Effectiveness of the lateral pedicled endonasal flap for prevention of restenosis in frontal sinus drillouts.

BACKGROUND: Frontal sinus median drainage according to Draf is an established procedure for achieving maximum drainage of the frontal sinus. Despite great efforts and several modifications, restenosis of the neo-ostium is still a persistent problem. This study presents an approach by implementing local mucosal flaps to prevent restenosis and compares it with the conventional technique without using the flap. METHODS: Description of endonasal, lateral pedicle mucosal flap. A Draf III procedure was performed on 156 patients between 2012 and 2021. Data for 123 of the included patients were retrospectively analyzed in terms of surgical indication, technique, postoperative aftercare and patency of the drainage pathway. The follow-up observation period was between 3 and 24 months. RESULTS: Treatment with the pedicle mucosal flap took place in 86 cases. 37 patients were treated as a control group without this flap. The analysis showed a significant association to the event "total closure of the drainage pathway" for surgical technique, as well as in the case of the presence of an allergy and the existence of Samter's triad. Furthermore, there was a significant association between the onset of "near total closure of the frontal sinus ostium" and Samter';s triad, CRS and revision surgery was involved. CONCLUSIONS: Use of an endonasal lateral pedicle flap for reconstruction of mucosal defects in frontal sinus surgery improves the long-term chances of a patent drainage pathway. Bone exposed by drilling was covered with a local mucosal flap for a faster epithelialization, healing and less scarring.

Phantom-based prospective analysis of the accuracy of photo registration technology in electromagnetic navigation of the frontal skull base.

OBJECTIVE: This prospective study compared the accuracy of two different company-specific registration methods (Fiagon GmbH, Hennigsdorf, Germany) in the electromagnetic navigation of the frontal skull base. A newly developed photo registration technology (Fiagon tracey©) promises an increase in accuracy and user-friendliness, but there is no phantom-based prospective study comparing the new method with the classic approach of tactile surface registration. MATERIALS AND METHODS: A phantom skull was prepared with 27 markers in the sagittal, axial and coronary planes, and their reference coordinates were determined using a navigational CT (low dose, slice 0.6 mm). Subsequently, 20 runs of automatic photo registration and tactile surface registration were carried out, and the resulting marker coordinates were compared with the reference coordinates. The target registration error (TRE) of the 27 markers was assessed and compared between the two methods using a 2-factor ANOVA with repeated measures. RESULTS: The mean TRE using surface registration was 1.97 mm ± 0.57, while the mean TRE of the automatic photo registration was 1.54 mm ± 0.24 (p < 0.001). In a subgroup analysis limited to markers in anatomical regions of clinical relevance in terms of paranasal sinus surgery, the mean TRE for the photo registration procedure can even be reduced to 1.29 mm (± 0.43) compared to tactile registration (1.80 mm; ±0.50; p=0.01). CONCLUSIONS: Photo registration is a promising new technology in the field of electromagnetic navigation in paranasal sinus surgery. This prospective phantom-based study showed that the photo registration method achieves a significantly lower target registration error (1.29 mm) compared to the surface-based tactile registration procedure (1.80 mm).

TIMolol nasal spray as a treatment for epistaxis in hereditary hemorrhagic telangiectasia (HHT) - Study protocol of the prospective, randomized, double-blind, controlled cross-over TIM-HHT trial.

