An effective management regimen for laryngeal granuloma caused by gastro-esophageal reflux: combination therapy with suggestions for lifestyle modifications

According to our previous study, lifestyle modification in combination with drug therapy is much more effective than drug therapy alone in cases of laryngopharyngeal reflux (LPR). Most patients with LPR will have chronic gastro-esophageal reflux diseases (GERD) and require long-term medical therapy for control, resulting in high total expenditure on pharmacologic agents. We combined pharmacologic management with lifestyle modifications for the management of GERD with successful outcomes in patients with GERD-related laryngeal granulomas. Although further studies are needed, guidance concerning lifestyle modifications in combination with PPI therapy may be not only a clinically effective but also a cost-effective method for the management of laryngeal granulomas caused by gastro-esophageal reflux.     

Tongue thrust, tongue tip position at rest, and sigmatism: a review

This article reviews the available evidence regarding the incidence of tongue thrust swallowing and the possible relation between this deglutition pattern, tongue tip position at rest, and sigmatism. It is found that tongue thrust swallowing a) is the rule rather than the exception in children under 10 years of age, b) is not correlative with low tongue tip position at rest, c) is not closely linked up with dental malocclusion, and d) does not prevent, but may delay, the acquisition of correct sibilant articulation.     

关于改善高等学校聋生课堂教学的几点建议

本文在对北京联合大学特殊教育学院聋生各班进行大量调研的基础上，分析了高等学校聋生的教学现状，阐明高等学校聋生教学中存在的诸多问题，提出了改进聋生教学工作的几点建议。     

Characterization of effective primary voice therapy for dysphonia

Despite advances in the development of voice outcome measures, there is no methodology to define and quantify the elements of the complex process of speech therapy. The components of therapy given by one therapist to the intervention limb of a controlled trial were characterized according to a list of five minutes. The intervention was of proven benefit compared with a control period of observation. Indirect approaches comprised two thirds of therapy time. The types and duration of intervention were assessed but no treatment category seemed more associated with a favourable outcome. The design shows that it is possible to perform a prospective, structured analysis of the components of voice therapy. The method appears viable for the future comparison of the widely varying techniques current in voice therapy practice.     

Motivational factors in aphasia therapy: Research suggestions

Following Wepman (1953), the process of recovery from aphasia is seen as involving stimulation, motivation, and facilitation. The most adequate studies of aphasia therapy outcome focus on facilitation to the virtual exclusion of stimulation and motivation, although clinical experience suggests their importance. Motivation includes both the subjective and experiential aspects of the patient's response to aphasic disablement (anxiety, feelings of inadequacy) and the quality of the speech-therapist/ patient alliance during the treatment. Retrospective studies utilizing sufficiently improved aphasics and ratings of the patient-therapist alliance are suggested as preliminary means of defining “motivation” in this context more accurately. Research approaches are also outlined which would assess the importance of and interaction between the three factors implicated in recovery for therapeutic outcome.     

Submucosal minimally invasive lingual excision: an effective, novel surgery for pediatric tongue base reduction

OBJECTIVES: The aim of this study was to develop an effective single intraoral, minimally invasive technique to reduce the enlarged tongue base in children with obstructive macroglossia. METHODS: We present the anatomic dissection of fresh cadavers and a representative case series of children who underwent submucosal minimally invasive lingual excision (SMILE) with a plasma-mediated radiofrequency device (coblation) under intraoral ultrasonic and endoscopic guidance. Multiple anatomic dissections determined the relative location of the hypoglossal nerve and lingual neurovascular bundle in relation to removable tongue base musculature. A pediatric case series demonstrates the straightforward SMILE technique. RESULTS: Laboratory anatomic dissection and clinical lingual ultrasonography revealed the surgical safety borders for SMILE. The surgical safety and efficacy of SMILE is demonstrated by preoperative and postoperative clinical examinations and polysomnograms in children with obstructive macroglossia (such as Beckwith-Wiedemann and Down syndromes and tongue vascular malformation). Coblation submucosally removes excessive tongue base tissue through a small anterior tongue incision. SMILE was performed without excessive pain, bleeding, edema, infection, or tongue dysfunction. CONCLUSIONS: SMILE is an effective novel operation that incorporates coblation with ultrasonography and endoscopic guidance for children who need tongue base reduction. Anatomic dissection and clinical cases demonstrate the potential for aggressive yet relatively safe tissue removal by this minimally invasive technique. SMILE also has significant potential for adults with obstructive sleep apnea due to a large tongue base.     

Some suggestions on how to evaluate a transposer hearing aid.

