[Long-term efficiency of vocal aptitude tests and voice training in student teachers]. / Langzeiteffekte von Stimmgutachten und Stimmtraining bei Lehramtsstudenten.

OBJECTIVE: Teachers are subject to exceptionally high vocal stress throughout their lives and have an increased prevalence of voice disorders. The aim of this study was to evaluate the long-term efficiency of voice training in student teachers during their lifelong career as a teacher. In addition, we investigated the relationship between vocal aptitude tests and teachers' vocal health. METHODS: In a multicentre case-control study, 202 teachers (median age: 48 years, 165 women, 37 men) were examined. The examination consisted of a standardised anamnesis, analysis of the voice, laryngostroboscopy and audiometry. Subjects were attributed to the case group if at least two of the following criteria were met: pathological videolaryngostroboscopic findings, pathological analysis of the voice, subjective vocal complaints. RESULTS: 65/202 teachers were categorised as cases. Comparing the groups, cases were older (p=0.001), worked more often in primary schools (p=0.008) and had more problems with reflux (p=0.002). 63.8% of the controls had completed a vocal aptitude test before starting their studies, compared to 47.6% of the cases (p=0.031). A multivariate analysis showed an OR of 1.6 for developing dysphonia if neither voice training nor a vocal aptitude test has taken place during the course of study. CONCLUSION: Many risk factors associated with dysphonia in teachers are often difficult or impossible to change. Vocal aptitude tests and voice training during the studies represent a primary prevention of occupational dysphonia in the teaching profession.

Auditory Spatial Discrimination and Sound Localization in Single-Sided Deaf Participants Provided with a Cochlear Implant.

INTRODUCTION: Spatial hearing is most accurate using both ears, but accuracy decreases in persons with asymmetrical hearing between ears. In participants with deafness in one ear but normal hearing in the other ear (single-sided deafness [SSD]), this difference can be compensated by a unilateral cochlear implant (CI). It has been shown that a CI can restore sound localization performance, but it is still unclear to what extent auditory spatial discrimination can be improved. METHODS: The present study investigated auditory spatial discrimination using minimum audible angles (MAAs) in 18 CI-SSD participants. Results were compared to 120 age-matched normal-hearing (NH) listeners. Low-frequency (LF) and high-frequency (HF) noise bursts were presented from 4°, 30°, and 60° azimuth on the CI side and on the NH side. MAA thresholds were tested for correlation with localization performance in the same participants. RESULTS: There were eight good performers and ten poor performers. There were more poor performers for LF signals than for HF signals. Performance on the CI side was comparable to performance on the NH side. Most difficulties occurred at 4° and at 30°. Eight of the good performers in the localization task were also good performers in the MAA task. Only the localization ability at 4° on the CI side was positively correlated with the MAA at that location. CONCLUSION: Our data suggest that a CI can restore localization ability but not necessarily auditory spatial discrimination at the same time. The ability to discriminate between adjacent locations may be trainable during rehabilitation to enhance important auditory skills.

[Detection of relevant changes in the speaking voice of women measured by the speaking voice profile]. / Nachweis von relevanten Veränderungen der Sprechstimme bei Frauen, gemessen im Sprechstimmprofil.

BACKGROUND: A healthy voice serves us as a basis for communication and an indispensable tool in a modern society with a growing number of vocal-intensive professions. There are indications that the average frequency of the speaking voice of women has decreased in recent years and is approaching that of men in the sense of sociophony. An epidemiological prospective cohort study will investigate the influences of age, personality traits and socio-demographic factors on the speaking voice of women. MATERIAL AND METHODS: Within the framework of a standardized examination procedure, the speaking voice of 2478 voice-healthy female participants between 5 and 83 years of age was registered in 4 different intensity levels (softest voice, conversational voice, classroom voice and shouting voice). Subsequently, the collected values for frequency and loudness of the different intensity levels were examined for correlation with age and results from questionnaires on personality (FFFK and BFI-10), on (mental) health (Patient-Health-Questionnaire - PHQ) and on socio-economic status (SES). RESULTS: Significant age-related influences on the speaking voice could be demonstrated for all voice intensities. For the personality traits investigated, significant positive correlations between the volume of the calling and speaking voice and extraversion were found. For the frequency of the softest voice and speaking voice, significant correlations were found for the personality traits of extraversion and tolerance. While no significant associations were found between the voice parameters of the speaking voice and the PHQ, it was found that the SES has a significant influence on both frequency and intensity. CONCLUSION: In addition to age-related changes, relevant influences of personality traits and the SES on speaking voice parameters in women were confirmed, which should be considered in clinical care of dysphonia.

