[Audiologic diagnosis in children. Applicability of different speech material]. / Audiologische Diagnostik bei Kindern. Verwendbarkeit von unterschiedlichem Sprachmaterial.

The aim of our study was to establish bench-mark values for speech intelligibility in noise for children. We also considered which of the two dichotic discrimination tests, Feldmann's or Uttenweiler's, would be most suitable for use within this age group. We examined 102 children aged between 7 and 10 years (second year, primary school), with an average age of 8 years. After confirming normal hearing acuity (examination of the ear, tympanometry and audiogram), speech perception was tested. This was performed with and without noise using the Göttingen Audiometric Speech Test for Children II and the monosyllables of the Freiburger Speech Intelligibility Test. The percentage of word intelligibility was recorded. Furthermore, dichotic hearing was tested using a combination of Feldmann and Uttenweiler dichotic discrimination tests. We rated the percentage of correct word pair repetitions with the correct article. The results showed that the best method for testing speech perception in noise for this age group was the Göttingen Test II for Children. Speech perception below 70% for word intelligibility should be considered as pathologic. For testing dichotic hearing, Uttenweiler's dichotic discrimination test for children was most suitable. In this test values below 80% should be considered as pathologic.

[Brainstem acoustic evoked potentials in children with developmental disabilities--a useful tool for differential diagnosis]. / Frühe akustisch evozierte Potentiale bei Kindern mit Entwicklungsstörungen--eine sinnvolle Ergänzung der Diagnostik?

In a retrospective study brainstem acoustic evoked potentials (BAEP) were evaluated in 222 children with psychomotor retardation or dysmorphic signs. Registrations were done, when no clear response to acoustic stimuli of medium intensity (60-80 dBA) could be obtained during clinical examination. Only 118 children (53%) had normal BAEP. 50 patients (22%) suffered from hearing impairment. 39 children (17%) showed disturbances of neuronal conduction. In 15 cases (7%) a combination of both conditions occurred. The mean age of our children with hearing impairment was 33.1 months, no case having been diagnosed before. In 57% the impairment was of the conductive type with an amount of less than 40 dB nHL This type was predominant in children with skeletal dysplasias (43%), chromosomal aberrations (43%) and malformation syndromes (40%). Severe hearing deficits of the sensorineural type with more than 69 dB nHL were found in children with malformation syndromes (28%), perinatal injuries (23%) and cns malformations (16%). As far as reference data were available, the hearing impairment in the BAEP was confirmed in 92% by our pedaudiologists. As a consequence hearing aids were first prescribed in 10 children, their medium age being 33.6 months. In 18 cases grommets were inserted. 9 children required paracentesis and 4 adenotomy. Disturbances of neuronal conduction with increased interpeak latencies and deformed potentials were predominantly found in the group of children with neurometabolic diseases (67%) and cns malformations (32%). Early diagnosis of hearing impairment in children with psychomotor retardation remains a problem as it is in the general population. More attention in clinical examination and appropriate screening is necessary. BAEP provide a powerful tool for hearing screening and additional information for differential diagnosis especially in children with neurometabolic diseases.

[Early indications for surgical vocal cord medial relocation in unilateral recurrent nerve paralysis in advanced age]. / Frühzeitige Indikation zur operativen Stimmlippenmedianverlagerung bei einseitigen Recurrensparesen im fortgeschrittenen Lebensalter.

BACKGROUND: Unilateral vocal cord paralysis is usually treated conservatively. Phonosurgery is not indicated before 1 year after the onset of the palsy as during this period spontaneous recovery can be expected. In the elderly patient conservative voice rehabilitation is often limited by a restricted general condition. In these cases a severe communication disorder may result unless vocal cord function recovers spontaneously. PATIENTS AND METHODS: In 4 patients aged 68 to 79 years who had suffered from latrogenic unilateral vocal cord paralysis for 6 to 9 months, surgical medialisation of the paralysed vocal cord was carried out in local anaesthesia as an Isshiki-Type-I-operation after unsuccessful conservative treatment prior to surgery. RESULTS: In all cases a definite amelioration of voice function could be reached. There were no local or general complications. No spontaneous recovery of nerve function could be detected by electromyography between 6 to 9 months after the operation. Voice function remained stable during this period. CONCLUSIONS: We conclude that in elderly patients with unilateral vocal cord paralysis with no signs of spontaneous recovery and unsuccessful conservative treatment, surgical voice rehabilitation may be indicated before 1 year after the onset of the palsy.

[Specificity and sensitivity of transient click-evoked otoacoustic emissions (TEOAE)]. / Untersuchungen zur Spezifität und Sensitivität transienter click-evozierter otoakustischer Emissionen (TEOAE).

