Intraoral electrical muscle stimulation in the treatment of snoring.

The tone of the intraoral und pharyngeal muscles of the upper airway is of particular importance for the development of snoring. By increasing the tone with electrical stimulation, a reduction in snoring may be achieved. The aim of the study was to record the effects of intraoral muscle stimulation during the day on snoring at night. The prospective bi-centric study included 16 patients with snoring and mild obstructive sleep apnoea (Apnoea Hypopnoea Index [AHI] < 15, BMI < 32). After initial polygraphy, snoring was monitored over 2 weeks (baseline) using a visual analogue scale (VAS; 0-10). This was followed by a 6-week treatment phase (2â€¯× 20 min daily) with an intraoral electrical stimulation device. During and up to 2 weeks after therapy, snoring intensity in addition to use and potential side effects were documented on a daily basis. Three patients discontinued therapy because of technical problems. The 13 remaining patients (11 male/2 female, BMI 26.9 ± 3.2, AHI 9.3 ± 4.6) underwent per-protocol analysis. The mean snoring score was reduced from 5.6 ± 1.1 (baseline) to 3.2 ± 2.7 (after therapy) and remained stable until 2 weeks after treatment (3.3 ± 2.4). In 7 patients (53.9%) the score was reduced by more than 50%. Patients with an AHI < 10 responded better to therapy. No unexpected events occurred. In the present pilot study, the first signs of the effectiveness of intraoral muscle stimulation in snoring patients were shown. In addition to a technical improvement of the stimulator, carrying out controlled trials and assessing potential influencing factors on the success of therapy are necessary.

Heidelberg Phoneme Discrimination Test (HLAD): normative data for children of the third grade and correlation with spelling ability.

OBJECTIVE: The Heidelberg Phoneme Discrimination Test (HLAD), developed and standardized in 1998, is widely used in the differential diagnosis of dyslexia. Normative data have only been available for children of the 2nd and 4th grades, while norms for the 3rd grade are still missing. PATIENTS AND METHODS: We assessed three HLAD subtests [auditory phoneme discrimination, kinesthetic phoneme discrimination (repeating minimal pairs) and phoneme analysis] in 140 children of the 3rd grade from eight elementary schools. Writing capacity was tested via DRT3. RESULTS: Comparing children of the 2nd, 3rd and 4th grades, we found a continuing increase in phoneme discrimination capacity with age. This increase was especially evident for the task of auditory comparison. For the 3rd grade, the correlation between HLAD and writing test (qualitative analysis) was 0.55, and 0.36 between HLAD and writing (quantitative analysis). The correlation with writing tasks was highest in the 2nd grade. CONCLUSION: The steady increase in phoneme discrimination capacity from the 2nd to 4th grade may indicate maturation and learning effects at least until the age of 10 years.

[Different patterns of velopharyngeal dysfunction in cleft palate patients]. / Formen der velopharyngealen Dysfunktion bei Spaltpatienten.

BACKGROUND: Velopharyngeal dysfunction (VPD) is generally known to be difficult to influence. Dysfunctional velopharyngeal motor patterns during speech were analyzed with the aim of optimizing the therapeutic strategies. METHODS: Velopharyngeal dysfunctions were videotaped and contextually analyzed during 89 speech sequences in 25 patients. Distinctive features of the motor patterns formed the basis of categorization by three therapists experienced in nasopharyngoscopy. There was a high inter-rater reliability of 94%. RESULTS: A total of four different function profiles were found: 1. VPD with retracted articulatory placement (compensatory articulation) (38%), 2. VPD with motor coordination problems characterized by mistiming of VP movements and voice onset/offset (15%), 3. VPD with verbal dyspraxia characterized by a silent positioning of VP closure before phonation started and a malregulation of muscle tonus (10%) and 4. phoneme-specific VPD (37%). CONCLUSION: Specific knowledge regarding the characteristics of dysfunctional speech motor patterns enables specifically tailored therapy.

[Gamma nail osteosynthesis of per- and subtrochanteric femoral fractures. 4 years experiences and their consequences for further implant development]. / Gammanagel-Osteosynthese per- und subtrochanterer Femurfrakturen. 4-Jahres-Erfahrungen und ihre Konsequenzen für die weitere Implantatentwicklung.

The Gamma nail can be used in all types of per- and subtrochanteric fractures because of its biomechanical characteristics. In this prospective evaluation of our 330 patients treated between November 1989 and November 1993 the usefulness of the Gamma nail for the osteosynthesis of all types of fracture was evaluated. The rate of intraoperative and postoperative complications but also gait function, postoperative weight bearing, general complications, and survival were analysed. We compared the results of four therapy periods to evaluate the importance of the expertise of the surgeon and the 'learning curve'. The Gamma nail osteosynthesis was performed in 72-98% in unstable per- and subtrochanteric fractures. The nail diameters used shifted to the 12 mm nail (99%) and the 130 degrees angle (93%) in the fourth examination period. The intraoperative complication rate is highly dependent from the expertise of the surgeon and the experience with the system. The rate decreased from 42.2% in the first to 17.2% in the fourth examination period. The most important complications were: additional fractures (1.7%), distal locking screw problems (7%), femoral head rotation (2,4%), and not sufficient fracture reduction (4.1%). Whereas in general these did not influence the postoperative management the use of a too short femoral neck screw lead to instability. Postoperative local complications were: rotation of the femoral head and neck (0.6-5.5%), related to the gliding of the neck screw (0.6-4%), fracture at the end of the nail (1.8-4%), fatigue break of the nail (1 case) and hematoma (1.2-8.3%). In all these cases reoperation was needed. To reduce the rate of intra- and postoperative complications a new gliding nail (GN) is presented. Due to the double T-profile of the femoral neck blade the implant is stable for neck rotation. The blade has a collar which makes it impossible to implant the blade to deep in the femoral neck. The larger nail profile at the femoral neck perforation reduces the risk of implant failure. The implant can be used as dynamic compression as well as static implant both in the direction of femoral neck and shaft.