Learning impaired children exhibit timing deficits and training-related improvements in auditory cortical responses to speech in noise

The physiological mechanisms that contribute to abnormal encoding of speech in children with learning problems are yet to be well understood. Furthermore, speech perception problems appear to be particularly exacerbated by background noise in this population. This study compared speech-evoked cortical responses recorded in a noisy background to those recorded in quiet in normal children (NL) and children with learning problems (LP). Timing differences between responses recorded in quiet and in background noise were assessed by cross-correlating the responses with each other. Overall response magnitude was measured with root-mean-square (RMS) amplitude. Cross-correlation scores indicated that 23% of LP children exhibited cortical neural timing abnormalities such that their neurophysiological representation of speech sounds became distorted in the presence of background noise. The latency of the N2 response in noise was isolated as being the root of this distortion. RMS amplitudes in these children did not differ from NL children, indicating that this result was not due to a difference in response magnitude. LP children who participated in a commercial auditory training program and exhibited improved cortical timing also showed improvements in phonological perception. Consequently, auditory pathway timing deficits can be objectively observed in LP children, and auditory training can diminish these deficits.     

Functional outcomes after primary oropharyngeal cancer resection and reconstruction with the radial forearm free flap

OBJECTIVE: To report prospectively collected aeromechanical, acoustical, and perceptual speech outcomes, as well as preliminary swallowing data, in patients having reconstruction with radial forearm free flaps after primary resection for oropharyngeal cancer. STUDY DESIGN: Prospective cohort study. METHODS: Acoustical, aeromechanical, and perceptual speech data and swallowing data were gathered at three evaluation times (preoperatively and before and after radiation therapy) for patients treated for oropharyngeal cancer by means of primary resection and reconstruction with a radial forearm free flap. Degree of involvement of the soft palate and base of tongue, along with reconstructive techniques, were entered as between-group factors in the analysis. RESULTS: There were no significant differences in speech intelligibility between the patient groups based on the degree of palate and tongue resected. However, patients with resections of half or more than half of the soft palate had significantly higher nasalance values and larger velopharyngeal orifice areas than individuals who had less than half of the soft palate resected. Significant within-subject differences were revealed across evaluation times for the dependent variables nasalance, velopharyngeal orifice area, and word intelligibility. Ninety-four percent of the patients were able to resume a normal or soft diet. There was a 6% incidence of aspiration in 128 swallows that were analyzed. The amount of base of tongue resected did not significantly affect any of the speech or swallowing parameters. CONCLUSIONS: Radial forearm free flaps are a good reconstructive option after oropharyngeal cancer extirpation. Our acoustic and aeromechanical results indicated that issues related to quality of the speech signal require further study for resections of half or more than half of the soft palate.     

Long-term developmental outcomes of children identified through a newborn screening program with a metabolic or endocrine disorder: a population-based approach

OBJECTIVE: To conduct surveillance of the developmental status of children who screen positive and are diagnosed with a metabolic or endocrine disorder. STUDY DESIGN: The Centers for Disease Control and Prevention linked three data sources in Georgia: (1) Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP), (2) Special Education Database of Metropolitan Atlanta (SEDMA), and (3) State of Georgia Newborn Blood-Spot Screening Program (NBSP). RESULTS: When MADDSP and NBSP were linked (birth cohorts 1981-1991), of an estimated 147 infants who screened positive for a metabolic or endocrine disorder and were at risk for mental retardation if left untreated, only three children were identified with mental retardation. When SEDMA and NBSP were linked (birth cohorts 1981-1995), of an estimated 216 children who screened positive for a metabolic or endocrine disorder, nine children were identified as having a developmental disability less severe than mental retardation, eg, speech and language impairments. CONCLUSIONS: Although children found in MADDSP or SEDMA have a low occurrence of developmental disabilities attributable to these metabolic or endocrine disorders, our finding of cases of developmental disabilities of varying severity attributable to a metabolic or endocrine disorder suggests a need for ongoing population-based monitoring of the long-term developmental outcomes of children identified through newborn screening programs.     

Autonomic recovery and habituation in social anxiety

Growing evidence suggests that, contrary to expectation, high trait socially anxious (HTSA) and low trait socially anxious (LTSA) individuals show comparable autonomic reactivity during stressful speech tasks. To test the hypothesis that autonomic differences between groups might emerge during recovery or habituation, 35 HTSA and LTSA participants gave two impromptu speeches. Measures of anxiety experience as well as cardiovascular, electrodermal, respiratory, and vagal activation were obtained. Despite greater reports of anxiety experience in the HTSA versus the LTSA participants, autonomic measures showed comparable reactivity, habituation, and recovery in the two anxiety groups. These results suggest minimal autonomic differences between HTSA and LTSA individuals, thus supporting theories of social anxiety that emphasize cognitive factors.     

Ability to speak at the age of 1 year and alexithymia 30 years later

OBJECTIVE: We studied the association between speech development in the first year of life and alexithymia in young adulthood. METHODS: The study forms a part of the Northern Finland 1966 Birth Cohort. The original material consisted of all liveborn children in the provinces of Lapland and Oulu in Finland with an expected delivery date during 1966. The comprehensive data collection began during the antenatal phase. In 1997, a 31-year follow-up study was made on a part of the initial sample. The 20-item version of the Toronto Alexithymia Scale (TAS-20) was given to 5983 subjects. Of them, 84% returned the questionnaire properly filled in. The ability to talk was classified according to whether the child spoke no words, one or two words, or three or more words at the age of 1 year. Statistical analyses on the association between the ability to speak at the age of 1 year and alexithymia at the age of 31 years were performed, adjusted for birth weight, mother's parity, place of residence and wantedness of pregnancy. RESULTS: The mean of the total TAS score was lowest among early speakers and for both genders separately. The differences were statistically significant. A parallel significant difference was found among males on TAS Factors 2 and 3 and in case of females on TAS Factors 1 and 3. CONCLUSIONS: We found evidence for an association between speaking development in early childhood and later alexithymia. Our results support the theory that alexithymia may be a developmental process starting in early childhood and reinforcing itself in a social context.     

