Voice improvement in patients with recurrent respiratory papillomatosis after combined treatment with cidofovir and CO2 laser surgery.

Mechanical debulking of laryngeal papillomas is associated with voice disorders due to impairment of the vocal fold's mucosa. Intraepithelial injection of cidofovir reduces damage to the laryngeal structures and thus improves vocal parameters. The aim of our study was to compare vocal quality before and after cidofovir and CO2 laser treatment by means of objective phoniatric parameters and to obtain evidence concerning voice outcomes. The vocal parameters of 42 patients with RRP were assessed before and after intralesional cidofovir and CO2 laser debulking treatment (Lumenis AcuPulse 40 CO2 laser, wavelength 10.6 µm; Lumenis Ltd., Yokneam, Israel). The laser was used in SuperPulse™ mode with power tailored on the target structures (average 7 W). The depth of tissue penetration was 1 mm with a single burst of energy lasting 0.3 ms. Most of the patients had previously undergone traditional surgery (1-105 procedures); in 7/42, the video stroboscopic examination revealed extensive scar tissue covering the mucosa of the vocal folds, limiting the mucosal wave. The significance level for all calculations was p < 0.05. Statistical analysis was performed using Statistica 10 by StatSoft Polska. The methodology included subjective voice evaluation (GRBAS), videostroboscopy, analysis of the acoustic laryngeal tone (MDVP), spectrographic analysis, and voice handicap index (VHI). The GRBAS scale during spontaneous conversation revealed better phonation results after cidofovir treatment in all 42 patients. Scars were not observed in the presented group. In the MDVP laryngeal tone analysis before surgery parameters defining the amplitude and frequency of laryngeal tone were significantly elevated compared to the state after surgery. After treatment, both jitter and shimmer were reduced in all subjects. Even more pronounced changes were observed in the spectrographic analysis. In all analyzed patients, there was a significant reduction in VHI scores showing improvement in voice self-assessment. A satisfactory improvement in voice quality was observed in all RRP patients treated with cidofovir and CO2 laser.

Assessing auditory processing disorders in children with developmental dyslexia using auditory cognitive event-related potentials.

OBJECTIVES: It has been suggested that dyslexia is linked to a core cognitive deficit in phonological awareness tasks and/or in the processing of auditory stimuli. Auditory evoked potentials are a valid, objective measure of the accuracy of central auditory processing in humans. The aim of this study was to assess auditory evoked potentials in children with dyslexia. PATIENTS AND METHODS: Sixty-six children participated in the study. A set of hearing tests and the recording of complex event-related potentials (ERPs) were performed. RESULTS: Mixmatch negativity (MMN) and P300 waves were significantly more frequent in the healthy children (control group) than in children with dyslexia. The P300 wave was present in all subjects from the control group, the MMN wave in 92% of them. In the dyslexic group, complex ERPs were recorded roughly 33% of the time. Latencies of complex ERPs in children with dyslexia were greater than latencies in children in the control group. MMN and P300 maturation (change with age) was observed only for the control group. A wide range of MMN and P300 responses was observed across children with dyslexia. CONCLUSION: Complex ERPs may be useful in determining the condition of audiologic functions; however, on their own they are not sufficient to recognize dyslexia because of the heterogeneity of nonspecific changes.

[Mutation voice disorders conditioned by psychic factors]. / Zaburzenia glosu mutacyjnego uwarunkowane czynnikami psychicznymi.

The case of 17 year old boy with mutational falsetto conditioned by a complex of psychic factors particulary with personality disorders and strong emotional bond with his mother was described. Phonation exercises lowered the average voice pitch. The stable results of phoniatric rehabilitation is dependent on effectiveness of psychological therapy of the whole family. Acoustic voice analysis demonstrates objectively the results of rehabilitation.

Subjective and Objective Assessments of Post-traumatic Olfactory Dysfunction.

