Short-term study of the effect of speech coding strategy on the auditory performance of pre- and post-lingually deafened adults implanted with the Clarion CII®

Objective The auditory performance of cochlear implantees is linked to numerous variables, such as audiological characteristics, age and type of speech coding strategy. In recent years, many different ways of processing sounds have been developed, with possible implications for auditory performance. The purpose of this study was to evaluate the intra-individual differences of patients for speech perception tasks in quiet and in noise as a result of switching from a standard strategy [Continuous Interleaved Sampling (CIS)/Simultaneous Analog Strategy (SAS)] to Hi-Resolution (HiRes).

Material and Methods A total of 14 post-lingual adults implanted with the Clarion CII® were selected for trials. At switch-on, six patients chose a CIS strategy and eight an SAS strategy. After an average period of 9.3 months, all patients were switched over to HiRes. All patients were tested (open-set mode) with bisyllabic words and sentences, in both quiet and noise [speech/noise ratio (SNR)=+10]. Testing was carried out after an initial period with the CIS/SAS strategy and 3 months after switching over to HiRes.

Results After switch-over a significant improvement was seen for both speech in quiet (words +25.2%, sentences +10.8%) and speech in noise (words 44.8%, sentences 45.4%).

Conclusion Despite individual differences, all patients improved their performance with HiRes use, the greatest improvements being seen under unfavourable listening conditions (SNR=+10). Subjective improvements in speech discrimination and overall sound quality perception were reported even after the first week of HiRes use.     

Auditory speech sounds evaluation (A§E®): a new test to assess detection,discrimination and identification in hearing impairment

Abstract

This paper describes a set of suprathreshold tests, available as a software package (A§E®), for the auditory evaluation of the hearing impaired. It uses isolated speech sounds as test material for a discrimination, identification and detection test, and is specifically suited to test preverbal children. All tests allow strict analytical interpretation. The test material and procedures are described. Their clinical use is illustrated. The authors claim that suprathreshold tests are feasible in the preverbal child, allowing analytical evaluation of the auditory capacities. These tests are complementary to the routinely used detection tests and add significantly to the hearing evaluation in preverbal children. The authors recommend the phoneme discrimination test for selection of cochlear implant candidates and for the evaluation and fitting of cochlear implants. Copyright © 2006 John Wiley & Sons, Ltd.     

Is Susac syndrome (microangiopathy of the inner ear, retina, and central nervous system) an underdiagnosed cause of sensorineural hearing loss?

Susac syndrome is a rare disorder caused by the development of microangiopathic lesions in the inner ear, retina, and central nervous system. Although relatively few cases have been reported in the literature, this diagnosis is becoming more frequent as physician awareness increases. A high index of suspicion is needed to make the diagnosis because the signs and symptoms of Susac syndrome are those of a wide range of differential diagnoses. Otolaryngologists should be familiar with this syndrome because hearing loss may be the initial presenting symptom. We describe a new case of Susac syndrome to further promote physician awareness, and we discuss the options for diagnosis and treatment.     

Castleman’s disease (giant lymph node hyperplasia) of the neck: a case report

Castleman’s disease (giant lymph node hyperplasia) is an uncommon cause of neck mass. Its cause and pathogenesis are still unknown. Giant lymph node hyperplasia (GLH) usually presents as an asymptomatic solitary mass and can occur anywhere in the head and neck. Diagnostic test results are always inconclusive. Excision and histopathological evaluation are the only ways to make a definitive diagnosis. The disease is curable by surgical excision. A case of GLH presenting as a solitary neck mass in a 68-year-old man is reported. There has been no recurrence during about 7 months. Received: 25 May 1999 / Accepted: 7 September 2000     

Multisystem Langerhans’ cell histiocytosis (Hand-Schüller-Christian disease) in an adult: a case report and review of the literature

Langerhans cell histiocytosis (LCH) is a rare and enigmatic clonal disorder that affects mainly children. It is characterized by single or multiple granulomatous mass lesions composed of cells with the Langerhans cell phenotype. Clinical presentation and behavior are heterogeneous and can range from a solitary lytic bone lesion (i.e., eosinophilic granuloma) with a favorable course to a fatal disseminated leukaemia-like form, with a wide spectrum of intermediate clinical presentations between these two extremes. Although LCH typically involves the bone, lesions can be found in almost all organs. We are reporting the case of a multisystem LCH in a 47-year-old patient who presented with a panhypopituitarism and diabetes insipidus, and who, 5 years later, developed mandibular, mastoid and femoral lesions. The final diagnosis of LCH was made on mandibular biopsy.     