[Auditory localisation in hearing impaired schoolchildren with and without hearing aids]. / Die Lokalisationsfähigkeit schwerhöriger Schulkinder mit und ohne Hörgeräte.

OBJECTIVE: Auditory localisation is part of central auditory processing. The study examined the impact of hearing aids on the auditory localisation ability of non-linguistic stimuli in hearing impaired schoolchildren. PATIENTS AND METHODS: Above threshold acoustic signals were presented to 20 children (7-17 years) in a free field condition with 45 loudspeakers placed on a semicircular array. All participants had a bilaterally symmetric moderate sensorineural hearing loss (WHO grade 2) and used behind the ear style (BTE) hearing aids with conventional earmolds. The children had to indicate the position of the signal by a laser pointer. Both high- and low-frequency noise bursts were employed in the tests to separately address spatial auditory processing based on interaural time differences and interaural intensity differences. The examination was performed with and without BTE hearing aids. RESULTS: There was no significant difference between results in the aided and the unaided condition: neither for the different frequency bands nor for the signal positions. The auditory localisation of the hearing impaired children was reduced by 3°-4° for frontal and 5°-11° for lateral positions compared to normal-hearing children. There was no age-relation. CONCLUSIONS: In our experimental setting, BTE hearing aids could not compensate the impaired auditory localisation ability of children with sensorineural hearing loss.

[Auditory processing in children and adolescents with cleft palate]. / Auditive Verarbeitung und Wahrnehmung bei Kindern und Jugendlichen mit Gaumenspalte.

BACKGROUND: Patients with cleft palate often suffer from recurrent otitis media chronica with effusion during infancy. The consecutive binaural conductive hearing loss is seen as a risk factor for developing auditory processing disease. Since there are just a few studies examining auditory processing in this population this study aimed to investigate on an own patient cohort with different cleft manifestations in terms of auditory processing disorders in context to given studies. MATERIAL AND METHODS: This study included 48 patients (5-16 years): all patients had a non-syndromic cleft palate and normal peripheral hearing at the time of examination. The protocol included otoscopy, pure tone audiogram, speech intelligibility in noise, dichotic speech discrimination, auditory short-term memory and a parental questionnaire. RESULTS: The majority of the parents did not indicate problems in the parental questionnaire. 69 % of the participants showed conspicuous results in the speech intelligibility in noise, whereas the dichotic speech discrimination and the auditory short-term memory were suspicious in 16.7 % only. The results in both tests proved mainly a problem in younger children. Noticeable results in speech intelligibility in noise were found in all age groups. CONCLUSION: Children and adolescents with cleft palate are at risk to develop auditory processing disorders. In this study population speech intelligibility in noise was the most common problem. 90 % of the children had received a speech therapy which could have already compensated problems concerning dichotic speech discrimination and the auditory short-term memory but not problems in speech intelligibility in noise.

[Central auditory processing in adolescents with communication impairments]. / Auditive Verarbeitung und Wahrnehmung bei Jugendlichen mit Kommunikationsbeeinträchtigungen.

BACKGROUND: In Germany, there are specialized vocational training units (BBW) for adolescents and young adults with special needs. The BBW Leipzig for people with disorders in hearing, language and communication registers a rising number of adolescents with auditory processing disorder (APD). However, test material to diagnose APD at this age is sparse. This study investigates auditory processing in adolescents with normal hearing but communication impairment with the available test material. MATERIALS AND METHODS: 35 normal hearing adolescents (26 male, 9 female, mean age: 18.1 years) were included. All were trained at BBW Leipzig. Dichotic listening, understanding of speech in noise, accelerated speech, differentiation and analysis of phonemes were examined. In addition, non-verbal general intelligence, concentration, figural retentivity, and linguistic abilities were assessed. RESULTS: 25 participants showed conspicious results concerning APD; 5 had never been diagnosed with APD so far. In 9/25 adolescents, there was no hint of top-down disorders. These participants had problems in accessing auditory information and holding and manipulating information in working memory, although both linguistic and intellectual abilities were normal or even above average. CONCLUSIONS: The study has shown that adolescents can be conspicuous according to the APD criteria of the DGPP and that an APD diagnosis from childhood is not necessarily already present. It also became clear that multi-professional diagnostics remains important beyond childhood. Standardized tests with corresponding age norms are needed.

Localization and Spatial Discrimination in Children and Adolescents with Moderate Sensorineural Hearing Loss Tested without Their Hearing Aids.

