RESUMO
INTRODUCTION: Ankyloglossia is a congenital condition that restricts tongue mobility. The aim of this study is to evaluate the relationship between gender and pediatric ankyloglossia and evaluate the planning of ideal timing of surgery. METHODS: The files of pediatric patients in the Turkish population treated surgically for tongue-tie between June 2014 to June 2018 were scanned retrospectively. RESULTS: Three hundred and eighty-two pediatric patients were included in the study. Of these, 115 (30.1%) were female and 267 (69.9%) were male. The prevalence of ankyloglossia was significantly higher in males than in females (P < .001). The age of the patients at time of surgery ranged from 1 day to 114 months. The most common indication was sucking/feeding difficulties (82%) in patients younger than 2 years, and the most common symptom was speech problems (67%) in patients aged 2 years and older. CONCLUSION: In our study, the prevalence of ankyloglossia in Turkish society was significantly higher in males. Frenectomy surgery is a safe procedure that can be performed on the first day of life in newborns.
Assuntos
Anquiloglossia/cirurgia , Fatores Sexuais , Tempo para o Tratamento/estatística & dados numéricos , Língua/anormalidades , Língua/cirurgia , Anquiloglossia/complicações , Anquiloglossia/epidemiologia , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Prevalência , Estudos Retrospectivos , Distúrbios da Fala/etiologia , Distúrbios da Fala/prevenção & controle , Turquia/epidemiologiaRESUMO
PURPOSE OF REVIEW: Submucous cleft palate (SMCP) represents an uncommon congenital palatal anomaly with a variable rate of velopharyngeal dysfunction or resulting speech abnormality. Classic teaching regarding management of this entity involves delayed repair until a perceptual speech assessment by a skilled speech-language pathologist can be performed, typically at age 3-5 years. An assessment of timing of intervention, surgical techniques, and patient comorbidities is critical for optimized outcomes. RECENT FINDINGS: Early diagnosis and surgical intervention for SMCP are associated with improved speech outcomes. Expanding indications for surgery are being actively investigated. Timing of intervention and surgical technique may be influenced by a syndromic diagnosis, specifically 22q11.2 deletion syndrome. SUMMARY: Diagnosis of classic SMCP and occult SMCP may be difficult based on provider experience. Variable surgical techniques may be used with good outcomes; patient comorbidities including syndromic diagnoses may determine best surgical technique. Expanding indications for surgery and timing of repair continue to evolve and warrant additional study.
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Fissura Palatina/diagnóstico , Fissura Palatina/cirurgia , Procedimentos de Cirurgia Plástica , Fissura Palatina/complicações , Diagnóstico Precoce , Humanos , Distúrbios da Fala/etiologia , Distúrbios da Fala/prevenção & controle , Insuficiência Velofaríngea/diagnóstico , Insuficiência Velofaríngea/etiologia , Insuficiência Velofaríngea/cirurgiaRESUMO
PURPOSE OF REVIEW: Cleft lip with or without palate is one of the most common pediatric birth anomalies. Patients with cleft palate often have speech difficulties from underlying anatomical defects that can persist after surgery. This significantly impacts child development. There is a lack of evidence exploring, which surgical techniques optimize speech outcomes. The purpose of this update is to report on recent literature investigating how to optimize speech outcomes for cleft palate. RECENT FINDINGS: The two-flap palatoplasty with intravelar veloplasty (IVVP) and Furlow double-opposing Z-plasty has the strongest evidence for optimizing speech. One-stage palatal repair is favored at 10-14 months of age, while delays are associated with significant speech deficits. For postoperative speech deficits, there is no significant difference between the pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation. Surgical management should be guided by closure pattern and velopharyngeal gap but few studies stratify by these characteristics. SUMMARY: According to recent evidence, the two-flap palatoplasty with IVVP and Furlow palatoplasty result in the best speech. The pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation are all viable techniques to correct residual velopharyngeal insufficiency. Future research should focus on incorporating standardized measures and more robust study designs.
