Position Statement of the Union of European Phoniatricians (UEP): Fees and Phoniatricians' Role in Multidisciplinary and Multiprofessional Dysphagia Management Team.

The need for multidisciplinary and multiprofessional management of dysphagia is constantly increasing and creating a major challenge for healthcare professionals and society, especially in terms of professional expertise and human resources. The distribution of tasks among the dysphagia team members, which includes phoniatricians, otolaryngologists, and speech-language therapists, is flexible and overlapping. For assessing dysphagia, the (fibreoptic) flexible endoscopic evaluation of swallowing (FEES), with or without videofluoroscopy, is a pivotal diagnostic tool. This position paper aims to illustrate the phoniatrician's role in performing a FEES, which is an indispensable component of the diagnostic workup of patients suffering from oropharyngeal dysphagia. It is based on the current collaborative expert view of the Swallowing Committee of the Union of European Phoniatricians and a literature review. A FEES is one of the core competences of phoniatricians due to their endoscopic expertise and experience in the field of dysphagia and diseases of the upper aerodigestive tract. Therefore, the phoniatrician is an important member of the dysphagia team, for the medical diagnostics of the aerodigestive tract and dysphagia as well as for FEES. Phoniatric competence is especially important for head and neck cancer patients, infants, and complex cases.

A long-term follow-up study on otoacoustic emissions testing in paediatric patients with severe malaria in Gabon.

BACKGROUND: In a previous study, severe and cerebral malaria have been connected with acute cochlear malfunction in children, demonstrated by a decrease of transitory evoked otoacoustic emissions (TEOAEs) reproducibility. This study aims to determine whether cochlear malfunction persists for 4 years after recovery from severe malaria in a subset of the previous study's collective. Follow-up TEOAEs were performed on site (CERMEL, Hôpital Albert Schweitzer, Lambaréné, Gabon) or at the participants' homes; 33 out of 90 participants included in the initial investigation by Schmutzhard et al. could be retrieved and were re-examined, 31/33 could be included. Of the 57 missing participants, 51 could not be contacted, 1 had moved away, 4 refused to cooperate, and 1 had died. METHODS: As in the initial investigation, participants of this prospective follow-up study were subjected to TEOAE examination on both ears separately. A wave correlation rate of > 60% on both ears was considered a "pass"; if one ear failed to pass, the examination was considered a "fail". The results were compared to the primary control group. Additionally, a questionnaire has been applied focusing on subsequent malaria infections between the primary inclusion and follow-up and subjective impairment of hearing and/or understanding. RESULTS: The cohort's mean age was 9 years, 14 children were female, 18 male. 31 had been originally admitted with severe, one with cerebral malaria. 83.8% of participants (n = 26) presented with a TEOAE correlation rate of > 60% on both ears (the cut-off for good cochlear function); in the control group, 92.2% (n = 83) had passed TEOAE examination on both ears. Recurrent severe malaria was associated with a worse TEOAE correlation rate. Age at infection and gender had no influence on the outcome. CONCLUSIONS: Cochlear malfunction seems to be persistent after 4 years in more than 16% of children hospitalized for malaria. In a healthy control group, this proportion was 7.8%. Yet, the severity of the initial TEOAE-decrease did not predict a worse outcome.

Do Personality Factors Assessed Before Cochlear Implantation Predict Hearing-Related Quality Of Life After Cochlear Implantation in Postlingually Deafened Adults?

BACKGROUND: Studies have shown that cochlear implants improve deaf patients' hearing-related quality of life (hrQoL), but the degree of improvement varies considerably between patients. This study investigated whether personality factors contribute to hrQoL outcome after cochlear implantation. METHOD: Fifty adult patients with postlingual hearing loss who received a unilateral cochlear implant were administered the Neuroticism-Extraversion-Openness Five-Factor Inventory (NEO-FFI; a personality inventory) and the Nijmegen Cochlear Implant Questionnaire (NCIQ; a hrQoL questionnaire). The NEO-FFI was administered only before implantation; the NCIQ was administered before implantation and 12 months after implant activation. A linear regression analysis was computed to detect whether NCIQ scores at 12 months were predicted by the NEO-FFI personality factors (i.e., Extraversion, Neuroticism, Openness to Experience, Agreeableness, and Conscientiousness) assessed before implantation. RESULTS: HrQoL scores had significantly improved 12 months after cochlear implantation in all subdomains of the NCIQ. Of the five personality factors, solely Neuroticism was negatively associated to the NCIQ subdomain self-esteem (ß = -0.34; p = 0.013) at 12 months after cochlear implantation. CONCLUSIONS: While significant improvement of hrQoL was seen 12 months after implant activation, this improvement was barely predicted by the Big-Five personality traits measured before implantation. Only Neuroticism was found to moderately influence postimplantation hrQoL in our patients, in the way that higher degrees of Neuroticism tend to go along with lower degrees of self-esteem (as conceptualized by the NCIQ). The failure to detect personality effects on hrQoL could partly be due to the low levels of Extraversion and Openness to Experience observed in our sample of patients with hearing loss.

