[Long-term course after inpatient speech therapy: educational and language development of children with severe specific language impairment (SLI)]. / Langzeitverlauf nach stationärer Sprachtherapie: schulische und sprachliche Entwicklung von Kindern mit schwerer spezifischer Sprachentwicklungsstörung (SES).

BACKGROUND: Studies from primarily English-speaking countries have shown that specific language impairments can lead to disadvantages in educational and professional development. Corresponding studies for Germany have not been published. This study surveys the educational and language outcomes of adolescents and young adults who were treated in an inpatient setting during childhood. MATERIALS AND METHODS: A total of 193 young adults who had received inpatient treatment between 1998 and 2005 at the Department of Communication Disorders of the Department of Otorhinolaryngology, Head, and Neck Surgery (ENT) of the Mainz University Medical Center were assessed. The cohort was contacted by telephone and interviewed about aspects of their educational and language development using a specially developed questionnaire. It was possible to include 70 participants in the study. RESULTS: Almost half (48.6%; n = 34) of the participants had attended a regular elementary school and 50% (n = 35) attended a special school with a focus on speech-language development (others: 1.4%, n = 1). Regarding school-leaving qualifications, 31.5% (n = 22) finished school with an Abitur/Fachabitur (high-school-level certificate), 33% (n = 23) with a Realschulabschluss (secondary school certificate), 30% (n = 21) with a Hauptschulabschluss (lower secondary certificate), and 4% (n = 3) with a special school certificate. Only one participant left school without a qualification. Of the interviewed participants, 71% (n = 50) do not feel any speech language limitations anymore. CONCLUSION: The results indicate a positive educational and language development of children with SLI after inpatient treatment in Germany. Over 90% of the participants finished school with a regular certification and most of them do not feel any speech and language limitations anymore.

The use of narrow band imaging for the detection of benign lesions of the larynx.

In the cases of uncertainty, even if the patient has no complaints about his voice quality, sometimes, benign vocal fold mass lesions are removed to exclude malignancy with the risk of resultant dysphonia. Narrow Band Imaging (NBI) enables a specific visualization of vessel structures in the superficial tissue. Benign lesions of the larynx are frequently characterized by abnormal vessel configuration or an absence of vessels in the area of the lesion. It was hypothesized that, in the primary diagnosis of patients with these benign lesions, the combination of white light and NBI endoscopy enables a better detection compared with white light endoscopy alone. Twenty-nine patients (eight patients with a cyst on a vocal fold, eight with a polyp, seven with a Reinke´s edema, two with a leukoplakia, one with a carcinoma, one with a granuloma, and two without any pathologic finding) were examined with normal white light and NBI endoscopy. 87 video sequences (29 white, 29 NBI, and 29 white/NBI) were generated and randomized and presented to 20 otolaryngologists who rated the videos in terms of the suspected diagnosis. Results were compared with the histopathologic findings of microlaryngoscopy. The probability of detecting benign lesions of the vocal folds was higher using NBI in combination with white light endoscopy compared with white light endoscopy alone. For vocal fold cysts, this difference was statistically significant. NBI endoscopy in combination with normal white light endoscopy improves the detection rate of benign lesions of the larynx, especially of vocal fold cysts.

Narrow Band Imaging: A Tool for Endoscopic Examination of Patients With Laryngeal Papillomatosis.

OBJECTIVES: Narrow band imaging (NBI) is supposed to be a technique for a better visualization of vessel structures in superficial tissue as it selects the wavelengths of hemoglobin. It was hypothesized that, in the regular follow-up examination of patients with recurrent laryngeal papillomatosis, NBI enables a better detection of laryngeal papillomatosis in contrast to normal white light endoscopy. METHODS: Eleven patients, 10 with a known recurrent papillomatosis (8 with a relapse, 2 without) and 1 with a primary diagnosis of papillomatosis, were examined with normal white light and NBI endoscopy. Twenty-six video sequences (11 white, 11 NBI, 4 doubled for validity) were generated and randomly presented to 20 otolaryngologists who rated the videos in terms of lesions seen and number of lesions identified. Results were compared with the histopathologic findings of microlaryngoscopy. RESULTS: Detection of papillomatosis and the correct number of lesions identified were more accurate with NBI than with normal white light endoscopy. There was a significantly higher probability of detecting laryngeal papillomata with NBI. CONCLUSIONS: NBI endoscopy enables a more accurate detection of laryngeal papillomatosis than white light endoscopy.

High-Speed Imaging Analysis of Register Transitions in Classically and Jazz-Trained Male Voices.

BACKGROUND: Little data are available concerning register functions in different styles of singing such as classically or jazz-trained voices. Differences between registers seem to be much more audible in jazz singing than classical singing, and so we hypothesized that classically trained singers exhibit a smoother register transition, stemming from more regular vocal fold oscillation patterns. METHODS: High-speed digital imaging (HSDI) was used for 19 male singers (10 jazz-trained singers, 9 classically trained) who performed a glissando from modal to falsetto register across the register transition. Vocal fold oscillation patterns were analyzed in terms of different parameters of regularity such as relative average perturbation (RAP), correlation dimension (D2) and shimmer. RESULTS: HSDI observations showed more regular vocal fold oscillation patterns during the register transition for the classically trained singers. Additionally, the RAP and D2 values were generally lower and more consistent for the classically trained singers compared to the jazz singers. However, intergroup comparisons showed no statistically significant differences. CONCLUSION: Some of our results may support the hypothesis that classically trained singers exhibit a smoother register transition from modal to falsetto register.