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Fissura Palatina/cirurgia , Procedimentos de Cirurgia Plástica , Distúrbios da Fala/prevenção & controle , Fissura Palatina/complicações , Fissura Palatina/reabilitação , Humanos , Lactente , Desenvolvimento da Linguagem , Distúrbios da Fala/etiologia , Distúrbios da Fala/reabilitaçãoRESUMO
OBJECTIVE: Given the interindividual variance of functional language anatomy, risk prediction based merely on anatomical data is insufficient in language area-related brain tumor surgery, suggesting the need for direct cortical and subcortical mapping during awake surgery. Reliable, noninvasive preoperative methods of language localization hold the potential for reducing the necessity for awake procedures and may improve patient counseling and surgical planning. Repetitive navigated transcranial magnetic stimulation (rnTMS) is an evolving tool for localizing language-eloquent areas. The aim of this study was to investigate the reliability of rnTMS in locating cortical language sites. METHODS: Twenty-five patients with brain tumors in speech-related areas were prospectively evaluated with preoperative rnTMS (5 Hz, train of five, average 105% resting motor threshold) and navigated direct cortical stimulation (DCS; bipolar, 50 Hz, 6-8 mA, 200-µsec pulse width) during awake surgeries employing a picture-naming task. Positive and negative stimulation spots within the craniotomy were documented in the same MRI data set. TMS and DCS language-positive areas were compared with regard to their spatial overlap, their allocation in a cortical parcellation system, and their linguistic qualities. RESULTS: There were over twofold more positive language spots within the exposed area on rnTMS than on DCS. The comparison of positive rnTMS and DCS (ground truth) overlaps revealed low sensitivity (35%) and low positive predictive value (16%) but high specificity (90%) and high negative predictive value (96%). Within the overlaps, there was no correlation in error quality. On DCS, 73% of language-positive spots were located in the pars opercularis and pars triangularis of the frontal operculum and 24% within the supramarginal gyrus and dorsal portion of the superior temporal gyrus, while on rnTMS language positivity was distributed more evenly over a large number of gyri. CONCLUSIONS: The current protocol for rnTMS for language mapping identified language-negative sites with good dependability but was unable to reliably detect language-positive spots. Further refinements of the technique will be needed to establish rnTMS language mapping as a useful clinical tool.
Assuntos
Mapeamento Encefálico/métodos , Neoplasias Encefálicas/complicações , Córtex Cerebral/fisiopatologia , Craniectomia Descompressiva , Estimulação Elétrica/métodos , Neuronavegação/métodos , Cuidados Pré-Operatórios/métodos , Distúrbios da Fala/etiologia , Fala/fisiologia , Estimulação Magnética Transcraniana/métodos , Adulto , Idoso , Neoplasias Encefálicas/cirurgia , Craniectomia Descompressiva/efeitos adversos , Feminino , Humanos , Período Intraoperatório , Funções Verossimilhança , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Distúrbios da Fala/prevenção & controle , Inteligibilidade da Fala , VigíliaRESUMO
BACKGROUND: Macroglossia, a cardinal feature of the (epi)genetic disorder Beckwith-Wiedemann syndrome, is associated with obstructive sleep apnea, speech and/or feeding difficulties, and dental or jaw malalignment. These sequelae may be treated and/or prevented with tongue reduction surgery; the authors sought to determine whether certain Beckwith-Wiedemann syndrome patients may benefit from early surgical intervention before age 12 months. METHODS: The authors conducted a retrospective review of patients with Beckwith-Wiedemann syndrome who underwent tongue reduction from 2014 to 2019. The authors assessed primary outcomes of change in obstructive sleep apnea by polysomnography, respiratory support required, and feeding route before and after tongue reduction, and reviewed postoperative complications and the need for repeated tongue reduction. RESULTS: Of the 36 patients included, the median age at tongue reduction was 9.5 months (interquartile range, 3.8 to 22.8 months). For those with severe obstructive sleep apnea, there was a significant reduction in the obstructive apnea hypopnea index from 30.9 ± 21.8 per hour to 10.0 ± 18.3 per hour (p =0.019) and improvement in nadir oxyhemoglobin saturation from 72 ± 10 percent to 83 ± 6 percent (p =0.008). Although there was no significant change in overall supplemental feeding tube or respiratory support, there were specific patients who experienced clinically meaningful improvement. Of note, these positive outcomes applied equally to those who underwent surgery at a younger age (<12 months). To date, only one patient required a repeated tongue reduction. CONCLUSION: Based on improved polysomnographic findings and rarity of surgical complications or repeated surgery, the authors' data support the safety and efficacy of this early intervention when clinical indications are present and an experienced multidisciplinary team is available for consultation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Assuntos