Auditory and cognitive development in a partially deaf child with bilateral electro-acoustic stimulation: a case study.

OBJECTIVE: To study the long-term evolution of speech and intelligence in a child with partial deafness and normal hearing in the low frequencies after sequentially receiving cochlear implants in both ears. DESIGN: Retrospective chart review. STUDY SAMPLE: Male child aged 6 years was followed over a time period of four years. RESULTS: The paediatric patient had normal hearing up to 1 kHz and profound hearing loss at all higher frequencies symmetrical in both ears. Deprivation of high-frequency sounds resulted in retarded development of speech, language and cognitive skills. The choice for rehabilitation was cochlear implantation with the aim of preserving a considerable amount of low-frequency hearing. With natural hearing at low frequencies and electrical stimulation at high frequencies, the child was able to compensate most of his developmental deficits. Moreover, spatial hearing was almost normal. CONCLUSIONS: Electro-natural stimulation without amplification of the low frequencies (electro-natural hearing) provides access to the whole audible frequency range for children, who suffer from partial deafness in the high frequencies and are normal hearing at low frequencies. Such provision allows for regular speech development and favours the development of spatial hearing. The case report also demonstrates a strong impact on intellectual performance.

Bilateral use of active middle ear implants: speech discrimination results in noise.

Binaural sound reception has advantages over unilateral perception, including better localization and sound quality as well as speech and tone reception in both quiet and noisy environments. Up to now, most active middle ear implant (AMEI) users have been unilaterally implanted, but patient demand for an implant on the other side is increasing. Ten bilaterally-AMEI implanted native German-speaking adults were included in the study. The Oldenburg sentence test was used to measure speech reception thresholds in noise. The subject's signal-to-noise ratio (SNR) at a speech reception score of 50 % was calculated for different noise conditions. SRT was measured as a function of noise condition (nc) and listening condition (lc)-for example, SRT (lc, nc), with nc from S0N0, S0N-90, or S0N90 and lc from left, right or both. For each noise condition, the squelch effect and the binaural summation effect were calculated. Patients in this study demonstrated improvement with bilateral AMEIs compared to right or left AMEI only in all three tested listening conditions. Statistical significance was found in the S0N0 condition to favor usage of bilateral AMI versus either the right or left side only. The benefits of binaural hearing are well known, also in normal-hearing individuals. In the future every bilateral implantation should be a part of the clinical routine. Bilateral implantation can help to reduce problems in background noise and restore directional hearing.

Severe malaria in children leads to a significant impairment of transitory otoacoustic emissions--a prospective multicenter cohort study.

BACKGROUND: Severe malaria may influence inner ear function, although this possibility has not been examined prospectively. In a retrospective analysis, hearing impairment was found in 9 of 23 patients with cerebral malaria. An objective method to quickly evaluate the function of the inner ear are the otoacoustic emissions. Negative transient otoacoustic emissions are associated with a threshold shift of 20 dB and above. METHODS: This prospective multicenter study analyses otoacoustic emissions in patients with severe malaria up to the age of 10 years. In three study sites (Ghana, Gabon, Kenya) 144 patients with severe malaria and 108 control children were included. All malaria patients were treated with parental artesunate. RESULTS: In the control group, 92.6 % (n = 108, 95 % confidence interval 86.19-6.2 %) passed otoacoustic emission screening. In malaria patients, 58.5 % (n = 94, malaria vs controls p < 0.001, 95 % confidence interval 48.4-67.9 %) passed otoacoustic emission screening at the baseline measurement. The value increased to 65.2 % (n = 66, p < 0.001, 95 % confidence interval 53.1-75.5 %) at follow up 14-28 days after diagnosis of malaria. The study population was divided into severe non-cerebral malaria and severe malaria with neurological symptoms (cerebral malaria). Whereas otoacoustic emissions in severe malaria improved to a passing percentage of 72.9 % (n = 48, 95 % confidence interval 59-83.4 %) at follow-up, the patients with cerebral malaria showed a drop in the passing percentage to 33 % (n = 18) 3-7 days after diagnosis. This shows a significant impairment in the cerebral malaria group (p = 0.012 at days 3-7, 95 % confidence interval 16.3-56.3 %; p = 0.031 at day 14-28, 95 % confidence interval 24.5-66.3 %). CONCLUSION: The presented data show that 40 % of children have involvement of the inner ear early in severe malaria. In children, audiological screening after severe malaria infection is not currently recommended, but is worth investigating in larger studies.

