ABSTRACT
In accordance with international consensus papers, Auditory Processing Disorders are defined here as disorders of central processes of hearing, which enable, among other things, the pre-conscious and conscious analysis, differentiation, and identification of changes in time, frequency, and intensity of acoustic or auditory speech signals as well as processes of binaural interaction (e.â¯g., for localization, lateralization, noise clearance, and summation) and dichotic processing. Following the establishment of a commission of experts from the German Society for Phoniatrics and Pediatric Audiology, the existing S1 guideline was revised and updated. In this chapter, a position is taken on the definition of this clinical disorder as well as on the delimitation of similar disorders.
Subject(s)
Audiology , Auditory Perceptual Disorders , Speech Perception , Auditory Perceptual Disorders/diagnosis , Child , Hearing , Hearing Tests , Humans , NoiseABSTRACT
In accordance with international consensus papers, auditory processing disorders (APD) are defined as disorders of central processes of hearing. Following the establishment of a commission of experts from the German Society for Phoniatrics and Pediatric Audiology, the existing S1 guideline was revised and updated. In this chapter, a position is taken on the clinical diagnostics of APD as well as on the delimitation of similar disorders.
Subject(s)
Audiology , Auditory Perceptual Disorders , Hearing/physiology , Practice Guidelines as Topic , Auditory Perception , Auditory Perceptual Disorders/diagnosis , Child , Hearing Tests , HumansABSTRACT
BACKGROUND: To transport a bolus from the mouth into the stomach, regular contraction of the pharyngeal muscles and a coordinated function of the upper esophageal sphincter (UES) are necessary. The muscle contraction generates intraluminal pressure, which pushes the bolus continuously forward. In contrast to imaging studies, manometric methods enable assessment of intraluminal pressure buildup and the function of the muscles involved. These methods were initially established for the esophagus and have been used increasingly in the pharynx for 7-8 years. Pharyngeal high-resolution manometry (pHRM) allows pressure measurements in high spatial and temporal resolution, and assessment of pharyngeal swallowing dynamics. OBJECTIVE: An overview is given of the implementation, evaluation, and interpretation of the pHRM data, as well as of the current state of research. MATERIALS AND METHODS: PubMed and Scopus were searched for the keywords "high-resolution manometry" and "pharynx" or "upper esophageal sphincter". Original articles, reviews, and book chapters on the subject pHRM were included. RESULTS: Swallowing pressure conditions in the pharynx and the UES can be assessed by pHRM. The spatiotemporal pressure plot gives an overview of changes in pharyngeal motor function. Determination of swallowing parameters enables a sophisticated evaluation of swallowing; a comparison with normal values permits delimitation of pathologies. CONCLUSION: Although several swallowing parameters still need to be further evaluated for clinical routine, a pHRM study should nowadays always be carried out for a comprehensive evaluation of the swallowing process.
Subject(s)
Deglutition Disorders , Deglutition , Esophageal Sphincter, Upper , Deglutition Disorders/diagnosis , Esophageal Sphincter, Upper/physiopathology , Humans , Manometry , Pharynx/physiopathology , PressureABSTRACT
BACKGROUND: The laryngeal adductor reflex (LAR), a reflexive vocal fold closing mechanism, includes an early, probably di- or oligosynaptic ipsilateral LAR1- and a late ipsilateral and contralateral LAR2 polysynaptic component. In a clinical evaluation of dysphagia the LAR can be triggered by air pulses or tactile stimuli and typically assessed only qualitatively. METHODOLOGY: The development and construction of a device that can selectively shoot very small water droplets (microdroplet impulse testing MIT). RESULTS: The MIT device has a water reservoir with an infinitely adjustable pressure. The opening period of the piezo-electrically operated valve determines the droplet size. With a high-speed camera system, the change in the airspeed of the drop can be determined, depending on the set water reservoir pressure. With the knowledge of the droplet size, the shooting speed and the estimation of the distance between the valve and laryngeal mucosa or airspeed can be determined the muzzle energy. By mounting the MIT device to a high speed glottography system, the time between the impact of the droplet on the laryngeal mucosa and the start of the laryngeal adduction, the LAR latency can be determined using an image by image evaluation. DISCUSSION: In dysphagia with penetration or aspiration it is presumed that the protective function of the larynx is no longer adequately ensured. The MIT-LAR device provides a valid and reliable method to assess LAR quantitatively. Furthermore, it holds the promise of being a simple to handle method that can be used clinically for routine diagnostics.