BACKGROUND: Hereditary hemorrhagic telangiectasia (HHT) is an inherited orphan disease, in which the absence of capillary beds between arterioles and venules lead to arteriovenous shunts. Epistaxis is the core symptom. Several case reports have described the nonselective beta-adrenergic receptor antagonist timolol as a successful treatment method of nosebleeds due in HHT patients. OBJECTIVE: TIM-HHT is a single-site, prospective, randomized, placebo-controlled, double-blind, cross-over study to investigate whether the efficacy of standard laser treatment of epistaxis in HHT patients can be increased by the additional use of timolol nasal spray (1 mg/d). METHODS: Twenty patients will be randomly allocated to one of two treatment sequences. Primary outcome is the severity of epistaxis determined by the Epistaxis Severity Score (ESS). Secondary outcomes are subjective satisfaction, quality of life, as well as the hemoglobin, ferritin, and transferrin levels of the participating patients. Safety outcome is assessed by means of pulse, blood pressure, and adverse events. CONCLUSION: TIM-HHT will evaluate the efficacy and safety of timolol as an additional treatment of epistaxis in HHT patients in a three-month trial period. Benzalkonium chloride is used as a placebo, which has no documented positive effect on the nasal mucosa and hence on epistaxis in HHT patients (in contrast to saline). TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00020994. Registered on 10 March 2020.

[Pager-supported waiting time management in a university hospital ENT outpatient department : A pilot project for more distance and more comfort]. / Pager-gestütztes Wartezeitmanagement in einer universitären HNO-Ambulanz : Pilotprojekt für mehr Abstand und für mehr Komfort.

BACKGROUND: Due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, sufficient distance between people is absolutely necessary, especially in waiting rooms of medical care institutions. This is frequently difficult to realize due to restricted spatial capacities. OBJECTIVE: This study investigated the possibility of enabling patients to spend the waiting period outside of the waiting room of the ENT outpatient department, in order to reduce the number of patients in the waiting rooms and therefore observe distancing rules. This was realized by the use of a pager system. MATERIALS AND METHODS: During the timeframe of 12.5 weeks (04.06.2020-31.08.2020), ENT outpatients were issued with pagers. The patients could thus move freely within the hospital and grounds. The pager system was activated 10-15 min before the appointment, to call patients back to the outpatient ENT clinic. questionnaires were used to evaluate the system and examine patients' acceptance and satisfaction. RESULTS: The 137 questionnaires analyzed showed satisfaction with the system, not only regarding distancing rules but also with the more comfortable waiting time. CONCLUSION: Introduction of a pager system for patients could help to meet hygiene and distance rules, and also increase comfort during (often unavoidable) waiting times for patients in the university hospital ENT outpatient department. The long-term use of such a system seems promising.

[Effects of the SARS-CoV­2 pandemic on the otolaryngology university hospitals in the field of research, student teaching and specialist training]. / Auswirkungen der SARS-CoV­2-Pandemie auf die universitäre Hals-Nasen-Ohren-Heilkunde im Bereich der Forschung, Lehre und Weiterbildung.

BACKGROUND: From spring 2020, SARS-CoV­2 began to spread worldwide, with what is now known as the first wave of the pandemic, starting in March 2020. This resulted in restructuring and shift of resources at many hospitals. The aim of our work was to detect the effects of the pandemic on the german Oto-Rhino-Laryngology (ORL) university hospitals in terms of research, student teaching and further specialist training. MATERIAL AND METHODS: The chairmen of the 39 ORL university hospitals in Germany were asked about the effects of the pandemic on research, student teaching and ORL specialist training (residency) in the period from March to April 2020 using a structured online survey. RESULTS: All 39 chairmen took part in the survey. Of these, 74.4% (29/39) stated that their research activities had deteriorated as a result of the pandemic. In 61.5% (24/39) pandemic-related research issues were addressed. All hospitals reported a restriction for in-house teaching and 97.5% (38/39) introduced new digital teaching methods. During the observation period, 74.4% of the chairmen did not see ORL specialist training (residency)at risk. CONCLUSION: Our results provide an insight into the heterogeneous effects of the pandemic. The fast processing of pandemic-related research topics and the introduction of innovative digital concepts for student teaching impressively demonstrates the great innovative potential and the ability of the ORL university hospitals to react quickly in order to maintain their tasks in research, student teaching and ORL specialist training in the best possible way even during the pandemic.

[Quality in the appraisal of head and neck sonography results in university hospitals-a random sample]. / Qualität in der Befundung von Kopf- und Halssonographien an Universitätskliniken ­ eine Stichprobe.