Síndrome de Beckwith-Wiedemann/cirurgia , Glossectomia/métodos , Macroglossia/congênito , Complicações Pós-Operatórias/epidemiologia , Apneia Obstrutiva do Sono/cirurgia , Síndrome de Beckwith-Wiedemann/complicações , Síndrome de Beckwith-Wiedemann/genética , Pré-Escolar , Estudos de Viabilidade , Métodos de Alimentação/estatística & dados numéricos , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/prevenção & controle , Feminino , Seguimentos , Glossectomia/efeitos adversos , Humanos , Lactente , Macroglossia/complicações , Macroglossia/genética , Macroglossia/cirurgia , Masculino , Polissonografia/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Sistema de Registros/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/etiologia , Distúrbios da Fala/etiologia , Distúrbios da Fala/prevenção & controle , Tempo para o Tratamento , Língua/cirurgia , Resultado do TratamentoRESUMO
INTRODUCTION: Objective techniques for hearing threshold estimation in infants and children with profound or severe hearing loss play a key role in pediatric audiology to prevent speech acquisition disorders by choosing the adequate therapy. Auditory brainstem responses and auditory steady-state responses are available for frequency-dependent hearing threshold estimations and both techniques show strong correlations. However, various systems and stimuli are available, which is one reason why comparison is challenging, and, so far, no single "gold standard" could be established for hearing threshold estimation in children suffering from profound or severe hearing loss. The aim of the study was to compare hearing threshold estimations in children with profound or severe hearing loss derived with narrow-band CE-chirps evoked auditory brainstem responses and auditory steady-state response. SUBJECTS: and Methods: 71 children (121 ears) with an age from 3 month to 15 years were measured with the Interacoustics Eclipse EP25 ABR system® (Denmark) with narrow-band CE-chirps® at 500, 1000, 2000 and 4000 Hz under identical conditions. RESULTS: Auditory brainstem responses and auditory steady-state responses highly correlate (r = 0.694, p < 0.001). Correlation coefficients differ depending on the center frequency and patient age. Generally, auditory steady-state responses show a better hearing threshold than auditory brainstem responses or a remaining hearing threshold when auditory brainstem responses could not be obtained. In approximately 15% of cases this would have affected the therapeutic strategy when only taking one technique into account. CONCLUSION: Auditory brainstem responses and auditory steady-state responses should be jointly used in the diagnostic approach in children with suspected profound or severe hearing loss.
Assuntos
Limiar Auditivo , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Potenciais Evocados Auditivos , Perda Auditiva/diagnóstico , Adolescente , Limiar Auditivo/fisiologia , Criança , Pré-Escolar , Surdez/diagnóstico , Surdez/fisiopatologia , Feminino , Audição/fisiologia , Perda Auditiva/fisiopatologia , Humanos , Lactente , Masculino , Distúrbios da Fala/prevenção & controleRESUMO
BACKGROUND: Velopharyngeal insufficiency (VPI) results from incomplete closure of the velopharyngeal (VP) sphincter with oral pressure consonants during speech. Maxillary hypoplasia is common among cleft children and often requires LeFort I advancement. This results in anterior movement of the soft palate with the bony maxillary segment. Consequently, the size of the VP sphincter is increased and may result postoperative VPI or worsening of prior VPI. To better counsel our patients and their families of the risk of VPI after LeFort I advancement, we chose to evaluate our own cohort. METHODS: We conducted an institutional review board-approved prospective review of all cleft children presenting to Texas Children's Hospital who underwent LeFort I advancement after previous palatoplasty between 2013 and 2016 in a three-surgeon, consecutive patient series. Data collected included age, sex, ethnicity, cleft type, prior secondary speech surgery, presence of preoperative fistula, planned distance of advancement, orthognathic surgery performed, and any concurrent procedures performed. Primary outcomes measured included preoperative and postoperative VP function and hypernasality as measured by a certified speech pathologist. RESULTS: Velopharyngeal function was unchanged in 67% of our cohort after LeFort I advancement. Of those patients, 83% had evidence of VPI preoperatively, and 17% had normal speech preoperatively. Twenty-two percent of the patients displayed worsening VP function after surgery, and 6% displayed evidence of improvement. Velopharyngeal function was unable to be assessed in 6% of patients. Nasality ratings worsened in 39% of patients, were unchanged in 39%, and improved in 22%. Of the patients with incompetent VP function after surgery, 50% already received or are currently scheduled for secondary speech surgery, 25% declined secondary surgery, and 25% are pending scheduling. CONCLUSIONS: Although VP function remains unchanged in a majority of patients after LeFort I advancement, VPI should be carefully screened for after surgery. If detected, secondary operations to correct speech should be strongly considered.
Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Procedimentos Cirúrgicos Bucais/efeitos adversos , Distúrbios da Fala/prevenção & controle , Insuficiência Velofaríngea/etiologia , Criança , Fenda Labial/complicações , Fissura Palatina/complicações , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Ortognáticos/efeitos adversos , Estudos Retrospectivos , Distúrbios da Fala/etiologia , Insuficiência Velofaríngea/cirurgiaRESUMO
INTRODUCTION: The Speech Arm Vision Eyes (SAVE) scale, a 4-item clinical scale emphasizing binary scoring and avoidance of nuanced examination distinctions, predicts LVOs with similar characteristics as more complex scales. METHODS: Receiver operating characteristic analyses of the prospective STOPStroke study assessed the ability of the SAVE scale and other published scales to predict LVO. We identified scale thresholds with positive likelihood ratios with 95% confidence intervals of ≥5.0 or negative likelihood ratios with 95% confidence intervals of ≤0.5. RESULTS: 735patients were studied. LVO prevalence was 33%. Area under the curve was 0.79 for SAVE, 0.82 for FAST-ED, 0.80 for mNIHSS and NIHSS, and lower for all other scales. SAVE=4, EMSA=6, mNIHSS≥10, NIHSS≥16, and RACE≥8 had positive likelihood ratios with 95% confidence intervals ≥5.0. SAVE≥2, CPSS≥2, C-STAT≥1, EMSA≥4, FAST-ED≥3, G-FAST≥3, mNIHSS≥6, NIHSS≥9, PASS≥1, RACE≥2, VAN=1, and 3I-SS≥1 had negative likelihood ratios with 95% confidence intervals ≤0.5. CONCLUSIONS: SAVE=4 performed similarly to more complex scales at predicting LVO. Other simplified scales did not have thresholds with positive likelihood ratios with 95% confidence intervals ≥5.0. Validation is need in a prehospital cohort of patients with suspected stroke.
Assuntos
Debilidade Muscular/diagnóstico por imagem , Distúrbios da Fala/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Transtornos da Visão/diagnóstico por imagem , Idoso , Braço/fisiologia , Estudos de Coortes , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Feminino , Humanos , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Debilidade Muscular/prevenção & controle , Valor Preditivo dos Testes , Estudos Prospectivos , Estudos Retrospectivos , Fala/fisiologia , Distúrbios da Fala/etiologia , Distúrbios da Fala/prevenção & controle , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/prevenção & controle , Transtornos da Visão/etiologia , Transtornos da Visão/prevenção & controle , Visão Ocular/fisiologiaRESUMO
OBJECTIVE: To assess the impact of hypothermic neural rescue at birth on health-related quality of life (HRQL) in middle childhood. DESIGN: Six-year to 7-year follow-up of surviving children from the Total Body Hypothermia for Neonatal Encephalopathy (TOBY) Trial. SETTING: Community study including a single parental questionnaire to collect information on children's HRQL. PATIENTS: 145 children (70 in the control group, 75 in the hypothermia group) whose parents consented and returned the questionnaire. INTERVENTIONS: Intensive care with cooling of the body to 33.5°C for 72 hours or intensive care alone. MAIN OUTCOME MEASURES: HRQL attributes and utility scores using the Health Utilities Index (HUI). RESULTS: At 6-7 years, speech appeared disproportionately affected when compared with other aspects of HRQL but levels of normal emotional functioning were similar in both groups. The mean (SE) HUI3 HRQL scores were 0.73 (0.05) in the hypothermia group and 0.62 (0.06) in the control group; mean difference (95% CI) 0.11 (-0.04 to 0.26). CONCLUSIONS: Findings of non-significant differences were not unexpected; the study used data from long-term survivors in a neonatal trial and was underpowered. However, results favoured moderate hypothermia and so complement the clinical results of the TOBY Children study. The work provides further insight into the long-term HRQL impact of perinatal asphyxial encephalopathy and provides previously unavailable utility data with which to contemplate the longer term cost-effectiveness of hypothermic neural rescue. TRIAL REGISTRATION NUMBER: This study reports on the follow-up of the TOBY clinical trial: ClinicalTrials.gov number NCT01092637.
