Virusmeningitis und Hörvermögen

Ohne Zusammenfassung     

Das Hörvermögen bei Sauerstoffmangel

Zusammenfassung Das Hörvermögen nimmt im Höhenversuch, audiometrisch an Schwellenwerten bestimmt, für die mittleren Frequenzen gleichmäßig ab. Der Hörverlust beträgt im Mittel bei 3000 m 0, bei 4000 m 2, bei 5000 m 4, bei 6000 m 8–10 Dezibel, bei mittleren Höhenfestigkeiten in 6500 m Höhe etwa 20 Dezibel, bei guter Höhenfestigkeit in 7000 m Höhe etwa 15 Dezibel. In den Einzelmessungen bestehen Schwankungen, die Streuung der Werte nimmt mit der Höhe zu. Bei einem Teil der Vp. ist in 3000 m Höhe eine Erniedrigung der Schwellenwerte nachzuweisen.Durch Kontrollversuche mit Sauerstoffatmung wird gezeigt, daß bei der Versuchsanordnung eine physikalische Wirkung des Unterdrucks auf die Schalleistung im mittleren Tonbereich ausgeschlossen ist, und daß der Hörverlust zumindesten in diesem Frequenzbereich auf einer biologischen Höhenwirkung durch Sauerstoffmangel beruht.Der Hörverlust entspricht bei 6000 m einer leichten und bei Auftreten deutlicher Höhenwirkungserscheinungen von seiten des Kreislaufs und der psychischen Funktionen einer beträchtlichen Schwerhörigkeit.Das Hörbild bei Sauerstoffmangel zeigt einen gleichmäßigen Hörverlust.     

Über das Hörvermögen bei chronischer Otitis ohne Cholesteatom

Ohne ZusammenfassungMit 4 Textabbildungen     

Hörfeldskalierung mit Kindern

BACKGROUND AND OBJECTIVE: Loudness measurements in children have been carried out using different psychoacoustical methods. Besides absolute magnitude estimation (AME) and cross modality matching (CMM) category and non-category loudness scalings have been performed. However, there is a lack of systematic evaluation in loudness scalings with children. PATIENTS/METHODS: A clinically feasible categorical method is presented which was evaluated in 10 normally hearing children of 7 to 8 years. Furthermore, measurements with hearing disabled children were performed in the framework of hearing aid evaluation. RESULTS: Normal hearing children scaled slightly louder than a group of adult subjects with normal hearing. Regarding the shape of the loudness functions measured they were very similar. Particularly, they showed a steeper course at higher levels than for low input signals. Intraindividual scatter of the loudness judgements was larger for children than for adults. However, high correlation appeared between the data across test and retest. Hence, the outcome of the scalings appears to be sufficient reliable. CONCLUSIONS: Clinical measurements confirmed that the method is appropriate for children from approximately 5-10 years. Loudness judgements became more consistent and more subtly differentiated with increasing age and decreasing hearing loss. Especially with view of hearing aid evaluation the method can give valuable indications because of the possibility to directly measure individual loudness over a broad range of levels and frequencies.     

Angeborene Erkrankungen des Hörvermögens bei Kindern Teil 2: Genetische Hörstörungen

Molecular genetic tests enable a differentiated view of patho-physiological correlation of sensori-neural hearing impairment. On the basis of 4791 records of the German Central Registry on Childhood Hearing Loss (Deutsches Zentralregister für kindliche Hörstörungen (DZH)) it was shown that 35% of all permanent hearing impairment in Germany is caused genetically and 20% are acquired. The proportion of indistinct etiology remains at 45%. The number of children who have a hearing impairment by birth is also vague. It has to be expected that approximately 5% of these children develop a hearing impairment afterwards albeit its genetic determination. In 4791 cases a syndromal phenotype was assumed in 8.9%. Practical advice is given for clinical routine diagnostics with pragmatic suggestions and some distinct syndromes are described. Hitherto identified deafness genes reveal their role in pathological auditory function. Future diagnostic and therapeutic strategies are outlined on the basis of molecular genetic methods.     