Introduction: Traumatic brain injuries are the most common cause of olfactory dysfunction. Deficits in olfaction may be conductive or neurosensory in nature, with varying degrees of impairment resulting in a diminished quality of life and an increased risk for personal injury among patients. The aim of this research is to evaluate the results of the subjective and objective quantitative examinations of olfactory function in a group of patients with post-traumatic anosmia in order to predict its value in identifying olfactory deficits in clinical practice. Materials and Methods: The present study included 38 patients who reported anosmia or hyposmia caused by a traumatic head injury, and a group of 31 age- and sex-matched controls without olfactory dysfunction or prior history of head injury. The comparison of odor perception and identification of two oils (mint and anise) was assessed with the use of blast olfactometry with cortical olfactory event-related potentials. Results: Subjective olfactory tests revealed anosmia or hyposmia in 94% of patients with head injury-related olfactory dysfunction. Objective tests revealed olfactory event-related potentials from cranial nerve I produced by the stimulation with both mint and anise in 20 patients (52.6%). Olfactory event-related potentials from cranial nerve V produced by the stimulation with mint were registered in 26 patients (68.4%). The lack of any responses, from both cranial nerve I and V, was found in 12 patients (32% of cases). Conclusions: Findings from our study indicate the application of both subjective and objective examinations in the evaluation of patients with olfactory impairment. In the diagnosis of post-traumatic anosmia or hyposmia, objective examinations are particularly useful when the patients' level of cognition may be impaired or when subjects may be exaggerating their olfactory defects for a secondary gain. The diagnosis of damage to the olfactory system, specifically in the receptive part of the olfactory pathway, can be established in patients who showed reduced amplitudes or absent cortical responses in addition to absent odor identification and perception threshold in the subjective examination.

[Perceptiv-acoustic characteristic after supracricoid laryngectomy with cricohyopexy or cricohyoepiglottopexy]. / Charakterystyka percepcyjno-akustyczna glosu i mowy po laryngektomiach nadpierscieniowych z CHP lub CHEP.

INTRODUCTION: Supracricoid laryngectomy with cricohyopexy (CHP) and cricoepiglottopexy (CHEP) are the one of functional laryngectomy. AIM: The aim of the study is phonation assessment of the reconstruction larynx. Material and methods. The examined group consisted of 58 patients (49 males and 9 female). An average age 54. 32 patients underwent CHP and 26-CHEP CHP was performed in following modes: a) 1 arytenoid cartilage left in 17 cases, b) 2 arytenoid cartilages left in 14 cases and c) 1 arytenoid cartilage left and second was resected with subsequent reconstruction in 1 case. The arytenoid cartilage was reconstructed in 19 cases (8 after CHP and 11 after CHEP). The vascularized thyroid lobe was used to the reconstruction of arytenoid cartilage in 8 cases (6 after CHP and 2 after CHEP), cuneiform or corniculate cartilage was used in 4 patients (1 CHP and 3 CHEP) and mucous membrane in 7 cases (1 CHP and 6 CHEP). RESULT: Socially efficient speech was found in 74% patients and the results were better after CHEP. CONCLUSION: The phonetic-acoustic structure of voice and resonant speech was considerably different from the phonetic-acoustic structure of voice and speech under physiologic conditions. These differences applied to segmental (formant structure, frequencies, noise range), as well as suprasegmental voice features.

[Methods of larynx phoniatory function measurement in the Poznan University Department of Ear, Throat, Nose and Larynx Diseases between 1922 and 1939]. / Metody badania czynnosci fonacyjnej krtani w Klinice Otolaryngologicznej Uniwersytetu Poznanskiego w latach 1922-1939.

INTRODUCTION: Indirect laryngoscopy development and progress initiated in 1854 by the autolaryngoscopy of the famous singing voice teacher Manuel Garcia in ENT speciality is connected with the names of L. Tuerck and J.N. Czermak, the last one being called the father of laryngoscopy. In 1878 M. Oertel used for the first time stroboscopic light in indirect laryngoscopy. The perception of stroboscopic picture is based on the Talbot principle. OBJECT OF THE PAPER: Two apparatuses used for the evaluation of larynx function in the Poznan ENT Department before the II World War are presented:--Polylaryngoscop enabling evaluation the indirect laryngoscopy simultaneously by several individuals.--Mechanical stroboscop of Oertel type with perforated disc moved by electrical engine. CONCLUSION: For 130 years laryngostroboscopy belongs to the basic examination methods of larynx phonatory function.

[Further research on speech tests]. / Dalsze badania nad testami mowy utrudnionej.

