Irena Hočevar Boltežar

Effects of Recurrent Otitis Media in Infancy on Auditory Perception and Speech

INTRODUCTION Recurrent otitis media is commonly encountered in children before 3 years of age. Conductive hearing loss up to 40 dB is frequently associated with suppurative otitis media. Good hearing is believed to be critical to the development of normal language. This study was undertaken to evaluate the effect of recurrent otitis media on auditory perception and speech. PATIENTS AND METHODS The experimental group consisted of 33 children with a history of at least three episodes of acute otitis media before 2 years of age. A control group of 29 children experienced one or fewer episodes of otitis media in the first 2 years of age. At the time of investigation, all children were 8 to 10 years of age and had attended similar pre-school, kindergarten, and elementary school programs. None showed evidence of mental retardation nor behavioral or emotional disorders. Speech ability was assessed by a battery of tests specific for Slovene language. Subtests of the Wechsler Intelligence Scale for Children were used as well as the Reading and Writing Test. RESULTS Auditory perception disorders were evident in 88% of children investigated who had a history of at least three episodes of otitis media by 2 years of age. Decreased auditory stimulation during the time of auditory maturation could prevent the development of these functions completely. No statistically significant differences were observed in the development of articulation. These observations underscore the importance of early management of recurrent otitis media during the first 2 years of age.

IMPAIRED MOBILITY OF VOCAL FOLDS – DIAGNOSTIC PROCEDURES AND TREATMENT, part 2

Paresis or paralysis of one or both vocal cords affects phonation, swallowing and breathing. The major cause for reduced mobility or even immobility is innervation damage, less often mechanical disorder. The main procedures in the diagnostics of disordered vocal fold mobility are indirect laryngoscopy and videoendostroboscopy. Different imaging techniques (especially computerized tomography) are of great value in searching for a cause of the impaired mobility. In unilateral vocal fold immobility, the treatment is focused on the improvement of voice quality and the prevention of aspiration during swallowing. In bilateral paralysis, it is crucial to find a balance between effective breathing and sufficient voice quality. The treatment of unilateral paralysis is started with voice therapy and swallowing rehabilitation. If these procedures are not enough surgical treatment for the medialization of the paralyzed vocal fold is applied. In the case of breathing difficulties in bilateral vocal fold immobility there is a possibility of surgical lateralization of one or both folds or a surgical excision of a part or the entire vocal fold. Surgical reinnervation, functional electrostimulation of certain laryngeal muscles and gene therapy are developing treatment modalities.

Reinke’s edema of the vocal cords

Background: Reinke’s edema is one of the most frequent head and neck diseases. A great majority of the patients are middle-aged women. In the initial stage of the disease, a deeper voice appears. Hoarseness is a sign of an advanced disease. An enormous edema can even cause breathing problems. The known etiologic factors for the development of Reinke’s edema are smoking, gastroesophageal reflux, vocal overuse, unfavourable microclimate at work and possibly thyroid disfunction and allergy. Besides the causal treatment, in a majority of patients the surgical treatment is the only possibility of cure. The voice therapy after the surgical procedure helps the patient to regain a proper vocal technique and vocal habits. Conclusions: Reinke’s edema is quite a frequent cause of voice disorders. In order to treat the disease and prevent a recurrence, all etiological factors must be detected and eliminated or extenuated. A proper voice therapy that follows the surgical treatment can enable the patient to regain a good voice quality.