[Submucous cleft palate and a congenitally short velum: effects of surgical intervention]. / Submuköse Gaumenspalte und kongenital kurzes Velum: Effekte der operativen Intervention.

BACKGROUND: A submucous cleft palate and a congenitally short velum are diagnosed rather late, because symptoms are often mild. OBJECTIVES: The pre- and postoperative clinical symptoms for both conditions are presented. MATERIALS AND METHODS: The data of 180 patients with a submucous cleft palate (161) or congenitally short velum (19) were retrospective analyzed. In 23.3%, a syndromic association was found. RESULTS: Clinical findings for both conditions included middle ear problems, hypernasal speech, nasal penetration, the absence of the posterior nasal spine of the hard palate and/or a bifid uvula with a zona pellucida. The average age at diagnosis was 4.2 years in submucous clefts and 5.7 years in children with a congenitally short velum. Surgical palatoplasty with fusion of soft palate muscles and/or elongation of the soft palate was performed in 83.9% of the children, aiming to achieve sufficient velopharyngeal closure (VPC) with a significant decrease of symptoms and, hence, better conditions for speech therapy interventions. The overall success rate of the VPC was 63.7% with improvement in up to 2 of the 3 clinical symptoms (hypernasal speech, nasal penetration, middle ear problems). Hypernasal speech was more common (in 89.5%) in children with a congenitally short velum before surgery and in 81.3% 8 weeks after surgery; however, prior to surgery they had a short soft palate. CONCLUSION: Surgical intervention was particularly effective in children younger than 5 years. Syndromic diseases are disproportionately associated with soft palate defects.

[Comparative ultrasonographic and histomorphologic examination of the lips]. / Vergleichende sonographische und histomorphologische Untersuchungen der Lippen.

BACKGROUND: High-resolution ultrasonography of the lips offers the opportunity to investigate the orbicularis oris muscle (OOM) and evaluate its morphology and function. OBJECTIVES: The goals of this paper are verification of the lip structures visible on ultrasound images by using histological section preparations and recommendation of uniform standards for sonographic examinations of the lips. MATERIALS AND METHODS: The lips of 78 healthy volunteers (age 4-77 years) where scanned with a Hitachi Hi Vision Avius ultrasound device equipped with a linear transducer (L75, variable frequency range 5.0-18.0 MHz). Systematic B-mode examination was performed at five defined points, and the lips where also scanned dynamically in multiple directions. The ultrasonography findings were verified by using histologic samples from five male body donors (age 72-83 years). RESULTS: All parts of the OOM could be well distinguished from one another both histologically and ultrasonographically. Sonographically visible lip structures could be verified histologically. Labial glands and blood vessels of the mucosa could be identified with both methods. CONCLUSION: Ultrasonography allows identification of lip structures and all parts of the OOM. Scars, injuries and atrophy of the lip musculature are well detectable. Functional examinations can visualize muscular dysfunctions and may support the diagnosis of dystonic or hypotonic functional deficits. The following parameters are mandatory for a standardized examination of the lips: sagittal and transverse images of upper and lower lips; use of anatomical "landmarks"; functional diagnostics in tensed and relaxed conditions.

[Frequency of hearing disorders in children with langerhans' cell histiocytosis]. / Häufigkeit von Hörstörungen bei Langerhans-Zell-Histiozytose im Kindes- und Jugendalter.

BACKGROUND: The aims of the study were to find out the frequency of hearing disorders in children with Langerhans' cell histiocytosis (LCH) and to find out possible risk factors for hearing disorders due to the disease itself and the therapy. PATIENTS AND METHODS: 30 patients with LCH were examined audiologically by using standard audiometric procedures. In cases of central nervous system (CNS) lesions, brainstem evoked response audiometry (BERA) was done additionally. A significant hearing disorder was defined as a hearing impairment affecting speech, thus being characterized by the following features: Both ears should present either conductive and/or sensorineural hearing loss of at least moderate degree. The frequencies important for speech development (1 - 4 kHz) had to be affected. Also, prolongation of BERA interpeak latencies was regarded as a significant hearing impairment, because those children had an increased risk for a central auditory and speech processing disorder. RESULTS: In our study 3 patients had a significant hearing disorder according to our definition. The prevalence of a significant hearing disorder is increased in patients with LCH compared to the prevalence of permanent hearing disorders in German children. We found the following risk factors for the development of a significant hearing disorder: LCH of the temporal bone, CNS lesions. CONCLUSIONS: We recommend periodical audiological follow up examinations for LCH patients with lesions of the temporal bone and/or the brain. BERA is indicated in cases with CNS lesions, because central auditory and speech processing disorders are possible in those patients.