INTRODUCTION: The purpose of speech audiometry is to extend the diagnostics of central auditory processes. First audiometric tests were monaural tests introduced in the fifties by Bocca and Calearo to diagnose Central Auditory Processing Disorders (CAPD). Monaural tests are characterized by low redundancy, which allows for deciphering a given word or phrase only if the amount of accessible information exceeds a required minimum. Until now, a new monaural filtered speech test has been drawn up at the Department of Phoniatrics and Audiology. The purpose of the research was to draw up and assess the effectiveness of monaural low redundancy tests, in which the acoustic signal has been compressed or noise has been added. MATERIALS AND METHOD: 35 people with normal hearing, aged 16-60, have been examined. The test material included: a compressed speech test, in which the speech signal has been accelerated by 25% with the use of Cool Edit Pro 2.0; the pauses between the words have not been shortened a speech-in-noise test, in which the noise has been added with the use of Cool Edit Pro 2.0. The signal/noise ratio has been set at the level of 10 dB. The examination has been conducted at three different volume levels: 25, 35 and 45 dB. CONCLUSIONS: Best results have been achieved at the volume level of 45 dB (above hearing threshold); There were differences in results at volume levels 25 dB and 35 dB in compressed speech test and at volume level 25 dB in speech in noise. Both tests have shown the influence of age on the test result which suggests undiagnosed CAPD among people (with normal hearing) aged over 55.

Knowledge of parents from urban and rural areas vs. prevention methods of hearing loss threats seen as challenges for public health.

[b]Introduction.[/b] Parents as day-to-day caregivers looking after their children's health and upbringing are crucial in the process of hearing loss prevention among the young. The aim of the study was to assess the parents' knowledge and awareness of hazards bringing about hearing loss, possibilities to prevent this, as well as their reaction in the case of problems of their children with hearing. [b]Material and methods. [/b]The research group comprised respondents (402 persons), medical or paramedical professionals. None of the surveyed was a doctor. 56% of the surveyed were inhabitants of large cities, 24% of small towns, and 20% of village, mostly located in the area of Greater Poland (Wielkopolska) (97%). To perform the research a survey was devised. GSES scale was applied as an accessory tool. [b]Results. [/b]The subjects surveyed posses a great deal of knowledge concerning basic conditions that could adversely affect the hearing of children. Village inhabitants are half as afraid of hearing loss hazards as the inhabitants of large cities. More than 40% of the respondents claimed they do nothing to counteract their children's overexposure to noise. In 48.5% of cases, GPs had not drawn parents' attention to possible complications resulting from upper respiratory tract infections in children. Parents know where they should go to in case their children develop hearing problems or sudden hearing loss. [b]Conclusions.[/b] Knowledge and awareness of factors that may trigger hearing loss is not synonymous with avoidance of the problem. Main components of hearing loss prevention among children and youths should be administrative actions, extensive education, and proper childcare at home.

Hypothyroidism Affects Olfactory Evoked Potentials.

Background. Objective electrophysiological methods for investigations of the organ of smell consist in recordings of olfactory cortex responses to specific, time restricted odor stimuli. In hypothyroidism have impaired sense of smell. Material and Methods. Two groups: control of 31 healthy subjects and study group of 21 with hypothyroidism. The inclusion criterion for the study group was the TSH range from 3.54 to 110 µIU/mL. Aim. Assessment of the latency time of evoked responses from the olfactory nerve N1 and the trigeminal nerve N5 using two smells of mint and anise in hypothyroidism. Results. The smell perception in subjective olfactory tests was normal in 85% of the hypothyroid group. Differences were noticed in the objective tests. The detailed intergroup analysis of latency times of recorded cortical responses PN5 and PN1 performed by means between the groups of patients with overt clinical hypothyroidism versus subclinical hypothyroidism demonstrated a significant difference (p < 0.05) whereas no such differences were found between the control group versus subclinical hypothyroidism group (p > 0.05). Conclusion. We can conclude that registration of cortex potentials at irritation of olfactory and trigeminal nerves offers possibilities for using this method as an objective indicator of hypothyroidism severity and prognostic process factor.

[Velopharyngeal incompentance treated by the pharyngeal flap and the Orticochea pharyngoplasty--a comparison of speech results]. / Ocena porównawcza skutecznosci leczenia niewydolnosci podniebienno-gardlowej po faryngofiksacji i operacji Orticochea.

