[Evaluation of current assessment tools in early detection of developmental deviations in speech and language in the German preventive paediatric examination (Kindervorsorgeuntersuchung U8)]. / Analyse aktueller Untersuchungsinstrumente zur Früherkennung von Auffälligkeiten in Sprechen und Sprache in der pädiatrischen Vorsorgeuntersuchung U8.

OBJECTIVE: The current analysis is a contribution to application information and quality assurance. It is intended to evaluate and optimise the use of German developmental screening instruments to identify deficits in speech, speech fluency and language during the early paediatric toddler check-up Kindervorsorgeuntersuchung U8 in the age of 43-50 months. METHODS: A systematic literature search was conducted seeking current specific, standardised, norm-referenced assessment tools, particularly those relevant to the early detection of developmental speech and language retardation. They were subsequently evaluated quantitatively and qualitatively with specific regard to 15 psychometric criteria and construction features. RESULTS: 4 assessment tools (ETS 4-8; KiSS; SSV; TSVK-Screen) resulted from literature search. They were subjected to a detailed and rigorous comparative analysis. Quantitatively they met 7-12 of the 15 psychometric criteria whose quality was partly low or demonstrated survey standard to a lesser degree. CONCLUSION: These developmental screening instruments utilised in the paediatric toddler check-up U8 cannot be recommended without reservation with regard to a dichotomous decision (suspected disorder versus no suspected disorder). More qualificatory research focusing specifically on the existing screenings and the construction of new screening tools is required in order to gain vital developmental psychological information of the speech/language status of a child during the preventive paediatric examination U8. Alternatively, it should be evaded to the approach of taking diagnostic language developmental tests.

[Evaluation of current assessment tools in the early detection of language retardation in the German preventive paediatric examinations (Kindervorsorgeuntersuchung U7/U7A)]. / Vergleichende Analyse aktueller Untersuchungsinstrumente zur Früherkennung von Sprachentwicklungsretardationen in den pädiatrischen Vorsorgeuntersuchungen U7/U7A.

OBJECTIVE: The current analysis is a contribution to user orientation and quality assurance that seeks to evaluate and optimise the use of German language development assessment tools during early paediatric toddler check-ups ( KINDERVORSORGEUNTERSUCHUNG U7 OR U7A). METHODS: All current, standardised assessment tools, particularly those relevant to early detection of developmental language retardation - normed on German speaking children - were evaluated quantitatively and qualitatively with particular regard to their psychometric criteria (13 criteria) and design features. RESULTS: 8 assessment tools (ELAN; ELFRA-2; Short Form ELFRA-2; FRAKIS; FRAKIS-K; SBE-2-KT; SBE-3-KT; SETK-2) were located in the literature and subjected to a detailed and rigorous comparative analysis. Quantitatively they met 9 to 11 of the 13 psychometric criteria. CONCLUSION: In Germany, there are several assessment tools for dichotomous identification of language retardations on high levels of psychometric criteria that can be used in the above-mentioned preventive paediatric examinations. Nevertheless, the collecting of actual norm scores of representative samples should be kept in mind.

[Which phonological memory measure distinguishes children with from children without auditory processing disorders? A group analysis]. / Welche phonologische Arbeitsgedächtnisleistung trennt Kinder mit AVWS von unauffälligen Kindern? Eine Gruppenanalyse.

AIM: The aim of this study was to compare performance in phonological working memory across children with auditory processing disorders (APD), partly associated with different developmental disorders, and to examine which memory measure distinguishes children with from children without APD. METHOD: Data from a health care research database were retrospectively analyzed. All children completed three measures of phonological serial recall: one-syllable digits, one-syllable words, and multi-syllabic nonwords of increasing length (2-6 syllables). PARTICIPANTS: The study included 48 subjects with APD only (mean age: 87.9 months; SD 12.9 months); 35 with co-occurring APD and developmental language disorder (DLD) (mean age: 82.2; SD 13.4); 16 with co-occurring APD and dyslexia (mean age: 109.2; 18.7); 10 with co-occurring slight intelligence reduction and APD (mean age: 102.4; SD 12.5), while 13 were non-affected, typically forming controls (non-APD; mean age: 86.0; SD 16.1). The mean intelligence (T-score) of the first three mentioned APD groups and the controls were significantly different (p<0.0001) from the children with lowered intelligence and APD (35.4; SD 3.1). RESULTS: Mean performance in all three verbal memory measures was significantly different from the controls in children with DLD+APD (digit span: p=0.0009; word span: p=0.0012; nonwords: p=0.05) and children with APD only (digit span: p=0.0037; word span: p=0.0006; non words: p=0.05). The set of memory measures (excluding the small and older group with lowered intelligence) went into a stepwise discriminate analysis. A significant group separation APD vs. non-APD was made by the subvocal rehearsal component of the phonological loop, as indicated by word span (F=14.40; p=0.0002) and digit span (F=2.87; p=0.0932). The rate of misclassification was 23%. CONCLUSION: The present results raise the question of the validity of APD diagnostics which includes the phonological working memory on principle. It remains controversial whether the assessment of the cognitive function "phonological memory" should remain part of (C)APD diagnosis. Further research should aim to replicate the study with subjects of the same age and supplementary studies of the "central executive" and processing precision of the phonological store.

