省级康复机构低龄听障儿童康复训练情况调查

目的 了解我国省级听障儿童康复机构中3岁以下听障儿童的康复状况,探讨未来听障婴幼儿的康复模式.方法 采用问卷调查的方式,对全国省级听障儿童康复机构进行调查,重点调查2009年底前听障婴幼儿开始接受康复的时间和模式.结果 在省级康复机构最早接受康复指导和训练的听障儿童年龄为2个月,多采取由家长定期带小儿到机构接受训练的形式.同时结合定期举办家长培训班及指导家庭康复的方法 ;随着新生儿听力筛查的推广和普及,听障婴幼儿早期康复干预需求呈上升趋势,家长和机构对早期康复较过去更加重视.结论 政府对听障儿童的康复投入不断增加.低龄听障儿童的康复越来越受到重视;未来的康复应把低龄听障儿童作为重点,根据家庭、社会的需求,采取机构、社区、家庭等多种形式的康复教育,加大对家长的培训及社区家庭指导力度.     

听障儿童家庭康复入户指导的个案研究

目的 探讨听障儿童家庭康复入户指导模式的可行性和有效性.方法 以一名3岁听障儿童为被试,对其进行为期半年的家庭康复入户指导干预,干预前后定期进行听觉能力评估、语言能力评估、学习能力评估以及EARS评估.结果 通过半年的家庭康复入户指导,个案在听觉、语言以及学习能力各方面都有明显好转;其家长也逐渐参与到康复训练中,基本掌握了康复训练的方法并主动承担起康复训练课程.结论 听障儿童家庭康复入户指导的模式具有可行性和推广性,有利于听障儿童全面发展和家庭和谐,但在康复效果评估以及后续跟踪方面需要进一步完善.     

普通话儿童言语理解力测试(MPSI)

1 研发背景 随着科学技术的飞速发展和政府对听障儿童的日益重视,越来越多的听障儿童在出生后不久即能得到及时发现、诊断和干预.但这只是听障儿童成功康复的第一步,因为它只是让听障儿童有机会去聆听声音.听力康复的最终目标是让听障儿童能像健听儿童一样在日常生活的各种复杂环境中自如地与人沟通交流,要实现这一步必须在听力问题的早期发现、早期诊断和早期干预后,定期随访听觉言语发育情况,制订科学的个体化听觉言语康复计划,并根据评估结果进一步指导康复[1].     

浅谈听觉口语法的推行与挑战

近年来，听觉口语法在听障儿童康复中得到了大力推广。本文结合听觉口语法的指导原则，从助听技术发展、康复对象、家庭康复教育三方面讨论了听觉口语法在国内推行的必然趋势及其给听障儿童康复教学带来的挑战。     

社区在耳聋预防及早期干预中的重要作用

本文主要论述了社区在耳聋预防及早期干预工作中的重要作用。提出了在社区如何提高公众的防聋意识，尤其对育龄青年家庭普及相关知识是减少出生缺陷的关键。早期干预和家庭康复是不可分割的一对结合体，建立以康复机构为指导，以家庭康复为中心的训练模式是实现早期干预的必然途径．同时强调耳聋预防及早期干预工作是社会化、多学科合作的系统工程，只有在政府及有关职能部门统筹协调规划下，才能全面贯彻落实。     

运用听觉口语法规范听障儿童个别化训练

听障儿童是有特殊需要的儿童,克服听力障碍、发展听说能力、提高全面素质是听障儿童康复的主要任务。如何发展听障儿童的听说能力,使其畅通无阻地与人沟通、交流学习,参与社会,是听障儿童康复专业人员一直努力探索的问题。全面康复模式提出了听障儿童听觉言语训练规范化和专业化的要求,并将听觉口语法作为听觉言语个别化训练的主要方法,本文旨在分析听障儿童康复机构在全面康复理念的指导下选择运用听觉口语法规范个别化训练的背景、策略及面临的挑战。     

听障儿童全面康复质量评价指标体系的结构与变量

听障儿童的康复效果取决于康复服务质量的优劣。听障儿童全面康复模式的提出与推广,为现行听障儿童康复服务实践提供了意识与行动的指南。本文以听障儿童全面康复理念为指导,遵循生态学和教育评价学的基本思维方法,从影响康复效益的关键因素出发,阐述听障儿童全面康复质量的结构要素与变量,以期为全国听障儿童全面康复服务质量监测体系的建立提供专业性的探讨。     