Assuntos
Asfixia Neonatal/terapia , Hipotermia Induzida/métodos , Qualidade de Vida , Asfixia Neonatal/complicações , Asfixia Neonatal/psicologia , Criança , Desenvolvimento Infantil , Cuidados Críticos/métodos , Deficiências do Desenvolvimento/etiologia , Deficiências do Desenvolvimento/prevenção & controle , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Hipóxia-Isquemia Encefálica/etiologia , Hipóxia-Isquemia Encefálica/prevenção & controle , Recém-Nascido , Masculino , Psicometria , Distúrbios da Fala/etiologia , Distúrbios da Fala/prevenção & controleRESUMO
BACKGROUND: Submucous cleft palate is a congenital deformity that may present as velopharyngeal insufficiency. The degree of anatomical abnormality varies widely among patients and does not predict severity of symptom. We present our 10-year experience treating submucous cleft palate patients with double opposing z-plasty and explore the effect of age at surgery and compensatory articulation on speech. METHODS: Preoperative assessment included intraoral examination, nasoendoscopy, and perceptual speech evaluation. Age, gap size, and severity of hypernasality were assessed to determine the timing and type of surgery. A retrospective study of 74 submucous cleft palate patients undergoing double-opposing z-plasty from 2005 to 2016 by a single surgeon (Baek RM) was conducted. Double opposing z-plasty was modified to fully release all abnormal insertions of the levator veli palatini muscle. Postoperative velopharyngeal function was measured and statistical analyses were performed. RESULTS: The ages of patients at surgery ranged from 11 months to 19 years. Postoperatively 87 percent of the patients achieved velopharyngeal competency and 13 percent had remaining mild hypernasality. Age was a significant factor in predicting speech outcome, and patients receiving surgery prior to the age of 5.5 years had a higher normalization rate. Compensatory articulation did not have an impact on postoperative hypernasality. There were no cases of postoperative hyponasality or airway problems. CONCLUSION: Satisfactory speech outcome was achieved with the authors' protocol and modification of the double-opposing z-plasty. A comprehensive assessment of patient age, intraoral findings, severity of hypernasality, and gap size, is necessary for proper treatment of submucous cleft palate patients.
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Fissura Palatina/cirurgia , Fala/fisiologia , Adolescente , Criança , Pré-Escolar , Fissura Palatina/fisiopatologia , Humanos , Lactente , Satisfação do Paciente , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Distúrbios da Fala/prevenção & controle , Resultado do Tratamento , Insuficiência Velofaríngea/fisiopatologia , Insuficiência Velofaríngea/cirurgia , Esfíncter Velofaríngeo/fisiologia , Adulto JovemRESUMO
PURPOSE OF REVIEW: In this review article, aimed at those likely to encounter but relatively unfamiliar with paediatric facial paralysis, we summarize reconstructive options in its surgical management. RECENT FINDINGS: The article looks at static and dynamic reconstructions available to address the problems encountered in the different anatomical regions of paralyzed face. SUMMARY: Although multiple surgical options are available for each anatomical region, decision-making should be taken in a multidisciplinary environment, and take into account the individual requirements of the family and patients.
Assuntos
Paralisia Facial/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Criança , Úlcera da Córnea/etiologia , Úlcera da Córnea/prevenção & controle , Nervo Facial/anatomia & histologia , Paralisia Facial/complicações , Paralisia Facial/psicologia , Humanos , Distúrbios da Fala/etiologia , Distúrbios da Fala/prevenção & controleRESUMO
BACKGROUND: Cleft lip and palate are among the most common congenital malformations, with an incidence of around 1 in 700. Cleft palate (CP) results in impaired Eustachian tube function, and 90% of children with CP have otitis media with effusion (OME) histories. There are several approaches to management, including watchful waiting, the provision of hearing aids (HAs) and the insertion of ventilation tubes (VTs). However, the evidence underpinning these strategies is unclear and there is a need to determine which treatment is the most appropriate. OBJECTIVES: To identify the optimum study design, increase understanding of the impact of OME, determine the value of future research and develop a core outcome set (COS) for use in future studies. DESIGN: The management of Otitis Media with Effusion in children with cleft palate (mOMEnt) study had four key components: (i) a survey evaluation of current clinical practice in each cleft centre; (ii) economic modelling and value of information (VOI) analysis to determine if the extent of existing decision uncertainty justifies the cost of further research; (iii) qualitative research to capture patient and parent opinion regarding willingness to participate in a trial and important outcomes; and (iv) the development of a COS for use in future effectiveness trials of OME in children with CP. SETTING: The survey was carried out by e-mail with cleft centres. The qualitative research interviews took place in patients' homes. The COS was developed with health professionals and parents using a web-based Delphi exercise and a consensus meeting. PARTICIPANTS: Clinicians working in the UK cleft centres, and parents and patients affected by CP and identified through two cleft clinics in the UK, or through the Cleft Lip and Palate Association. RESULTS: The clinician survey revealed that care was predominantly delivered via a 'hub-and-spoke' model; there was some uncertainty about treatment strategies; it is not current practice to insert VTs at the time of palate repair; centres were in a position to take part in a future study; and the response rate to the survey was not good, representing a potential concern about future co-operation. A COS reflecting the opinions of clinicians and parents was developed, which included nine core outcomes important to both health-care professionals and parents. The qualitative research suggested that a trial would have a 25% recruitment rate, and although hearing was a key outcome, this was likely to be due to its psychosocial consequences. The VOI analysis suggested that the current uncertainty justified the costs of future research. CONCLUSIONS: There exists significant uncertainty regarding the best management strategy for persistent OME in children with clefts, reflecting a lack of high-quality evidence regarding the effectiveness of individual treatments. It is feasible, cost-effective and of significance to clinicians and parents to undertake a trial examining the effectiveness of VTs and HAs for children with CP. However, in view of concerns about recruitment rate and engagement with the clinicians, we recommend that a trial with an internal pilot is considered. FUNDING: The National Institute for Health Research Health Technology Assessment programme. This study was part-funded by the Healing Foundation supported by the Vocational Training Charitable Trust who funded trial staff including the study co-ordinator, information systems developer, study statistician, administrator and supervisory staff.
