Treatment of dysarthria: a case report.

There is little information available to the speech clinician on management of dysarthria. This article presents the rationale, procedural outline, and results of an approach to communication training for one dysarthic subject in view of suggestions made by Darley et al. (1975).     

Local rifampicin in treatment of rhinoscleroma

Many antibiotics, chemotherapeutic agents and other chemicals have been tried in the treatment of scleroma without much success (Toppozada et al., 1967). The most popular of these drugs are streptomycin and aureomycin (Botros et al., 1954; Zwiefach, 1955; El-Mofty, 1962), terramycin and chloromycetin (Hoover and King, 1953) and ampicillin, septrin and vibramycin (Ssali, 1975). El-Mofty and Attia (1957) attributed considerable value to the use of 20 per cent aureomycin ointment locally in treating the disease. Nigonol in the form of a local injection was tried by Toppozada et al. (1967) and they claimed good results. Shaer et al. (1981) reported that local application of 2 per cent acriflavine solution over an eight-week period was an effective and safe remedy for rhinoscleroma. Rifampicin has been used systemically with success as a new antibiotic for the treatment of scleroma (Riad, 1982). The aim of the present study was to evaluate the response of rhinoscleroma to local medication with rifampicin.     

SCORE risk scale as a prognostic factor after sudden sensorineural hearing loss

European Archives of Oto-Rhino-Laryngology - Menezes et al. recently published an interesting study on cardiovascular prognostic factors for sudden sensorineural hearing loss (SSNHL), analyzing...     

Otolaryngology manpower in Canada: a crisis in the making?

Physician manpower issues have been of interest to Canadians and government officials for several decades. Since the first otolaryngology manpower survey was completed by Dr. Percy Ireland in 1962, there have been progressive declines in the physician-to-population ratio across Canada from 1 in 42 000 in 1962 to approximately 1 in 75 000 in 2000. The expected increase in our population over the next decade, the cutbacks in medical school enrollment, and an aging population will compound this problem. The system is in crisis, and this country is desperately in need of more otolaryngologists.     

Acoustic dimensions of hearing-impaired speakers' intelligibility: segmental and suprasegmental characteristics

Regression and principal components analyses were employed to study the relationship between 28 segmental and suprasegmental acoustic parameters of speech production and measures of speech intelligibility for 40 severely to profoundly hearing-impaired persons in an effort to extend the findings of Metz, Samar, Schiavetti, Sitler, and Whitehead (1985). The principal components analysis derived six factors that accounted for 59% of the variance in the original 28 parameters. Consistent with the findings of Metz et al., a subsequent regression analysis using these six factors as predictor variables revealed two factors with strong predictive relationships to speech intelligibility. One factor primarily reflected segmental production processes related to the temporal and spatial differentiation of phonemes, whereas the other primarily reflected suprasegmental production processes associated with contrastive stress. However, the predictive capability of the present factor structure was somewhat reduced relative to the findings of Metz et al. (1985). Data presented indicate that the populations sampled in the two studies may have differed on one or more dimensions of subject characteristics. Considered collectively, the present findings and the findings of Metz et al. support the tractability of employing selected acoustic variables for the estimation of speech intelligibility.     

Peer review: studying the major otolaryngology journals

OBJECTIVE: To determine if the otolaryngology literature is comparable to other surgical specialty journals with respect to quality and types of articles published. METHODS: The four major otolaryngology journals--Annals of Otology, Rhinology and Laryngology, Archives of Otolaryngology--Head and Neck Surgery, Laryngoscope, and Otolaryngology--Head and Neck Surgery--were studied for 6-months and examined for the following variables: 1) proportion of clinical or basic science research, 2) proportion of prospective or retrospective studies, 3) types of statistics used, 4) sample sizes of the studies, and 5) proportion of single case reports. A composite group of surgical specialty journals consisting of Journal of Bone and Joint Surgery, Neurosurgery, and Ophthalmology was also studied for the same time period. The otolaryngology journals and other specialty journals were compared with respect to each of these variables, after which the comparison was conducted within the group of otolaryngology journals. RESULTS: Analysis of 905 articles, comprising 508 articles from the four major otolaryngology journals and 397 articles from the composite of the other specialty journals, was conducted. No significant difference in the proportion of single case reports between the otolaryngology journals (15.0%) and the other specialty journals (12.8%) was noted (P = .364). The otolaryngology journals had a significantly higher proportion of basic research than the other specialty journals (27.4% vs. 14.5%, P<.001) as well as a higher percentage of prospective studies (62.1% vs. 49.0%, P = .001). The studies in the otolaryngology journals had a much lower mean sample size than those in the other specialty journals (70.2 vs. 373.8, P = .010). No difference between the two groups was found in the use of statistics (P = .228). Among the otolaryngology journals, Laryngoscope was found to publish fewer single case reports than the other three journals, and Annals of Otology, Rhinology and Laryngology had the highest proportion of prospective studies (P = .031 and .012, respectively). No differences were found for sample sizes and use of statistical analysis (P = .266 and P = .710, respectively) among the otolaryngology journals. CONCLUSIONS: The otolaryngology literature compares quite favorably with the literature of other surgical specialties, excelling in prospective studies and basic science research. It only lags with respect to sample size. The study composition among the different major otolaryngology journals is largely similar with respect to basic study parameters, suggesting comparable quality among the journals.     

