Inge Zink

Voice quality after narrow-margin laser cordectomy compared with laryngeal irradiation

Voice quality remains the issue often used to support preference for radiotherapy in treatment of early glottic cancer. We therefore conducted a perceptual voice study in 2 groups, one treated with radiotherapy for malignant disease and the other with narrow-margin laser cordectomy for either malignant or extensive benign lesions. Sequential patients, 12 treated with radiotherapy and 30 with CO2 laser excision, were included. Voice samples were recorded before and at intervals after surgery. Ratings of validated judges were used for statistical analysis of various voice characteristics at each time point. Voice deteriorated temporarily after surgery as compared with the radiated group; however, at 6 and 24 months no significant differences were found between the groups. Preferential use of narrow-margin laser cordectomy for appropriate early glottic tumors can be supported not only for oncologic reasons but also on the basis of voice results, cost, and efficiency considerations. (Otolaryngol Head Neck Surg 1999;121:528–33.)

Is There a Common Neuroanatomical Substrate of Language Deficit between Autism Spectrum Disorder and Specific Language Impairment

Discussion of an overlap between specific language impairment (SLI) and autism spectrum disorder (ASD) is on going. The most intriguing overlap between both phenotypes is the similarity in the observed language deficits described in SLI and a subgroup of ASD with co-occurring linguistic impairment, ASD-LI. Examining whether a similar neuroanatomical substrate underlies this phenotypical linguistic overlap, we studied the white matter microstructural properties of the superior longitudinal fascicle (SLF) of 19 ASD-LI adolescents (mean age 13.8 ± 1.6 years) and 21 age-matched controls and compared them with 13 SLI children (mean age 10.1 ± 0.4 years) and 12 age-matched controls. A linguistic profile assessment and a diffusion tensor imaging analysis of the SLF were performed. Linguistic testing revealed a mixed receptive-expressive disorder profile in both groups, confirming their overlap at phenotypical level. At neuroanatomical level, no significant differences in mean SLF fractional anisotropy (FA) and mean SLF apparent diffusion coefficient values between ASD-LI participants and controls were seen. By contrast, the mean SLF FA was significantly reduced in the SLI children as compared with their controls. The observation of structural SLF disturbances in SLI but not in ASD-LI suggests the existence of a different neuroanatomical substrate for the language deficits in both disorders.

Altered functional connectivity of the language network in ASD: Role of classical language areas and cerebellum

The development of language, social interaction and communicative skills is remarkably different in the child with autism spectrum disorder (ASD). Atypical brain connectivity has frequently been reported in this patient population. However, the neural correlates underlying their disrupted language development and functioning are still poorly understood. Using resting state fMRI, we investigated the functional connectivity properties of the language network in a group of ASD patients with clear comorbid language impairment (ASD-LI; N = 19) and compared them to the language related connectivity properties of 23 age-matched typically developing children. A verb generation task was used to determine language components commonly active in both groups. Eight joint language components were identified and subsequently used as seeds in a resting state analysis. Interestingly, both the interregional and the seed-based whole brain connectivity analysis showed preserved connectivity between the classical intrahemispheric language centers, Wernickes and Brocas areas. In contrast however, a marked loss of functional connectivity was found between the right cerebellar region and the supratentorial regulatory language areas. Also, the connectivity between the interhemispheric Broca regions and modulatory control dorsolateral prefrontal region was found to be decreased. This disruption of normal modulatory control and automation function by the cerebellum may underlie the abnormal language function in children with ASD-LI.

Prospective randomized comparative study of tracheoesophageal voice prosthesis : Blom-Singer versus Provox

Objectives: Compare the most commonly used types of tracheoesophageal voice prostheses, Blom Singer and Provox. Study Design: Prospective study of 113 prostheses placed in 52 patients randomly selected to receive Blom‐Singer and Provox. Methods: Postoperative voice was recorded at 1 and 4 months after valve placement. Survival time of the prosthesis and four objective voice parameters were analyzed. Eight judges rated all recordings in a random order for six subjective voice parameters. Subgroup analysis for primary versus secondary placements and type of procedure was performed. In addition, patients were asked for their subjective assessment. Results: Overall, Blom‐Singer and Provox prostheses give very similar voice quality, lifetime, and patient satisfaction. Cleaning management is somewhat better for Provox, but there is a trend toward better overall voice quality for the Blom‐Singer prosthesis. In subgroup analysis secondarily placed prostheses score somewhat better than primary placements, and patients with total laryngectomy have better voices than patients with extended laryngectomy combined with partial pharyngectomy. Conclusions: Given the equal and good results in terms of voice quality, other factors (e.g., costs, surgery‐related factors, maintenance, patient preference) should be taken into account when deciding which type of tracheoesophageal voice prosthesis to use. Laryngoscope, 108:1561–1665, 1998

Structural and functional underconnectivity as a negative predictor for language in autism.

The development of language, social interaction, and communicative skills are remarkably different in the child with autism spectrum disorder (ASD). Atypical brain connectivity has frequently been reported in this patient population. However, the interplay between their brain connectivity and language performance remains largely understudied. Using diffusion tensor imaging tractography and resting‐state fMRI, the authors explored the structural and functional connectivity of the language network and its relation to the language profile in a group of healthy control subjects (N = 25) and a group of children with ASD (N = 17). The authors hypothesized that in children with ASD, a neural connectivity deficit of the language network can be related to the observed abnormal language function. They found an absence of the right‐hemispheric arcuate fascicle (AF) in 28% (7/25) of the healthy control children and in 59% (10/17) of the children with ASD. In contrast to healthy control children, the absence of the right‐hemispheric AF in children with autism was related to a lower language performance as indicated by a lower verbal IQ, lower scores on the Peabody Picture Vocabulary Test, and lower language scores on the Dutch version of the Clinical Evaluation of Language Fundamentals (CELF‐4NL). In addition, through iterative fMRI data analyses, the language impairment of children with ASD could be linked to a marked loss of intrahemispheric functional connectivity between inferior frontal and superior temporal regions, known as the cortical language network. Both structural and functional underconnectivity patterns coincide and are related to an abnormal language function in children with ASD. Hum Brain Mapp 35:3602–3615, 2014.