[Voice function and quality of life--patients with laryngeal carcinoma following minimal-invasive laser surgery and function voice rehabilitation]. / Stimmfunktion und Lebensqualität--Patienten mit Larynxkarzinom nach minimal-invasiver Laserchirurgie und "Funktionaler Stimmrehabilitation''.

BACKGROUND: Quality of life is a relevant criterion for therapeutical outcome in laryngeal carcinoma patients. The aim of this study was to assess the self-related complaints in quality of life and functional outcome of voice among persons who had undergone laryngeal cancer surgery. METHODS: The examination took place 67 months (SD 34.8) after the last surgery, on average and finishing of 60 therapy sessions (median). First a measurement with the Goettinger Hoarseness Diagram (GHD) was carried out. Next the subjects answered self-reported standardized questionnaires for life quality in oncological patients on the same day: EORTC-QLQ-C30 and 3 scales of the German Fragebogen zur Lebenszufriedenheit (health-related fulfillment, fulfillment with work/occupation, fulfillment with social environment). For disease-related symptoms of different head and neck domains the EORTC-HandN35 was administered. SUBJECTS: Forty-four patients (37 males, 7 females) who were treated primarily with minimal invasive laser surgery followed by functional voice rehabilitation (Goettinger Konzept). Mean age: 60.1 (SD 9.7) years. RESULTS: The acoustic voice quality according to the GHD showed a significant correlation with self-reported "Somatic Functioning" (- 0.32, p = 0.04) and "Social Functioning" (- 0.38, p = 0.01) in the EORTC-QLQ-C30 as well as with the symptom scales "Speech" (0.45, p < 0.0024) resp. "Social Contact" (0.45, p = 0.0021) in the EORTC-HandN35. Also hoarseness and health-related fulfillment (- 0.36, p = 0.02) as well as fulfillment with work/occupation (- 0.33, p = 0.03) correlated significantly. On the other hand, there was no significant association between the GHD and the assessment of global quality of life. CONCLUSION: Postoperative phonatory reductions in patients with laser surgically treated laryngeal carcinoma have only a slight influence on overall quality of life. The same is true for the GHD. Assessment of self-reported quality of life in recommendation of oncologic treatment may not be able to replace the objective findings, but may be useful to detect other problems, e.g. psychosocial.

Psychological profiles of patients with laryngeal contact granulomas.

The association between laryngeal contact granuloma and demographic/psychological variables was examined by using a psychosomatic approach to health research. A stepwise procedure of logistic regression analyses was utilized to get a final multivariate model of variables associated with the clinical finding of a laryngeal contact granuloma. The subjects consisted of 47 patients with contact granulomas and 110 patients with voice disorders due to other causes. Our analysis of 22 variables uncovered the following statistically significant factors for developing a contact granuloma: male gender (P = 0.0001), low achievement orientation (P = 0.0007), fear of physical lesions (P = 0.0038), impulsiveness (P = 0.0016), age > 60 years (P = 0.0012), low extraversion (P = 0.004), high achievement orientation (P = 0.0079), fear of appearing in public (P = 0.0216) and strain (P = 0.03). These results show that a variety of variables are important for predicting the development of a laryngeal contact granuloma. The usefulness of this set of risk variables for predicting a contact granuloma remains to be proved in a prospective study. It is possible that not only the nature but the number of risk factors are the prime determinants of outcome.

[Follow-up of patients with laryngeal contact granuloma]. / Ein Follow-up von Patienten mit laryngealem Kontaktgranulom.

A conservative approach (vocal rest, voice therapy, antibiotic treatment of infections and/or management of esophageal reflux) and microsurgery have been used to heal laryngeal contact granulomas. Unfortunately, recurrences have been found in most cases. In the present study we followed 45 patients after an initial diagnosis of a contact granuloma was made based on laryngoscopy and stroboscopy with video-documentation. All studies were conducted in the Department of Phoniatrics (University of Göttingen) during the past four years, with follow-ups made at 3 month-intervals up to 12 months after diagnosis. All patients were counselled using a focal psychosomatic approach. Follow-up was possible for 41 patients. Findings showed that 19 patients lost their contact granulomas completely without therapy, 12 of which occurred over a period to 13 months after diagnosis. Seven patients underwent microsurgery at their own requests, with 5 developing recurrences when compared with the first diagnosis, 15 patients still had a contact granuloma. Emotional strain in connection with specific personality traits seemed to operate as a significant variable in the remission of contact granulomas.