Angeborene Erkrankungen des Hörvermögens bei Kindern Teil 1: Erworbene Hörstörungen

The results of international investigations on connatally acquired hearing loss are compared with the data of the German Registry on Childhood Hearing Loss (4058 cases). The connatal hearing disorders have shown a notable change in the last years regarding to aetiology and prevalence. In contrast to countries of the third world in developed nations the prevalence of permanent childhood hearing loss has been reduced down to 1 in 1.000 births. The results let assume a prevalence of approximately 1:1.200 births in Germany. For instance the number of rubella embryopathia decreased effectively. In contrast CMV infections and alcohol fetopathia are playing an increasing role. In the patients of the German Registry on Childhood Hearing Loss the percentage of certainly progressive hearing loss is 10.3 within the 4058 children with permanent hearing impairment. Diagnostic procedures first of all for the early diagnosis of CMV but also of toxoplasmosis are considerable because these infections may result in treatable hearing loss. Also consequent hearing tests are demanded in children with alcohol fetopathia.     

Fremdk?rperingestion im Gastrointestinaltrakt bei Kindern und Jugendlichen

The diagnosis of foreign bodies in the gastrointestinal (G-I) tract can sometimes be difficult. Esophageal foreign bodies are dangerous and should be extracted as soon as possible whereas foreign bodies in the stomach usually pass through the GI-tract without complications. Exceptions are large, sharp or potentially toxic foreign bodies, such as button batteries or magnetic foreign bodies. Extraction by flexible endoscopy with the patient under deep sedation has proven to be effective, relatively minimally invasive and safe. Complications, such as ulcers, fistulas and perforations occur in 13% of patients and are strongly correlated to the localization in the esophagus.     

Sequenzielle Informationsverarbeitung bei Kindern mit und ohne auditive Verarbeitungs- und Wahrnehmungsstörung

Background

It is a controversial issue whether sequential processing in children with auditory processing disorders (APD) is a unimodal auditory impairment.

Patients and methods

Normal achieving controls (n=12; mean age: 101.1 months; SD 20.3) and children referred to clinical facilities for assessment including children with monosymptomatic APD (n=25; mean age: 90.8 months; SD 9.8), children with developmental language disorder (DLD]) + APD (n=11; mean age: 89.5 months; SD 14.9), children with dyslexia + APD (n=10; mean age: 113.8 months; SD 17.1) were compared using the subtest digit recall of the German version of the K-ABC (Melchers & Preuß 2001) and the K-ABC subtest hand movements in the visual modality.

Results

On average all groups tended to perform alike in visual sequential processing and memory (T-score>50). Normal controls (non-APD) showed on average the best test performance (T-score 57.4; SD 10.5), but the mean performance did not differ significantly from children with APD. All groups also presented on average normal test performance in the auditory modality however, children of the clinical groups were below the age mean (DLD + APD: T-W 43.1; SD 6.8; monosymptomatic APD: T-W 45.8; SD 9.8; dyslexia + APD: 46.7; SD5.8). Children with DLD + APD and those with monosymptomatic APD exhibited a significantly lower but not poor performance in auditory processing of sequences compared to their performance in visual sequential processing. The results of auditory and visual processing of sequences were significantly correlated in the clinical groups DLD + APD (0.58) and monosymptomatic APD (0.34), but not in the smallest group dyslexia + APD (0.48) and in normal achieving controls (0.32).

Conclusion

On the basis of the results of the present study it may be concluded that a normal test performance on visual measure does not exclude a bimodal or pansensory seriation disorder in children with APD. It does, however, indicate the existence of a primary auditory sequential processing deficit, because at least the processing of phonological and visual stimuli was not separately carried out in children with DLD + APD.     

Funktionelle und ästhetische Rehabilitation der Mikrotie bei Kindern und Jugendlichen

Background

Microtia leads to a severe functional and aesthetic handicap. Traditionally, the auricle is often reconstructed with cartilage transplants, which is, however, associated with some partially substantial disadvantages. The authors have instead used implants of porous polyethylene for successful ear reconstruction for years, thus, avoiding some of these disadvantages. A significant benefit for the patient is achieved by simultaneous hearing rehabilitation by the implantation of active middle ear prostheses.

Methods

The authors present their surgical concept which allows functional and aesthetic rehabilitation of microtia in children and adolescents in a single operation. In the respective patient collective, audiometric measurements in quiet and noisy environments were conducted pre- and postoperatively, and health-related quality of life was determined using a validated questionnaire.

Results

All patients experienced a substantial hearing gain both in quiet and noisy environments. The evaluation of health-related quality of life showed a significant benefit from the intervention.

