[Recognition function for the Freiburg monosyllabic test in noise with a signal to noise ratio (SNR) of 5 dB]. / Die Verständlichkeitskurve für den Freiburger Einsilbertest im Störschall mit einem Signal-Rausch-Abstand (SNR) von 5 dB.

OBJECTIVE: The Freiburg monosyllabic test (FBE) has been an important German speech audiometry test for years. It is nowadays also used to assess the benefit of hearing aids in noise (FBE-S). This study investigates hearing in noise using the FBE at different sound pressure levels and a signal to noise ratio of 5 dB to generate a recognition curve. METHODS: In autumn 2018, 60 normal-hearing German native speakers (age 18-31 years) participated in the study at the military hospital in Hamburg. Using one FBE test list, speech intelligibility was measured from sound pressure levels of 15 to 90 dB in 5­dB steps with a noise level 5 dB lower in each case. Subsequently, the average of all intelligibility rates and 95% confidence intervals (CI) were determined. RESULTS: Participants comprised 29 female and 31 male subjects. Average age was 24.32 years (±3.29 years). The fixed effects analysis of variance with recognition as the dependent variable demonstrated a highly significant correlation between the levels of sounds/noise and the intelligibility of speech (p < 0.0001). The average intelligibility rates with 95% CI and the frequency distributions were presented tabularly and graphically. CONCLUSION: In comparison to the normative curve, the FBE­S recognition curve is shifted to the right. The average values of the FBE­S reach the saturation area at a volume of 70/65 dB with an intelligibility rate of 90% (for comparison: the point of saturation for 100% intelligibility of the FBE without noise is reached at 55 dB). Using these averaged values of the FBE­S enables better interpretation of individual results without and with hearing aids. In the future, the benefit of hearing aids should be measured at lower noise levels than it is today.

[Guideline: Auditory processing and perception disorders: Proposal for treatment and management of APD : S1 guideline of the German Society of Phoniatrics and Pediatric Audiology]. / Leitlinie "Auditive Verarbeitungs- und Wahrnehmungsstörungen": Vorschlag für Behandlung und Management bei AVWS : S1-Leitlinie der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie.

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. In patients with hearing loss, this must first be compensated or resolved. Only hereafter can a suspected APD be confirmed or excluded. Diagnosis of APD requires that a clear discrepancy between the child's performance in individual auditory functions and other cognitive abilities be demonstrated. Combination of therapeutical modalities is considered particularly more beneficial in APD patients than a single modality. Treatment modalities should consider linguistic and cognitive processes (top-down), e.g., metacognitive knowledge of learning strategies or vocabulary expansion, but also address underlying auditory deficits (bottom-up). Almost 50% of children with APD also have a language development disorder requiring treatment and/or dyslexia. Therefore, each therapeutic intervention for a child with APD must be individually adapted according to the diagnosed impairments. Musical training can improve phonologic and reading abilities. Changes and adaptations in the classroom are helpful to support the weak auditory system of children with APD. Architectural planning of classrooms can be a means of ensuring that direct sound is masked by as little diffuse sound as possible. For example, acoustic ceiling tiles are suitable for reducing reverberant and diffuse sound.

[Guideline: Auditory Processing and Perception Disorders: Differential Diagnosis : S1 guideline of the German Society of Phoniatrics and Pediatric Audiology]. / Leitlinie "Auditive Verarbeitungs- und Wahrnehmungsstörungen": Differenzialdiagnose : S1-Leitlinie der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie.

As a prerequisite for diagnosing auditory processing disorders (APD), differential diagnostic considerations are essential, especially with regard to language comprehension disorders, attention deficit hyperactivity disorder, specific cognitive impairments (e. g., in memory or multi-modal perception performance), specific learning disorders affecting reading and/or spelling, and autistic-type diseases. The current clinical management is presented in detail in the updated APD guidelines, as are the resulting conclusions for the interpretation of individual test results.

[Guideline: Auditory Processing and Perception Disorders: Diagnostics : S1-Guideline of The German Society of Phoniatrics and Pediatric Audiology]. / Leitlinie: "Auditive Verarbeitungs- und Wahrnehmungsstörungen": Diagnostik : S1-Leitlinie der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie.

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.