北京市3～7岁听障儿童与健听儿童智力测验的比较研究

目的研究北京市听障儿童智力发育的特点,比较听障儿童与健听儿童智力发育的差别,为北京市听障儿童康复工作提供理论依据。方法采用希一内学习能力测验的健听常模对56名听障儿童和56名相同年龄的健听儿童的智力进行测验。结果3～7岁听障儿童的比率智商是94．99±14．27,56名健听儿童的比率智商是96．49±12．98,两者的差别没有统计学意义;4岁之前二者的智力水平发展一致,随着年龄的增加,二者的差距增大,差别无统计学意义。与健听儿童相比,听障儿童的手眼协调、空间知觉、视觉记忆和抽象思维发展较好,而色彩记忆和分析综合能力发展滞后。结论北京市听障儿童智力发育良好,已接近健听儿童的水平,社会和家庭应继续关注听障儿童的早期干预和心理健康,以期达到全面康复的目的。     

互联网络助力中国听障儿童康复

互联网络技术能够在中国听障儿童康复事业中发挥很好的服务和宣传作用。本文介绍了如何利用互联网络技术推动听障儿童康复事业的发展,分享了中国听障儿童服务网及微博管理的若干经验。以期为我国听障儿童康复服务网络建设提供借鉴。     

简易版普通话早期言语感知测试(LV-MESP)的临床应用简介

儿童时期是听觉-言语-语言能力发育的重要时期,幼儿期的言语发育尤为关键[1,2]。听障幼儿言语语言的成功康复需要早期干预。普遍新生儿听力筛查的开展、助听器和人工耳蜗等各种早期干预技术的迅速发展和推广,使听障幼儿的早期诊断和干预成为可能。言语测听在听障幼儿的早期诊断和     

One‐stop neck lump clinic: phase 2 of audit. How are we doing?

One‐stop neck lump clinic: phase 2 of audit. How are we doing? Regular monitoring and audit of a service are integral to ensuring maintenance of efficiency and standards. This is particularly important where the quality of the service is operator dependent, as is the case in the clinical diagnosis of neck lumps and fine needle aspiration cytology. The one‐stop neck lump clinic has now been running in the department for more than 20 months. A previous article described the results of the first phase audit carried out at 6 months and had identified a waiting time to be seen that was longer than that recommended by the British Association of Otorhinolaryngologists, Head and Neck Surgeons. Measures were implemented to reduce this waiting time and a second audit was carried out after another 10 months with the aims of assessing if modification of the means of referral reduces waiting time and if the outcomes of clinical performance in phase 1 could be maintained or improved. We discuss the results of phase 2 in the audit spiral.     

A Decrease in Maxillary Sinus Pressure,as Seen in Upper Airway Allergy or Infection,Results in an Increase in Upper Airway Nitric Oxide Levels

The paranasal sinuses are connected to the nasal cavity via small osties. Ostial occlusion, caused by mucosal swelling, will result in a slowly increasing negative pressure inside the sinus cavity. In parallel, the oxygen content in the sinus will decrease, resulting in the development of relative hypoxia. Hypoxia is a powerful inducer of nitric oxide (NO) synthase, and inducible NO synthase has been shown to be present in considerable amounts in the upper airways, including the sinuses. The present study was designed to investigate whether a reduction in sinus pressure would affect upper airway NO production. Thirteen healthy volunteers were investigated. A pressure chamber was used to lower the ambient pressure to-4.9 kPa. NO was sampled from one nostril or via a drainage tube inserted into the maxillary sinus before, during and after the hypobaric exposure. When the pressure was decreased, NO levels increased from 256 &#45 15 to 316 &#45 19 ppb ( n =13, p <0.001). The NO levels remained elevated (282 &#45 21 ppb; p <0.05) when measurements were repeated 20 min after leaving the chamber. The nasal airway resistance (V2 tot ) also increased as a result of the chamber session (from 16 &#45 2° before to 21 &#45 3° after; p <0.05). An increase in NO levels was also found when the experiments were repeated with NO sampled directly from the maxillary sinus (225 &#45 6 before and 265 &#45 9 ppb after; n =6, p <0.001). For control purposes the nasal analyses were repeated again, this time under hyperbaric conditions (+4.9 kPa). This resulted in a slight decrease in the NO levels (from 273 &#45 22 to 241 &#45 17 ppb; n =10, p <0.001), but there was no change in the nasal airway resistance. We conclude that a reduction in sinus pressure, as seen in upper airway allergy or infection, may result in an increase in upper airway NO production.     