Central distribution of neuronal cell bodies innervating the levator veli palatini muscle and associated pattern of myosin heavy chain isoform expression in rat

The levator veli palatini (LVP) is a muscle that plays a very important role in the complex functions regulating velopharyngeal function. Although previous studies have indicated that the contraction properties of the LVP closely resemble those of the intrinsic laryngeal muscle, histological evidence has not yet been obtained. The LVP is generally considered to be innervated by the glossopharyngeal nerve, which contains efferent and afferent components. LVP motoneurons are localized in the nucleus ambiguus (Amb), and afferent neurons project into the bilateral regions of the nucleus of the solitary tract (NST). However, the position of neuronal cell bodies on afferent neurons has remained unknown. The present study examined serial muscle cross-sections using monoclonal antibodies specific for myosin heavy chain (MyHC), to characterize muscle fibers of the LVP, clarify the central distribution of LVP motoneurons within the Amb and afferent terminals within the NST, and elucidate the location of LVP afferent neuronal cell bodies. Clear separation was observed within the LVP between fibers containing only fast MyHC and others positive for both slow and fast MyHC. Horseradish peroxidase (HRP)-labeled motoneurons in the Amb were separated into rostral and caudal divisions, corresponding to the B?tzinger complex and the rostral ventral respiratory group, respectively. HRP-labeled afferent neuronal cell bodies were observed in a glossopharyngo-vagal complex ganglion, and HRP-labeled afferent terminals were observed in bilateral lateral regions of the NST. These results suggest a relationship between MyHC isoform expression and the central distribution of LVP motoneurons or central projections of afferent neurons, with regard to activity of the LVP during both inspiration and expiration.     

单、双耳阈上不同给声强度对言语识别率的影响

目的研究阈上不同强度测试声对双耳及左、右耳言语识别率的影响方法在隔声环境中，测试听力正常青年左右耳的听阈，以阈上10dB，20dB，30dB的言语声测试言语识别率，比较双耳及左．右单耳在阈上不同强度测试声分别获得的富语识别率。结果单耳阈上10dB，20dB，30dB测试声之间的言语识别率差异有显著性；阈上10dB，20dB，30dB给声，左、右单耳之间富语识别率差异无显著性；双耳阈上20．30dB给声与阈上10dB给声的富语识别率差异有显著性；阈上10dB，20dB的测试声，双耳与左．右单耳的言语识别率差异有显著性，阈上30dB测试声双耳与左．右单耳的言语识别率差异无显著性（p〉0．05）。结论随着声音强度的增加，左．右单耳，双耳的言语识别率均显著提高。在阈上10dB，20dB时，双耳聆听的富语识别率较单耳有明显优势。而在阈上30dB时，双耳聆听的言语识别率优势不明显，未发现有双耳聆听干扰现象。     

气管食管裂隙状发声孔发声机制研究

目的：探讨气管食管裂隙状发声孔的发声机制。方法：用大功率遥控X线机和动态频闪喉镜观察40例行全喉切除，Ⅰ期或Ⅱ期发声重建术患者发声时的贮气相、送气相、发声相。结果：患者吸气时肺部膨隆，食管黏膜闭拢；食管入口黏膜内翻呈环形缩小；随之，下咽腔增大呈一尖端向下的三角锥形；食管上端迅速膨大。发声开始时，食管上端扩张如球，食管人口黏膜以冠状位呈唇样外翻，气体从咽食管部冲出；黏膜、黏液发生振动，发出基音。后胸廓缩小，食管入口黏膜再次内翻，发声结束。结论：气管食管音发声的动力器官是肺，气管-食管造瘘口的通畅对发声至关重要。发声时，下咽黏膜、食管口黏膜与黏液均参与振动。     

喉良性增生性病变的嗓音学特点及治疗转归

目的 :探讨喉良性增生性病变对发声功能的影响及CO2 激光显微外科术后的转归特点。方法 :对2 92例喉良性增生性病变患者 (声带息肉、任克水肿、声带小结、囊肿、慢性肥厚性喉炎 )的流行病学、嗓音声学、形态及CO2 激光显微外科术后转归进行分析。结果 :声带小结患者均为青年女性 ,2 3.0 8%与职业有关 ;任克水肿为中老年患者。声带息肉及小结病变局限 ,手术仅涉及声带局部 ,术后改善明显 ,术后 1个月达正常状态 ;任克水肿患者术后 1个月改善明显 ,术后 3个月恢复最佳稳定 ;声带囊肿患者术后 1个月声音达最佳状态 ,但由于病变切除术后局部存在缺损 ,一定程度上影响预后 ;慢性肥厚性喉炎患者术后改善不满意。术后声门上代偿纠正均不明显。结论 :喉良性增生性病变主要累及声带被覆层 ,嗓音声障碍的程度及疗效与受累范围有关 ,激光显微外科手术可以保留良好结构及功能。除外科治疗外 ,还应及时矫正不良发声习惯等因素 ,以期获得最佳疗效。