[The adaptive Freiburg monosyllabic test in noise : Development of a procedure and comparison of the results with the Oldenburg sentence test]. / Die adaptive Messung des Freiburger Einsilbertests im Störschall : Entwicklung einer Messmethode und Vergleich der Ergebnisse mit dem Oldenburger Satztest.

BACKGROUND: Whereas sentence tests are commonly performed using an adaptive procedure, this method has not yet been transferred to the Freiburg monosyllabic speech test, the most important word test. When using different procedures, a comparison of results between sentence and word tests is not possible. Therefore, an adaptive procedure which has proven itself in sentence tests was transferred to the Freiburg monosyllabic test in noise. The results of the new procedure were compared to the standard of sentence tests, i.e., the Oldenburg sentence test. METHODS: The adaptive Freiburg monosyllabic speech test and the Oldenburg sentence test were applied in 40 otologically normal subjects in a randomized order. Results were analyzed with respect to time requirements, possible gender differences, the influence of test order, and correlation of test results. RESULTS: The time required for the adaptive Freiburg monosyllabic speech test was significantly higher than for the Oldenburg sentence test. No significant impact of gender or test order could be shown. The mean signal-to-noise ratio for 50% speech discrimination of the Oldenburg sentence test was significantly smaller than for the adaptive Freiburg monosyllabic speech test. No correlation could be shown between the results of the two tests CONCLUSION: The Freiburg monosyllabic test can not only be used for quantifying discrimination loss in percentage terms, but also to measure the 50% speech recognition threshold with an adaptive algorithm. However, the procedure of the adaptive Freiburg monosyllabic test is more time consuming than that of the Oldenburg sentence test. Concerning a possible missing correlation between the results for 50% speech discrimination, further studies with hearing-impaired persons are needed.

[Everyday relevance of APHAB questions : Influence on answer frequency]. / Alltagsrelevanz der APHAB-Fragen : Einfluss auf die Beantwortungshäufigkeit.

BACKGROUND: The Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire measures subjective hearing impairment in different situations. Recently, a survey demonstrated that some APHAB questions were answered more rarely than others. This study aims to evaluate the everyday relevance of each APHAB question and investigate whether this relevance for daily life influences answer frequency. METHODS: Between July 2016 and November 2017, 517 hearing impaired patients from 11 ENT practices in Schleswig-Holstein, Germany, were evaluated using the APHAB. In parallel, the everyday relevance of each APHAB question for the subjects was assessed on a four-step scale (often/sometimes/rarely/never). The answers were listed in a cross table and statistically analyzed. RESULTS: The average age of all subjects was 67.4 years (±14.0 years); 45.3% were female and 54.7% were male. One APHAB question (no. 21) was answered noticeably less often than the others. Overall, five types of distribution for the everyday relevance of APHAB questions could be determined. Using the χ2-test, no correlation between the frequency of answers and their everyday relevance could be detected (p < 0.001). CONCLUSION: No correlation between everyday relevance and answer frequency was detected. However, the five types of distribution could be used for an individual interpretation of single APHAB answers. In the future, a possible influence of everyday relevance on ranking within a specific APHAB answer should be investigated.

[Management of developmental speech-language disorders in children : Part 1: Diagnosis and underlying comorbid diseases]. / Management von Sprachentwicklungsstörungen und Aussprachestörungen bei Kindern : Teil 1: Diagnosen und Ursachen.

Compared to other countries, the prevalence of speech-language disorders among children and also the intervention frequency appear to be much higher in Germany. Since otorhinolaryngologists often initiate speech-language interventions, the first part of this review systematically outlines the guideline-conform diagnostic pathway from examination to therapeutic intervention. The process of first developing a suspected diagnosis which justifies speech-language tests is explained. Beyond this, the rational selection of a set of tests from all those available-some of which the otorhinolaryngologist can perform, some of which require referral-is discussed, as is how these results can be used to assess the severity of the disorder. A special focus of this paper is the differential diagnosis of underlying causes, e. g., hearing disorders and global developmental disorders. A complete set of tests permits a working diagnosis and ICD-10 classification of the case.

[Management of developmental speech-language disorders in children : Part 2: Intervention and remediation]. / Management von Sprachentwicklungsstörungen und Aussprachestörungen bei Kindern : Teil 2: Behandlungsmöglichkeiten.