Otoacoustic emission testing in Ghanaian children with sickle-cell disease.

OBJECTIVE: To evaluate hearing loss in children as a complication of sickle-cell disease. METHODS: In Kumasi, Ghana, 35 children with SCD aged 6 months to 10 years underwent transient-evoked otoacoustic emissions testing (TEOAE) to investigate the function of the inner ear. Healthy Ghanaian children recruited in school and kindergarten served as controls. RESULTS: One of 35 children with SCD and 13 of 115 control children failed the otoacoustic emissions testing. This difference between the control group and the children with SCD was not statistically significant. CONCLUSION: Early hearing impairment does not regularly occur in sickle-cell disease, and in children, it is not a likely cause of delayed or impaired language development.

Evaluation of a minimally invasive surgical fixation technique for young children with the Concerto Pin cochlear implant system.

In 2011, Med-El (Innsbruck, Austria) introduced a new cochlear implant system, designed to require a minimally invasive surgical technique and allow greater positional flexibility for its fixation on the skull. The Concerto Pin implant system is a good option for patients with thinner bone, such as children and elderly. The aim of this study was to investigate the implant's stability in children using our minimally invasive surgical technique. This was a prospective, longitudinal study with a single-subject, repeated-examination design. Six children, implanted with a Concerto Pin using our minimally invasive surgical technique between October 2011 and September 2012, were assessed 1, 3 and 6 months after surgery. In each case, the implant remained in a stable position and no adverse events or problems with healing were observed at any time during the investigation. The minimally invasive technique and the method of implant fixation that bypass drilling a deep implant bed constitute a good option for patients with thinner bone, such as children. This clinical study shows the safety and stability of the Concerto Pin implant system using a minimally invasive surgical technique.

The influence of tinnitus acceptance on the quality of life and psychological distress in patients with chronic tinnitus.

Recent findings show the importance of acceptance in the treatment of chronic tinnitus. So far, very limited research investigating the different levels of tinnitus acceptance has been conducted. The aim of this study was to investigate the quality of life (QoL) and psychological distress in patients with chronic tinnitus who reported different levels of tinnitus acceptance. The sample consisted of outpatients taking part in a tinnitus coping group (n = 97). Correlations between tinnitus acceptance, psychological distress, and QoL were calculated. Receiver operating characteristic (ROC) curves were used to calculate a cutoff score for the German "Tinnitus Acceptance Questionnaire" (CTAQ-G) and to evaluate the screening abilities of the CTAQ-G. Independent sample t-tests were conducted to compare QoL and psychological distress in patients with low tinnitus acceptance and high tinnitus acceptance. A cutoff point for CTAQ-G of 62.5 was defined, differentiating between patients with "low-to-mild tinnitus acceptance" and "moderate-to-high tinnitus acceptance." Patients with higher levels of tinnitus acceptance reported a significantly higher QoL and lower psychological distress. Tinnitus acceptance plays an important role for patients with chronic tinnitus. Increased levels of acceptance are related to better QoL and less psychological distress.

Localization of Low- and High-Frequency Sounds in Cochlear Implant Recipients Using a Contralateral Hearing Aid.

BACKGROUND AND OBJECTIVES: The ability to localize sounds is partly recovered in patients using a cochlear implant (CI) in one ear and a hearing aid (HA) on the contralateral side. Binaural processing seems effective at least to some extent, despite the difference between electric and acoustic stimulation in each ear. To obtain further insights into the mechanisms of binaural hearing in these listeners, localization of low- and high-frequency sounds was tested. STUDY DESIGN: The study used a within-subject design, where participants were tasked with localizing sound sources in the horizontal plane. The experiment was conducted in an anechoic chamber, where an array of seven loudspeakers was mounted along the 24 azimuthal angle span from -90° to +90°. Stimuli were applied with different frequencies: broadband noise and high- and low-frequency noise. SUBJECTS: Ten CI recipients participated in the study. All had an asymmetric hearing loss with a CI in the poorer ear and an HA on the contralateral side. MAIN OUTCOME MEASURES: Accuracy of sound localization in terms of angular error and percentage of correct localization scores. RESULTS: The median angular error was 40° in bimodal conditions for both broadband noise and high-frequency noise stimuli. The angular error increased to 47° for low-frequency noise stimuli. In the unilaterally aided condition with an HA, only a median angular error of 78° was observed. CONCLUSIONS: Irrespective of the frequency composition of the stimuli, this group of bimodal listeners showed some ability to localize sounds. Angular errors were larger than those reported in the literature for bilateral CI users or single-sided deaf listeners with a CI. In the unilateral listening condition with HA, only localization of sounds was not possible for most subjects.