Subject(s)
Deglutition Disorders/diagnosis , Deglutition Disorders/physiopathology , Laryngeal Muscles/physiopathology , Laryngoscopes , Microfluidics/instrumentation , Reflex, Stretch , Equipment Design , Equipment Failure Analysis , Humans , Physical Stimulation/instrumentation , Reproducibility of Results , Sensitivity and Specificity , Vocal CordsABSTRACT
Despite normal hearing thresholds in pure tone audiometry, 0.5-1 % of children have difficulty understanding what they hear. An auditory processing disorder (APD) can be assumed, which should be clarified and treated. Based on a selective literature search in the PubMed and Scopus databases using the term "auditory processing disorder", several consensus papers are discussed. Numerous studies on APD have revealed partially contradicting results, thus fueling critical discussion regarding validity and reliability-of specific audiometric APD methods and the APD construct in particular. In order to correctly advise parents and, where necessary, treat affected children, otorhinolaryngologists, phoniatrists, and pediatric audiologists must understand the psychometric properties of applied tests and have knowledge of current discussion. Diagnosis is generally a multistep interdisciplinary process.
Subject(s)
Audiometry/methods , Audiometry/psychology , Auditory Perceptual Disorders/diagnosis , Auditory Perceptual Disorders/psychology , Psychometrics/methods , Child , Child, Preschool , Diagnosis, Differential , Female , Germany , Humans , Infant , Infant, Newborn , Male , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
The laryngeal adductor reflex and the pharyngoglottal closure reflex protect the trachea and lower respiratory tract against the entrance of foreign material. The laryngeal expiration reflex and the cough reflex serve to propel foreign material, which has penetrated in the cranial direction. The inspiration reflex, the sniff reflex, and the swallowing reflex are further larynx-associated reflexes. In patients with dysphagia the laryngeal adductor reflex can be clinically tested with air pulses. The water swallow test serves to show the integrity of the cough reflex. The sniff reflex is useful to test the abduction function of the vocal folds. Future studies should address laryngeal reflexes more specifically, both for a better understanding of these life-supporting mechanisms and to improve diagnostic procedures in patients with impaired laryngeal function.
Subject(s)
Diagnostic Techniques, Digestive System , Laryngeal Diseases/diagnosis , Laryngeal Diseases/physiopathology , Larynx/physiopathology , Reflex, Abnormal/physiology , HumansABSTRACT
BACKGROUND: The larynx is considered a crossing point between breathing and swallowing pathways. During swallowing, the airway below the glottis must be protected against food components by an appropriate laryngeal closure mechanism. The laryngeal adductor reflex (LAR) with an early, probably di- or oligosynaptic interconnected ipsilateral LAR1- and a late ipsilateral and contralateral LAR2 polysynaptic component is believed to serve as such a mechanism. Here we aimed to measure and characterize the LAR in healthy volunteers and to compare the data obtained with previously published data. METHODS: We designed a prospective pilot study. 10 healthy volunteers (22-57 years) participated. To elicit the LAR we used a newly designed microdroplet impulse testing (MIT) device: very small waterdroplets were shot onto the endolaryngeal mucosa. By simultaneously observing the anatomical structures with a high speed glottography system, the time between impact of the microdroplet on the mucosa and the beginning of the adduction movement and thus an approximate value for the reflex latency could be determined. RESULTS: An early adduction movement corresponding to LAR1 could not be detected. The measured LAR2 latency time was higher than the EMG LAR2 data. No significant latency difference between right and left stimulation was found. DISCUSSION: Since we were unable to demonstrate any LAR1 component it may be that muscle activity observable by EMG may not be sufficient to lead to a visible medial vocal cord movement. The longer LAR2 latency compared to EMG data may be explained by the fact that the visually vocal cord movement occurs after a delay although muscle activity already started as evidenced by EMG.Further studies on LAR are warranted, especially since our results also raise questions about the clinical significance of the LAR.