In the first part of this seminar paper, speech-language development tests were presented and the importance of the differential diagnosis of the underlying causes of the diagnosed language development disorder was discussed. The second part focuses on counseling and training of the parents, as well as the different treatment methods used for speech-language therapy for affected children in out- and inpatient settings. These procedures should be applied according to the individual developmental age. The official guidelines are to be respected, especially for medical speech-language therapy. Generally underestimated issues are risks and side effects of language and speech therapy, which obviously do exist, e. g., as induction of consciousness of the disorder in the treated child.

[Dependency of APHAB score in the ECu subscale on age, gender and subjective hearing loss : Hearing aid fitting in two subjective hearing loss groups]. / Abhängigkeit des APHAB-Werts in der ECu-Skala von Alter, Geschlecht und objektivem Hörverlust : Hörgeräteerstversorgung in 2 subjektiven Hörverlustgruppen.

OBJECTIVE: The Abbreviated Profile of Hearing Aid Benefit (APHAB) determines subjective impairment by hearing loss in four situations before and after hearing aid fitting. The first part (APHABu) of the questionnaire can be used independently of hearing aid fitting. Previous research has demonstrated that the answers in the ECu subscale for hearing under easy conditions are concentrated in two groups: one with subjectively better, one with subjectively worse hearing. This study aimed to investigate in a large collective whether there are differences between these two groups in terms of age, gender, and individual hearing loss. PATIENTS AND METHODS: The data of 1755 patients were analyzed, whose APHAB answers and pure-tone thresholds had been collected during hearing aid fitting. Group 1 had an average ECu score ≤37.5%; in group 2 it was ≥67.5%. The individual hearing losses was determined. Statistical analysis was performed using Mann-Whitney U, χ2, Spearman, and Pearson tests. RESULTS: The 616 members of group 1 were significantly younger (68.7 vs. 73.0 years) and comprised more females (53.9 vs. 46.1%) than the 1139 members of group 2. Hearing was frequency specific in group 1, and hearing loss as classified using standard audiograms and according to the three-frequency table was significantly lower in group 1 than in group 2, CONCLUSION: The distribution with two maximums in the ECu subscale can be explained by individual differences in terms of age and hearing loss, in part also by gender. The lower absolute number of patients in group 1 could be explained by the still relatively late fitting of hearing aids in general.

Sensitivity and specificity of the abbreviated profile of hearing aid benefit (APHAB).

Subjective hearing loss in hearing-impaired patients can be assessed by inventory questionnaires. The abbreviated profile of hearing aid benefit (APHAB) measures subjective hearing loss in four typical hearing situations (subscales). It is used to fit hearing aids in patients with statutory insurance in Germany. In addition, the unaided APHAB (APHABu) can be used as a primary diagnostic instrument in audiology. There are no published data regarding the sensitivity and specificity of the unaided APHABu. Therefore, we investigated these parameters for detecting hearing loss of at least 25 dB at any frequency between 0.5 and 8.0 kHz. We used the APHABu to determine hearing loss in 245 subjects aged 50 years and older without any reported disease of the ears. Due to incomplete answering of the APHAB form, 55 subjects have been excluded. We also measured the pure-tone thresholds by air conduction for all octave frequencies between 0.5 and 8 kHz. Receiver operating characteristic (ROC) curves and the Youden Index were used to determine the diagnostic value of the APHABu, particularly sensitivity and specificity, in three different ways: (1) separately for ease of communication (ECu), background noise (BNu), and hearing with reverberation (RVu) subscales; (2) with the mean value of ECu, BNu, and RVu; and (3) with a logistic regression model. The area under the ROC curve was lower for BN only (0.83) and nearly equal for all other methods (0.87-0.89). Depending on how we performed the analyses, the sensitivity of the APHABu was 0.70-0.84 (single subscales), 0.76 (mean value of ECu, BNu, and RVu), or 0.85 (logistic regression model). The specificity was 0.79-0.95. The use of single APHABu subscales for determining the sensitivity and specificity of the APHABu due to confusing results. In comparison, the use of the mean value of ECu, BNu, and RVu and the use of the logistic regression model due to equal values in the ROC curves but a higher sensitivity in the logistic regression model. Therefore, we would recommend the last method for determining the sensitivity and specificity of the APHABu.