Assuntos
Fissura Palatina/complicações , Fissura Palatina/terapia , Otite Média com Derrame/complicações , Otite Média com Derrame/terapia , Adolescente , Criança , Pré-Escolar , Fissura Palatina/economia , Análise Custo-Benefício , Técnica Delphi , Estudos de Viabilidade , Feminino , Auxiliares de Audição , Transtornos da Audição/prevenção & controle , Humanos , Lactente , Entrevistas como Assunto , Masculino , Ventilação da Orelha Média , Otite Média com Derrame/economia , Seleção de Pacientes , Distúrbios da Fala/prevenção & controle , Inquéritos e Questionários , Reino UnidoRESUMO
BACKGROUND: One of the most controversial topics concerning cleft palate is the diagnosis and treatment of velopharyngeal insufficiency (VPI). OBJECTIVE: This paper reviews current genetic aspects of cleft palate, imaging diagnosis of VPI, the planning of operations for restoring velopharyngeal function during speech, and strategies for speech pathology treatment of articulation disorders in patients with cleft palate. MATERIALS AND METHODS: An updated review of the scientific literature concerning genetic aspects of cleft palate was carried out. Current strategies for assessing and treating articulation disorders associated with cleft palate were analyzed. Imaging procedures for assessing velopharyngeal closure during speech were reviewed, including a recent method for performing intraoperative videonasopharyngoscopy. RESULTS: Conclusions from the analysis of genetic aspects of syndromic and nonsyndromic cleft palate and their use in its diagnosis and management are presented. Strategies for classifying and treating articulation disorders in patients with cleft palate are presented. Preliminary results of the use of multiplanar videofluoroscopy as an outpatient procedure and intraoperative endoscopy for the planning of operations which aimed to correct VPI are presented. CONCLUSION: This paper presents current aspects of the diagnosis and management of patients with cleft palate and VPI including 3 main aspects: genetics and genomics, speech pathology and imaging diagnosis, and surgical management.
Assuntos
Fissura Palatina/diagnóstico , Fissura Palatina/terapia , Erros de Diagnóstico/prevenção & controle , Distúrbios da Fala/diagnóstico , Insuficiência Velofaríngea/diagnóstico , Insuficiência Velofaríngea/terapia , Fissura Palatina/complicações , Diagnóstico Diferencial , Humanos , Distúrbios da Fala/etiologia , Distúrbios da Fala/prevenção & controle , Avaliação de Sintomas/métodos , Insuficiência Velofaríngea/complicaçõesRESUMO
BACKGROUND: During a 6-week course of (chemo)radiation many head and neck cancer patients have to endure radiotherapy-induced toxicity, negatively affecting patients' quality of life. Pretreatment counseling combined with self-help exercises could be provided to inform patients and possibly prevent them from having speech, swallowing, and shoulder problems during and after treatment. OBJECTIVE: Our goal was to investigate the feasibility of a multimodal guided self-help exercise program entitled Head Matters during (chemo)radiation in head and neck cancer patients. METHODS: Head and neck cancer patients treated with primary (chemo)radiation or after surgery were asked to perform Head Matters at home. This prophylactic exercise program, offered in three different formats, aims to reduce the risk of developing speech, swallowing, shoulder problems, and a stiff neck. Weekly coaching was provided by a speech and swallowing therapist. Patients filled out a diary to keep track of their exercise activity. To gain insight into possible barriers and facilitators to exercise adherence, reports of weekly coaching sessions were analyzed by 2 coders independently. RESULTS: Of 41 eligible patients, 34 patients were willing to participate (83% uptake). Of participating patients, 21 patients completed the program (64% adherence rate). The majority of participants (58%) had a moderate to high level of exercise performance. Exercise performance level was not significantly associated with age (P=.50), gender (P=.42), tumor subsite (P=1.00) or tumor stage (P=.20), treatment modality (P=.72), or Head Matters format (Web-based or paper) (P=1.00). Based on patients' diaries and weekly coaching sessions, patients' perceived barriers to exercise were a decreased physical condition, treatment-related barriers, emotional problems, lack of motivation, social barriers, and technical problems. Patients' perceived facilitators included an increased physical condition, feeling motivated, and social and technical facilitators. CONCLUSIONS: Head Matters, a multimodal guided self-help exercise program is feasible for head and neck cancer patients undergoing (chemo)radiation. Several barriers (decreased physical condition, treatment-related barriers) and facilitators (increased physical condition, feeling motivated) were identified providing directions for future studies. The next step is conducting a study investigating the (cost-)effectiveness of Head Matters on speech, swallowing, shoulder function, and quality of life.