Auditory Processing and Speech Perception in Children with Specific Language Impairment: Relations with Oral Language and Literacy Skills.

This longitudinal study investigated temporal auditory processing (frequency modulation and between-channel gap detection) and speech perception (speech-in-noise and categorical perception) in three groups of 6 years 3 months to 6 years 8 months-old children attending grade 1: (1) children with specific language impairment (SLI) and literacy delay (n = 8), (2) children with SLI and normal literacy (n = 10) and (3) typically developing children (n = 14). Moreover, the relations between these auditory processing and speech perception skills and oral language and literacy skills in grade 1 and grade 3 were analyzed. The SLI group with literacy delay scored significantly lower than both other groups on speech perception, but not on temporal auditory processing. Both normal reading groups did not differ in terms of speech perception or auditory processing. Speech perception was significantly related to reading and spelling in grades 1 and 3 and had a unique predictive contribution to reading growth in grade 3, even after controlling reading level, phonological ability, auditory processing and oral language skills in grade 1. These findings indicated that speech perception also had a unique direct impact upon reading development and not only through its relation with phonological awareness. Moreover, speech perception seemed to be more associated with the development of literacy skills and less with oral language ability.

Who Is At Risk for Dyslexia? Phonological Processing in Five-to Seven-Year-Old Dutch-Speaking Children With SLI

A disproportionally high number of children with specific language impairment (SLI) develop dyslexia. Yet it is hard to predict which individual child is at risk. This article presents a longitudinal study of phonological and early literacy development of 18 Dutch-speaking children with SLI, compared to 18 typically developing controls over a period of 2 years. These matched pairs of children were followed from 1 year before until 1 year after the start of formal literacy instruction. Children with SLI had problems with phonological awareness (PA) and verbal short-term memory (vSTM) in kindergarten. PA and vSTM in kindergarten were not good predictors for dyslexia in children with SLI, but rapid automatized naming (RAN) measured in kindergarten was strongly correlated with reading and spelling in both groups. We can infer that only SLI children who additionally failed on RAN in kindergarten developed reading and spelling problems at the end of Grade 1.

Oral Language and Narrative Skills in Children with Specific Language Impairment with and without Literacy Delay: A Three-Year Longitudinal Study.

This longitudinal study compared the development of oral language and more specifically narrative skills (storytelling and story retelling) in children with specific language impairment (SLI) with and without literacy delay. Therefore, 18 children with SLI and 18 matched controls with normal literacy were followed from the last year of kindergarten (mean age=5 years 5 months) until the beginning of grade 3 (mean age=8 years 1 month). Oral language tests measuring vocabulary, morphology, sentence and text comprehension and narrative skills were administered yearly. Based on first and third grade reading and spelling achievement, both groups were divided into a group with and a group without literacy problems. Results showed that the children with SLI and literacy delay had persistent oral language problems across all assessed language domains. The children with SLI and normal literacy skills scored also persistently low on vocabulary, morphology and story retelling skills. Only on listening comprehension and storytelling, they evolved towards the level of the control group. In conclusion, oral language skills in children with SLI and normal literacy skills remained in general poor, despite their intact literacy development during the first years of literacy instruction. Only for listening comprehension and storytelling, they improved, probably as a result of more print exposure.

Teaching Adults With Intellectual Disability Manual Signs Through Their Support Staff: A Key Word Signing Program

PURPOSE The goal of this study was to evaluate a key word signing (KWS) program in which adults with mild to severe intellectual disability (ID) were taught manual signs through their support staff. Our hypothesis was that spontaneous manual sign production of participants would increase significantly after 12 months of implementation of the KWS program. METHOD A KWS immersion program was implemented in a facility for adults with ID. First, 8 support workers received 8 hr of training. These KWS ambassadors then taught 2 manual signs per week to their colleagues, who modeled the use of the signs throughout the day in natural interactions with their clients. KWS use in 15 adults with ID and 15 of their support staff was evaluated before the start of the program and at a 12-month follow-up using a narrative task and during spontaneous conversation. RESULTS Manual sign production of support workers and adults with ID had increased significantly 12 months after the start of the program. The adults with ID were able to express significantly more communicative functions in their narrative language after the intervention and when using KWS. CONCLUSION The KWS program was successful and can be applied in similar clinical settings.

Young children with language difficulties: A dimensional approach to subgrouping

A dimensional approach was used to create bottom-up constructed subgroups that captured the behavioral heterogeneity in 36 Dutch-speaking children with language difficulties. Four subgroups were delineated based upon differences in cognitive ability, symbol understanding, joint attention and autism spectrum disorder related characteristics. Children with a different developmental disorder were found within a single cluster. Therefore, the results of this study suggest that bottom-up constructed subgroups might capture the heterogeneous behavioral profiles of young children with developmental difficulties in a more meaningful way. Furthermore, joint attention and symbol understanding seem important skills to assess in young children presenting with language difficulties.