Jan Mikulicz-Radecki (1850–1905): a fundamental contributor to world surgery; surgeon of the head, neck, and esophagus

We present some of many valuable and unique achievements of Jan Mikulicz-Radecki with special regard to his contribution to laryngology. He constructed esophagogastroscope, and was one of the first to perform endoscopy of esophagus and ventricle. He published several papers describing new approaches to maxillary sinus through inferior meatus, surgical management of tonsillar cancer via lateral pharyngotomy, correction of post-traumatic nasal deformations, and the use of iodophorm in healing wounds. Among Mikulicz’s many celebrated scientific achievements, the most important remains the development of asepsis and creation of a surgical school, which was a modernized continuation of Langenbeck–Billroth achievements.     

Transnasal flexible esophagoscopy (TNE): an evaluation of the patient’s experience and time management

The aim of this study was to evaluate patient’s experience when performing transnasal flexible endoscopy using EndoSheath Technology without sedation in an ENT outpatient department. Patients were seen at the laryngological clinic of the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, presenting with complaints of reflux like throat cleaning, persistent cough, globus sensation, heartburn, or voice problems. First, we performed stroboscopy. In cases where physical examination findings revealed the presence of LPR, we performed a transnasal flexible esophagoscopy (TNE) using sterile EndoSheath Technology under local anesthesia. 55 patients were investigated and completed a questionnaire on subjective discomfort that they felt during the procedure. The different steps of the examination were assessed separately. Complications were noted down by the surgeon. All patients underwent a complete examination of the upper aerodigestive tract. The time needed for preparation, examination and cleaning measures was recorded as well. The average preparation time for each examination was 24 min. No complications were observed during the procedure. The procedure was well tolerated by all patients and was classified on average as “low-grade unpleasant”. In summary, TNE is a safe, quick and well-tolerated procedure that can be performed in a regular examination room under local anesthesia without sedation.     

Clients’ perspective on quality of audiology care: Development of the Consumer Quality Index (CQI) ‘Audiology Care’ for measuring client experiences

Objective: Clients’ perspective on the quality of audiology care has not been investigated thoroughly. Research has focused primarily on satisfaction with, and limitations of hearing aids. We developed a Consumer Quality Index (CQI) questionnaire ‘Audiology Care’ to systematically assess client experiences with audiology care. Design: The CQI Audiology Care was developed in three steps: (1) posing open-ended questions through e-mail (n?=?14), (2) two small-scale surveys assessing psychometric properties of the questionnaire (n?=?188) and importance of quality aspects (n?=?118), and (3) a large-scale survey (n?=?1793) assessing psychometric properties and discriminatory power of the questionnaire. Study sample: People with complex hearing impairments and/or balance and communicative disorders who visited an audiology care centre during the past year. Results: Important quality aspects were translated into seven reliable scales: accommodation and facilities, employees’ conduct and expertise, arrangement of appointments, waiting times, client participation and effectiveness of treatment. Client experiences differed among the participating centres concerning accommodation and facilities, arrangement of appointments, waiting times and client participation. Conclusion: The CQI Audiology Care is a valid and reliable instrument to assess clients’ experiences with audiology care. Future implementation will reveal whether results can be used to monitor and improve the quality of audiology care.     

A comparison of the efficacy of 5-fluorouracil/triamcinolone, carnitine and dexamethasone therapy on wound healing in tracheal injury: potential for preventing tracheal stenosis?

The aim of the study was to investigate the efficacy of 5-flourouracil/triamcinolone acetonide (5-FU/TA), carnitine and dexamethasone on wound healing in an animal model of tracheal injury. Twenty-eight rats underwent surgical injury of the tracheal mucosa and perichondrium under general anesthesia, and were randomized into four groups. Group I (the control group) received nothing after tracheal trauma. Group II received intratracheal 5 mg 5–FU/TA combined with 0.2 ml sodium hyaluronic acid once. Group III received intraperitoneal carnitine 100 mg/kg/day for 20 days. Group IV received intramuscular dexamethasone 0.1 mg/day for 20 days. After 1 month, the levels of superoxide dismutase enzyme activity (SOD) and levels of malondialdehide (MDA) and nitric oxide (NO) in serum were measured and the tracheal specimens were harvested for histopathologic examination. SOD was significantly lower in the carnitine group compared to the control group. A statistically significant decrease in MDA levels were observed in the 5-FU/TA and carnitine groups compared to the control group. NO levels were significantly lower in the 5-FU/TA group, but significantly higher in the dexamethasone group, compared to the control group. The fibrotic tissue volumes of tracheal specimens were significantly lower in both the 5-FU/TA and carnitine groups than those of the control group, but trended toward higher volumes in the dexamethasone group when compared to controls. We concluded that 5-FU/TA and carnitine diminish the occurrence of tracheal stenosis (TS) secondary to experimentally induced tracheal trauma.     