BACKGROUND: Ultrasound diagnostics are widely used and are standard for radiologists, otolaryngologists, and oral and maxillofacial surgeons in the diagnostic work-up of various pathologies. There is agreement that digital documentation is urgently needed at present to improve and standardize the quality of sonographic documentation. There are more and more publications on the implementation of standardized documentation of findings in imaging diagnostics, including head and neck sonography. OBJECTIVE: The present work aims to determine the quality of routine head and neck sonography findings on a random basis, according to the criteria of the Bavarian Association of Statutory Health Insurance Physicians (KVB) at a selection of German university otolaryngology departments (ENT). MATERIALS AND METHODS: A total of 70 randomly selected anonymized written findings including image documentation from seven ENT departments were retrospectively analyzed by an experienced KVB examiner concerning fulfilment of KVB criteria. The data were evaluated descriptively. RESULTS: Of the 70 reports, 69 were eligible for evaluation. The average documentation completeness was 80.6%. A total of 9 findings were correctly documented in full (13%). The documentation completeness of the individual departments was sorted in ascending order from 68.1% to 93%. With 88.5% vs. 75%, the hospitals with a structured report showed a higher level of completeness. In 75% of the cases the hospitals with structured reports also had digital solutions for reporting and image archiving. CONCLUSION: In general, there is potential for optimization regarding the completeness and quality of routinely prepared head and neck sonography findings at the selected university ENT departments. The implementation of structured reporting masks and the conversion of analogue documentation into digital solutions as well as digital networking with the hospital information systems, picture archiving and communication systems should be promoted. Supervision by senior doctors is required to ensure the quality of findings of inexperienced colleagues and to help to achieve standards in reporting.

[Hygiene during otorhinolaryngological examinations : Prevention of nosocomial infections]. / Hygiene bei der HNO-Untersuchung : Vermeidung nosokomialer Infektionen.

Awareness of the importance of working as aseptically as possible first emerged in the 19th century. In the meantime, there is an obligation to prevent transmission and further spread of pathogens, including adherence to the Infection Protection Act. Pathogens can also survive for a long time on inanimate surfaces, from where they can be transferred via the hands of personnel and thus lead to infections. Studies have shown that even contamination of untouched instruments after an otorhinolaryngological examination is not a rare occurrence. The Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) of the Robert Koch Institute gives recommendations for general hygiene measures (basic or standard hygiene). These must be adapted and implemented accordingly for the otorhinolaryngological examination. Due to the increasing development of resistance of nosocomial pathogens and the current pandemic, consistent implementation of these infection-prevention measures is important.

[The diagnostic course : A new form of teaching in otorhinolaryngology education]. / Der Diagnostik-Parcours : Eine neue Lernform im Studierendenkurs der Hals-Nasen-Ohren-Heilkunde.

BACKGROUND: A lack of practical courses and increasing numbers of students generate a requirement for innovative teaching methods. We have established a diagnostic course representing the essence of our discipline of otorhinolaryngology. OBJECTIVE: The main aim of the diagnostic course is compact presentation of the functional diagnostic methods in an otorhinolaryngology department as well as the practical and varied organization of the training block. MATERIALS AND METHODS: The first day of the five-day training block includes a "mirror course", in which students learn how to perform an ENT mirror examination. After rotation in the wards, the outpatient department, and the operating rooms, the diagnostic course is completed on day 5, in which four different stations comprising practical ENT diagnostic exercises are passed through. RESULTS: The evaluation of the practical training block showed a significant improvement after introduction of the diagnostic course: in the 2019 summer semester, 38% of n = 105 had grade 1.4. Personal feedback and requests for clinical traineeships also underlined this positive assessment. CONCLUSION: The advantages of our diagnostic course are the opportunity to apply practical skills and the small group sizes (maximum five students). The discipline of otorhinolaryngology and its varied character could be optimally presented in this manner. Disadvantageous are the high personnel and logistic requirements, which should, however, be met during university teaching.