Conclusion

Functional and aesthetic rehabilitation of microtia with active middle ear implants and ear reconstruction using porous polyethylene leads to good and reliable long-term results and can increase the health-related quality of life of affected children and adolescents. The main advantage of this concept is the possibility of a single procedure.     

Ueber den Einfluss der Radicaloperation auf das Hörvermögen

Ohne Zusammenfassung     

Zur Beziehung zwischen den binauralen Differenzpotentialen und dem Richtungshörvermögen

Background

Central auditory processing disorders (CAPD) are associated with reduced discriminatory abilities of the auditory system. One of these abilities is directional hearing, which is based on the evaluation of interaural signal differences. Since these differences affect also the binaural difference potentials (BDP), these derived evoked potentials could be suitable for the objective detection of disabilities in acoustic localization.

Method

Auditory brainstem responses (ABR) evoked by monaural and binaural stimulation were recorded in 32 adult normal-hearing volunteers at stimulus levels between 10 and 80 dB nHL and the BDP were derived. Additionally, a test of directional hearing was performed and evaluated.

Results

BDP are detectable at all stimulus levels without difficulties, with acceptable examination times and with satisfactory reliability in a routine clinical environment. The electrodes can be positioned at the mastoid (A1 and A2) and vertex (Cz) as for conventional ABR recording. Normal ranges are given for latency and amplitude as well as for their lateral differences.

Conclusion

The spectrum in directional hearing ability as covered by normal-hearing subjects is not mirrored in the parameters of their BDP. Nevertheless, it cannot be ruled out that a real impairment of directional hearing goes along with significantly altered BDP.     

Zur Hörgeräte-Trageakzeptanz bei Kindern

BACKGROUND: Having one or 2 hearing aids is not a guarantee that a child will wear the instruments constantly. The purpose of this study was to evaluate the hearing aid acceptance by children (assessed using the daily wearing time). PATIENTS AND METHODS: A total of 116 parents of a patient population of persistent hearing-impaired children with a need for a hearing aid (average age 51.1 +/- 30.1 months) rated the wearing acceptance of their children on a 5-point-Likert-scale. This assessment was made after the child had received its individual hearing aid for its specific disorder (on average after 5 months). Hearing levels ranged from mild to profound. RESULTS: 58.6% of the children accepted their electroacoustic aids amplier "excellent" or "good", 18.1% did it "average", 23.3% "bad" to "miserable" or even "not at all". There was no significant difference between girls and boys. The wearing acceptance from children with unilateral hearing impairments was reduced, especially from those with chronic conductive disorders by malformations of the ears. Very young children (prelingual hearing impairments), mainly those with additional handicaps and/or not German speaking homes demonstrated a "bad" to missing wearing behaviour. Hearing acceptance did not correlate with the severity of the disorder. CONCLUSION: The wearing acceptance as one aspect of compliance should be rated before each regular hearing aid control. Finally it is an efficient and sensitive mean to detect faulty amplification and changed diagnosis.     

Diagnostik auditiver Verarbeitungs- und Wahrnehmungsstörungen bei Kindern

Despite normal hearing thresholds in pure tone audiometry, 0.5–1?% of children have difficulty understanding what they hear. An auditory processing disorder (APD) can be assumed, which should be clarified and treated. Based on a selective literature search in the PubMed and Scopus databases using the term “auditory processing disorder”, several consensus papers are discussed. Numerous studies on APD have revealed partially contradicting results, thus fueling critical discussion regarding validity and reliability—of specific audiometric APD methods and the APD construct in particular. In order to correctly advise parents and, where necessary, treat affected children, otorhinolaryngologists, phoniatrists, and pediatric audiologists must understand the psychometric properties of applied tests and have knowledge of current discussion. Diagnosis is generally a multistep interdisciplinary process.     

Management von Sprachentwicklungsstörungen und Aussprachestörungen bei Kindern

Compared to other countries, the prevalence of speech-language disorders among children and also the intervention frequency appear to be much higher in Germany. Since otorhinolaryngologists often initiate speech-language interventions, the first part of this review systematically outlines the guideline-conform diagnostic pathway from examination to therapeutic intervention. The process of first developing a suspected diagnosis which justifies speech-language tests is explained. Beyond this, the rational selection of a set of tests from all those available—some of which the otorhinolaryngologist can perform, some of which require referral—is discussed, as is how these results can be used to assess the severity of the disorder. A special focus of this paper is the differential diagnosis of underlying causes, e.?g., hearing disorders and global developmental disorders. A complete set of tests permits a working diagnosis and ICD-10 classification of the case.     