Recreational noise exposure and its effects on the hearing of adolescents. Part II: Development of hearing disorders Exposición a ruido recreativo y sus efectos en la audición de los adolescentes. Parte II: desarrollo de trastornos auditivos

Part II, continuation of a previous paper, describes the significant hearing threshold shift found during the third year of the long-term study, which continued to be present in the fourth year, in a number of adolescents classified as Subgroup 2, who showed a higher mean HTL in the middle and especially in the high frequency ranges than the rest of the studied adolescents, classified as Subgroup 1. In both subgroups, the subjects showed high participation in recreational activities; nevertheless, the adolescents in Subgroup 2 showed higher participation in some of them in the last year of the study. From the beginning of the study, the mean HTL of the adolescents in Subgroup 2 was higher than the mean HTL of the adolescents in Subgroup 1. The exposure to high sound levels during leisure activities can be a cause of permanent hearing damage among young people with ‘tender ears’.     

The effect of a Heat and Moisture Exchanger (Provox® HME) on pulmonary protection after total laryngectomy: a randomized controlled study

The goal of this randomized controlled study was to investigate the effect of Heat and Moisture Exchanger use on pulmonary symptoms and quality of life aspects in laryngectomized patients. Eighty laryngectomized patients were included and randomized into an HME and Control group. The effect of the HME was evaluated by means of Tally Sheets and Structured Questionnaires. The results showed a significant decrease in the frequency of coughing, forced expectoration, and stoma cleaning in the HME group. There were trends for the prosthetic speakers to report more fluent speech with the HME and for the HME group to report fewer sleeping problems. In conclusion, this study, performed in Poland, confirms the results of previous studies performed in other countries, showing that pulmonary symptoms decrease significantly with HME use and that related aspects such as speech and sleeping tend to improve, regardless of country or climate.     

An update on COVID-19 for the otorhinolaryngologist – a Brazilian Association of Otolaryngology and Cervicofacial Surgery (ABORL-CCF) Position Statement

IntroductionWe are facing a pandemic with a great impact worldwide, as a result of the rapid spread of the novel coronavirus (COVID-19). The medical community is still getting to know behavior of this virus and the consequences from a population point of view. All this knowledge is extremely dynamic, so some behaviors are still not well established. Otorhinolaryngologists have a central role in the management of this situation, in which they must assess the patient, avoid contamination to and by health professionals and other patients. Thus, the recommendations of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery (ABORL-CCF) have the main objective of reducing the spread of the new coronavirus during otorhinolaryngological care and assisting in the management of these patients.MethodsReview of the main recommendations of national and international scientific societies, decisions by government agencies and class councils. The topics will be related to the general aspects of COVID-19, personal protective equipment, care in patient assistance, endoscopic exam routines and the management of sinonasal, otological and pediatric evaluations related to COVID-19.ResultsThe use of personal protective equipment is considered crucial in routine ENT care. We recommend postponing appointments, exams and elective surgeries to reduce the spread of COVID-19. Similarly, we recommend changing routines in several areas of otolaryngology. Additionally, guidance is provided on the use of telemedicine resources during the pandemic period.ConclusionsWe are still at the beginning of the COVID-19 pandemic and scientific evidence is still scarce and incomplete, so these ABORL-CCF recommendations for otorhinolaryngologists may be updated based on new knowledge and the pattern of the new coronavirus spread.     

Structured clinical assessment of the ear, nose and throat in patients with granulomatosis with polyangiitis (Wegener’s)

The objective of this prospective cross-sectional study is to describe the clinical otorhinolaryngological manifestations of granulomatosis with polyangiitis (Wegener’s) (GPA) in a prospective cohort. All patients suffering from GPA seen in a tertiary centre between March 2007 and November 2008 had a detailed clinical assessment by an ENT surgeon of their ear, nose and head and neck complaints. An evaluation of whether there was disease activity and/or infection in each ENT area was made using the European Vasculitis Study Group guidelines. The number of patients assessed was 144. The proportion of female patients was 47 % (n = 69) and the median age was 57.7 years (IQ range 42.5–68.5). The prevalence of ENT involvement was 87 % (125/144). Hearing loss and abnormal tympanic membrane appearance were more common in patients with active disease and no infection (7/8 and 6/8, respectively, in active disease cf. 59/131 and 52/131, respectively, in remission). Nasal crusting was the most common nasal complaint recorded (52/144, 36 %) and bloody rhinorrhoea was the most common symptom in patients with disease activity. Rhinoscopy was highly sensitive in diagnosing disease activity (100 %). Subglottic stenosis was the most common head and neck manifestation (27/121, 22 %) and 74 % were symptomatic. In conclusion, the pattern and frequency of clinical ENT manifestations in GPA have been described in a large patient cohort. The use of tools readily available in the ENT clinic was essential to assess these patients accurately. This dataset will form the basis of an objective scoring system to measure disease activity in the ENT system.