Release of intracranial pressure leads to improvement of otoacoustic emissions--a case report of a Kenyan child with complicated tuberculous meningitis.

Intracranial pressure usually is measured with invasive techniques. The usability of transient evoked otoacoustic emissions as non-invasive approach has been evaluated only once by Frank et al. This article presents the case of a Kenyan boy with tuberculous meningitis and an active malresorptive hydrocephalus. At this stage, the otoacoustic emissions did show very low correlations. After releasing pressure, the otoacoustic emissions improved significantly. This case report points out the possible usability of otoacoustic emissions in intracranial pressure monitoring.

Improving Spatial Hearing when Wearing Ski Helmets in Order to Increase Safety on Ski Slopes.

This study investigated the effect of a new type of ear pads for ski helmets on the hearing performance of 13 young adults (mean age: 22 years). Free-field hearing thresholds and sound localization performance of the subjects were assessed in three conditions: without helmet, with a conventional helmet and with the modified helmet. Results showed that the modified helmet was superior to the conventional helmet in all respects, but did not allow for a performance level observed without a helmet. Considering the importance of precise hearing and sound localization during alpine skiing, acoustically improved ear pads of ski helmets, as demonstrated in this study, can essentially contribute to enhancing the safety on ski slopes.

Cost-utility Analysis of Cochlear Implantation in Adults With Single-sided Deafness: Austrian and German Perspective.

BACKGROUND: Single-sided deafness (SSD) is associated with a loss of binaural hearing. Major limitations of such patients are poor speech understanding in noisy environments and a lack of spatial hearing. To date, cochlear implantation is the most promising approach to overcome these deficits in this group of patients. OBJECTIVE: Cost-effectiveness analyses of cochlear implantation in patients with unilateral deafness. The model targets Austrian and German SSD patients who can either opt for treatment with a cochlear implant (CI) or decide against a CI and stay without any treatment. METHODS: A Markov model analyzed as microsimulation was developed using TreeAge Pro 2019 software. Pre- and postoperative utility values generated with HUI-3 were used to populate the model. Costs covered by the national insurance were considered. Costs and utilities were discounted by 3%. A model time horizon of 20 years was set. RESULTS: According to Austrian base-case analysis, the incremental cost-utility ratio (ICUR) was €34845.2 per quality-adjusted life year gained when comparing the "CI strategy" to the "no treatment strategy." The ICUR is marginally lower when adapting a German cost perspective-it was €31601.25 per quality-adjusted life year gained. Sensitivity analyses showed that the cost-effectiveness results are stable. Analyses also showed that the longer the time horizon is set, the more favorable the cost-effectiveness result is. CONCLUSIONS: Based on currently available data, the Markov microsimulation model suggests that cochlear implantation is cost-effective in Austrian and German patients with SSD if no other treatment option is considered within the model.

Long-Term, Multicenter Results With the First Transcutaneous Bone Conduction Implant.