Fundamental frequency, sound pressure level and vocal dose of a vocal loading test in comparison to a real teaching situation.

Vocal loading capacity is an important aspect of vocal health, especially for people in vocally demanding occupations such as teaching. To analyze vocal loading, vocal loading tests (VLTs) or portable voice devices such as accelerometers have been used. However, it remains unclear how much a VLT in a clinical setup reflects the vocal effort of a real situation, in particular for teachers in a given classroom lesson. In this study of vocally healthy 101 student teachers, we analyzed different vocal doses for a 10-min VLT (80 dB at a distance of 30 cm) and a real 45-min teaching lesson. The phonation time, fundamental frequency, sound pressure level, and noise level were recorded using the VoxLog accelerometer/microphone system for both conditions. From these measurements the time dose, cycle dose, distance dose, energy dissipation dose, and radiated energy dose were calculated. The VLT was associated with a higher fundamental frequency, a higher sound pressure level, and higher relative phonation time compared to the real teaching lesson. Nevertheless, most vocal doses did not differ significantly between the conditions. A VLT of 10 min with >80 dB at 30 cm distance shows only small differences of vocal doses in comparison to a real teaching situation of 45 min. Thus, for clinical vocal assessment the vocal load of a VLT can be related to an approximately 45-min teaching situation.

Standardization and Feasibility of Voice Range Profile Measurements in Epidemiological Studies.

OBJECTIVES: The voice range profile (VRP) is composed of the speaking VRP (spVRP) and the singing VRP (siVRP). Different examination methods of VRP and effects of interobserver variability were evaluated to define a standard operating procedure (SOP) suitable for the specific use in epidemiological studies. Subsequently the feasibility of the SOP was investigated in a larger number of participants. STUDY DESIGN: Cross-sectional study. METHODS: In a first phase both the spVRP and the siVRP of 51 female students were measured by four differently experienced examiners. Using a cross-over study design the effects of two different recording methods (manual vs automatic) and three different types of instructions given by the examiner (none vs before vs during recording) were investigated. In a second phase, the SOP for VRP recording was tested in the framework of a feasibility study in 110 (55 female and 55 male) participants. RESULTS: The average total investigation time was significantly (P = 0.001) higher for the manual recording method (6.1 minutes ± 1.0) in comparison to the automated (5.5 minutes ± 0.7) recording method. The manual recording method led to significantly lower values of minimum frequency (F0min) (P = 0.013) and minimum intensity (SPLmin) (P < 0.001) and higher values of the maximum frequency (F0max) (P = 0.005) of the siVRP. The maximum phonation time, F0max, SPLmax of the siVRP and the frequency and intensity of the shouting voice (Level IV) of the spVRP showed significantly (P < 0.001) higher values when the examiner was allowed to give instructions and advise during the recording. Voice parameters of the siVRP did not show significant associations with the experience of the examiner. CONCLUSIONS: Standardization of VRP measurements is important to obtain correct and reproducible data in a reasonable examination time. The SOP proposed here proved to be feasible in the setting of an epidemiological study.

High-speed imaging using rigid laryngoscopy for the analysis of register transitions in professional operatic tenors.

INTRODUCTION: Vocal fold oscillation patterns in tenors singing at high pitches (stage voice above the passaggio) are not yet understood in detail. MATERIALS AND METHODS: Nine professional opera tenors performed a transition from modal register (220 Hz) to falsetto or stage voice above the passaggio (440 Hz) on an /i/ vowel. High-speed digital imaging was performed using a rigid laryngoscopic system with a frame rate of 4,000 frames per second. RESULTS: During the transition to stage voice above the passaggio seven out of nine tenors exhibited a strong retraction of the epiglottis with rising F0, which prevented further analysis of vocal fold oscillations. During transitions to falsetto many supraglottic modifications were also observed. CONCLUSION: Tenor stage voice above the passaggio seems to be typically associated with retraction of the epiglottis for the vowel /i/ thus preventing examination of vocal fold oscillations using rigid laryngoscopy.

High-speed imaging and electroglottography measurements of the open quotient in untrained male voices' register transitions.

Vocal fold oscillation patterns in vocal register transitions are still unclarified. The vocal fold oscillations and the open quotient were analyzed with high-speed digital imaging (HSDI) and electroglottography (EGG) in 18 male untrained subjects singing a glissando from modal to the falsetto register. Results reveal that the open quotient changed with register in both HSDI and EGG. The in-class correlations for different HSDI and EGG determinations of the open quotient were high. However, we found only weak interclass correlations between both methods. In 10 subjects, irregularities of vocal fold vibration occurred during the register transition. Our results confirm previous observations that falsetto register is associated with a higher open quotient compared with modal register. These data suggest furthermore that irregularities typically observed in audio and electroglottographic signals during register transitions are caused by irregularities in vocal fold vibration.