Transient click evoked otoacoustic emissions (TEOAE) have been shown to be a good test of hearing impairment especially when used for infant screening. However, occasional cases of false positive results--TEOAEs in spite of severe hearing loss--have been reported. This study encompasses 243 children whose hearing thresholds were known from subjective hearing tests and--in questionable cases--derived from additional auditory evoked potentials. The TEOAEs proved to have a high sensitivity (93%) and a reasonable specificity (67%), if the margin between good and bad hearing was set at 30 dB. However, four ears showed good TEOAEs in spite of poor hearing thresholds. In three cases, the children proved to have a central auditory hearing loss due to a cerebral disorder. One child with bilaterally superb TEOAEs had a unilateral deafness of unclear origin with no obvious retrocochlear or central disorder. Possible explanations under discussion included the presence of a retrocochlear lesion which was too small to show up in the tests used or that the defect was located just between the outer hair cells and the first neuron, for example in the inner hair cells. Additionally, efferent inhibition might cause a functional deafness as described by Rajan (1989) for the guinea pig. The results also show that TEOAEs should always be used in the differential diagnosis of hearing impairment in generally disabled children. The need for hearing aids and especially their adjustment has to be discussed in case of good TEOAEs, i.e., normal peripheral hearing.(ABSTRACT TRUNCATED AT 250 WORDS)

[Transitory evoked otoacoustic emissions in patients with cerebellopontile angle tumors]. / Transitorisch evozierte otoakustische Emissionen (TEOAE) bei Patienten mit Kleinhirnbrückenwinkeltumoren.

Click-evoked transitory otoacoustic emissions (TEOAE) were recorded in 34 patients suspected of having an acoustic neuroma with consequent hearing loss. Measurements took place one day prior to transtemporal removal of tumor. The evoked otoacoustic emissions were compared to hearing thresholds of the pure-tone audiogram. In 31 of the 34 patients tested, the spectrum of the emissions corresponded to the audiogram, in that an emission was not detectable at frequencies with a hearing loss exceeding 30 dB HL. Three patients showed good emissions in spite of a demonstrable hearing loss. This can be expected when only retrocochlear lesions are present. These results suggest that in most cases the hearing loss accompanying a retrocochlear process is combined with secondary lesions of the cochlea and is rarely due to isolated retrocochlear malfunction.

[Ear manifestations in adolescents after closure of lip-jaw-palate- or isolated palatal clefts]. / Ohrbefunde bei Jugendlichen nach Verschluss einer Lippen-Kiefer-Gaumen- oder isolierten Gaumenspalte.

We examined two groups of teenagers who had been surgically treated as small children for cleft palate. Most patients were between 13 and 21 years of age. One group had been looked after by the Dept. of Orthodontics at the University of Erlangen-Nürnberg, the other by the Dept. of Orthodontics at the University of Rostock. There were differences in sequence and time of the surgical closure between the two departments. Additionally, 60% of the people treated in Rostock had a velopharyngoplastic, which was rarely the case in Erlangen. In both groups only a few patients had been seen by an ENT-doctor regularly. Only some patients had been previously treated with tubes. There was one patient in each group with a bilateral, most likely genetically determined, sensorineural hearing loss. In Erlangen we examined 66 teenagers (132 ears). Six ears had been previously treated with one or more tympanoplasties. 10 ears needed further treatment due to a seromucotympanon, adhesions, perforations of the ear drum, suspicion of cholesteatoma or insufficient improvement of hearing after previous tympanoplasty. Another 18 ears showed signs of former inflammations. The control group in Rostock included 63 patients (i.e. 126 ears). 14 of the ears examined had undergone one or more tympanoplasties previously. 13 other ears needed further treatment for seromucotympanon, adhesions, perforations of the ear drum, insufficient improvement of hearing after tympanoplasty or cholesteatoma. Residuals due to prior inflammations were found in another 26 ears. Possible reasons for the different occurrence of middle ear problems in both groups are discussed.

[Otosclerosis in the elderly. The effect of stapes-plasty on hearing ability and hearing aid management]. / Otosklerose im Alter. Der Einfluss der Stapesplastik auf Hörvermögen und Hörgeräteversorgung.

We examined 105 patients who underwent partial stapedectomies at the age of 65 years or older as treatment for combined hearing losses due to otosclerosis. Among other things investigated was the influence of the operation on the hearing of both the operated and unoperated ears, as well as on tinnitus existing preoperatively and the use of a hearing aid. Findings showed that tinnitus decreased or vanished in 75% of the cases. Sixty-one percent of the patients needed a hearing aid continuously preoperatively, with 48% not needing it post-operatively and 13% using it only occasionally. The degree of sensorineural hearing loss had by the other patients was so severe that the use of a hearing aid was also necessary post-operatively. However, in some of these cases, a successful use of a hearing aid became possible for the first time due to the surgical improvement in hearing.

[Short-term changes in the larynx and voice after intubation]. / Kurzzeit-Veränderungen an Kehlkopf und Stimme nach Intubation.

The endoscopic and stroboscopic picture of the larynx as well as the voice were examined pre-operatively and on the first or second post-operative day in 75 patients who had been anaesthesized with intubation. The stroboscopic findings were evaluated according to the criteria suggested by Schürenberg (1990). The quality of the voice was estimated with a voice purity index (Moser 1984) and the dynamic and frequency range of the voice was measured. After intubation, we found alterations of the mucous membrane in 73% of the patients: increased amount of visible blood vessels, bleeding into the vocal cords or the trachea, bruises at the processus vocals or the arytenoid cartilages. The stroboscopic picture showed deterioration: pre-operatively large amplitudes and/or mucosal waves became even larger postoperatively, small amplitudes and mucosal waves decreased even further. The timing and the spatial symmetry of the vocal cord movements also deteriorated. On the average, the dynamic range and the frequency range of the voice did not change. However, in individual cases the changes were considerable. The same was true for the parameters of the voice purity index. There was no statistically significant dependency on sex or age of the patients, the duration of the intubation or the diameter of the intubation tube.