OBJECTIVE: Investigation of long-term safety and performance of an active, transcutaneous bone conduction implant in adults and children up to 36 months post-implantation. STUDY DESIGN: Prospective, single-subject repeated-measures design. SETTING: Otolaryngology departments of eight German and Austrian hospitals.∗†‡§||¶#∗∗†† Affiliations listed above that did not participate in the study.‡‡§§||||¶¶. PATIENTS: Fifty seven German-speaking patients (49 adults and eight children) suffering from conductive or mixed hearing loss, with an upper bone conduction threshold limit of 45 dB HL at frequencies between 500 and 3000 Hz. INTERVENTION: Implantation of the Bonebridge transcutaneous bone conduction hearing implant (tBCI). MAIN OUTCOME MEASURES: Patients' audiometric pure tone averages (PTA4) (0.5, 1, 2, 4 kHz) thresholds (air conduction, bone conduction, and sound field) and speech perception (word recognition scores [WRS] and speech reception thresholds [SRT50%]) were tested preoperatively and up to 36 months postoperatively. Patients were also monitored for adverse events and administered quality-of-life questionnaires. RESULTS: Speech perception (WRS: pre-op: 17.60%, initial activation [IA]: 74.23%, 3M: 83.65%, 12M: 83.46%, 24M: 84.23%, 36M: 84.42%; SRT50%: pre-op: 65.56 dB SPL, IA: 47.67 dB SPL, 3M: 42.61 dB SPL, 12M: 41.11 dB SPL, 24M: 41.74 dB SPL, 36M: 42.43 dB SPL) and sound field thresholds (pre-op: 57.66 dB HL, IA: 33.82 dB HL, 3M: 29.86 dB HL, 12M: 28.40 dB HL, 24M: 28.22 dB HL, 36M: 28.52 dB HL) improved significantly at all aided postoperative visits. Air and bone conduction thresholds showed no significant changes, confirming preservation of patients' residual unaided hearing. All adverse events were resolved by the end of the study. CONCLUSIONS: Safety and performance of the tBCI was demonstrated in children and adults 36 months postoperatively.

Subjective Hearing Impression and Quality of Life in Patients With Bilateral Active Middle Ear Implants.

OBJECTIVE: This study compared the quality of life in patients with bilateral active middle ear implants to their quality of life when they were unilaterally implanted. DESIGN: Twenty-one patients implanted sequentially with the Vibrant Soundbridge (VSB) active middle ear implant completed quality-of-life surveys. The patients were asked to rate whether and to what extent their quality of life has changed upon receiving a second VSB. Hearing-specific quality of life was assessed with the Speech, Spatial, and Qualities of Hearing Scale (SSQ12-B), and general quality of life was with the Glasgow Benefit Inventory (GBI). In addition, the patients completed a health-related quality-of-life questionnaire (AQoL-8D). Finally, the changes in hearing-related and general quality of life were correlated to the change in word recognition ability after implantation of the second VSB (Freiburg monosyllabic word test; unilateral VSB versus bilateral VSB at 65 dB SPL). RESULTS: On the SSQ12, subjects scored a median of + 2.73 (p < 0.001; significantly different from zero) on a scale of -5 to + 5 where 0 indicates no change. All three subscores showed significant improvement. On the GBI, patients reached a median overall score of + 23.6 (p < 0.001; significantly different from zero) on a scale of -100 to + 100 where 0 indicates no change. Here, the improvement was mainly visible in the general subscore, whereas the social support and physical health subscores did not change due to the intervention. Both subjective benefit rating scores strongly correlated with the change in word recognition scores, suggesting that both hearing and general quality of life improved with increased word recognition due to bilateral VSB use. No significant correlation was found between the subjects' general health (as measured by AQoL-8D utility scores) and SSQ12-B or GBI overall scores. CONCLUSION: Usage of a second active middle ear implant substantially improved our patients' subjective hearing and general quality of life compared with unilateral use. The increase in quality of life may be linked to improved speech understanding due to bilateral use of a middle ear implant. Furthermore, these outcomes were not influenced by our patients' general health state at the time of survey.

How the Brain Understands Spoken and Sung Sentences.

The present study investigates whether meaning is similarly extracted from spoken and sung sentences. For this purpose, subjects listened to semantically correct and incorrect sentences while performing a correctness judgement task. In order to examine underlying neural mechanisms, a multi-methodological approach was chosen combining two neuroscientific methods with behavioral data. In particular, fast dynamic changes reflected in the semantically associated N400 component of the electroencephalography (EEG) were simultaneously assessed with the topographically more fine-grained vascular signals acquired by the functional near-infrared spectroscopy (fNIRS). EEG results revealed a larger N400 for incorrect compared to correct sentences in both spoken and sung sentences. However, the N400 was delayed for sung sentences, potentially due to the longer sentence duration. fNIRS results revealed larger activations for spoken compared to sung sentences irrespective of semantic correctness at predominantly left-hemispheric areas, potentially suggesting a greater familiarity with spoken material. Furthermore, the fNIRS revealed a widespread activation for correct compared to incorrect sentences irrespective of modality, potentially indicating a successful processing of sentence meaning. The combined results indicate similar semantic processing in speech and song.

Impact of listening to music while wearing a ski helmet on sound source localization.

