audiometric testing in workplace audiometry, as well as in ENT practice, often reveal a higher disability rating compared to formal audiological (university) assessment, even if these discrepancies do not reach statistical significance.ZusammenfassungZiele der ArbeitZur Klärung, ob den Berufsgenossenschaften der Verdacht einer beruflichen Lärmschwerhörigkeit rechtzeitig gemeldet wird und ob die Qualität audiometrischer Voruntersuchungen mit der gutachterlichen Untersuchung übereinstimmt, wurde ein Qualitätsvergleich audiologischer Befunde einer universitären phoniatrisch/pädaudiologischen Einrichtung mit niedergelassenen HNO-Ärzten bzw. dem arbeitsmedizinischen Dienst durchgeführt.Methoden/ErgebnisseRetrospektiv wurde anhand von 95 Lärmgutachten festgestellt, dass 78 Personen von einem HNO-Arzt und 70 beim AMD audiologisch voruntersucht worden waren. Bei 26 durch den AMD untersuchten Personen (27%) errechnete sich eine MdE von mindestens 20%. Davon wurde nur in 5 Fällen eine gutachterliche Untersuchung innerhalb eines Jahres veranlasst. Bei 50% lag eine zeitliche Frist von >5 Jahren vor. Ein Vergleich der gutachterlich festgestellten MdE-Bewertungen ergab in 47% eine Übereinstimmung zum AMD und in 48% zu den HNO-Praxen. In 27% (AMD) bzw. 33% (HNO-Ärzte) errechnete sich ein höherer MdE Wert im Vergleich zur gutachterlichen Untersuchung.FazitDie Auswertung ergab, dass der AMD die Hörstörung häufig erst dann an die BG gemeldet hat, wenn der Hörverlust bereits eine entschädigungspflichtige MdE von mindestens 20% bedingte.Die audiometrischen Messungen beim AMD ebenso wie in der HNO-ärztlichen Praxis führten häufig zu höheren MdE-Bewertungen als die in einer universitären Einrichtung—allerdings ohne statistische Signifikanz.AbstractAimAn investigation was made to reveal whether suspicion of occupational hearing loss can be satisfactorily determined by an otolaryngologist or workplace audiological measurement. These were compared with a formal audiometrical assessment at a university clinic.Methods and resultsA retrospective study was made of 95 cases of noise induced hearing loss. A total of 78 individuals were investigated by an otolaryngologist and 70 by workplace audiometry. Using workplace audiometry, 27% of the tests showed a reduction in working capacity of at least 20%. In only five of these was a specialist opinion sought within a year. In 50%, this took longer than 5xa0years. A comparison of audiometric data from expert opinion revealed that there was conformity in only 47% with workplace audiometry and 48% with otolaryngologist testing. In some cases (27% workplace and 33% ENT practice), the measured hearing loss and calculation of disability exceeded that determined by the experts.ConclusionsThe results of workplace audiometry demonstrated that hearing loss was frequently reported only after the workers had received a disability of at least 20%. Possible reasons for discrepancies in audiological testing might be the exaggeration of hearing loss by the worker, insufficient recovery time after noise exposure, or inexperienced audiologists. Our data show that audiometric testing in workplace audiometry, as well as in ENT practice, often reveal a higher disability rating compared to formal audiological (university) assessment, even if these discrepancies do not reach statistical significance.

Der medikamenteninduzierte Stimmlippenstillstand Eine seltene Differentialdiagnose

ZusammenfassungBerichtet wird über einen Patienten mit einem rechtsseitigen Stimmlippenstillstand, sehr wahrscheinlich verursacht durch eine antiarrythmische Langzeittherapie mit Cordarex. Der Patient wurde insgesamt 5xa01/2 Monate lang beobachtet und in regelmäßigen Abständen phoniatrisch, mikrolaryngoskopisch und mikrostroboskopisch untersucht. Unter logopädischer Therapie kam es 3xa01/2 Monate nach Absetzen des Medikaments zwar zu einer beginnenden Funktionsrückkehr der stillstehenden Stimmlippe, die volle Grobbeweglichkeit kehrte im Beobachtungsintervall jedoch nicht wieder zurück.SummaryA case is reported of a 57-year-old man who was found to have a right vocal cord paralysis that most likely followed prolonged treatment with the anti-arrythmic medication Amiodaron-HCl (Cordarex). Phoniatric treatment was given for 5xa01/2 months, during which time microlaryngoscopy and stroboscopy were performed. With the help of speech therapy, mobility of the paralyzed cord was seen to begin to return 3xa01/2 months after discontinuing the Amiodaron-HCl. Full cord mobility has not returned to date.