Citation analysis of otorhinolaryngology journals

Bibliometric analysis is used to assess the 'impact' of scientific journals. The commonest method of evaluation is impact factor. The aim of this study was to analyse the citation data for otorhinolaryngology journals of the years 1994 to 1998. Data on the total number of citations and impact factor of journals was obtained from the CD-ROM editions 1994-98 of the Journal Citation Reports and 'Web of Science' database. The adjusted impact factor and five-year impact factor has been calculated. Fifteen otorhinolaryngology journals have been identified and ranked according to the impact factor. Head and Neck has the highest adjusted impact factor. Archives of Otolaryngology - Head and Neck Surgery has the highest five-year impact factor. There is considerable variation in the ranking of journals calculated by the five-year impact factor. Impact factors of otolaryngology journals can help to direct readers to those journals that have a track record of publishing data that are frequently cited. Although there are several limitations to the use of citation data to rank journals, the authors recommend the use of the five-year period for calculation of the impact factor for ranking of otolaryngology journals.     

Auditory adaptation: notes on power and parabolic curve fitting across intensity: II

The classic Simultaneous Dichotic Loudness Balance (SDLB) procedure for the study of auditory adaptation was used by Weiler and Hood (1977) in a successful test of a model for predicting adaptation in db at intensities above the initial baseline values, using a linear approximation across levels. When Balzer et al (Brit. J. Audiol., 1984, 18, 49-50) fitted curves for simple baseline adaptation data from four studies based on SDLB data, they reported good fits for the Gompertz technique and for a parabolic formula, but did not test the relative goodness of fit for the linear formula, nor for power approximations as Stevens (1975) might have proposed. The present study makes use of the data used by Balzer et al but examines a linear fit as well as two approximations to Stevens' power law. The present finding that the linear approximation is the least efficient examined would suggest that the Weiler and Hood model should be re-examined to determine the degree to which the model can be improved by use of a curvilinear baseline fit. In addition, it might be noted that the curvilinear formulae, of necessity, involve two or more stages. It is the the current effort of this laboratory to determine whether this reflects a multifactor basis to the classic SDLB adaptation, as well as results from other adaptation techniques.     

Chondrosarcoma of the thyroid cartilage

A TUMOUR which had been present for nine years in the thyroid cartilage of a 45-year-old man, was shown on microscopy to be a chondrosarcoma. This tumour probably took its origin in a pre-existing benign tumour at this site. The literature on similar previously documented tumours is reviewed, and the classification, diagnosis and management of these rare tumours is briefly discussed. Primary cartilaginous laryngeal tumours are uncommon (Hyams and Rubuzzi, 1970; Zizmor et al., 1975). A tumour of the thyroid cartilage which had been present for about nine years was shown histologically to be a low-grade chondrosarcoma probably arising from a pre-existing chondroma at this site. The clinical and pathological features of this case are presented and discussed in the light of the available literature.     

Normative multifrequency tympanometry in infants and toddlers

Multifrequency tympanometry data were measured multiple times between the ages of four weeks and two years from 33 infants/toddlers. Tympanograms were also measured from 33 adult participants. Tympanograms recorded with five probe-tone frequencies (226, 400, 630, 800, and 1000 Hz) were classified using the Vanhuyse et al model classification system (Vanhuyse et al, 1975). Admittance at +200 daPa (Y200) and middle ear admittance (Y(ME)) were calculated. The proportion of Vanhuyse et al patterns in infants and toddlers was different than in adults, especially for younger ages. Y(ME) and Y200 both increased with age. Y(ME) and Y200 data for all infant/toddler groups were significantly lower than adult values at all of the tested probe-tone frequencies. These data can be used as a guide in the clinic to assess normal tympanometric values for infants and toddlers.     