Associations between the probabilities of frequency-specific hearing loss and unaided APHAB scores.

The Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire reports subjective hearing impairments in four typical conditions. We investigated the association between the frequency-specific probability of hearing loss and scores from the unaided APHAB (APHABu) to determine whether the APHABu could be useful in primary diagnoses of hearing loss, in addition to pure tone and speech audiometry. This retrospective study included database records from 6558 patients (average age 69.0 years). We employed a multivariate generalised linear mixed model to analyse the probabilities of hearing losses (severity range 20-75 dB, evaluated in 5-dB steps), measured at different frequencies (0.5, 1.0, 2.0, 4.0, and 8.0 kHz), for nearly all combinations of APHABu subscale scores (subscale scores from 20 to 80%, evaluated in steps of 5%). We calculated the probability of hearing loss for 28,561 different combinations of APHABu subscale scores (results available online). In general, the probability of hearing loss was positively associated with the combined APHABu score (i.e. increasing probability with increasing scores). However, this association was negative at one frequency (8 kHz). The highest probabilities were for a hearing loss of 45 dB at test frequency 2.0 kHz, but with a wide spreading. We showed that the APHABu subscale scores were associated with the probability of hearing loss measured with audiometry. This information could enrich the expert's evaluation of the subject's hearing loss, and it might help resolve suspicious cases of aggravation. The 0.5 and 8.0 kHz frequencies influenced hearing loss less than the frequencies in-between, and 2.0 kHz was most influential on intermediate degree hearing loss (around 45 dB), which corresponded to the frequency-dependence of speech intelligibility measured with speech audiometry.

[APHAB scores for individual assessment of the benefit of hearing aid fitting]. / APHAB-Scores zur individuellen Beurteilung des Nutzens von Hörgeräteversorgungen.

OBJECTIVE: The Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire measures subjective hearing impairment on four different subscales pertaining to different listening situations. Using a very large patient cohort, this study aims to show how answers are distributed within the four subscales before and after hearing aid fitting, and what benefit the patients experience. The results are discussed on the basis of the available literature. PATIENTS AND METHODS: Between April 2013 and March 2016, 35,000 APHAB questionnaires from nine German statutory health insurance providers were evaluated. The average values before and after hearing aid fitting, as well as the benefit, were determined for all four APHAB subscales and analyzed graphically. RESULTS: The results of the subjective evaluation of hearing impairment before and after hearing aid fitting and the resultant benefit were plotted by percentile distribution graphs and boxplots. The data were analyzed statistically. There was no overlap of the interquartile ranges before and after hearing aid fitting in any of the APHAB subscales. In three scales (EC, BN and RV), the median improvement after hearing aid fitting was nearly 30 percentage points. In the AV subscale, this value was slightly negative. DISCUSSION: The percentile distribution graphs used in this study allow individual evaluation of subjective hearing impairment before and after hearing aid fitting, as well as of the resultant benefit, on the background of a huge database. Additionally, it is demonstrated why presentation as boxplots and the average benefit values calculated from these is problematic.

The influence of frequency-dependent hearing loss to unaided APHAB scores.

Hearing loss can be measured by pure-tone and speech audiometry. The subjective hearing impairment can be assessed using questionnaires. The APHAB determines this for four typical hearing situations. It has not been researched previously whether a particular frequency-specific hearing loss leads to a particular unaided APHAB score in one of the subscales or not. Clarification could be helpful using the unaided APHAB as an instrument for primary diagnostics of hearing loss independently of whether hearing aids were subsequently fitted or not. A total of 4546 records from a database were analysed; the average age of the subjects was 69.3 years. Using a multivariant mixed linear model, a possible correlation was examined between a frequency-specific hearing loss (0.5-8.0 kHz) and particular unaided APHAB scores for its subscales. Furthermore, it was determined whether the subject's gender has a corresponding impact. There was no evidence of gender-specific dependence of the unaided APHAB scores. For the EC scale frequencies above 0.5 kHz, for the RV scale all frequencies and for the AV scale the frequencies at 1.0 and 2.0 kHz showed a significant correlation between hearing loss and the APHAB score. For each decibel of hearing loss there was an average rise in the APHAB score for the EC and RV scale of approximately 0.2 percentage points and an average decrease in the AV scale of 0.1 percentage points for each frequency. For the BN scale there was no evidence of this kind of correlation. The very varied possibility between individuals compensating for hearing loss in situations with background noises could be that there is no correlation between frequency-specific hearing loss and an associated unaided APHAB score. The described frequency-specific influence of hearing loss to the EC and RV score could be explained by fewer compensating possibilities for the patients in these specific hearing situations than for the BN scale described. Using the unaided APHAB form in primary diagnostics of hearing impairment is helpful for understanding individual problems.