The research presented here indicates that transposer hearing aids, which are now available commerically, might be helpful to some people. Specifically, it might help some people to detect the /s/, /integral/, /t/, /tintegral/, and possibly /k/ phonemes in speech. Any person considering the purchase of a transposer should be properly tested with one to determine whether the information provided by frequency transposition is helpful. It appears this evaluation cannot be done properly using procedures developed to evaluate a conventional hearing aid for a person with a mild or moderate communication impairment. Rather than outline a specific procedure, this report makes suggestions that a clinician might find useful when asked to evaluate the possible benefits of a transposer hearing aid for a client.     

Management of the thick-skinned nose: A more effective approach

A bulky nose is a challenging issue to manage, and surgeons have not found the ultimate solution to this problem in the evolution of rhinoplastic surgery. Because of the multiplicity of techniques and controversies published in the literature, it has become confusing for the operating surgeon to find the most appropriate and effective way of solving this frustrating dilemma. The subcutaneous fat is the thickest in the supratip area, and the soft tissue thickness over the tip of the nose varies considerably from patient to patient. The focus of this study was to find a method for reducing the overlying soft tissue of the tip for better re-draping of skin over the nasal skeleton. The hallmark of this technique is to undermine the nasal skin in two layers. We believe that soft tissue trimming in biplane dissection can minimize the thickness of the tip skin in a relatively safe and homogeneous way. With this report we introduce a new method of dissection of nasal soft tissue and of trimming it in different areas of the nose for different purposes. In the authors' opinion, this approach is one of the most effective ways of handling unpliable, thick nasal skin.     

Neck dissection prior to radiation therapy for squamous cell carcinoma of tongue base

BACKGROUND: Squamous cell carcinoma of the tongue base can be treated with comparable control and survival rates when neck dissection (ND) is performed before radiation therapy (RT). METHODS: Fourteen patients were treated between 1990 and 2000. Tumor stage on presentation was: T2, 6; T3, 4; T4, 4. Average radiation dose was 7,268 cGy. Follow-up ranged from 2 to 11 years (median, 50 months). Ten patients (71.4%) who presented with cervical metastases underwent neck dissection. All neck dissections were performed prior to RT. RESULTS: The initial local control rate was 85.7%. The 10-year survival rate was 62.8%. Patients tolerated their procedure well and were ready for RT within 2 to 4 weeks. CONCLUSIONS: Our preliminary data indicate that our treatment protocol results in control and survival rates which are comparable with other regimens. It is our impression that in contrast to patients undergoing ND after radiation, our patients tolerated their initial ND well and were better prepared for the second part of the treatment. Future studies will use quality-of-life research methods to study this aspect of the treatment protocol.     

言语矫治渗透到聋校低年级语言教学中的探讨

言语矫治是提高聋童言语清晰度的有效手段。针对聋童因听力障碍导致言语清晰度下降，加之聋童因学科学习任务重，语训时间过少的问题，分析了将言语矫治渗透到聋校低年级语言教学中的可行性和必要性。并从特教老师专业技能发展，教学内容、教学方法、教学组织形式以及教学评价等方面提出了相应措施及建议。     

舌等离子射频打孔消融术

目的：探讨舌等离子射频打孔消融术（CCT）治疗舌肥厚的手术方式。方法：伴有舌肥厚的重度OSAHS患者31例,所有患者舌肥厚为FriedmanⅢ或Ⅳ度。所有患者均行鼻中隔偏曲矫正术、双侧下鼻甲等离子射频消融术及等离子射频辅助下的UPPP。对舌根及舌体行垂直进针的同时,结合侧缘平行向后的斜行进针打孔消融。对术中及术后出血等并发症进行了观察,并通过舌MRI的检查进行了12个月的术后随访。结果：术后舌后气道间隙扩大,术中有2例局部打孔处出血,经局部压迫后出血停止。术后均无舌瘫、舌血肿及脓肿形成。术后舌体由术前的Ⅲ或Ⅳ度缩小为术后的I～Ⅱ度。1例接受了3次CCT治疗。结论：CCT治疗舌肥厚是一种体现个体化的安全、有效且微创的治疗方式。     

The use of adalimumab for cricoarytenoid arthritis in ankylosing spondylitis--an effective therapy

This report describes cartilaginous regeneration in a cricoarytenoid joint affected by spondyloarthropathy using tumor necrosis factor-alpha (TNF-α) blockade, monitored by magnetic resonance (MR) and computed tomography (CT) imaging. This case is interesting for several reasons. It is only the eighth case of destructive ankylosing spondylitis-related cricoarytenoid arthritis published in the English language literature. It describes, for the first time, full recovery of vocal cord mobility following TNF-α blockade. It is also the first case to be published with MR imaging demonstrating regeneration of the cricoarytenoid cartilage following treatment. This case represents a landmark in the treatment of patients presenting with destructive arthritis involving the cricoarytenoid joint.