INTRODUCTION: Velopharyngeal insufficiency is observed in about 10-40% of patients treated for cleft palate. Opinions on the effectiveness of applied methods differ in the assessment of specialists involved in the treatment of velopharyngeal insufficiency. MATERIAL AND METHODS: Since 2011, thirty-eight patients were treated for this defect at the Hospital of Polanica Zdrój. The report compares the effects of treatment by pharyngofixation and Orticochea's surgery. All the patients underwent prospective examinations--phoniatric evaluation with aural speech assessment, nasometry (using the device for objective and automatic nasality testing) as well as acoustic speech analysis (by means of MDVP). RESULTS: The effectiveness of both modalities of treatment was evidenced on the basis of statistical analysis of the findings of the perceptual speech evaluation as well as differences-- p > 1. Moreover, the statistical analysis of nasometric examinations revealed improvement achieved after the use of both methods, in this case Orticochea's method being considered slightly more effective-- p = 0.084. CONCLUSIONS: Concluding, both operations may be considered safe and effective in the treatment of velopharyngeal insufficiency in cleft palate patients.

[Horizontal glottectomy--oncological and functional results. Part II. Morphology of the glottis and perceptive-acoustics characteristic of the voice and speech after horizontal glottectomy]. / Laryngektomia pozioma glosniowa-- wyniki onkologiczne i funkcjonalne. Czesc II. Morfologia glosni i charakterystyka percepcyjno-akustyczna glosu i mowy po laryngektomii poziomej glosniowej.

INTRODUCTION: The authors showed findings concerning glottis morphology and perceptual-acoustic characteristics of voice and speech after partial classical (PCGLg) and extended glottic partial laryngectomy (PEGLg). MATERIAL AND METHODS: 10 patients (9 M., 1 F. average age 56 (min. 47 max. 65) were examined. All patients were undergone glottic partial laryngectomy: a) classical (n = 5) b) extended of vocal process (n = 3) with (n = 2) or without (n = 1) the removal of the mucous false folds, c) extended of part of arytenoid cartilage with (n = 2) or without (n = 1) the removal of the mucous of the false folds. The following examinations were executed: phoniatric, videolaryngoscopic and perceptual-acoustic analysis. RESULTS: After PCGLg and one extended of vocal process, voice and speech has mostly characterized of features of hypofunction dysphonia. Hyperfunction was found in patients after removal of the mucous of the false folds due to leucoplakia. In case of removing of a part of arythenoid cartilage the notable or entire standstill or lack of full phonatory closure were found. The phonetical-acoustic analysis showed that in patients using melodious voice, the character of the source of actuating was periodically-noise, with the component of noise in all range of the course of the acoustic signal of voice. The parameters such as F0, jitter, shimmer does not make coherent conclusions and are less useful in the assessment of the quality of voice. CONCLUSIONS: In case of the resection of the part of the arythenoid cartilage during glottis laryngectomy, we take into account lack of full phonatory closure and using whisper by the patients. Obtaining the reliable conclusions needs continuations of the investigations and increasing number of patients. These researches are in progress.

[Effect of smoking on phonation]. / Wplyw palenia tytoniu na funkcje fonacyjna krtani.

The aim of this paper was presentation of voice estimation in smokers, who did not complain of voice disorders. The examination was performed in 20 patients with history of chronic tobacco using (at least 20 years). The videolaryngostroboscopy and acoustic voice analysis were performed. The specific changes as in organic dysphonia were found in larynx in both examinations. The most important finding in acoustic voice analysis was abnormal parameter describing vFo--Fundamental Frequency Variation and lower comparing to normal voices fundamental frequency.

[Introduction to clinical investigation of olfactory evoked potentials]. / Wstepne badania kliniczne wechowych potencjalów wywolanych.

The modified own constructed device served automatically odour stimulus to nasal cavity allowed registration evoked cortical potentials in 30 patients with normal olfaction sensitivity and identification. It is possibly to differentiate the nerve V receptors responses on odour stimulation (latency range 180-360 ms) as well as nerve I receptors responses (latency range 380-600 ms).

[Selected marketing aspects in the hearing aids fitting and their distribution]. / Wybrane aspekty marketingu w procesie doboru i dystrybucji aparatów sluchowych.