[Distribution and Scattering of APHAB Answers Before and After Hearing Aid Fitting]. / Die Verteilung und Streuung von APHAB-Antworten vor und nach einer Hörgeräteversorgung.

Objective: Questionnaires are an important diagnostic elements in audiology. In Germany the APHAB is regularly used for hearing aid fitting. This study is investigating whether there are any specific questions which are answered more rarely by the subjects than other and whether inverted questions have any influence to this. Methods: Between April 2013 and August 2015 the number of 23 557 APHAB forms by 10 associations of statutory health insurance registered physicians have been collected and evaluated. For all questions the frequency of answers before and after hearing aid fitting have been determined. Results: For the EC scale there was one group of patients without hearing aid which a lot of problems of hearing and a second without. For the BN and RV subscale the majority of the patients addresses problems of understanding. For the AV scale no specific kind of problems found has been found. After successful hearing aid fitting problems of understanding for EC, BN, and RV subscale were reduced on average, for the AV scale no relevant change could be observed. Except for the numbers 11, 18, and 21 all APHAB questions were answered by 93-94% by all subjects. The questions number 11 and 18 were answered by 92%, question number 21 by 87%. Some questions have a similar tendency in deviation from the average (1, 3, 13, 16, and 17). Conclusions: Inverted questions have no influence to the frequency of answers in APHAB questions. The 3 questions which are answered more rarely are describing hearing situations in cinemas, theatres, and at church. Presumably, this hearing situations are not so common for most patients than the other described by the APHAB.

[The Influence of Hearing Loss Represented by Standard Audiogram Types to Unaided APHAB Scores]. / Die Abhängigkeit von APHABu-Scores von Hörverlusten in Standardaudiogrammen.

BACKGROUND: Questionnaires as the APHAB (Abbreviated Profile of Hearing Aid Benefit) are besides pure-tone and speech-audiometry the third method of diagnostics in audiology. Up to now there has been no research on the influence of individual hearing loss, represented by standard audiograms, on the scores of the unaided APHAB (APHABu) done with a big number of subjects. This study will investigate whether there does exist such a relationship or not. METHODS: A total of 2 745 records provided by a database were analysed. First, the subjects' audiograms (air conduction) were allocated to 7 standardised audiogram types. By using a multivariant mixed linear model a potential connection was examined between these standard audiograms and particular APHABu scores for its four subscales: EC - ease of communication, BN - background noise, RV - reverberation, AV - aversiveness of sounds. RESULTS: There was no evidence for a dependency between any type of hearing loss dependence and unaided APHAB-scores. The values on the EC-scale vary between 49.8 and 58.0, on the BN-scale between 45.3 and 46.6, on the RV-scale between 44.4 and 52.4, and on the AV-scale between 47.6 and 50.1. DISCUSSION: This result confirms earlier studies with other questionnaires. Therefore, the APHABu can be used as an initial instrument for the diagnostics of individual hearing loss independently on whether hearing aids will be fitted subsequently or not.

Results in using the Freiburger monosyllabic speech test in noise without and with hearing aids.

The Freiburger Speech Test (FST) has been the gold standard in speech testing by word recognition score in Germany for many years. Recently, it has been demonstrated that for an amount of 104 test-persons there is no significant deviation within the lists. The objective of this study was to determine the percentiles of the distinct measuring situations in quiet and with noise (e.g. applied in hearing aid fitting) and the average benefit using hearing aids. In this prospective study, 623 patients with SNHL and equipped with hearing aids for at least 3 months have been investigated by means of the Freiburger monosyllabic test (FBE) without and with hearing aids and in quiet or with noise (CCITT noise, 65/60 dB signal-noise ratio) in free field conditions at 65 dB to determine the ratio of intelligibility. To investigate the different diagnostic conditions a linear mixed model was applied. The dependent binary variable corresponds to the number of understood syllables. The average age of all subjects was about 72.6 years. The average rate of understanding in the FBE without hearing aids and in quiet was 38.5 %, with hearing aids and in quiet 67.7 %, without hearing aids and with noise 22.4 %, and with hearing aids and with noise 39.8 %. All results were presented with the depending confidence intervals. The extent of hearing loss and the quality of hearing aid fitting can be successfully measured using the FST in quiet and with background noise (CCITT noise). In quiet, an average hearing improving gain of 29.2 % points and with noise a gain of 17.4 % points could be estimated with a successful hearing aid fitting.

