Cochlear implantation versus auditory brainstem implantation in children with auditory nerve deficiencies.

BACKGROUND: Cochlear nerve deficiency is one of the known causes of congenital sensorineural hearing loss. Management of hearing loss in children with cochlear nerve deficiency poses a multidimensional challenge. The absent or hypoplastic cochlear nerve may prevent electrical stimulation from reaching the brainstem and the auditory cortex. A deficient cochlear nerve can be associated with other inner ear malformations, which may diminish the success of cochlear implantation in those children. Promising results in adults after auditory brainstem implantation led to the expansion of candidacy to include the pediatric populations who were contraindicated for CIs. OBJECTIVE: To review the outcomes of cochlear implantation versus that of auditory brainstem implantation in children with various conditions of the auditory nerve. METHODS: This retrospective chart review study comprised two pediatric groups. The first group consisted of seven ABI recipients with cochlear nerve aplasia and the second group consisted of another seven children with cochlear nerve deficiencies who underwent CI surgery. The participants' auditory skills and speech outcomes were assessed using different tests selected from the Evaluation of Auditory Responses to Speech (EARS) test battery. RESULTS: There were some individual variations in outcomes depending on the status of the auditory nerve. The mean CAP score of the ABI group was 2.87, while the mean SIR score was 0.62. On the other hand, the mean CAP score of the CI group was 1.29, while the mean SIR score was 0.42. CONCLUSION: Our results are in good agreement with the reported auditory perception and speech and language development outcomes of pediatric auditory brainstem implantation. We added to the growing body of literature on the importance of verifying and identifying the status of the cochlear nerve in the decision-making process of the surgical management of those pediatric groups.

Características do padrão de refluxo na posição ortostática versus posição supina em pacientes com refluxo laringofaríngeo

Resumo Introdução: Muitos problemas relacionados à laringe têm sido atribuídos ao refluxo laringofaríngeo, inclusive disfonia, pigarro frequente, tosse crônica e sensação de "globus" faríngeo. No entanto, ainda há controvérsias quanto ao diagnóstico e à apresentação clínica dessa condição clínica. Objetivo: Descrever as características do refluxo laringofaríngeo de diferentes posições, em pacientes diagnosticados por meio de pHmetria orofaríngea. Método: Foi feita uma revisão retrospectiva de prontuários de 161 pacientes com refluxo laringofaríngeo diagnosticado por pHmetria orofaríngea de 24 horas. Os indivíduos do estudo foram categorizados em grupos com refluxo laringofaríngeo na posição ortostática e refluxo laringofaríngeo na posição supina com base nos resultados do pH. Os dois grupos foram comparados quanto à apresentação clínica e às características do pH. Resultados: Foram encontradas taxas significativamente mais altas de refluxo laringofaríngeo na posição ortostática em comparação à posição supina (p < 0,0001). Os resultados do índice de sintomas de refluxo foram significativamente maiores no grupo com refluxo laringofaríngeo na posição ortostática em comparação com o grupo com refluxo laringofaríngeo na posição supina. O uso do escore de Ryan composto (composite Ryan score) para a pHmetria orofaríngea de 24 horas foi significantemente maior no grupo com refluxo laringofaríngeo ortostático em relação ao grupo supino (p < 0,0001). Nenhuma diferença significante foi encontrada entre os grupos refluxo laringofaríngeo na posição ortostática e posição supina em relação à frequência da apresentação clínica ou classificações do índice de desvantagem vocal. Conclusão: O refluxo laringofaríngeo foi mais prevalente na posição ortostática entre os grupos de estudo. As características relacionadas ao refluxo, inclusive parâmetros de pH, foram mais evidentes no refluxo laringofaríngeo na posição ortostática.

Auditory and language skills development after cochlear implantation in children with multiple disabilities.

