Resident training in head and neck flap reconstruction in U.S. academic otolaryngology programmes

The main objective of this study was to assess resident training in head and neck flap reconstruction, and to determine the confidence of graduating residents in performing these flaps independently. Questionnaires were distributed to otolaryngology residents graduating in 1997. Respondents recorded the number of pedicled and free flap procedures they performed, or assisted with, and indicated flaps they felt confident about performing independently. Pectoralis major myocutaneous (PMMC) (n = 560, mean 6.59) and radial forearm (RF) (66, 0.78) were the most common pedicled and free flaps performed. There was a significant difference (p = 0.0002, Mann-Whitney U test) between median confidence for pedicled (44.5 per cent) and free flaps (two per cent). Ten of the 17 flaps showed a significant Pearson correlation (p < 0.05) between number of procedures performed and confidence in performing them independently. Of the pedicled flaps, latissimus dorsi (LD) showed good correlation (r = 0.67), PMMC showed low correlation (r = 0.19) and other pedicled flaps fair correlation. Of the free flaps, LD (r = 0.64) and fibula (r = 0.50) showed good correlation and rectus abdominis and RF fair correlation. There was a fair inverse correlation (r = -0.29) between numbers of pedicled and free flaps performed. Higher correlation in flaps uncommonly performed reflects greater operative training necessary to achieve the confidence for performing these flaps independently. As respondents performed greater numbers of free flaps, the number of pedicled flaps decreased. It might thus be important to train residents in all aspects of pedicled flaps. Most respondents were of the opinion that additional training in free flaps was necessary for those planning a career in head and neck reconstructive surgery.     

Multicenter U.S. bilateral MED-EL cochlear implantation study: speech perception over the first year of use

OBJECTIVE: Binaural hearing has been shown to support better speech perception in normal-hearing listeners than can be achieved with monaural stimulus presentation, particularly under noisy listening conditions. The purpose of this study was to evaluate whether bilateral electrical stimulation could confer similar benefits for cochlear implant listeners. DESIGN: A total of 26 postlingually deafened adult patients with short duration of deafness were implanted at five centers and followed up for 1 yr. Subjects received MED-EL COMBI 40+ devices bilaterally; in all but one case, implantation was performed in a single-stage surgery. Speech perception testing included CNC words in quiet and CUNY sentences in noise. Target speech was presented at the midline (0 degrees), and masking noise, when present, was presented at one of three simulated source locations along the azimuth (-90, 0, and +90 degrees). RESULTS: Benefits of bilateral electrical stimulation were observed under conditions in which the speech and masker were spatially coincident and conditions in which they were spatially separated. Both the "head shadow" and "summation" effects were evident from the outset. Benefits consistent with "binaural squelch" were not reliably observed until 1 yr after implantation. CONCLUSIONS: These results support a growing consensus that bilateral implantation provides functional benefits beyond those of unilateral implantation. Longitudinal data suggest that some aspects of binaural processing continue to develop up to 1 yr after implantation. The squelch effect, often reported as absent or rare in previous studies of bilateral cochlear implantation, was present for most subjects at the 1 yr measurement interval.     

The role of the binaural test in filtered speech audiometry.

The value of the binaural resynthesis test administered according to Matzker's principle can be estimated only when a comparable monaural test can be used as a control. The most common positive finding in the filtered speech test is asymmetrical discrimination. Both parts of the message delivered to either ear must therefore have the same intelligibility in normal material. Binaural intelligibility is highly resistant to degenerative changes in the auditory system, for example. Positive findings in the binaural test are encountered frequently in brain stem lesions with vascular or traumatic aetiology.     

Linguistic interaction: the active role of parents in speech therapy for cleft palate patients

As speech and language intervention becomes more naturalistic, it seems obvious that language and other developmental competencies are, in a strong way, a function of the quality and quantity of relationships in which the child evolves. This paper compares two different speech therapy groups of cleft palate children. Children included in the first group received therapy alone with the speech pathologist, whereas children from the second group received speech therapy accompanied by their mothers. The purpose was to evaluate and provide the mothers with interaction modes for facilitating communication. Both groups were evaluated before and after the therapy period in order to measure the advance of each group. The patients accompanied by their mothers showed a significantly higher linguistic advance as compared to patients receiving therapy without their mothers. The results in this study support the statement that linguistic development in the cleft palate child is strongly related to adult-child mode of interaction.     

Effects of training on the acoustic phonetic representation of synthetic speech.

PURPOSE: Investigate training-related changes in acoustic-phonetic representation of consonants produced by a text-to-speech (TTS) computer speech synthesizer. METHOD: Forty-eight adult listeners were trained to better recognize words produced by a TTS system. Nine additional untrained participants served as controls. Before and after training, participants were tested on consonant recognition and made pairwise judgments of consonant dissimilarity for subsequent multidimensional scaling (MDS) analysis. RESULTS: Word recognition training significantly improved performance on consonant identification, although listeners never received specific training on phoneme recognition. Data from 31 participants showing clear evidence of learning (improvement>or=10 percentage points) were further investigated using MDS and analysis of confusion matrices. Results show that training altered listeners' treatment of particular acoustic cues, resulting in both increased within-class similarity and between-class distinctiveness. Some changes were consistent with current models of perceptual learning, but others were not. CONCLUSION: Training caused listeners to interpret the acoustic properties of synthetic speech more like those of natural speech, in a manner consistent with a flexible-feature model of perceptual learning. Further research is necessary to refine these conclusions and to investigate their applicability to other training-related changes in intelligibility (e.g., associated with learning to better understand dysarthric speech or foreign accents).