Subject(s)
Larynx/physiology , Reflex , Adult , Aged , Female , Humans , Male , Middle Aged , Pilot Projects , Prospective Studies , Vocal CordsABSTRACT
BACKGROUND: Patients with myotonic dystrophy (MD) are known to suffer from oropharyngeal dysphagia and esophageal motility disorders, which are often the cause of aspiration pneumonia. So far only little is known about the pharyngeal contractility and the function of the upper esophageal sphincter in these patients, in particular only few data are available for manometric investigations allowing assessment of the pharyngeal pressure build-up during swallowing. The aim of this study was to collect such data in patients with MD using high resolution manometry. METHOD: In two patients with MD high resolution manometry studies were performed during swallowing and phonation to determine pressure-dependent parameters. The results were compared with normal values from healthy subjects. RESULTS: In both patients a reduced pressure in the entire pharynx during swallowing was determined. The duration of the contraction in the velopharynx and tongue base region was shortened. The structural course of the swallowing process and the opening and closing functions of the upper esophageal sphincter were regular. During realization of closed vowels a reduced pressure build-up in the velopharyngeal region was observed. CONCLUSION: The force of contraction and the associated pharyngeal pressure build-up during swallowing were reduced resulting in an incomplete clearing of the pharynx. Beside myopathic disorders, neuromuscular disorders also have to be considered. The functional course of the swallowing process and the swallowing pattern was retained. The reduced pressure build-up in the velopharyngeal region can be considered as the cause for rhinophonia. To evaluate the pharyngeal function in patients with MD, high resolution manometry is a useful tool for assessing the pharyngeal function besides the basic diagnostics.
Subject(s)
Deglutition Disorders/physiopathology , Deglutition , Manometry/methods , Myotonic Dystrophy/physiopathology , Pharyngeal Muscles/physiopathology , Deglutition Disorders/diagnosis , Deglutition Disorders/etiology , Female , Humans , Male , Middle Aged , Muscle Contraction , Myotonic Dystrophy/complications , Myotonic Dystrophy/diagnosis , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
As a highly differentiated physiological process, swallowing may be affected by a variety of confounding factors. Primarily described are swallowing disorders caused by mechanical anatomic changes (e. g., alteration of the cervical spine, goiter), surgery for head and neck tumors, thyroid abnormalities, and neuromuscular disorders. Age-related cerebral neurological and blood vessel-associated changes can also cause dysphagia (so-called presbyphagia) or worsen the condition.Medication-associated dysphagia is recognized far less frequently, not paid due attention, or accepted in silence; particularly in older patients. Furthermore, pharmacological interference of different medications is frequently inadequately considered, particularly in the case of polypharmacy.Initial treatment of medication-induced dysphagia includes a critical review of medication status, with the aim of reducing/discontinuing the causative medication by giving precise instructions regarding its administration; as well as antacid medication, diet, and professional oral stimulation or swallowing training.To date, medication-induced dysphagia has not occupied the focus of physicians and therapists. This is despite the fact that many active agents can have a negative effect on swallowing and medication-induced dysphagia caused by polypharmacy is not uncommon, particularly in old age. This article presents an overview of the different classes of drugs in terms of their direct or indirect negative effects on the swallowing function.
Subject(s)
Deglutition Disorders/chemically induced , Deglutition Disorders/prevention & control , Deglutition/drug effects , Administration, Oral , Deglutition Disorders/diagnosis , HumansABSTRACT
The APD guideline of 2009 was supplemented by the statements listed here. The addition is based on current knowledge and findings. Otherwise, the Guideline 2009 remains valid. Here, a summary of the updated APD guideline is given, thus proving an overview of the definition of APD, diagnosis, differential diagnosis and recommended for APD management.