[Mucosal epidermolysis bullosa acquisita complicated by laryngeal stenosis]. / Epidermolysis bullosa acquisita der Schleimhaut mit Larynxstenose.

Epidermolysis bullosa acquisita (EBA) is an acquired chronic autoimmune blistering skin disease that rarely affects mucous membranes. We report a 75-year-old female patient who had EBA restricted to oral, nasal and laryngeal mucous membranes with life-threatening laryngeal stenosis.

[Sector-related grey scale analysis of video ultrasound recorded tongue movements in swallowing]. / Sektorbezogene Grauwertanalyse videosonographisch aufgezeichneter Zungenbewegungen beim Schlucken.

Diseases of the oral cavity, floor of the mouth, and nervous system can be accompanied by disturbances in tongue movement during swallowing. These disturbances can be diagnosed by videosonography whereby the examiner has to evaluate extensive video documentation of lingual motion. It was the aim of this study to facilitate this evaluation by the application of a reproducible computer-assisted quantitative analysis procedure. Video sequences of 56 healthy adults and 19 patients with dysphagias of different etiologies were analysed. A numerical estimation of swallowing movements was carried out in abstraction from the structures imaged (bolus, air, muscles of the tongue, floor of the mouth, hyoid, etc.). Intensity changes of the pixels within previously defined radial image sectors were quantified in relationship to time and depicted as sector curves. The healthy adults demonstrated a characteristic pattern of two motion maxima that appeared within almost all sector curves. These maxima represented bolus transport movements and the reset movement of the tongue. Patients with diseases of the tongue or neuromuscular changes caused by disturbances of the central nervous system showed pathological deviations on videosonography. These appeared as local or general reductions in movement, slow speed motions, repetitive swallowing or unsorted additional movements of the tongue during swallowing.

[MRI examination of laryngeal height during vowel singing]. / Kernspintomographische Untersuchung der Kehlkopfstellungen beim Singen von Vokalen.

Larynx height positions were determined in 12 singing students and singers with magnetic resonance imaging. The examinations were carried out during the singing of 9 different pitch and loudness combinations of the vowels /a/, /u/ and /i/. It could be demonstrated that vertical larynx position differences were smaller in professional singers than in students. In 10 of 12 examined volunteers a correlation between raised larynx position and high pitch singing or between lowered larynx position and low pitch singing could be observed in at least one of the examined vowels. Loudness-dependent and vowel-dependent differences of larynx height position could not be identified.

[Solitary hearing and equilibrium damage after vaccinations]. / Solitäre Hör- und Gleichgewichtsschäden nach Impfungen.

Solitary impairments of hearing and equilibrium after vaccinations are rarely seen. They are usually connected with damage to the central nervous system, thus being combined with further neurological symptoms. In German and English literature 9 cases of isolated statoacoustic nerve lesions due to vaccinations could be found. They are summarized and their similarities and differences are discussed. Information relevant for the evaluation of possible causal relations between vaccinations and solitary 8th cranial nerve disorders is emphasized. Questions concerning the incidence, etiology and differential diagnosis of functional cochleovestibular impairments are highlighted.

[Unilateral recurrent nerve paralysis in suspected Lyme borreliosis]. / Einseitige Rekurrensparese bei Verdacht auf Lyme-Borreliose.

Cranial nerve palsy can often be observed in Borrelia burgdorferi infection. A dysphonic patient with a long lasting left-sided recurrent nerve palsy was treated with ceftriaxone, an antibiotic drug for the therapy of Lyme borreliosis. On the 7th day of application the paretic vocal fold showed recovering movements up to regular vocal fold function and normal stroboscopic results. Clinical and serologic constellations and their therapeutical implications are discussed.

[Functionally determined area changes in the oro-pharyngo-laryngeal vocal tract of singers as shown by magnetic resonance tomography]. / Funktionsbedingte Flächenänderungen des oro-pharyngo-laryngealen Vokaltraktes bei Sängern in der Magnetresonanztomographie.

The oro-pharyngeal-laryngeal resonating spaces were studied in 12 singers at varying stages of their training by means of medio-sagittal MRI images, and the results were compared. The singers were requested to sing /a/ /u/ and /i/ at various pitches and with increasing loudness. The total oro-pharyngo-laryngeal areas were integrated by means of the MRI sections. The relationship between the oro-pharyngeal and pharyngo-laryngeal areas was determined, as well as their ratio to total area. With increasing volume there was increase in the area of the oro-pharyngeal component with no change in the pharyngo-laryngeal component. The relationship of the partial areas depends on the extent of training of the singer.