[Effects of the SARS-CoV-2 pandemic on the otorhinolaryngology university hospitals in the field of medical care]. / Auswirkungen der SARS-CoV-2-Pandemie auf die universitäre Hals-Nasen-Ohrenheilkunde im Bereich der Krankenversorgung.

INTRODUCTION: Since December 2019, the SARS-CoV-2 virus has been rapidly spreading worldwide. In Germany, an exponential increase in the number of infections was registered at the beginning of March 2020 and led to a call of the Ministry of Health to create more capacity for intensive medical treatment in hospitals. The aim of the present study was to determine the effects of the SARS-CoV-2 pandemic on Oto-Rhino-Laryngology (ORL) university hospitals regarding patient care. MATERIALS AND METHODS: An online survey was sent out to all chairmen of the 39 ORL university hospitals in Germany. The answers to the questions referred to the defined period from March 15th to April 15th 2020 and were carried out using the online survey tool "SurveyMonkey". 87 questions focused on general information, health care, and structural effects in the respective institution. RESULTS: All chairmen of the 39 university hospitals in Germany participated in the survey. The collected data prove the considerable impact on organizational, structural and medical aspects of patient care. For example, the surveyed clinics reported a decrease in outpatient cases by 73.8 % to 26.2 ±â€Š14.2 % and in surgical treatments by 65.9 % to 34.1 ±â€Š13.9 %. In contrast, emergency treatment remained unchanged or even increased in 80 % of the facilities and surgical treatment of emergency patients remained unchanged or even increased in more than 90 %. Emergency outpatient and surgical treatment of patients was provided throughout the pandemic in all facilities. In total, about 35 000 outpatients and about 12 000 surgical cases were postponed. As a result of the acute structural changes, the potential danger of falling below current treatment standards was seen in individual areas of patient care. DISCUSSION: The assessment of the impact of the SARS-CoV-2 pandemic is heterogeneous. The majority of the chairmen are critically aware of the risk of falling below current medical treatment standards or guidelines. In the phase of an exponential increase in the number of infections, significant changes in treatment processes had to be accepted for understandable reasons. However, with the currently significantly reduced number of infections, falling below treatment standards and guidelines should not be allowed to remain constant and tolerated. SUMMARY: This study shows a differentiated picture with regard to the effects of the SARS-CoV-2 pandemic on outpatient, inpatient and operative patient care at the ORL university hospitals in Germany and illustrates the importance of these institutions for ensuring patient care during this critical phase.

Control of Fundamental Frequency in Dysphonic Patients During Phonation and Speech.

PURPOSE: The pitch-shift reflex (PSR) is the adaptation of the fundamental frequency during phonation and speech and describes the auditory feedback control. Speakers without voice and speech disorders mostly show a compensation of the pitch change in the auditory feedback and adapt their fundamental frequency to the opposite direction. Dysphonic patients often display problems with the auditory perception and control of their voice during therapy. Our study focuses on the auditory and kinesthetic control mechanisms of patients with muscle tension dysphonia (MTD) and speakers without voice and speech problems. Main purpose of the study is the analysis of the functionality of the control mechanisms within phonation and speech between patients with MTD and normal speakers. METHOD: Sixty-one healthy subjects (17 male, 44 female) and 22 patients with MTD (7 male, 15 female) participated following two paradigms including a sustained phonation (vowel /a/) and speech (['mama]). Within both paradigms the fundamental frequency of the auditory feedback was increased synthetically. For the analysis of the PSR the electroencephalogram, electroglottography, the voice signal, and the high-speed endoscopy data were recorded simultaneously. The PSR in the electroencephalogram was detected via the N100 and the mismatch negativity. Statistical tests were applied for the detection of the PSR in the physiological response within the electroglottography, voice, and high-speed endoscopy signals. The results were compared between both groups. RESULTS: No differences were found between the controls and patients with MTD regarding latency and magnitude of the perception of the pitch shift in both paradigms, but for the magnitude of the behavioral response. Differences also could be found for both groups between the "no pitch" and "pitch" condition of the two paradigms regarding vocal fold dynamics and voice quality. Patients with MTD showed more vibrational irregularities during the PSR than the controls, especially regarding the symmetry of vocal fold dynamics. CONCLUSION: Patients with MTD seem to have a disturbed interaction between the auditory and kinesthetic feedback inducing the execution of an overriding behavioral response.