Subject(s)
Auditory Perceptual Disorders/diagnosis , Auditory Perceptual Disorders/therapy , Hearing Tests/methods , Language Tests , Otolaryngology/standards , Practice Guidelines as Topic , Auditory Perceptual Disorders/classification , Diagnosis, Differential , Germany , Humans , Terminology as TopicABSTRACT
BACKGROUND: High resolution manometry (HRM) can provide information about the muscular contraction of the pharynx and the upper esophageal sphincter (UES) and represents an important tool in the diagnostics of dysphagia. To compare the results of swallowing studies interindividually and to identify pathological swallows, normative data are necessary. Normative data for the use of an HRM-probe with a large diameter has already been published. As previously has been shown these probes can influence the normal contraction of the pharynx and the UES. In this study comprehensive normal values are presented for small HRM-probes in diameter (2 mm), that only minimally affect pharyngeal and UES contractions. METHOD: 29 healthy volunteers underwent pharyngeal and upper esophageal HRM. All subjects performed 10 water swallows of 2 ml in an upright position. Pressure and time dependent parameters of the velopharyngeal region, the tongue base and the UES have been evaluated. Mean and median values and different percentile ranges were calculated. RESULTS: The normative values for the key parameters were (mean±SD): maximum velopharyngeal pressure 269.9±113.1 mmHg, maximum tongue base pressure 278±93.6 mmHg, maximum UES pressure 205.8±64.0 mmHg, UES resting pressure 42.5±18.7 mmHg and relaxation time of the UES 681.6±86.8 ms. Further parameters have been measured. CONCLUSION: Time dependent values are comparable to those already published. Especially in the UES lower pressures can be measured when a small HRM-probe is used. The normative data established in this study might help to distinguish pathological from physiological swallows using HRM.
Subject(s)
Deglutition Disorders/diagnosis , Deglutition Disorders/physiopathology , Esophageal Sphincter, Upper/physiopathology , Manometry/methods , Pharynx/physiopathology , Adult , Female , Humans , Image Enhancement/methods , Image Interpretation, Computer-Assisted/methods , Male , Middle Aged , Muscle Contraction/physiology , Palate, Soft/physiopathology , Prospective Studies , Reference Values , Tongue/physiopathology , Young AdultABSTRACT
BACKGROUND: Before the era of objective audiometric procedures, the primary aim of subjective audiometric procedures was determination of the hearing threshold, e.g. to assess hearing aid indications. Nowadays, the results of objective audiometric procedures play a major role in hearing threshold determination in children. Contrastingly, subjective audiometric procedures are also employed in order to verify, or acquire an objective picture of, social hearing abnormalities evident from the children's anamneses. METHODS: A selective literature search was conducted in the PubMed and Scopus databases and current textbooks were also considered. RESULTS: Subjective audiometric procedures for children employ both nonlinguistic and linguistic stimuli. Procedures can differ in many ways and it can be differentiated between, for example, observational or behavioural audiometry and procedures in which the children are explicitly instructed on how to react to signals. DISCUSSION: Several subjective audiometric procedures have been developed to examine the hearing and listening skills of children. Some of these tests differ significantly in terms of their intended application, test construction and test quality criteria. Only a detailed understanding of the particular subjective audiometric procedure being applied enables formulation of the"correct" questions; which, providing the child is willing to cooperate, can also be specifically answered using the test.
Subject(s)
Audiometry/methods , Auditory Threshold , Hearing Loss/diagnosis , Child , HumansABSTRACT
German is a genuine verb-second (V2) language. For V2 languages it is assumed that all sentence structures can be derived from the underlying subordinate clause structure via the movement of individual components. The acquisition of German V2 structures represents a critical step in German first language acquisition and is usually mastered at the age of 3 years. However, not all children succeed in filtering the necessary information from the spoken input in order to acquire this key component of German syntax. Use of canonical sentence structures alone is not a confirmation of a successful V2 acquisition. Moreover, this structure often represents some kind of interim grammar. Only the use of complementizer phrase (CP)-related structures, such as wh-questions or topicalizations of objects is a real indication of a successful V2 acquisition.