Erste Ergebnisse der Chemotherapie des metastasierenden malignen Melanoms im Kopf-Hals-Bereich mit Cisplatin

Summary Melanoblastoma is quite a rare tumour making up 1–2% of all tumours. Characteristic for melanoblastoma is great malignity and a strong tendency to indiscriminate formation of metastasis. Among other things sex of the patient and the localization influence the prognosis and survival time: The head-throat region is favorable for the prognosis while Pelloni et al. (1981) report a median duration of remission for women of 9.5 months, for men of 3.5 months and a survival time of 13.5 and 7.7 months respectively.In the ENT-Department of the Saarland University Hospital, Homburg, 15 patients with metastatic melanoblastoma were treated between 1975 and the end of 1981. Nine patients were operated on and then treated with chemotherapy and immunotherapy. The other six were subjected to Cisplatin chemotherapy, five of them postoperatively. Following the positive reports of Chary et al. (1977) and Schmidt et al. (1979) a cisplatin-monotherapy was carried out with up to five cycles of a 100–120 mg/m² in 4 weekly intervals. Side effects noted were alopecia, nausea and vomiting. The average duration of remission increased from 6.9 to 10.1 months, compared with surgery plus chemotherapy/immunotherapy patients, the survival time increased from 12.8 to 18.6 months at present. The response rate is over 60%, two of six patients showed a progress of disease. These results show the use of Cisplatin to be an improvement in the treatment of metastatic malignant melanoblastoma.     

The residency experience in pediatric otolaryngology

OBJECTIVES: To assess the residency experience in pediatric otolaryngology, determine the impact of pediatric fellowship programs on residency training, and evaluate the need for fellowship training in pediatric otolaryngology. DESIGN: An anonymous, web-based survey of chief residents in otolaryngology. METHODS: Respondents described their experience in pediatric otolaryngology using a 5-point Likert scale and reported their comfort levels (yes/no) with various medical and surgical issues in pediatric otolaryngology. RESULTS: The survey was successfully completed by 70 respondents, representing a response rate of 26%. The majority of the respondents reported positive experiences with regard to the following aspects of pediatric otolaryngology training: didactics (81%), clinical research opportunities (78%), positive faculty role models (87%), career mentorship (74%), independent medical (84%) and surgical (81%) decision-making, and overall comprehensive residency experience (87%). Basic science research opportunities (50%) were reported as less available than clinical research opportunities (78%) (P = .002). Compared with other surveyed issues, a lower comfort level was reported for management of craniofacial anomalies (P < .001), excision of large lymphatic malformations (P < .001), cochlear implantation (P < .001), laryngotracheal reconstruction (P < .001), and surgical correction of velopharyngeal insufficiency (P < .001). No statistically significant difference was noted in responses based on the presence of a fellowship program at the institution. CONCLUSIONS: The residency experience in pediatric otolaryngology is perceived as comprehensive by graduating chief residents participating in this survey. The presence of a fellowship program does not appear to negatively impact the residency experience. Based on the reported comfort levels, the management of complex issues in pediatric otolaryngology may require additional training.     

Surgical skills training in middle-ear surgery

Until recently the practice of otological procedures on cadaver temporal bones was a common occurrence in otolaryngology departments. The difficulty in acquiring specimens has led to alternative techniques which involve artificial and computer-aided models. This article looks at the present situation in these rapidly developing areas and describes an artificial model developed by the senior author for training in middle-ear procedures.     

The enigma of post-radiation oedema and residual or recurrent carcinoma of the larynx and pyriform fossa

Persistence of significant laryngeal oedema following radiotherapy presents the surgeon with a diagnostic dilemma. Though the oedema may represent a prolonged response to irradiation, the possibility of residual carcinoma must be considered. Several authors have commented upon it and have suggested frequent biopsies to prove the presence of residual or recurrent neoplasm (Ward et al., 1975; Lederman, 1970; Calcaterra et al., 1972). Some reluctance to laryngeal biopsy has been exercised to avoid inciting a fulminant perichondritis. However, the difficulty of obtaining a positive biopsy in a post-irradiated case is well known, and repeated negative biopsies do not exclude the presence of a residual tumour. The present paper studies 52 histopathologically proven cases of carcinoma of the larynx and laryngopharynx which had received radiotherapy earlier. These cases underwent salvage radical surgery on clinical suspicion of residual/recurrent tumour, manifested by persistence of significant laryngeal oedema and/or fixation of the larynx. No positive biopsies had been obtained following radiotherapy.     