[Hearing aid fitting: Effect of doubling the standard rate on compliance, quality of results, and excess payments]. / Hörgeräteversorgung: Folgen der Festbetragsverdoppelung auf Compliance, Ergebnisqualität und Zuzahlungen.

BACKGROUND: This study investigates the effect that doubling the standard rate for hearing aid fitting which is covered by statutory insurance has had on the size of excess payments and compliance, as well as on benefits for patients and their satisfaction. METHODS: In April 2014, 859 members of a statutory insurance scheme (hkk) who received hearing aids in the 6 months prior to the reform were questioned on the timing and financial details of their hearing aid fitting, as well as on treatment compliance and quality of the results using a standardized questionnaire. In October 2014, the same questionnaire was used to collect these data from a further 622 insurance holders who had received hearing aids in the 8 months following introduction of the new regulation. Most of the questions concerning hearing quality corresponded to those of the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire. RESULTS: The project revealed a statistically significant decrease of 6 percent points in the proportion of hearing aid users who had to pay any excess whatsoever; from 80.6% to 74.1%. However, 40% of the insured persons continued to pay an excess of 1000 euros and more. The subjective hearing quality remained practically unimproved by the reform and was statistically, almost without exception, independent of whether hearing aid users wore expensive devices associated with a large excess, or devices available at the standard rate. Finally, the study confirmed a previously recognized usage pattern characterized by noncompliance. For example, approximately 40% of hearing aid users did not wear their device in the everyday environment. This observation was independent of the size of the excess and the timing of the most recent visit to the hearing aid acoustician. CONCLUSION: Despite doubling of the standard rate, three quarters of patients pay an excess--sometimes a substantial one. The subjective hearing quality was not improved by doubling the standard rate; the majority of patients continue to complain of considerable problems with hearing in difficult situations (environments with background or reverberant noise). Satisfaction with hearing quality is neither dependent on the doubling of the standard rate, nor on whether or not an excess was paid. Compliance may possibly be improved by structured follow-up, which should involve the prescribing otorhinolaryngologists, as well as phoniatrists, pedaudiologists, and hearing aid acousticians.

[Auditory processing and perception disorders (APPD): summary and updated overview]. / Auditive Verarbeitungs- und Wahrnehmungsstörungen (AVWS): Zusammenfassung und aktualisierter Überblick.

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.

[Botulinum Toxin in Functional Hypersalivation--All about Dosage?]. / Botulinumtoxin bei funktioneller Hypersalivation--alles eine Frage der Dosis?

BACKGROUND: The use of botulinum toxin injection in the salivary gland, is taking an increasing significance in the treatment of functional hypersalivation today. With due regard to the off -label use and the prospect of success, dosage levels are not yet standardized. MATERIAL AND METHODS: In a retrospective study, 54 patients resp. 117 treatments were analysed over a period of 5 years according to their dosage levels of botulinum toxin, outcome and side effects. RESULTS: In 90% of the cases, a reduction of saliva after botulinum toxin injections was reported, although a significant number of patients wished for an even greater effect. Compared to the first botulinum toxin injection, we therefore used a higher dosage plan in the following treatment in order to achieve better clinical results. Besides not enough saliva reduction, the main side effects were swallowing problems and thick or sticky saliva in patients with a tracheal cannula. With the exception of insufficient saliva reduction, the other described side effects were irrespective to the dosage level. CONCLUSIONS: Botulinum toxin injection as a treatment of hypersalivation is an effective method with only minor side effects, even in increased dosage levels. Nevertheless, certain modifications according to each individual treatment are required. Possible side effects such as swallowing problems or non-responding situations should always be part of informed consent, especially as the latter is even possible for higher dosage levels.