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Transtornos de Deglutição/prevenção & controle , Terapia por Exercício , Neoplasias de Cabeça e Pescoço/complicações , Ombro/fisiopatologia , Distúrbios da Fala/prevenção & controle , Adulto , Idoso , Estudos de Viabilidade , Feminino , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Qualidade de Vida , Radioterapia/efeitos adversos , AutocuidadoRESUMO
The mechanisms mediating the anxiolytic effects of attention bias modification (ABM) remain unclear. Accordingly, we randomly assigned speech-anxious subjects to receive four sessions of one of three training conditions: ABM, inverse ABM, and control. In the ABM condition, subjects viewed pairs of photographs of models displaying facial expressions of disgust and joy on a computer screen. Probes always replaced the positive face, and subjects pushed a button to indicate the identity of the probe (E or F) as rapidly as possible. In the inverse condition, the probes always replaced the negative face, and in the control condition, the probes replaced each face type equally often. After four training sessions, all groups exhibited statistically indistinguishable, but significant, reductions on self-report, behavioral, and physiological measures of speech anxiety. Self-report and behavioral measures of attentional control improved likewise. Contrary to early studies, ABM was not superior to control procedures in producing reductions on measures of social anxiety.
Assuntos
Transtornos de Ansiedade/prevenção & controle , Atenção , Terapia Cognitivo-Comportamental/métodos , Distúrbios da Fala/prevenção & controle , Adulto , Análise de Variância , Sinais (Psicologia) , Método Duplo-Cego , Feminino , Humanos , Masculino , Transtornos Fóbicos/prevenção & controle , AutorrelatoRESUMO
BACKGROUND: After cochlear implantation, most parents expect a normal speech and general development of their child. However, it remains unclear how quickly after early cochlear implantation these children can compensate for their deficits compared to normal-hearing children. METHODS: This study retrospectively analyzed ELFRA-1 questionnaire data from 40 children with borderline deafness or high-grade hearing loss (without other known impairments) who had undergone cochlear implantation at a university medical center before reaching 2 years of age. ELFRA-1 questionnaires were filled out parents assisted by specialists 12 months after implantation. Questions assessed the children's speech production and comprehension, as well as their use of gestures and fine motoric skills. RESULTS: At an average hearing-age of 12 months, the children achieved normal values in all of the subgroups that were comparable to those of 12-month-old children without hearing impairments. A significant correlation (p = 0.01) between the individual subgroups of the ELFRA-1 (speech production, speech comprehension, gestures and fine motor skills) was observed. Unilingual educated children performed significantly better overall. CONCLUSION: Within 12 months of receiving a cochlear implant, all children passed the four categories of the ELFRA-1. This demonstrates a rapid compensation of deficits in speech, motor skills and gesture development by children undergoing early cochlear implantation.
Assuntos
Implante Coclear , Transtornos da Audição/diagnóstico , Transtornos da Audição/terapia , Desenvolvimento da Linguagem , Distúrbios da Fala/diagnóstico , Distúrbios da Fala/prevenção & controle , Feminino , Transtornos da Audição/complicações , Humanos , Lactente , Masculino , Distúrbios da Fala/complicações , Inquéritos e Questionários , Resultado do TratamentoRESUMO
BACKGROUND: Ablative surgery of oropharyngeal tumors frequently leads to defects in the speech organs, resulting in impairment of speech up to the point of unintelligibility. The aim of the present study was the assessment of selected parameters of speech with and without resection prostheses. PATIENTS AND METHODS: The speech sounds of 22 patients suffering from maxillary and mandibular defects were recorded using a digital audio tape (DAT) recorder with and without resection prostheses. Evaluation of the resonance and the production of the sounds /s/, /sch/, and /ch/ was performed by 2 experienced speech therapists. Additionally, the patients completed a non-standardized questionnaire containing a linguistic self-assessment. RESULTS: After prosthesis supply, the number of patients with rhinophonia aperta decreased from 7 to 2 while the number of patients with intelligible speech increased from 2 to 20. Correct production of the sounds /s/, /sch/, and /ch/ increased from 2 to 13 patients. A significant improvement of the evaluated parameters could be observed only in patients with maxillary defects. The linguistic self-assessment showed a higher satisfaction in patients with maxillary defects. CONCLUSION: In patients with maxillary defects due to ablative tumor surgery, an increase in speech performance and intelligibility is possible by supplying resection prostheses.