A simple objective evaluation and grading for facial paralysis outcomes

Matrix metalloproteinase (MMP)-2 and -9 degrade type IV collagen, which is one of the major components of the basement membrane in normal tissue and expressed in the surroundings of the cancer nest in squamous cell carinoma. The degeneration of type IV collagen is an essential step in the metastasis to lymph nodes and distant organs. In this study, we examined MMP-2 and -9 levels of cancer tissue and serum obtained from patients with head and neck squamous cell carcinoma (HNSCC) in order to evaluate the relationship between the clinicopathologic features and MMPs. We examined the production of MMP-2 and -9 in cancer tissue homogenates of 73 patients who had HNSCC and the serum MMP levels of 16 patients with HNSCC and 8 healthy volunteers. We also studied the localization of MMP-2 in the carcinoma using an immunohistochemical approach. The concentrations of MMP-2 and -9 in the tissue homogenates and serum were measured by means of a sandwich enzyme immunoassay using a monoclonal antibody. Immunohistochemical analyses were performed with monoclonal antibody to MMP-2. The concentration of MMP-2 in the tumor tissue homogenates was unrelated to tumor size, but that in patients with lymph node metastases was significantly higher than in those without lymph node metastases. The concentration of MMP-9 was unrelated to lymph node metastasis and tumor size. The levels of both MMP-2 and -9 in serum were unrelated to lymph node metastasis. Immunohistochemistry indicated that MMP-2 was mainly expressed in cancer cells. Because MMP-2 degrades type IV collagen, the level of MMP-2 in carcinomas may be a useful indicator of the degree of invasion and metastasis.     

A case of cortical deafness and anarthria

The nasal epithelium protects the underlying tissue from damage. Epithelial cell growth is controlled by epidermal growth factor (EGF) and is possibly affected by toxic proteins, e.g. eosinophil cationic protein (ECP). The aims of this study were to examine nasal fluid epithelial cell counts and their relations to EGF, eosinophils and ECP in 23 patients with seasonal allergic rhinitis and 20 healthy controls. Nasal fluid epithelial cell counts were lower in patients than in controls. EGF levels did not differ between patients and controls, and correlated with epithelial cell counts in controls but not in patients. Eosinophils and ECP were higher in patients than in controls, but did not correlate with epithelial cell counts. The role of growth factors, such as EGF, in regulating epithelial cells merits further study.     

Bilateral versus unilateral cochlear implantation in young children

Objectives

To compare the preverbal communication skills of two groups of young implanted children: those with unilateral implantation and those with bilateral implantation.

Material and methods

The study assessed 69 children: 42 unilaterally and 27 bilaterally implanted with age at implantation less than 3 years. The preverbal skills of these children were measured before and 1 year after implantation, using Tait Video Analysis that has been found able to predict later speech outcomes in young implanted children.

Results

Before implantation there was no significant difference between the unilateral group and the bilateral group. There was still no difference at 12 months following implantation where vocal autonomy is concerned, but a strongly significant difference between the groups for vocal turn-taking and non-looking vocal turns, the bilateral group outperforming the unilateral group. Regarding gestural turn-taking and gestural autonomy, there was a strongly significant difference between the two groups at the 12 month interval, and also a difference before implantation for gestural autonomy, the unilateral group having the higher scores. Multiple regression of non-looking vocal turns revealed that 1 year following implantation, bilateral implantation contributed to 51% of the variance (p < 0.0001), after controlling for the influence of age at implantation and length of deafness which did not reach statistical significance.

Conclusions

Profoundly deaf bilaterally implanted children are significantly more likely to use vocalisation to communicate, and to use audition when interacting vocally with an adult, compared with unilaterally implanted children. These results are independent of age at implantation and length of deafness.     

Otolaryngologists may not be doing enough to diagnose pediatric eosinophilic esophagitis

Objective

To systematically evaluate the diagnosis of eosinophilic esophagitis (EE).

Methods

A retrospective review of 657 patients seen at the EE center of a tertiary care children's hospital between 1994 and 2007 was performed. Charts were reviewed for the 144 patients who were also seen by the otolaryngology service.

Results

One hundred forty-four patients received 193 otolaryngology-related diagnoses. Eustachian tube dysfunction (27.5%) and sleep disordered breathing (24.9%) were the most common, followed by dysphagia (13.0%), rhinosinusitis/nasal congestion (9.3%) and airway stenosis (5.2%). Seventy-nine patients (54.9%) had a pre-existing diagnosis of EE at the time of their otolaryngology consultation. Twenty-one patients (14.6%) were referred to the gastroenterology service for evaluation for EE. Forty-four patients (30.5%) remained undiagnosed. Twenty-five of these patients presented with dysphagia, 16 of whom were not previously diagnosed with EE; only 4 of these 16 patients were referred for evaluation for EE. In one case, a child with moderate sized tonsils underwent adenotonsillectomy for dysphagia and failure to thrive; this patient was diagnosed with EE 1 month post-operatively.

Conclusions

Twenty percent of patients with EE may require care by an otolaryngologist for a myriad of complaints. Even experienced pediatric otolaryngologists may not recognize this condition. Otolaryngologists should consider EE in patients presenting with dysphagia. A careful gastroenterology review of symptoms may also allow otolaryngologists to identify EE in patients with allergy mediated nasal complaints, or laryngeal/airway disorders.     