The developing of free market in Poland gives medical firms of opportunities but also necessity of adoption for more and more individual needs of customers. This article presents some aspects of marketing on the hearing aids market. The conclusions are based on long observation and empirical research. Problems mentioned in it are connected with principles like distribution channels, specific customers services and promotion. It also shows relations between medical firms, specialists, doctors, audiologists and real customers.

[The correlation between subjective and objective voice evaluation in organic and functional larynx disorders]. / Korelacja miedzy ocena subiektywna i obiektywna glosu w schorzeniach organicznych i czynnosciowych krtani.

The aim of this research is to develop and introduce into phoniatric diagnostic procedures the complex methodology of vocal function assessment, on the basis of comparison of subjective and objective voice estimation. The set of complex voice evaluation ought to include perceptual examination of the voice quality with quantitative GRBAS scale as a subjective method, vocal folds vibrations in videostroboscopy as a quasi-objective method and acoustic voice estimation in Multi Dimensional Voice Program (MDVP) as an objective method. The basic assumption of this report is to prove correlation existence for vocal folds vibration quality in videostroboscopy, parameters describing acoustic wave generating by vibration system in larynx (MDVP) and perceptual subjective voice assessment (GRBAS scale) in organic and functional voice disorders. Research was conducted on 100 subjects (65 with organic and 35 with functional voice disorder), aged 7-74 years randomly chosen from population of patients treated at the Department of Phoniatrics and Audiology, Karol Marcinkowski University School of Medical Sciences in Poznan in 1996-2001 and 60 subjects as a control group without any voice disorders according to phoniatric examination. The research methodology include perceptual voice evaluation based on Japanese (Hirano) GRBAS scale adapted to Polish language, in scale 0 to 3 as well as the vibrations of vocal folds in videostroboscopy with attempt at quantification (scale 1 to 3) of selected measure and for acoustic analysis of Multi Dimensional Voice Program (MDVP) for 17 estimated parameters. Due to results and statistic analysis the own, new scale of dysphonia severity was introduced.

[The auditory late potentials (P300, MMN) in central speech disorders in children]. / Pózne potencjaly wywolane (P300, MMN) w osrodkowych zaburzeniach mowy u dzieci.

The aim of this paper was introduction of preliminary study of late auditory evoked potentials P300 and MMN insome central communication process disorders. The investigations were performed in the group of three children with development dysphasia and pseudobulbar dyzarthria. The registration of endogenic late cognitive potentials was performed using the alternate application of stimulus of pure tones 1 and 2 kHz, and logatoms (da)-(ga). In all patients the normal hearing threshold and the unilateral disturbances in registration of P300 and mismatch negativity (MMN) were found.

[Preliminary results of objective audiological assessment of children with hearing impairment selected in neonatal hearing screening]. / Wstepne wyniki obiektywnej oceny sluchu u dzieci wyselekcjonowanych w ramach noworodkowych badan przesiewowych.

The aim of the paper was to present the results of the objective audiological assessment of 48 babies and infants at the age of 1-16 months, referred the Department of Phoniatrics and Audiology in Poznan (Poland) from January 2001 to July 2002. The children were selected in neonatal hearing screening, based on the OAE, questionnaire of hearing loss with high risk factors. We discuss high percentage of false positive results of OAE, late referrals for hearing screening, difficulties of follow-up.

[A model of healthcare for children with hearing disorders]. / Projekt modelu opieki zdrowotnej nad dzieckiem niedoslyszacym.

Hearing disorders have risen today to the status of a civilization disease. Hearing loss during development or the prelingual age is an enormous problem for the child. Undiagnosed in time, hearing loss may lead to serious limitations in intellectual, cognitive, and emotional development of the child, and to difficulties in speaking, writing, reading, and memorising. This paper presents current structural solutions regarding healthcare for children with hearing disorders. The system of early detection of hearing disorders (mainly inborn) is coherent for neonates and small children but lacks a well-coordinated healthcare model for older hearing-impaired children, especially in the context of disclosing acquired hearing defects. A model of healthcare for children with hearing disorders covering every stage of development (age) is presented, aiming at improvements in the system of early detection of inborn and acquired hearing defects. The model provides for systematic monitoring of patients with hearing defects and offers the opportunity of early intervention. Furthermore, the model serves to follow the developmental dynamics of the communication process.