Assuntos
Prótese Dentária/instrumentação , Neoplasias Maxilomandibulares/complicações , Neoplasias Maxilomandibulares/cirurgia , Próteses e Implantes , Distúrbios da Fala/etiologia , Distúrbios da Fala/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distúrbios da Fala/diagnóstico , Medida da Produção da Fala/métodos , Resultado do TratamentoRESUMO
The aim of the study was to discuss physiology and pathology of speech and review of the literature on speech disorders in Parkinson disease. Additionally, the most effective methods to diagnose the speech disorders in Parkinson disease were also stressed. Afterward, articulatory, respiratory, acoustic and pragmatic factors contributing to the exacerbation of the speech disorders were discussed. Furthermore, the study dealt with the most important types of speech treatment techniques available (pharmacological and behavioral) and a significance of Lee Silverman Voice Treatment was highlighted.
Assuntos
Doença de Parkinson/complicações , Acústica da Fala , Distúrbios da Fala/classificação , Distúrbios da Fala/etiologia , Inteligibilidade da Fala , Disartria/etiologia , Humanos , Qualidade de Vida , Fala , Distúrbios da Fala/prevenção & controle , Medida da Produção da Fala , Fonoterapia/métodosRESUMO
We evaluated the effect of osmotic-release oral system (OROS) methylphenidate on learning skills in adolescents with attention-deficit/hyperactivity disorder (ADHD). In an open-label study, 121 adolescents with ADHD were administered flexible doses of OROS methylphenidate for 12 weeks. The efficacy of methylphenidate on ADHD symptoms was evaluated by ADHD Rating Scale (ARS) and Clinical Global Impression Scale (CGI). Learning Skills Test (LST) was used to measure the learning skills of the participants at the baseline and the endpoint. Continuous performance test, visuospatial and verbal working memory, verbal fluency, and inhibition were evaluated before and after the 12 weeks of treatment. The mean total and subscores of LST were significantly increased after the 12-week treatment with OROS methylphenidate. Executive functions were also improved during the trial, with the exception of inhibition measured by the Stroop Test. To the best of our knowledge, this is the first study to examine the influence of OROS methylphenidate on learning skill. As a result, OROS methylphenidate was effective in enhancing learning skills in adolescents with ADHD.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Inibidores da Captação de Dopamina/administração & dosagem , Deficiências da Aprendizagem/prevenção & controle , Metilfenidato/administração & dosagem , Administração Oral , Adolescente , Anorexia/induzido quimicamente , Anorexia/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Criança , Preparações de Ação Retardada/administração & dosagem , Preparações de Ação Retardada/efeitos adversos , Preparações de Ação Retardada/uso terapêutico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Inibidores da Captação de Dopamina/efeitos adversos , Inibidores da Captação de Dopamina/uso terapêutico , Função Executiva/efeitos dos fármacos , Feminino , Humanos , Incidência , Inibição Psicológica , Aprendizagem/efeitos dos fármacos , Deficiências da Aprendizagem/etiologia , Masculino , Memória de Curto Prazo/efeitos dos fármacos , Metilfenidato/efeitos adversos , Metilfenidato/uso terapêutico , Pressão Osmótica , Distúrbios da Fala/etiologia , Distúrbios da Fala/prevenção & controleRESUMO
Patients with head and neck cancer often suffer from breathing, speaking, and eating deficits, which negatively affect their quality of life. These patients are often observed to repeatedly contract aspiration pneumonia, resulting in prolonged hospital stays. To help prevent aspiration pneumonia, enteral nutrition is often provided. Although this method helps avoid pneumonia, patients need to give up eating by mouth. Because oral intake of food is closely related to patient quality of life, abandoning eating results in a strong internal conflict. This report describes the case of a cancer patient who experienced repeated aspiration pneumonias after neck surgery. The patient required enteral nutrition to avoid repeated bouts of pneumonia. However, the patient opted for laryngeal closure surgery to regain the ability to take food orally, at the expense of his voice. The patient's choice caused an ethical conflict for the attending medical professionals, highlighting the need for physicians to communicate with their patients to understand their patients' sense of values.