Neuromuscular disorders

Laryngeal innervation and the functional disorders associated with lower motor neuron paralyses are reviewed. Causes of diffuse denervation, such as drug toxicities and demyelinating disease, are also discussed. Symptoms and treatment of myasthenia gravis, amyotrophic lateral sclerosis, and botulism are discussed as examples of neuromuscular blockade at various levels.     

Vestibular disorders

This article reviews and updates the pathology associated with the labyrinth and peripheral central nervous system. It serves as an overview to aid in the diagnosis and treatment of vertigo.     

Coincidence of chronic inflammatory paranasal sinus disorders and cochleo-vestibular disorders

In the course of initial examination the authors frequently observed a coincidence of labyrinthine symptoms with radiologic signs of chronic sinusitis. Of 72 patients who were hospitalized for acute labyrinthine symptoms, 72% presented with these signs. On the other hand, 49% of the patients admitted to sinus surgery manifested labyrinthine symptoms. A well-pneumatized mastoid was found in both groups. In the control group, consisting of patients whose consultation was unconnected to ear or nose complaints, chronic sinusitis was found in 28% and labyrinthine symptoms in 24%, but the two together were only found in 11%. It was shown by means of the chi2 test that the two symptom complexes are interdependent (p less than 0.01). Histologic examination of the mucosa of paranasal sinuses and peri-labyrinthine cells does not at the moment provide a satisfactory explanation. Pathologic autonomic nerve connections between the two systems may lead to higher vulnerability of the labyrinths of patients with chronic sinusitis. Other possible explanations, i.e., relating to certain neuropeptides and a well-pneumatized mastoid, are discussed. The authors wish to emphasize that their study is based on clinical data. At the moment a satisfactory pathophysiological explanation is lacking. In addition to antiphlogistic and rheologic medication, long-term planning of sinus surgery should be recommended for all patients in whom the two symptoms occur simultaneously. Whether this can help prevent recurrences, or put an end to progressive processes, can only be determined after a longer observation period.     

Inflammatory thyroid disorders

Inflammatory thyroid disorders encompass a broad spectrum of diseases that are generally self-limited, and relatively easy to diagnose and manage. Autoimmune subtypes are by far the most commonly encountered diagnoses and create the most confusion because of simultaneous overlap and the potential for interconversion among the subtypes. The otolaryngologist will frequently see these disorders and provide valued consultative care and surgical intervention as needed.     

Post-tonsillectomy taste disorders

Gustatory dysfunction is an uncommon complication following tonsillectomy with a potential impact on the quality of life. This retrospective study was undertaken to evaluate the incidence of post-tonsillectomy dysgeusia and its relationship to wound healing and pain. A retrospective chart review of 100 patients who had undergone tonsillectomy between June and December 2008 at a single tertiary care institution was performed. Clinical examination included evaluation of the patient’s history and psychophysical testing with cottons soaked with chininsulfate (0.075%; 0.2%), glucose (2%; 10%), citric acid (0.5%; 7.5%) and sodium chloride (0.5%; 2.5%) before, as well as 4 days to 3 months following tonsillectomy at a tertiary care hospital. Anatomical peculiarities, intubation problems, operation time, methods to achieve hemostasis were extracted from the charts. Healing was scored by the physician and pain was scored by the patient. Subjective taste dysfunction was registered in 29 patients 4 days after surgery. In all patients this dysgeusia regressed within weeks. Measured taste function showed lateralized and transient changes. No investigated factor such as pain, operating time, anatomical particularities, wound healing or haemostatic technique were associated with the occurrence of dysgeusia. Transient taste perception changes seem to be relatively frequent after tonsillectomy. Although our results indicate no correlation of even transiently altered taste perception and any of the investigated parameters, this further confirms the clinical impression that gustatory symptoms can occur even after uneventful tonsillectomy. Informed consent should include post-tonsillectomy gustatory dysfunction.     

Multiple otopathologic disorders

Temporal bones (1,383) from 713 patients were studied systematically for multiple pathologic lesions. Eleven percent (152 temporal bones) were found to have more than one pathologic finding. Males (60.5%) had multiple diseases more commonly than did females (37.7%). The most frequently occurring findings were otitis media (71.1%), otosclerosis (43.4%), endolymphatic hydrops (38.8%), labyrinthitis (25.0%), and cancer (24.3%). We conclude that multiple coexisting pathologic conditions can have coincidental or causative relationships. The otolaryngologist should consider multiple pathologic conditions when diagnosing and treating diseases of the ear.     

Retrocochlear hearing disorders

The diagnosis of retrocochlear hearing impairment is mainly based on threshold tone decay, absence of the stapedius reflex, abnormal dichotic speech discrimination and ERA findings. A relatively poor discrimination for monosyllables with regressive understanding at high intensities can also indicate a neural or central lesion provided that the unaffected side has been correctly masked. ERA results mainly show a synchronisation disorder within the brain-stem, i.e. the J V-response is prolonged or cannot be recorded at all. The cortical response N1, however, corresponds to the subjective threshold except that in impairments of the cortex, the N1-response is worse than expected from the pure tone threshold. Representative examples are given.     

Posttraumatic balance disorders

Head trauma is being more frequently recognized as a causative agent in balance disorders. Most of the published literature examining traumatic brain injury (TBI) after head trauma has focused on short-term prognostic indicators and neurocognitive disorders. Few data are available to guide those individuals who see patients with balance disorders secondary to TBI. Our group has previously examined balance disorders after mild head trauma. In this study, we study all classes of head trauma. We provide a classification system that is useful in the diagnosis and management of balance disorders after head trauma and we examine treatment outcomes. As dizziness is one of the most common outcomes of TBI, it is essential that those who study and treat dizziness be familiar with this subject.     

Communication disorders and emotional/behavioral disorders in children and adolescents

Recent research in child psychiatry has demonstrated a high prevalence of speech, language, and communication disorders in children referred to psychiatric and mental health settings for emotional and behavioral problems. Conversely, children referred to speech and language clinics for communication disorders have been found to have a high rate of diagnosable psychiatric disorders. Most of the emerging knowledge regarding relationships between communication disorders and psychiatric disorders has been presented in the child psychiatric literature. Speech-language pathologists and audiologists also need to be familiar with this information; an understanding of the complex interrelationship between communication disorders and emotional and behavioral disorders is important for diagnosis, assessment, and treatment. The purpose of this article is to review recent research and discuss clinical implications for professionals in speech-language pathology and audiology working with children and adolescents who have, or who are at risk for, developing emotional and behavioral disorders. Issues to be addressed include differential diagnosis, prevention, intervention, and the role of speech-language pathologists serving these children and adolescents.