Maximal nerve excitability testing vs electroneuronography

In an article published in 1977, Adour et al compared electroneuronography (neuromyography) with maximal nerve excitability testing (NET) and reached the conclusion that the prognostic value of the latter was more reliable in facial paralysis. Further analysis of the results of Adour et al leads, however, to the opposite conclusion and illustrates how one may avoid the pitfalls that exist in using electrical stimulation to evaluate facial nerve function. Certainly, electroneuronography (ENoG) is not a foolproof method and experience is needed in order to avoid errors in technique and to achieve reproducible results. The great advantage of ENoG vs maximal NET is the quantitative analysis of the number of degenerated fibers and the assessment of an accurate degeneration profile in Bell's palsy.     

Patient perceptions of the otolaryngology ward round in a teaching hospital

OBJECTIVE: This survey assesses patients' perceptions of a daily otolaryngology ward round in a teaching hospital. METHODS: Initial, open-ended questionnaires generated themes from which a structured questionnaire was constructed. Patients' perceptions in a wide range of areas were examined by asking them to indicate on a Likert scale the extent to which they agreed or disagreed with a number of statements concerning various aspects of the ward round. RESULTS: One hundred patients were surveyed. The response rate was 79 per cent. The findings showed overall patient satisfaction with the ward round, particularly in the areas of information-giving regarding diagnosis, treatment and follow-up arrangements. The large size of the ward round appeared to be intimidating and induced anxiety for approximately one-third of patients. Patients wished the roles of staff present to be better defined and to be informed of the presence of medical students. One-third of patients perceived staff to use language that was difficult to understand. CONCLUSIONS: The survey identified some improvement opportunities and will assist our department with its on-going endeavours to improve the ward round experience for both patients and staff.     

Simulation of pathological high impedance tympanograms

The Vanhuyse, Creten, and Van Camp (1975) model for analyzing high frequency tympanograms predicts the shapes of conductance, susceptance, and admittance tympanograms from the relationship between resistance and reactance tympanograms at the tympanic membrane. This model has been applied primarily to low impedance middle-ear pathologies but has not been applied extensively to the more commonly occurring high impedance pathologies. The purpose of this study was to extend the Vanhuyse et al. (1975) model to high impedance pathologies and to identify tympanometric parameters associated with otosclerosis, secretory otitis media, and lateral ossicular fixation. Data from previous experiments on the shape and absolute values of resistance and reactance tympanograms were used to calculate 678-Hz admittance tympanograms that were unique to each of the three high impedance pathologies. Guidelines for differentiating among the middle-ear pathologies on the basis of high frequency tympanometric shapes are presented.     

Duplicate publications in the otolaryngology literature

OBJECTIVE/HYPOTHESIS: A duplicate publication duplicates other published work by the same author(s). The purpose of the study was to define the extent of this problem within the otolaryngology literature.STUDY DESIGN: Retrospective review of the literature. METHODS: Original articles published in Archives of Otolaryngology-Head and Neck Surgery and Laryngoscope in 1999 were reviewed using the OVID search engine. Titles and abstracts from English articles written by the same first, second, or last author were analyzed, and suspected publications were evaluated. Duplicate publications were classified as dual (identical data set and conclusions) or suspected dual (nearly identical data set and conclusions) publications. RESULTS: Of the 492 articles evaluated, 40 index articles were identified. These led to a total of 42 (8.5%) duplicate articles of which 27 were classified as dual and 15 as suspected dual publications. Approximately half of the duplicate publications were published by authors in the United States (55%). Duplicate articles usually appeared within 12 months of the each other (74%) and failed to cross-reference the earlier publication (83%). CONCLUSIONS: Journal editors have become aware of an increase in the number of duplicate publications in the medical literature. The incidence of duplicate publications in the otolaryngology literature appears to be similar to that in other specialties.     

Cortical word deafness in a child: a case history.

Despite the recent report of Goldstein et al. (1975) on pure word deafness in an adult, it still seems worthwhile to study the case of cortical deafness in a child, not only because we believe this to be one of the very few cases duly reported upon, but also because of its interesting pathological history, its implications for the existence of specific speech sound detectors, and its evidence of pathological communicative behavior which deviates from that of a deaf child.