A 9-year analysis of transoral laser microsurgery (TLM) of head and neck cancer on their potential suitability for transoral robotic surgery (TORS) for estimation of future TORS-specific caseload.

OBJECTIVE: After that the establishment of transoral robotic surgery (TORS) for head and neck cancer has been adopted in North America, it has also recently been adopted in Europe. In these parts, transoral laser microsurgery (TLM) is widely applied. The aim of the study was to identify the absolute number of operations amenable to TORS at a TORS initiating institution on the basis of all former TLM cases. PATIENTS AND METHODS: All laser surgery procedures from May 2004 to April 2013 (108 months) were initially retrospectively registered; after that, all stage pT1 and pT2 squamous cell carcinomas of the oropharynx, hypopharynx, and larynx were selected. RESULTS: Over a period of nine years out of all TLM cases, there were 45 cases of pT1 and pT2 orohypopharyngeal and supraglottic squamous cell carcinomas, which could have been considered for TORS surgery. With the inclusion of a nowadays-typical TORS indication such as tonsil cancer, 142 cases would have been amendable to TORS. CONCLUSIONS: The indication for TORS would have been made in five of the TLM cases per year. Institutions initiating TORS, which own an intensive TLM experience, are encouraged to TORS indications in more than solely typical TLM indications. By indicating TORS instead of handheld surgery, a higher caseload of more than 15 cases per year can be achieved for TORS indications.

Value of confocal laser endomicroscopy in the diagnosis of vocal cord lesions.

OBJECTIVE: The aim of this study was to assess the reliability and limitations of confocal laser endomicroscopy (CLE) for diagnosing lesions of the vocal cords and differentiating malignant from non-malignant lesions. PATIENTS AND METHODS: During microlaryngoscopy, the vocal cords were scanned by probe-based CLE (pCLE: a GastroFlex probe with the Cellvizio® laser system, Mauna Technologies, Paris, France). The video recordings were analyzed and compared with the histological results. Thirty-one representative images were extracted and presented to four medical professionals (blinded examiners) for assessment. RESULTS: The accuracy for the category malignant/nonmalignant ranged between 58.1% and 87.1%. Overall interrater reliability was 0.29. Sensitivity ranged between 45.5 and 100%, specificity between 60.0 and 100%, PPV between 38.5% and 100% and NPV between 66.7 and 100%. CONCLUSIONS: CLE is a promising method for the non-invasive diagnosis of vocal cord lesions in vivo, but factors such as small penetration depth, not available contrast media for the nuclei and subjective analyses of the images limit, at the moment, its diagnostic value.

[Hearing restoration with cochlear implants after translabyrinthine vestibular schwannoma resection]. / Hörrehabilitation mit Cochleaimplantaten nach translabyrinthärer Vestibularisschwannomresektion.

BACKGROUND: Hearing restoration after translabyrinthine vestibular schwannoma resection is a challenge. Because the cochlea can begin to ossify a few months after cochlear or labyrinthine injury, the time interval for cochlear implant surgery is limited. To avoid complete ossification and to prolong the time interval until cochlear implantation, it is possible to insert a placeholder (depth gauge) into the cochlea and perform the cochlear implant surgery at a later time point (two-stage approach). OBJECTIVE: The aim of this retrospective case series was to present the outcomes after restoration of hearing with cochlea implants in six patients and to evaluate the use of the depth gauge in practice. METHODS: The hearing outcome of all patients with (n = 3) and without (n = 3) insertion of a depth gauge was measured with the Freiburg monosyllabic test without background noise at 65 dB. The first measurement was performed prior to the translabyrinthine vestibular schwannoma resection, the last measurement was performed up to 48 months after cochlear implantation. RESULTS: All 6 patients reached 22.5 ± 36.57% prior to vestibular schwannoma resection and 41.3 ± 26% 12 months after cochlear implantation. The understanding values of the patients with a depth gauge were 25.8 ± 16% after 12 months which is below the values of the other patients with 56.6 ± 25.0%. No severe intraoperative or postoperative complications occurred in any patient. CONCLUSION: The two-stage approach for cochlear implantation with depth gauge insertion following labrynthine incision and intact nerve appears to represent a very promising and safe variation for hearing restoration. Intensified research on this approach seems to be justified and necessary.