BACKGROUND: Cochlear implantation (CI) in children with additional disabilities can be a fundamental and supportive intervention. Although, there may be some positive impacts of CI on children with multiple disabilities such as better outcomes of communication skills, development, and quality of life, the families of those children complain from the post-implant habilitation efforts that considered as a burden. OBJECTIVE: To investigate the outcomes of CI children with different co-disabilities through using the Meaningful Auditory Integration Scale (MAIS) and the Meaningful Use of Speech Scale (MUSS) as outcome measurement tools. METHODS: The study sample comprised 25 hearing-impaired children with co-disability who received cochlear implantation. Age and gender-matched control group of 25 cochlear-implanted children without any other disability has been also included. The participants' auditory skills and speech outcomes were assessed using MAIS and MUSS tests. RESULTS: There was a statistically significant difference in the different outcomes measure between the two groups. However, the outcomes of some multiple disabilities subgroups were comparable to the control group. Around 40% of the participants with co-disabilities experienced advancement in their methods of communication from behavior to oral mode. CONCLUSION: Cochlear-implanted children with multiple disabilities showed variable degrees of auditory and speech outcomes. The degree of benefits depends on the type of the co-disability. Long-term follow-up is recommended for those children.

Development of the Arabic Voice Pathology Database and Its Evaluation by Using Speech Features and Machine Learning Algorithms.

A voice disorder database is an essential element in doing research on automatic voice disorder detection and classification. Ethnicity affects the voice characteristics of a person, and so it is necessary to develop a database by collecting the voice samples of the targeted ethnic group. This will enhance the chances of arriving at a global solution for the accurate and reliable diagnosis of voice disorders by understanding the characteristics of a local group. Motivated by such idea, an Arabic voice pathology database (AVPD) is designed and developed in this study by recording three vowels, running speech, and isolated words. For each recorded samples, the perceptual severity is also provided which is a unique aspect of the AVPD. During the development of the AVPD, the shortcomings of different voice disorder databases were identified so that they could be avoided in the AVPD. In addition, the AVPD is evaluated by using six different types of speech features and four types of machine learning algorithms. The results of detection and classification of voice disorders obtained with the sustained vowel and the running speech are also compared with the results of an English-language disorder database, the Massachusetts Eye and Ear Infirmary (MEEI) database.

Validation and Cultural Adaptation of the Arabic Version of the Eating Assessment Tool (EAT-10).

BACKGROUND AND OBJECTIVES: The Eating Assessment Tool (EAT-10) is a 10-item self-administered questionnaire. It is a noninvasive tool to measure patients' perception of their swallowing problems. The purposes of the present study were to develop an Arabic version of the EAT-10 and to evaluate its validity, consistency, and reliability in the Arabic-speaking population with oropharyngeal dysphagia. SETTING AND DESIGN: This was a prospective study carried out at the Communication and Swallowing Disorders Unit, King Saud University, Riyadh, Saudi Arabia. SUBJECTS AND METHODS: The Arabic EAT-10 was administered to 138 patients with oropharyngeal dysphagia and 83 control subjects. Internal consistency and test-retest reliability were evaluated. Content and clinical validity were studied, and the EAT-10 results were compared across patients and control groups. RESULTS: The Arabic EAT-10 showed excellent internal consistency (Cronbach's α = 0.92). Also, good test-retest reliability was found for the total scores of the Arabic EAT-10 (intraclass correlation = 0.73). There was a significant difference in Arabic EAT-10 scores between the oropharyngeal dysphagia group and the control group (p < 0.001). CONCLUSION: This study demonstrated that the Arabic EAT-10 is a valid tool that can be used for screening of dysphagia-related problems in an Arabic-speaking population.

Nasal bone length in Saudi rhinoplasty: a clinical-radiological study.

BACKGROUND AND OBJECTIVES: Hump reduction in the presence of short nasal bones can result in significant esthetic and/or functional problems in patients seeking rhinoplasty in the Middle East. The aims of this study were to determine the mean length of nasal bones, amount of nasal dorsum it forms in relation to the whole nose, and incidence of short nasal bones in the Middle Eastern population. DESIGN AND SETTINGS: A prospective study that has been carried out in a tertiary care hospital. PATIENTS AND METHODS: A total of 154 patients (80 females and 74 males) who were scheduled for computed tomography scan for the paranasal sinuses were included in the study. The inclusion criteria were adults with no history of facial/nasal trauma, sinus space occupying lesions, or surgery. RESULTS: In males, the mean clinical nasal bone length was 19.59 mm and the mean radiological nasal bone length was 24.96 mm. In females, the mean clinical nasal bone length was 18.17 mm and the mean radiological bone length was 22.82 mm. CONCLUSION: The bony vault represents 44.2% of the female nose and 44.3% of the male nose. In the present study, no patients displayed a short nasal bone that was less than one-third of the whole nasal length.