Identification and diagnostic evaluation of hearing impairments in early childhood in German-speaking infants.

The present study was devised to gather epidemiological information to aid in understanding the etiology, identification, and management of children with permanent hearing losses in Lower Saxony as a defined geographical area of Germany. All infants and preschool children were identified in the Department of Phoniatrics and Pediatric Audiology during a 1-year period (October 1994 until October 1995). Forty-four hearing-impaired children were identified, of whom 41 (93%) had sensorineural losses and 3 had pure conductive losses. Thirty-two children (73%) had bilateral hearing impairments. The causes of hearing loss were unknown in 17 children (39%). The median age of identification for the study group was 32 months, with a median age of 35.5 months when fitting hearing aids. Severity of hearing loss was inversely associated with age of identification. Prelingually deaf children had the worst comprehension levels of all children tested psychologically. Results were tabulated and special references to other studies were discussed. Our findings show again that the successful out-come of speech and language development depends on early identification and management of the hearing loss, and on continued assessment of the progress of habilitation. These require a basic assessment of the stage of language development (in perception and expression) as relevant rehabilitation measures. The next step is the treatment of existing linguistic deficits followed by retests at regular intervals.

[Psychological classification of functional voice disorders]. / Zur psychologischen Klassifikation von Stimmfunktionsstörungen.

In an explorative study the classification of a collective of patients with different voice disorders by discriminant and cluster analysis was tried. 21 variables, obtained from 128 patients with various diagnoses of voice disorders, were used. A first discriminant analysis on the basis of diagnoses-groups permitted no differentiation. A subsequent hierarchical cluster analysis indicated a four-cluster-solution. The clusters showed only little association with the phoniatric diagnoses. Cluster 1 is characterized by patients with non-organic voice disorders. Cluster 2 is marked by emotional unstable patients with organic dysphonia. Cluster 3 consists of patients with psychosomatic dysphonia by laryngeal contact granuloma, and cluster 4 contains emotional stable patients suffering from organic dysphonia and from spasmodic dysphonia. Thirteen psychological variables discriminated the clusters significantly: Anxiety about appearing in public, emotionality (neuroticism), life satisfaction, aggressiveness, anxiety, about physical injuries, extraversion.

Sociodemographic variables of a German sample of patients with contact granuloma.

We report 28 German patients with contact granuloma (27 male, 1 female). Their mean age was 52 years (ranging from 35 to 70). Thirty-two percent were retired. The occupations of the others represented a wide range of different jobs. The majority of the sample had a middle educational level. Most patients lived with their family or with a partner. According to self-assessments, 68% had average daily strain on their speaking voice. All patients were nonsmokers. The patients felt themselves more disturbed by somatic troubles as the general population. Heartburn was felt by nearly half of the patients. A little more than half of the patients suffered from globus sensation. Thus, it is not possible at present to explain the laryngeal contact granuloma by sociodemographic data, vocal stress, or special somatic complaints in this sample. Therefore a multifactorial etiology should be supposed.

[Laryngeal contact granuloma--a psychosomatic disorder?]. / Das laryngeale Kontaktgranulom--ein psychosomatisches Störungsbild?

In a multidimensional design using the hypothesis of a psychosomatic genesis, 28 patients (1 female, 27 male) showed, in their personality profile, increased scores in 'impulsiveness', 'emotionality (neuroticism)', 'strain' and 'inhibition'. In addition to the voice disorders other somatic symptoms were observed, especially general symptoms as dysthymia, depression and excessive vegetative stimulation. Their social competence was reduced by the fear of making contacts and the inability 'to say no'. Also psychosocial stress factors were registered due to loss of a loved one with feelings of an existential danger. Thus, contact granuloma can be considered as a secondary reaction to a specific combination of personal disposition and social life situation. Lastly a causal model is presented, which can be used as a diagnostic criterion.

[Psychosocial problems and coping with illness by patients with defective healing after facial paralysis]. / Psychosoziale Probleme und Krankheitsverarbeitung von Patienten mit Defektheilung nach Fazialisparese.

Twenty patients with defective healing following idiopathic or infection-induced facial paralysis (group 1) and 14 patients with defective healing after excision of an acoustic neuroma and subsequent hypoglossal-facial nerve anastomosis (group 2) were questioned as to their psychosocial conditions. The principle gueries involved the impact of facial impairment on social activities, behavior in public, professional performance and communication, as well as strategies in coping with disfigurement. One third of the patients (with a majority in group 2) experienced stigmatization and a feeling of embarrassment or anxiety in public. Many patients minimized facial expressions and communication in order to hide their paralyses. In particular, patients in group 2 frequently had to change their employment and had great problems in accepting their conditions. Additional problems had with a clinical diagnosis of "acoustic neuroma" involved greater stress and more pronounced social withdrawal than experienced by the patients with idiopathic pareses.