The present study investigated two measures of spatial acoustic perception in children and adolescents with sensorineural hearing loss (SNHL) tested without their hearing aids and compared it to age-matched controls. Auditory localization was quantified by means of a sound source identification task and auditory spatial discrimination acuity by measuring minimum audible angles (MAA). Both low- and high-frequency noise bursts were employed in the tests to separately address spatial auditory processing based on interaural time and intensity differences. In SNHL children, localization (hit accuracy) was significantly reduced compared to normal-hearing children and intraindividual variability (dispersion) considerably increased. Given the respective impairments, the performance based on interaural time differences (low frequencies) was still better than that based on intensity differences (high frequencies). For MAA, age-matched comparisons yielded not only increased MAA values in SNHL children, but also no decrease with increasing age compared to normal-hearing children. Deficits in MAA were most apparent in the frontal azimuth. Thus, children with SNHL do not seem to benefit from frontal positions of the sound sources as do normal-hearing children. The results give an indication that the processing of spatial cues in SNHL children is restricted, which could also imply problems regarding speech understanding in challenging hearing situations.

[Hearing Aid Fitting in Adults]. / Hörgeräteversorgung für Erwachsene.

The identification and treatment of hearing disorders belong to the fundamental tasks of an ENT-specialist. In this context the fitting of hearing aids has a special relevance. To verify a highly qualified medical care the knowledge of the audiological threshold values for the indication of the fitting of hearing aids and the detection of early signs for impaired communication are essential. The current quality assurance agreement defines technical and steric conditions pertaining to hearing aid fitting in the context of statutory health insurance. Only after approval of these postulated requirements the attending physician is allowed to bring to account his effort. The current regulations on medical devices specify both the basic requirement for a medical prescription and the expenses for hearing aids that are covered by the healthy insurances. A qualified hearing aid fitting is only possible if the ENT-specialist not only prescribes the device, but also conscientiously checks the comparative adjustments made by the hearing aid acoustician. Beside the knowledge about the general mode of operation and the different types of hearing aids ENT-specialist should know audiological and anatomic limits for the fitting of hearing aids.

[Implantable Bone Conduction and Active Middle Ear Devices]. / Implantierbare Knochenleitungs- und aktive Mittelohrhörsysteme.

In case of audiological and/or anatomical limitations in the provision of conventional hearing aids, semi- or fully-implantable hearing systems represent a modern therapy alternative. These hearing systems are divided according to their mode of action into active middle ear implants when stimulating the auditory ossicles or the round window, into bone conduction devices while stimulating the skull directly, into cochlear implants with direct acoustic stimulation to the cochlea with its auditory nerve and finally into auditory brainstem implants by bridging the peripheral auditory structures. Taking careful criteria of indications and anatomical specificities into account, significant improvements can be achieved in comfort, speech understanding and thus quality of life for a large number of patients.

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.

Diameter of the Cochlear Nerve Canal predicts Cochlear Nerve Deficiency in Children with Sensorineural Hearing Loss.

PURPOSE: Detection of cochlear nerve deficiency (CND) is usually straightforward using magnetic resonance imaging (MRI). In patients in whom MRI cannot be performed or imaging provides equivocal findings, computed tomography (CT) of the temporal bone might offer indirect evidence of CND. Our study aimed to derive a cut-off value for the diameter of the cochlear nerve canal (CNC) and internal auditory canal (IAC) in temporal bone CT to predict CND. MATERIALS AND METHODS: This retrospective study included 70 children with sensorineural hearing loss (32 with CND and 38 control patients). The height, width, and cross-sectional area of the IAC and diameter of the CNCs were determined using temporal bone CT. Receiver operating characteristic (ROC) and Student's t-tests were performed for each parameter. RESULTS: The mean diameter of the CNCs was significantly smaller in children with CND than in the control group (1.2 mm versus 2.4 mm, p < .001). The optimal threshold for CNC for separation of the two groups was 1.9 mm, resulting in a sensitivity of 98.7 % and specificity of 89.2 %. The IAC dimensions could not distinguish between children with CND and controls. CONCLUSION: A CNC diameter of less than 1.9 mm is a reliable predictor of CND in children with sensorineural hearing loss. KEY POINTS: · A small cochlear nerve canal predicts cochlear nerve deficiency (CND). · The size of the internal auditory canal cannot predict CND. · Whenever MRI is impossible or ambigous, CT can rule out CND. CITATION FORMAT: · Sorge M, Sorge I, Pirlich M et al. Diameter of the Cochlear Nerve Canal predicts Cochlear Nerve Deficiency in Children with Sensorineural Hearing Loss. Fortschr Röntgenstr 2022; 194: 1132 - 1139.