Management von Sprachentwicklungsstörungen und Aussprachestörungen bei Kindern

In the first part of this seminar paper, speech-language development tests were presented and the importance of the differential diagnosis of the underlying causes of the diagnosed language development disorder was discussed. The second part focuses on counseling and training of the parents, as well as the different treatment methods used for speech-language therapy for affected children in out- and inpatient settings. These procedures should be applied according to the individual developmental age. The official guidelines are to be respected, especially for medical speech-language therapy. Generally underestimated issues are risks and side effects of language and speech therapy, which obviously do exist, e.?g., as induction of consciousness of the disorder in the treated child.     

Verbale Lern- und Merkfähigkeitsdefizite bei Kindern mit Verdacht auf auditive Verarbeitungs- und Wahrnehmungsstörungen

Background

As unanimously found in several consensus papers, other conditions such as learning disorders need to be ruled out prior to labelling a child as having an auditory processing disorder (APD).

Methods

In a retrospective study data from 386 children (245 boys, 141 girls) aged 6;0–9;11 years were investigated. All children were referred for behavioural problems suspected to be due to APD. The German auditory verbal learning test (Verbaler Lern- und Merkfähigkeitstest, VLMT) was administered. Results in a range of more than one/two standard deviations from the mean were regarded as deviant/pathological, while a test result under 15.8 was considered below normal.

Results

The VLMT short term component was impaired in 202 children, the long term component (loss after interference) in 83 children and the recognition component in 298 children.

Discussion

Compared with previously published results, our results suggest that approximately half of all children referred for APD diagnosis suffer from short-term memory deficit. We suggest the VLMT, and thus testing of short- and long-term memory skills, be administered routinely for thorough APD assessments.     

Nichtorganische (funktionelle) Hörstörungen bei Kindern

Nonorganic (functional) hearing loss in children is characterized by hearing loss without a detectable corresponding pathology in the auditory system. It is not an uncommon disease in childhood. Typically, there is a discrepancy between elevated pure tone thresholds and normal speech discrimination in everyday life. We evaluated 85 original publications, 27 reviews and 4 textbook articles. Mean age at diagnosis was 11.3 years. Girls were affected twice as often as boys. Patient histories showed a high prevalence of emotional and school problems. Pre-existing organic hearing loss can be worsened by nonorganic causes. A brainstem audiometry should confirm the diagnosis. The differential diagnosis includes auditory processing disorder, elevated thresholds in mental retardation and auditory neuropathy. We recommend taking a personal history including biographical factors, a psychological assessment including intelligence testing and referral to a child psychiatrist. Prognosis seems to be dependent on the severity of the patient’s school and/or personal problems. Categorization following the Austen-Lynch model can be a valuable prognostic factor.     

Sprachentwicklung und allgemeine Entwicklung bei Kindern mit früher Cochleaimplantation

Background

After cochlear implantation, most parents expect a normal speech and general development of their child. However, it remains unclear how quickly after early cochlear implantation these children can compensate for their deficits compared to normal-hearing children.

Methods

This study retrospectively analyzed ELFRA-1 questionnaire data from 40 children with borderline deafness or high-grade hearing loss (without other known impairments) who had undergone cochlear implantation at a university medical center before reaching 2 years of age. ELFRA-1 questionnaires were filled out parents assisted by specialists 12 months after implantation. Questions assessed the children’s speech production and comprehension, as well as their use of gestures and fine motoric skills.

Results

At an average hearing-age of 12 months, the children achieved normal values in all of the subgroups that were comparable to those of 12-month-old children without hearing impairments. A significant correlation (p?=?0.01) between the individual subgroups of the ELFRA-1 (speech production, speech comprehension, gestures and fine motor skills) was observed. Unilingual educated children performed significantly better overall.

Conclusion

Within 12 months of receiving a cochlear implant, all children passed the four categories of the ELFRA-1. This demonstrates a rapid compensation of deficits in speech, motor skills and gesture development by children undergoing early cochlear implantation.