Psychosocial assessment of voice problems among Saudi teachers.

BACKGROUND AND OBJECTIVES: The teaching voice and its impact on the teaching profession have gained a special interest in several studies that are concerned with occupational voice disorders. This study aimed to explore the prevalence of voice problems among teachers in Riyadh city through studying the association between Voice Handicap Index (VHI) scores and different factors believed to have an influence on voice. DESIGN: Cross-sectional study. SUBJECTS AND METHODS: The Arabic VHI and a general questionnaire about voice disorders were distributed to a random sample of Saudi teachers in Riyadh city. The study included 416 teachers with a mean age of 34.3 ± 5.2 years. Statistical differences between the VHI scores of the teachers regarding different variables related to the teaching profession were investigated. RESULTS: Thirty-three percent of teachers in Riyadh city reported having voice problems. Teachers who reported the presence of certain living habits, teaching characteristics, and voice-related symptoms had significantly higher VHI scores compared to other teachers. CONCLUSION: Voice problems seem to be a prevalent disorder among teachers in Riyadh city. Such a condition could have a negative impact on the teaching profession. There appear to be many risk factors that can significantly affect the voice quality of teachers.

The effect of cochlear implantation on nasalance of speech in postlingually hearing-impaired adults.

OBJECTIVES/HYPOTHESIS: Hypernasality is considered a prevalent speech abnormality that could significantly contribute to the unintelligibility of the hearing-impaired speakers. The aim of this study was to evaluate the effect of cochlear implantation and the duration of hearing loss on nasalance of speech of a postlingually impaired group of Saudi adult patients. STUDY DESIGN: Retrospective study. METHODS: This study included 25 postlingually hearing-impaired patients who underwent cochlear implantation and 25 age-matched control subjects. Patients were divided into three groups according to the duration of hearing loss. The nasometric data of the hearing-impaired group were compared with the control group. Also, the preoperative values were compared with the postoperative values 6, 12, and 24 months after surgery. RESULTS: Significant differences were demonstrated between the preimplantation nasalance scores of the three subgroups and between the patients and control groups. There were statistically significant differences demonstrated between the pre- and the postimplantation nasalance values for the three groups of patients. CONCLUSION: Cochlear implantation appears to have significant effects on improving the nasalance of the speech of postlingually hearing-impaired adult patients. However, the degree of improvement might vary according to the duration of hearing loss the patients had preimplantation.

Medialization thyroplasty using autologous nasal septal cartilage for treating unilateral vocal fold paralysis.

OBJECTIVES: A persistent insufficiency of glottal closure is mostly a consequence of impaired unilateral vocal fold movement. Functional surgical treatment is required because of the consequential voice, breathing and swallowing impairments. The goal of the study was to determine the functional voice outcomes after medialization thyroplasty with using autologous septal cartilage from the nose. METHODS: External vocal fold medialization using autologous nasal septal cartilage was performed on 15 patients (6 females and 9 males; age range, 30 to 57 years). Detailed functional examinations were performed for all the patients before and after the surgery and this included perceptual voice assessment, laryngostroboscopic examination and acoustic voice analysis. RESULTS: All the patients reported improvement of voice quality post-operatively. Laryngostroboscopy revealed almost complete glottal closure after surgery in the majority of patients. Acoustic and perceptual voice assessment showed significant improvement post-operatively. CONCLUSION: Medialization thyroplasty using an autologous nasal septal cartilage implant offers good tissue tolerability and significant improvement of the subjective and objective functional voice outcomes.