Sound Localization in Single-Sided Deaf Participants Provided With a Cochlear Implant.

Spatial hearing is crucial in real life but deteriorates in participants with severe sensorineural hearing loss or single-sided deafness. This ability can potentially be improved with a unilateral cochlear implant (CI). The present study investigated measures of sound localization in participants with single-sided deafness provided with a CI. Sound localization was measured separately at eight loudspeaker positions (4°, 30°, 60°, and 90°) on the CI side and on the normal-hearing side. Low- and high-frequency noise bursts were used in the tests to investigate possible differences in the processing of interaural time and level differences. Data were compared to normal-hearing adults aged between 20 and 83. In addition, the benefit of the CI in speech understanding in noise was compared to the localization ability. Fifteen out of 18 participants were able to localize signals on the CI side and on the normal-hearing side, although performance was highly variable across participants. Three participants always pointed to the normal-hearing side, irrespective of the location of the signal. The comparison with control data showed that participants had particular difficulties localizing sounds at frontal locations and on the CI side. In contrast to most previous results, participants were able to localize low-frequency signals, although they localized high-frequency signals more accurately. Speech understanding in noise was better with the CI compared to testing without CI, but only at a position where the CI also improved sound localization. Our data suggest that a CI can, to a large extent, restore localization in participants with single-sided deafness. Difficulties may remain at frontal locations and on the CI side. However, speech understanding in noise improves when wearing the CI. The treatment with a CI in these participants might provide real-world benefits, such as improved orientation in traffic and speech understanding in difficult listening situations.

Monitoring and Evaluation of Late Functional Outcome in Post-treatment Follow-Up in Clinical Routine Setting.

Patients treated for head and neck cancer (HNC) often suffer from severe and visible loss of function as the cancer itself and the side effects of aggressive treatments have the potential to severely affect quality of life. Therefore, the aim of follow-up is not only the early detection of potentially curable recurrences and second primary tumors but also the diagnosis and rehabilitation of functional impairments. Clear guidelines determining the frequency of follow-up visits are missing, and the impact of follow-up visits on patient's prognosis is unclear. An intensive post-treatment follow-up is needed to detect functional impairments and to initiate their treatment. The aim is an optimal rehabilitation of the patients. This article focusses on goals of aftercare treatment and describes the spectrum of long-term sequelae, and the impact of Patient Reported Outcome (PRO) instruments of which three will be introduced.

Auditory localization accuracy and auditory spatial discrimination in children with auditory processing disorders.

The present study investigated spatial hearing in children aged 6-12 years diagnosed with Auditory Processing Disorders (APD) and compared their results to those of a group of control children matched in age. Sound source localization accuracy was quantified using an absolute localization task and sound source discrimination by measuring the minimum audible angle. Low- and high-frequency noise bursts were presented from eight loudspeaker positions in the left and right hemifields (0°, 30, 60°, and 90° azimuth). Median absolute localization accuracy did not differ between children with APD and control children. However, the intra-individual variability of pointing behavior was higher for children with APD. In contrast, children with APD had significantly higher minimum audible angle thresholds than control children. These findings show that APD impairs sound source discrimination, but does not affect the median relationship between actual and judged sound source locations.

Speaking Voice in Children and Adolescents: Normative Data and Associations with BMI, Tanner Stage, and Singing Activity.

OBJECTIVES: The aim of this study was to establish normative data concerning the speaking voice of children and adolescents for clinical diagnostics. STUDY DESIGN: Population-based mixed cross-sectional and longitudinal childhood cohort study. METHODS: Normative data measuring the speaking voice profile of 1352 male and 1274 female participants aged 6 to 17 years were collected. To evaluate the voice range, five different intensity levels as the quietest voicing speaking voice (Level I), conversational voice (Level II), classroom voice (Level III), shouting voice (Level IV), and again the quietest speaking voice (Level V) were investigated. Multivariable analyses were performed to describe the effects of body mass index, Tanner stage, and singing activity on the outcome variables. RESULTS: A clear distinction in frequencies and sound pressure levels between the five different voice levels can be found in both genders. In females the mean fundamental frequency of the conversational voice lowers from 223.3 to 205.8 Hz. In male participants it lowers from 223.3 to 102.3 Hz. The most substantial decrease in the fundamental frequency of the speaking voice in boys occurs at 13.5 years. Girls show an almost continuous decline in their fundamental frequency. Only the Tanner stage showed significant positive relationships with the grade of lowering of the fundamental frequency in both sexes. CONCLUSIONS: It was shown that the investigation of the speaking voice using predefined intensity-levels represents a feasible examination for children and adolescents. This study provides reference data on the range and age-adjusted normative values of the speaking voice.