[Applications of the "Speech Viewer II" in voice training in vocal cord paralysis]. / Einsatzmöglichkeiten des "Speech Viewer II" zum Stimmtraining bei Stimmlippenparesen.

Referring to traditional therapeutical concepts of vocal fold paralysis a microphone-controlled computer programme was used for voice treatment in 13 patients with unilateral vocal fold paralysis. 6 of these patients were female, 7 were male. The age ranged from 18 to 72 years (mean: 50 years). The etiology of the paralysis was distributed as follows: post strumectomy (4 cases), post operation of the aortic arch (3 cases), post mediastinoscopy (1 case), post operation of the cervical vertebrae (1 case). 2 cases are not decided yet, 2 are probably idiopathic. The vocal fold dysfunction lasted between 24 hours and 8 years before our first examination, less than 4 weeks in 11 cases. With 1 exception (intermediate) the vocal fold position was classified as paramedian. 8 patients suffered from left, and 5 patients from right vocal fold paralysis. The voice treatment took place with a microphone-controlled speech viewer including an audio capture and playback adapter. 7 of the 15 training modules of the computer programme were chosen to be useful for voice training. Those modules can be differentiated in physical-technical modules showing voice spectra or pitch scales and in object-related modules showing images such as landscapes, animals and others. These programme-specific modules (monitor exercises) were primarily built to train the following voice qualities separately: loudness, pitch, voicing, voice onset, fundamental frequency, sustained phonation etc. Modifying certain therapeutic instructions (see Tables 1 and 2) the monitor exercises were used to improve the coordination of different voice parameters, thus resembling physiological speech.(ABSTRACT TRUNCATED AT 250 WORDS)

[The phasic imaging of velopharyngeal sphincter movements]. / Die Phasendarstellung velopharyngealer Sphinkterbewegungen.

The velopharyngeal function while swallowing water was studied on a healthy volunteer patient with velopharyngeal closure and on a patient with velopharyngeal insufficiency. This patient suffers from open hypernasality as a result of shortened velum. Both subjects underwent nasoendoscopy with a flexible fiber glass optical device while swallowing water and while articulating the plosive consonant /k/. Velopharyngeal function was documented by means of videotaping and then the single video images were placed together along a time scale to form a new temporal image. This image makes possible a quick and comprehensive differentiation between physiological and disturbed motion patterns as demonstrated in this study using velopharyngeal function as the example. The videotaping in lapse time of such disordered movements can provide indicators of the therapeutical steps to be taken.

[NMR examination of Polish speech sounds]. / Badanie obwodowego narzadu mowy przy wymowie glosek polskich za pomoca jadrowego rezonansu magnetycznego (NMR).

Polish phonemas were examined using MRI Snapshot-FLASH-technique. Functional images of the articulators were obtained.

[Tongue ultrasound and pressure measurement in infantile sucking. Initial results]. / Zungensonographie und Druckmessungen beim Säuglingssaugen. Erste Ergebnisse.

The sucking procedure was examined in 10 healthy, term infants and in one newborn with disturbed sucking actions suffering from recurrent aspiration pneumonia. We applied ultrasonography of the tongue and simultaneous intraoral pressure measurements in the examinations. Observations were made with a bottle feeding system (NUK). Sonography and intraoral measurements both gave reliable informations. Parallel recordings of tongue dorsum movements by pseudo-3-dimensional imaging and simultaneously obtained pressure curves show, that increasing suction is maintained by withdrawing the tongue dorso-cranially. Computer-aided evaluation of ultrasound images and pressure data demonstrate the possibility to distinguish between coordinated and uncoordinated sucking movements. Simultaneous use of both examination techniques can be helpful in diagnosis and documentation of disturbed sucking actions.

[Sonographic imaging of internal jugular venous blood flow in juvenile hyperfunctional dysphonia]. / Badanie sonograficzne szybkosci przeplywu krwi w zyle szyjnej wewnetrznej w hyperfunkcjonalnej dysfonii dzieciecej.

Relative blood flow velocity peaks of the internal jugular vein were examined by simultaneous Doppler and B-mode sonography in 4 boys with hyperfunctional dysphonia. During phonation patients showed remarkably greater reduction of relative blood flow velocity peaks than a normal speaker.

Evaluation of functional positions of tongue and soft palate with MR imaging: initial clinical results.

Magnetic resonance imaging was used to analyze functional positions of the tongue and soft palate in 10 patients and 10 healthy volunteers. The patients had velopharyngeal insufficiency and/or dysfunction of the tongue. With snapshot FLASH (fast low-angle shot) sequences (data acquisition time, less than 1 second), malpositions of the articulatory apparatus were imaged and recorded for follow-up documentation.