Extracapsular dissection in the parapharyngeal space: benefits and potential pitfalls.

The aim of this study was to investigate the benefits and potential pitfalls of transcervical extracapsular dissection in the treatment of parotid gland tumours in the parapharyngeal space. We retrospectively evaluated the records of all patients with parapharyngeal parotid gland lesions treated between 2000 and 2015 by transcervical extracapsular dissection. Patients having revision operations and patients whose records were not complete were excluded, leaving 49 patients in the study. We found acceptable oncological and functional outcomes throughout. Special attention should be paid in cases with multilobular growth of the tumour on magnetic resonance imaging, satellite tumours of pleomorphic adenomas, tumours in broad contact with the inner surface of the deep lobe, and lesions suspected of malignancy. Extracapsular dissection in the parapharyngeal region is associated with acceptable oncological and functional outcomes. These outcomes can be expected only after a thorough assessment of patient's history and preoperative imaging.

Microcystic adnexal carcinoma (MAC)-like squamous cell carcinoma as a differential diagnosis to Bell´s palsy: review of guidelines for refractory facial nerve palsy.

BACKGROUND: Bell´s palsy is the most common cause of facial paralysis worldwide and the most common disorder of the cranial nerves. It is a diagnosis of exclusion, accounting for 60-75% of all acquired peripheral facial nerve palsies. Our case shows the first case of a microcystic adnexal carcinoma-like squamous cell carcinoma as a cause of facial nerve palsy. CASE PRESENTATION: The patient, a 70-year-old Caucasian male, experienced subsequent functional impairment of the trigeminal and the glossopharyngeal nerve about 1½ years after refractory facial nerve palsy. An extensive clinical work-up and tissue biopsy of the surrounding parotid gland tissue was not able to determine the cause of the paralysis. Primary infiltration of the facial nerve with subsequent spreading to the trigeminal and glossopharyngeal nerve via neuroanastomoses was suspected. After discussing options with the patient, the main stem of the facial nerve was resected to ascertain the diagnosis of MAC-like squamous cell carcinoma, and radiochemotherapy was subsequently started. CONCLUSION: This case report shows that even rare neoplastic etiologies should be considered as a cause of refractory facial nerve palsy and that it is necessary to perform an extended diagnostic work-up to ascertain the diagnosis. This includes high-resolution MRI imaging and, as perilesional parotid biopsies might be inadequate for rare cases like ours, consideration of a direct nerve biopsy to establish the right diagnosis.

Surfactant proteins of the human larynx.

PURPOSE: Surfactant proteins (SPs) originally identified in lung tissue are important players in the innate immune system. Beyond this, they contribute to stability and rheology of gaseous or aqueous interphases. In the present study, we determined the expression and presence of SPs (A, B, C and D) in different areas of the human larynx. METHODS: mRNA expression of SP-A, -B, -C and -D was analyzed by means of RT-PCR in healthy samples of epiglottis, vocal and vestibular folds, subglottis and trachea. Distribution and localization of all four SPs were analyzed by Western blot and immunohistochemistry in healthy human tissue samples. RESULTS: All four SPs were detected at the mRNA- and protein level in the human larynx as well as by means of immunohistochemistry in the different tissue samples of the human larynx. CONCLUSION: The results reveal that all four SPs are produced with different expression patterns within the human larynx. Based on the known functions, our results suggest that SPs might be involved in maintaining mucus rheology and subsequently they could be essential components for proper phonation. Moreover, the proteins seem to play a role in immune defense of the larynx.