Subject(s)
Child Development , Child Language , Comprehension , Language Development , Semantics , Speech Perception/physiology , Verbal Learning/physiology , Child , Germany , Humans , Models, BiologicalABSTRACT
BACKGROUND: During first language acquisition (L1), children need to gather knowledge about the speech sounds and grammar of their mother tongue. Furthermore, communication skills require an adequate vocabulary. Individual profiles of vocabulary acquisition can vary considerably. However, actively using around 50 words by the age of 24 months is considered a milestone in first language acquisition. This is usually followed by the so-called vocabulary spurt, a rapid increase in lexical knowledge. This article provides an overview of the theories of lexical development and discusses how the acquisition of vocabulary may be explained. METHODS: A selective literature search was conducted in PubMed and Scopus. Current textbooks were also considered. RESULTS: In order to acquire new words, a child has to identify what the new string of speech sounds refers to. The child has to construct a valid concept of the word and subsequently store both word and concept into long-term memory. Several theories have been put forward to explain lexicon organization, the acquisition of concepts and the mechanisms underlying the so-called fast mapping phenomenon in particular. All of these attempt to explain the phenomenon of lexicon acquisition in terms of a model scheme. In the context of the fast mapping mechanism, constraints and assumptions, cognitive, intentionalist and emergence-based theories are discussed. DISCUSSION: Knowledge of the different theories of vocabulary acquisition is mandatory to understand the construction of the tests used to assess vocabulary skills in clinical practice and to apply these appropriately.
Subject(s)
Child Development , Child Language , Language Development , Language Tests , Linguistics , Speech Perception/physiology , Verbal Learning/physiology , Child , Humans , Models, BiologicalABSTRACT
BACKGROUND: In principle, a child can seemingly easily acquire any given language. First language acquisition follows a certain pattern which to some extent is found to be language independent. Since time immemorial, it has been of interest why children are able to acquire language so easily. Different disciplinary and methodological orientations addressing this question can be identified. METHODS: A selective literature search in PubMed and Scopus was carried out and relevant monographies were considered. RESULTS: Different, partially overlapping phases can be distinguished in language acquisition research: whereas in ancient times, deprivation experiments were carried out to discover the "original human language", the era of diary studies began in the mid-19th century. From the mid-1920s onwards, behaviouristic paradigms dominated this field of research; interests were focussed on the determination of normal, average language acquisition. The subsequent linguistic period was strongly influenced by the nativist view of Chomsky and the constructivist concepts of Piaget. Speech comprehension, the role of speech input and the relevance of genetic disposition became the centre of attention. The interactionist concept led to a revival of the convergence theory according to Stern. DISCUSSION: Each of these four major theories--behaviourism, cognitivism, interactionism and nativism--have given valuable and unique impulses, but no single theory is universally accepted to provide an explanation of all aspects of language acquisition. Moreover, it can be critically questioned whether clinicians consciously refer to one of these theories in daily routine work and whether therapies are then based on this concept. It remains to be seen whether or not new theories of grammar, such as the so-called construction grammar (CxG), will eventually change the general concept of language acquisition.
Subject(s)
Language Development , Linguistics , Models, Biological , Verbal Behavior/physiology , Verbal Learning/physiology , Child , Humans , Neurolinguistic ProgrammingABSTRACT
BACKGROUND: In order to acquire language, children require speech input. The prosody of the speech input plays an important role. In most cultures adults modify their code when communicating with children. Compared to normal speech this code differs especially with regard to prosody. METHOD: For this review a selective literature search in PubMed and Scopus was performed. RESULTS: Prosodic characteristics are a key feature of spoken language. By analysing prosodic features, children gain knowledge about underlying grammatical structures. Child-directed speech (CDS) is modified in a way that meaningful sequences are highlighted acoustically so that important information can be extracted from the continuous speech flow more easily. CDS is said to enhance the representation of linguistic signs. DISCUSSION: Taking into consideration what has previously been described in the literature regarding the perception of suprasegmentals, CDS seems to be able to support language acquisition due to the correspondence of prosodic and syntactic units. However, no findings have been reported, stating that the linguistically reduced CDS could hinder first language acquisition.
Subject(s)
Child Language , Language Development , Linguistics , Models, Biological , Speech Perception/physiology , Verbal Learning/physiology , Adult , Child , Child Development , HumansABSTRACT
BACKGROUND: The requirement for otorhinolaryngologists and phoniatricians to diagnose dysphagia and evaluate its extent is on the rise, particularly in light of demographic changes. The gold standards in confirmatory diagnostics are fiberoptic endoscopic evaluation of swallowing (FEES) and the videofluoroscopic swallowing examination (VFS). Standardized assessments, such as questionnaires or assessments involving probatory swallows are often applied as screening or supportive measures. This article aims to give a critical overview of the assessment tools frequently used in clinical routine. Test quality is assessed, particularly compared to FEES and VFS. METHODS: A selective literature search using PubMed has been conducted. RESULTS: On the basis of this lierature search, 48 assessment tools were identified. These can be classified into screening tools, instrument-based tools (implementation standards and evaluation protocols) and questionnaire-based assessment inventories. DISCUSSION: In order to diagnose and evaluate dysphagia on the basis of assessment critieria, clinicians should be aware of indications for, as well as the advantages, disadvantages and test quality of the assessment tools. Considering the different assessment tools for anamnesis and probatory swallowing, rather low sensitivities and specificities for possible penetration and aspiration are evident. In cases where these symptoms of dysphagia are not evident and reliably assessable, confirmatory assessment via FEES or VFS is essential.