Correction of the Glosso-Larynx and Resultant Positional Changes of the Hyoid Bone and Cranium

In ankyloglossia with deviation of the epiglottis and larynx (ADEL) the tongue is located forward and as a result the epiglottis is elevated and leans towards the mouth. The larynx is also raised and curves ventrally. Various symptoms have been observed as a result of this condition. Correction of the glosso-larynx (CGL) is the operation performed to treat ADEL. The CGL procedure and the results obtained with it are reported in this paper. In addition, we studied the following six parameters using head and neck X-rays before and after CGL (the changes in these parameters as a result of CGL are shown in parentheses): ( i ) the shortest vertical length between the hyoid bone and mandible (+10.3 mm); ( ii ) the vertical length between the hyoid bone and the tangent line of C2-4 (+4.6 mm); ( iii ) the shortest length between the hyoid bone and the chin (+2.9 mm); ( iv ) the angle between the hyoid bone and the tangent line of C2-4 (+3.3°); ( v ) the length of H-M, where H is the intersection of a tangent line of C2-4 and a vertical line from the hyoid bone and M is the intersection of a tangent line of C2-4 and the mandible (+7.4 mm); and ( vi ) the width of the narrowest part of the hypopharynx (+3.0 mm). The changes in all the measured parameters after CGL were significantly different ( p <0.05).     

Autoimmunity in Sudden Sensorineural Hearing Loss: Possible Role of Anti-endothelial Cell Autoantibodies

In order to verify whether anti-endothelial cell autoantibodies (AECAs) can be used as serological markers of inner ear vasculitis in sudden sensorineural hearing loss (SSHL), 32 patients affected by idiopathic SSHL were investigated. All patients underwent a routine general physical examination and extensive audiovestibular, microbiological and immunological investigations. Fourteen normal subjects without a history of HL, autoimmune or metabolic disease served as controls. Detection of AECAs was performed using an indirect immunofluorescence technique. AECA-positive patients were treated with methylprednisone, while AECA-negative patients were treated with a combined regimen of steroids, plasma expander and aspirin. The average hearing recovery for 5 frequencies (0.25-4 kHz) was analyzed in each subject 1 month after treatment and every 3 months thereafter; median follow-up was 12 months (range 9-18 months). A total of 15/32 patients (46.8%; 11/19 females, 4/13 males) were AECA-positive and thus differed significantly from the normal population in whom only 2/14 tested cases were positive ( p =0.03). Severe hearing loss was associated with being AECA-positive in 8/11 cases. During follow-up, 25/32 patients improved their hearing and 17 of these patients were AECA-negative. The seven cases without hearing improvement were all AECA-positive. In patients with SSHL, immune-mediated vascular damage may have a pathogenetic role and AECAs may represent a serological marker of vasculitis even if they are not inner ear-specific and even if they represent an epi-phenomenon rather than the only cause of SSHL.     

Carcinoma of the Nasopharynx: Analysis of Treatment Results in 91 Patients

The outcome of 91 patients (69 males, 22 females; age range 16-82 years) with nasopharyngeal carcinoma treated in our hospital between 1971 and 1999 was evaluated. Factors that appeared to influence prognosis were assessed using the Kaplan -Meier method. The cause-specific cumulative 5-year survival rate for the entire study population was 61.2%. The 1997 International Union Against Cancer classification was used for disease staging. The 5-year survival rates were as follows: 66.7% ( n ¾ 3) for Stage I; 100% ( n ¾ 2) for Stage IIA; 90.9% ( n ¾ 11) for Stage IIB; 78.8% ( n ¾ 25) for Stage III; 53.0% ( n ¾ 29) for Stage IVA; 37.5% ( n ¾ 16) for Stage IVB; and 20.0% ( n ¾ 5) for Stage IVC. The disease-free cumulative 3-year survival rates of the patients classified based on initial therapy were as follows: radiation alone, 50.0% ( n ¾ 28); combined radiotherapy and chemotherapy that included an undefined anti-cancer drug, 67.2% ( n ¾ 39); combined radiotherapy and chemotherapy that included carboplatin (CBDCA), 92.3% ( n ¾ 19). These results showed a statistically significant difference ( p ¾ 0.043; log-rank test). Stage IVC patients were excluded from the analysis. We conclude that combined therapy, including chemotherapy with CBDCA, is necessary for the treatment of nasopharyngeal carcinoma. In terms of radiation therapy, a field covering the bilateral cervical regions seemed to produce favorable results, even if cervical node metastasis was not confirmed by palpation at the first hospital visit.