[3D visualization and analysis of vocal fold dynamics]. / 3D-Visualisierung und Analyse von Stimmlippenschwingungen.

BACKGROUND: Visual investigation methods of the larynx mainly allow for the two-dimensional presentation of the three-dimensional structures of the vocal fold dynamics. The vertical component of the vocal fold dynamics is often neglected, yielding a loss of information. The latest studies show that the vertical dynamic components are in the range of the medio-lateral dynamics and play a significant role within the phonation process. OBJECTIVES: This work presents a method for future 3D reconstruction and visualization of endoscopically recorded vocal fold dynamics. MATERIALS AND METHODS: The setup contains a high-speed camera (HSC) and a laser projection system (LPS). The LPS projects a regular grid on the vocal fold surfaces and in combination with the HSC allows a three-dimensional reconstruction of the vocal fold surface. Hence, quantitative information on displacements and velocities can be provided. The applicability of the method is presented for one ex-vivo human larynx, one ex-vivo porcine larynx and one synthetic silicone larynx. RESULTS: The setup introduced allows the reconstruction of the entire visible vocal fold surfaces for each oscillation status. This enables a detailed analysis of the three dimensional dynamics (i. e. displacements, velocities, accelerations) of the vocal folds. CONCLUSIONS: The next goal is the miniaturization of the LPS to allow clinical in-vivo analysis in humans. We anticipate new insight on dependencies between 3D dynamic behavior and the quality of the acoustic outcome for healthy and disordered phonation.

Assessing quality of life in patients after partial laryngectomy.

BACKGROUND: In the present prospective cross-sectional clinical study, correlations between global quality of life (QoL) and coping strategies were examined in patients who had undergone partial laryngeal resection for T1-T2 laryngeal cancer.  METHODS: Correlations between point scores in the "Trier Illness Coping Scales" and SF-36 were analysed in 71 patients (65 males, 6 females, mean age 62 years) at routine follow-up visits by means of linear regression and Pearson's R. RESULTS: The most important coping strategy was "threat control", followed by "search for social integration". Greater expression of "rumination" was statistically correlated with poorer quality of life, and patients with more advanced disease were more inclined to seek social integration. CONCLUSIONS: Coping strategies exert substantial influence on the quality of life of cancer survivors. Disease- or treatment-related day-to-day problems and anxieties about the oncological outcome have a greater influence on the quality of life of laryngeal cancer survivors than do voice changes. This finding should be taken into account in survivorship care planning.

[Validation of an automatic speech analysis in children with isolated cleft palate]. / Validierung einer automatischen Analyse der Sprechproben von Kindern mit isolierter Gaumenspalte.

BACKGROUND: Following surgical repair of cleft lip and palate, hearing and speech and language development are important issues for the continued care of affected childhood and adolescent patients. Therefore, PEAKS (Program for Evaluation and Analysis of all Kinds of Speech Disorders) was developed in order to rate speech intelligibility automatically and reduce the time required for diagnostics. PEAKS is based on a speech recognition system and was extended to incorporate a speaker model. This investigation validated PEAKS for isolated cleft palate. METHODS: From each of the 39 children with isolated cleft palate (3.1-14.5 years), 99 word productions were recorded digitally and analyzed-once "subjectively" by five experts and five nonexperts; once "objectively" using PEAKS. RESULTS: The automatic speech recognition system and the experts arrive at similar results with regard to speech intelligibility. The expert and nonexpert ratings differ significantly from each other. Within the group of nonexperts, a weak interrater reliability demonstrates the uncertainty associated with their ratings. CONCLUSION: PEAKS delivers reliable and representative results with regard to speech intelligibility among children and adolescents with isolated cleft palate. The automatic measurement of speech quality in children and adolescents with isolated cleft palate is possible.