Subject(s)
Deglutition Disorders/diagnosis , Deglutition Disorders/psychology , Diagnostic Self Evaluation , Mass Screening/methods , Quality of Life/psychology , Surveys and Questionnaires , Humans , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
In order to distinguish more accurately and easily between language difficulties in need of therapy or special support versus language impairments a S2K guideline was developed by interdisciplinary teams of different (medical) societies and professional associations. This guideline was published in 2011 and has replaced all existing monodisciplinary guidelines. According to the new S2K guideline standardised measures of language testing are mandatory. Apart from reviewing the S2K guidelines, this article aims to suggest how these guidelines can be established in clinical practice. By closely following this new guideline, testing and diagnosing children with language difficulties is believed to be enhanced considerably, and also comply with quality management standards.
Subject(s)
Language Development Disorders/classification , Language Development Disorders/diagnosis , Language Development , Language Tests/standards , Practice Guidelines as Topic , Speech Articulation Tests/standards , Speech-Language Pathology/standards , Germany , HumansABSTRACT
BACKGROUND: Animal experiments have shown that after specific nerve traumatization, neuromuscular electrostimulation (NMES) can promote nerve regeneration and reduce synkinesia without negatively interfering with normal regeneration processes. NMES is used routinely in physical rehabilitation medicine. METHODS: This systematic literature search in the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the DAHTA database, the Health Technology Assessment Database and MEDLINE or PubMed considered studies on the use of NMES in otorhinolaryngology that have been published in German or English. RESULTS: The search identified 180 studies. These were evaluated and relevant studies were included in the further evaluation. DISCUSSION: In the fields of otorhinolaryngology and phoniatry/paediatric audiology, clinical studies investigating the effects of NMES on facial and laryngeal paresis, as well as dysphonia and dysphagia have been carried out. The evidence collected to date is encouraging; particularly for the treatment of certain forms of dysphagia and laryngeal paresis.
Subject(s)
Deglutition Disorders/therapy , Dystonia/therapy , Electric Stimulation Therapy/statistics & numerical data , Facial Paralysis/therapy , Practice Patterns, Physicians'/statistics & numerical data , Vocal Cord Paralysis/therapy , Deglutition Disorders/diagnosis , Deglutition Disorders/epidemiology , Dystonia/diagnosis , Dystonia/epidemiology , Electric Stimulation Therapy/methods , Evidence-Based Medicine , Facial Paralysis/epidemiology , Humans , Prevalence , Risk Factors , Treatment Outcome , Vocal Cord Paralysis/epidemiologyABSTRACT
BACKGROUND: Otolaryngologists caring for patients with hearing and balance disorders are also responsible for advising patients about their increased risk of falling and informing them of fall prevention measures. This review will give a brief overview of appropriate programs. METHODS: This systematic review is based on a selective literature search. RESULTS: Intrinsic and extrinsic fall risk factors can be distinguished. The former include not only hearing and balance disorders, but also increasing age, nocturia, dementia, limited mobility and poor nutritional status. Extrinsic factors include, for example, unfixed carpet edges, poor lighting and poor footwear. Fall prevention can be achieved through appropriate counselling about risk factors and fall prevention courses. DISCUSSION: The frequency of falls--with potentially very adverse consequences--increases continuously beyond the age of 60 years. Furthermore, the risk of falling is significantly increased in patients with hearing and balance disorders. Otolaryngologists caring for this patient group should inform them about their fall risk and advise appropriate countermeasures during counselling. A basal knowledge of fall prevention measures is therefore helpful.