OBJECTIVES: In recreational skiing and snowboarding, listening to music may be associated with an increased injury risk due to impaired sound localization. Thus, we evaluated effects of listening to music at different sound levels on sound source localization while wearing a ski helmet. DESIGN: within-subjects design. METHOD: Sound source localization of 20 participants (50% females; age: 23.8±2.4years) was assessed in an anechoic chamber under six conditions: (1) head bare, (2) wearing a ski helmet, (3) wearing a ski helmet and insert ear phones, and (4-6) the latter and listening to music at 3 different sound levels of 45, 55, and 65dB sound pressure level (SPL), respectively. RESULTS: One-way repeated measures ANOVA show that the percentage of correct sound localization was significantly affected by various conditions: F (5, 95)=138.2, p<.001 (ƞ2=0.88). Compared to the situation "head bare" with a correct score of 88%, increasing music sound levels of 45, 55 and 65dB SPL significantly decreased the ability to correctly localize the sound source to 54%, 45% and 37% correct scores, respectively. Also, angular errors [F (5, 95)=31.0, p<.001, ƞ2=0.62] and front rear confusion [F (2.8, 53.4)=57.9, p<.001, ƞ2=0.75] were significantly affected by wearing a ski helmet and listening to music simultaneously. CONCLUSIONS: Listening to music while wearing a ski helmet impacts negatively on sound source localization. The extent of worsening strongly depends on the sound level.

A Transcutaneous Active Middle Ear Implant (AMEI) in Children and Adolescents: Long-term, Multicenter Results.

OBJECTIVE: Evaluation of the long-term safety and performance of an active middle ear implant (AMEI) in the treatment of hearing loss in children and adolescents with a primary focus on improvement in speech discrimination. STUDY DESIGN: Prospective, multicentric, single-subject repeated-measures design in which each subject serves as his or her own control. SUBJECTS: Thirty-one pediatric subjects aged 5 to 17 years. INTERVENTION: Implantation of an active middle ear implant. METHODS: Improvement in word recognition scores, speech reception thresholds (SRT) in quiet and noise, in addition to air conduction, bone conduction, and sound field thresholds were evaluated in two age groups. RESULTS: Residual hearing did not change over time and speech intelligibility significantly improved and remained stable after 36 months. Children aged 5 to 9 improved in WRS from 21.92 to 95.38% and in SRT in quiet and in noise respectively from 62.45 dB SPL (sound pressure level) and +1.14 dB SNR to 42.07 dB SPL and -4.45 dB SNR. Adolescents aged 10 to 17 improved in WRS from 12.78 to 84.71% and in SRT in quiet and in noise respectively from 63.96 dB SPL and +3.32 dB SNR to 35.31 dB SPL and -4.55 dB SNR. CONCLUSIONS: The AMEI, under investigation, is a safe treatment for children and adolescents, and significantly improved audiological performance that remains stable on the long-term scale (up to 36 mo postimplantation). In general, all adult-related issues and questions regarding safety and performance can also be applied to the pediatric population, as no apparent specific issues developed.

Dysphagia in cerebral hypoxia.

INTRODUCTION: Dysphagia is a frequent problem in various neurological disorders. However, knowledge on swallowing function in patients with cerebral hypoxia is sparse. The objective of this study is to report the development of swallowing function in a series of adolescent and young-adult patients with cerebral hypoxia. METHODS: We recruited eight patients (1 male) who were admitted to our institution after the acute phase following cerebral hypoxia. Each patient underwent detailed neurological evaluation, magnetic resonance imaging (MRI), standardized neurophysiological assessment and repeated clinical and fiber-endoscopic evaluation of swallowing. Furthermore, all patients received daily physical and occupational therapy and intensive logopedic therapy for swallowing. RESULTS: Mean age in this case series was 19.9±3.6 years (range 16-25). All eight patients initially displayed severe swallowing dysfunction, but the reflexive components of swallowing were intact in seven patients without brainstem lesions. The only patient with additional brainstem involvement initially suffered from absence of an intact swallowing reflex and developed silent aspiration. However, follow-up examinations revealed intact swallowing reflexes in all eight patients. DISCUSSION: Dysphagia is common in patients with cerebral hypoxia, mainly resulting in a delayed oral phase consistent with impaired volitional execution of swallowing. Additional lesions in the brainstem may affect the integrity of the central pattern-generating circuitry for swallowing, resulting in additional dysfunction of the non-volitional reflexive component. In conclusion, dysphagia in patients with cerebral hypoxia is a common complication particularly in the early stages of remission, while long-term prognosis with respect to swallowing is often good. Swallowing function should be closely monitored in patients with acquired brain injury.