The effect of cochlear implantation and post-operative rehabilitation on acoustic voice analysis in post-lingual hearing impaired adults.

Post-lingual deaf adults can develop some vocal abnormalities similar to those developed in pre-lingual deaf individuals. The aim of this work was to study the effect of cochlear implantation followed by post-operative rehabilitation on voice acoustics in post-lingual hearing impaired adults with different durations of hearing loss. The study included 35 post-lingual hearing impaired adults who underwent cochlear implantation. Patients were divided into two groups according to the duration of their hearing loss. Each group was further divided into two subgroups according to whether they received auditory rehabilitation or not. Using the Multi-Dimensional Voice Program (MDVP) parameters, comparisons were made between each subgroup of patients and the normal MDVP Saudi database, and between subgroups of patients. Most of the patients in the two groups reported significant improvement in their MDVP results post-implantation. Further, significantly deviant MDVP parameters were reported in the group of patients with longer duration of hearing loss. Patients who received rehabilitation significantly improved more than those who did not. In conclusion, it appears that cochlear implantation improves the auditory control of voice production in post-lingual deaf adults. Also, it is obvious that cochlear implantation at an early stage of hearing loss gives better results on voice control, especially if augmented with auditory rehabilitation.

Laryngeal myofibroblastic tumor: case series and literature review.

Inflammatory myofibroblastic tumor (IMT) or (plasma cell granuloma) of the larynx is a rare benign lesion that usually involves the lungs and broncopulmonary tree, as well as abdominal viscera. Overall this kind of tumor represents less than 1% of all tumors in the lung and respiratory tract with only 31 cases reported to date in the English language literature of laryngeal IMT. We report the first 2 cases in Saudia Arabia of IMT of the larynx treated at King Abdulaziz University Hospital (KAUH) with literature review.

Validation and cultural modification of Arabic voice handicap index.

The voice handicap index (VHI) is one of the most widely used instruments for measuring a patient's self-assessment of voice severity. In some ways, it reflects the patient's quality of life. Although it has been recognized and widely applied to populations in European countries and to English speaking populations, it has not been used in its present forms in the Arabic speaking countries due to the specific language constraints of Euro-American terminology. The purposes of this study were to generate an Arabic version of VHI, to assess its reliability, and to apply it to a wide variety of normal and dysphonic individuals of Arabic descent. The Arabic version of VHI was derived in the standard way for test translation. The translated version was then administered to 65 patients with voice disorders and 65 control subjects. Participants' responses were statistically analyzed to assess the validity, and to compare the pathological group with the control group. The Arabic VHI showed a significant high internal consistency and reliability (Cronbach's α = 0.97 and r = 0.89, respectively), high item-domain and domain-total correlation (r = 0.73-0.94). There was a statistically significant difference between the control and the voice-disordered groups (P < 0.001). The results of this study demonstrated strong internal consistency of the Arabic VHI. Thus, the Arabic version of VHI is considered to be a valid and reliable self-assessment tool for the severity of voice disorders in Arabic language speaking patients.

Reflux symptom index versus reflux finding score.

OBJECTIVES: We examined the correlation between the Reflux Symptom Index (RSI) and the Reflux Finding Score (RFS) to determine the laryngeal signs and symptoms that were most significantly correlated. METHODS: Forty randomly selected patients were included in the study. A retrospective chart review was performed for patients who fit the inclusion criteria. Videostroboscopic samples for the study group were reviewed and RFS-rated by 6 experienced raters on 2 different occasions to evaluate the interrater and intrarater reliability. The RSI and the RFS were statistically compared regarding both the total scores and the individual parameters. RESULTS: The RFS ranged from 0 to 20, and the RSI varied from 14 to 38. There was a high agreement between the raters' scores, demonstrating high interrater and intrarater reliability for RFS. Additionally, the RSI and RFS were highly correlated (p < .0001). Hoarseness was highly correlated with vocal fold edema and thick laryngeal mucus (p < .01), and excessive throat clearing correlated significantly with thick endolaryngeal mucus (p < .01). CONCLUSIONS: The study demonstrates a highly significant correlation between the RFS and the RSI.