Laryngopharyngeal sensory deficits and impaired pharyngeal motor function predict aspiration in patients irradiated for nasopharyngeal carcinoma.

OBJECTIVES/HYPOTHESIS: To assess the contribution of laryngopharyngeal sensory deficits and impaired pharyngeal motor function to aspiration in patients irradiated for nasopharyngeal carcinoma. STUDY DESIGN: A retrospective study at a tertiary referral university teaching hospital. METHODS: One hundred consecutive patients who underwent radiotherapy for nasopharyngeal carcinoma referred to a dysphagia clinic underwent sensory testing of their laryngopharynx and endoscopic evaluation of their swallowing. The sensory threshold of the laryngopharynx was determined, the pharyngeal contraction assessed, and the status of the larynx and hypopharynx documented before and after swallowing. The presence of laryngeal penetration and aspiration was noted. RESULTS: The average time from radiation therapy to assessment was 10.2 years, and the mean duration of swallowing symptoms was 27 months. Laryngopharyngeal sensation was deficient in 89% of patients and the pharyngeal contraction impaired in 93% patients. Laryngeal penetration and aspiration occurred in 87% and 74% of patients, respectively. Aspiration was associated with food residue in the pyriform fossae after swallowing (P < .001) and impaired pharyngeal contraction (P < .001), but not with laryngopharyngeal sensory deficiency. There was no association between a laryngopharyngeal sensory deficit and impaired pharyngeal contraction. CONCLUSIONS: Impaired pharyngeal contraction and food bolus clearance from the hypopharynx during swallowing are more important than laryngopharyngeal sensory deficiency in predicting aspiration in patients who underwent radiotherapy for nasopharyngeal carcinoma.

Age and outcome of cochlear implantation for patients with bilateral congenital deafness in a Cantonese-speaking population.

OBJECTIVE: To evaluate the effect of age at implantation by assessment of speech perception in cochlear implant users with bilateral congenital deafness. DESIGN: A retrospective cohort analysis of 60 cochlear implant users (age at implantation, 1.01 to 22.0 yr) who have at least 2 yr of experience. Their outcome performance was defined by the change in i) speech perception category (SPC) score based on postoperative assessment results and ii) the type of education attended after implantation. The association of age at implantation with SPC scores was analyzed at different ages at implantation (2, 3, 4, 5, and 6 yr old). The SPC scores for a particular age at implantation were compared at 6, 12, and 24 mo after implantation. The impact of age at implantation on choice of education was evaluated by analyzing the transition from a school for the deaf to mainstream education for the 45 children who were operated on before the age of 10, because older children are less likely to make such a change. RESULTS: Children implanted at the ages of 2, 3, 4, 5, and 6 yr all obtained significant improvements in SPC scores 24 mo after implantation. The greatest improvement was noted at 24 mo after implantation among those operated on before age 3. For all age groups, improvement at 24 mo after implantation is greater than at 12 mo, whereas the latter is greater than the improvement noted at 6 mo after implantation. Comparison of children implanted before the age of 3 and between ages 3 and 10 showed a significant difference in the choice of education after implantation. Children who were implanted before the age of 3 were more likely to attend mainstream education after implantation. CONCLUSION: Results from the present study are consistent with the current belief that implantation at a younger age provides greater benefit. The proportion of children attending mainstream education was significantly higher for those implanted before age 3, which may be a potential benefit to early implantation for relieving the burden of governments in providing special education.

Cantonese tone perception ability of cochlear implant children in comparison with normal-hearing children.

BACKGROUND AND OBJECTIVE: Cantonese is a tone language. A change in the fundamental frequency pattern within the same phonemic segment causes a change in the lexical meaning. The present study examined the Cantonese tone perception ability of cochlear implant children in comparison with normal-hearing children. It was hypothesized that cochlear implant children follow a similar pattern of tone perception development, as do normal children. METHOD: 225 normal-hearing and 15 hearing-impaired children with cochlear implants were recruited. The high level (tone 1), high rising (tone 2) and low falling (tone 4) were the target tones examined. The three tones were arranged into tone pairs for identification. Each pair shared exactly the same segmental information but differed only in tones (e.g. /sy/ in tones 1 and 2 meaning 'book' and 'mouse', respectively). Subjects were required to point to the corresponding pictures after the live voice presentations. RESULTS: for each tone pair, each subject was awarded a score representing the proportion of stimuli pairs that were correctly discriminated by the subject. The average scores in the normal-hearing and hearing-impaired groups were 0.92 and 0.64, respectively. The normal group had the lowest average score in tone 2/tone 4 (0.87) while the hearing-impaired group performed the worst in tone 1/tone 2 (0.53) perception between the three tone contrasts. CONCLUSIONS: the normal-hearing group performed significantly better than the hearing-impaired group in basic Cantonese tone perception. The pattern of tone perception development of cochlear implant children did not seem to follow that of normal children. Contributing factors on the tone perception performance of the cochlear implant children were subject's age, duration of special training, and durations of wearing the hearing aid and the cochlear implant.