Speech rehabilitation during the first year after total laryngectomy.

BACKGROUND: Gaining a new voice is one of the major aims after total laryngectomy. The objective of this study was to describe the process and results of speech rehabilitation during the first year after surgery. METHODS: Speech intelligibility was measured 6 months (n = 273) and 1 year (n = 225) after total laryngectomy. RESULTS: Objective (23.4 to 47.5 points, p < .0001) and subjective (51.6 to 64.7 points, p < .0001) speech intelligibility improved between 6 months and 1 year after total laryngectomy. Patients who used tracheoesophageal puncture (TEP) had the best results in speech intelligibility 6 months and 1 year after total laryngectomy. In all, 12% of the patients who used TEP initially no longer used it 1 year later. Patients who had received rehabilitation had better objective speech intelligibility than those who did not. CONCLUSIONS: Speech improves considerably between 6 months and 1 year after total laryngectomy. Nonattendance of rehabilitation is associated with a worse functional outcome in speech rehabilitation.

Influence of singing activity, age, and sex on voice performance parameters, on subjects' perception and use of their voice in childhood and adolescence.

The aim of the study was to investigate the extent to which regular singing activity and voice training in children and adolescents enhance their voice performance parameters and their perception of their own voice and the extent to which their voice control is improved. At the same time, additional effects of age and sex were also taken into account. We investigated 183 children and adolescents between 6 and 19 years of age (mean age: 13.5 years) and assigned them to groups with different levels of voice strain and training with voice specialists. This was done on the basis of a classification of singing activity which we developed ourselves. We measured the voice parameters, and all of the test subjects were asked to appraise their perception and conscious control of their voices based on a questionnaire comprising 21 items. The higher the degree of vocal strain (taking regularity and organization of singing into consideration) and voice training, the more the perception and conscious control of the voice. Furthermore, the more intense the voice training, the wider the voice range becomes; the stronger the vocal strain, the better the capacity for messa di voce. On the other hand, the maximum duration of sustained phonation unexpectedly decreased, which we attribute to methodological reasons. Older children evince more differentiated perception of the sound of their own voices and imitate other voices more frequently. Boys show better values than girls as far as maximum voice intensity, maximum duration of phonation, and capacity for messa di voce are concerned. Boys also control their voices more consciously than girls. The results underscore the positive effects of regular singing and individual voice training on voice performance, sound perception, and conscious control of the voice. These results should encourage parents and pedagogues to provide opportunities for regular (organized) singing and voice training for as many children as possible. Moreover, age and gender have additional effects which should be taken into account in phoniatric and voice pedagogical counseling.

Empirical criteria for establishing a classification of singing activity in children and adolescents.

This study evaluated a proposed classification system to assess the nature and extent of voice use in young singers to support diagnostic routines, the treatment of voice disorders, and future research in children and adolescents. A classification system was developed and studied in 186 children and adolescents (age range 6-19 years, M=13.5 years). The system was based on three parameters previously shown to contribute to the development of voice disorders in young singers: amount of voice strain, amount of voice training, and the amount of wind instrument use. The subjects were selected on the basis of information from schools and choirs. After this selection, they were interviewed in detail by seven phoniatricians, logopaedists, and voice teachers. The standardized interviews were recorded and used for classification. Afterward, 124 physicians/logopaedists, choirmasters, music teachers, and lay people classified the singing activity by means of six randomized interviews, resulting in a total of 744 second appraisals. The agreement concerning the classification on the part of the interviewers was evaluated for each preselection and each second appraisal result for all three dimensions of the classification for each subject. All of the second appraiser groups showed moderately strong agreement with the interviewers (kappa=0.65-0.83). In the selection in which the test subjects were not interviewed, there was significantly less agreement (kappa=0.29-0.47). However, the additional strain caused by the instrument was already appraised with a very high degree of agreement in the preliminary selection (kappa=0.88-0.93). This classification system is a practical instrument for evaluating singing activity in young singers. It is accessible to lay persons, simplifying and standardizing communication among physicians, logopaedists, and singing teachers. It can be used at the level of a group comparison in scientific investigations.