[Update on vocal fold augmentation]. / Update Stimmlippenaugmentation.

Unilateral vocal fold palsy is a frequent cause of hoarseness. In the presence of glottis closure insufficiency, the effectiveness of conservative voice therapy is often limited and phonosurgery may be indicated. Injection laryngoplasty is effective for correction of insufficiency. Early intervention during the first 6 months after diagnosis is desired to avoid subsequent insufficient endogenous compensation. Particularly patients with glottic closure insufficiency ≤2 mm in stroboscopy may benefit from this procedure. With appropriate patient selection, duration of the effect exceeding 12 months has been described for hyaluronic acid, calcium hydroxylapatite, and autologous fat. Due to rare complications such as allergic swelling at the injection site, regular laryngoscopic monitoring and observation for two nights after injection are recommended. The voice must only be rested for a few hours.

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

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

[Occupational Hearing Loss (BK-No. 2301) - A Retrospective Analysis of 100 Consecutive Cases]. / Lärmschwerhörigkeit (BK-Nr. 2301) ­ Eine retrospektive Analyse von 100 konsekutiven Fällen.

Introduction: In order for a diagnosis of Occupational Hearing Loss (BK-no. 2301) to be made certain criteria must be fulfilled to establish that the hearing loss is occupational in origin. This work compares 2 groups, those who fulfil the criteria (BKE) and those who do not (BKNE). Methods: A 100 consecutive reports ("Lärmgutachten BK-no. 2301") written by the authors were examined retrospectively. These recorded audiometric examination, an analysis of any tinnitus and noise exposure plus use of hearing protection. Pre- and post-noise exposure status together with an expert assessment of work limitations was made to produce a 7 point score. Results: 67% of the group fulfilled the conditions for occupational hearing loss (9% were entitled to compensation). In the BKE group 82% showed typical audiometric signs of noise damage with 75% of them fulfilling at least 6 criteria of occupational disease no. 2301. Tinnitus typical for noise exposure was found in 26%. Discussion: A 7 point score could be useful in the future as a method of helping distinguish hearing loss and tinnitus from occupational as opposed to other causes.

[Manifestation of rheumatic diseases in the larynx]. / Erkrankungen des rheumatischen Formenkreis mit Manifestation im Larynx.

Rheumatic disorders (rheumatoid arthritis, sarcoidosis, systemic lupus erythematosus, Wegener's granulomatosis, relapsing polychondritis) may affect the larynx. The clinical symptoms are often unspecific, leading to delayed diagnosis. Malignant tumours should be considered in differential diagnosis with necessitating biopsy. Treatment may require interdisciplinary approach together with a specialist in internal medicine and rheumatology.

[Characterisation of a Collective of Children with Early Language Delay, 'Late Talkers']. / Charakterisierung eines Kollektivs von Kindern mit früher Verzögerung im Spracherwerb "Late Talkers".

BACKGROUND: By considering their general development, 2-year-old children with delayed speech development (late -talkers, LT) were examined and described with respect to linguistic competence and hearing. METHODS: Initially, 50 monolingual German speaking LT (age: 23-28 months) were recruited. In addition to audiological tests (impedance testing, otoacoustic emissions, reaction audiometry), language development status test was performed (clinical impression during examination, expressive vocabulary: FRAKIS, receptive competence: SETK-2). RESULTS: After exclusion of 10 children with general retarded development (3 premature infants, 2 children with suspicion of autism and 2 children with infantile brain damage) 33 LTs with normal hearing were included. The expressive vocabulary (FRAKIS) of 82% of these 33 LTs were below the normal range. 39% showed deficits in language comprehension tests (SETK-2) although parental reports mentioned language comprehension problems in only 3 LT. No correlation was found between vocabulary (FRAKIS) and language comprehension (SETK-2). CONCLUSION: The clinical collective in this study showed severely affected children with a high percentage of other abnormalities and speech perception problems in many cases. Despite normal hearing, vocabulary and especially speech comprehension should also be tested. LT with language comprehension problems require early developmental psychological investigation in order to prevent language and general developmental limitations. Only in this way, remedial instruction adapted to the develop-mental level can be initiated.

[Vocal cord paralysis--analysis of a cohort of 400 patients]. / Stimmlippenparesen--Untersuchungen an einem Kollektiv von 400 Patienten.

Vocal cord paralysis has diverse etiologies. In the present study, vocal chord paralysis caused by surgery/trauma was present in more than two thirds of the cases, followed by primary malignancy-associated paralysis. Thyroidectomy was the most common cause in bilateral paresis, especially if performed in recurrent or malignant disease. Voice therapy was promising in pa-tients with unilateral paresis and hoarseness as main symptom. Persistent dysphonia due to insufficiency of the glottic closure led to an operative glottis restricting procedure in only 6% of cases. In almost half the patients with dyspnea as the main symp-tom of bilateral vocal cord paresis, temporary tracheotomy or surgical glottis widening procedures had to be performed. The group of idiopathic and traumatic paresis patients showed the best spontaneous recovery within the first 12 months in comparison to primary malignancy-associated paralysis, which showed no recovery of the recurrens nerve.

[Children with specific language impairment: electrophysiological and pedaudiological findings]. / Kinder mit Spezifischer Sprachentwicklungsstörung:Elektrophysiologische und pädaudiologische Befunde.

BACKGROUND: Auditory deficits may be at the core of the language delay in children with Specific Language Impairment (SLI). It was therefore hypothesized that children with SLI perform poorly on 4 tests typically used to diagnose central auditory processing disorder (CAPD) as well in the processing of phonetic and tone stimuli in an electrophysiological experiment. MATERIAL AND METHODS: 14 children with SLI (mean age 61,7 months) and 16 children without SLI (mean age 64,9 months) were tested with 4 tasks: non-word repetition, language discrimination in noise, directional hearing, and dichotic listening. The electrophysiological recording Mismatch Negativity (MMN) employed sine tones (600 vs. 650 Hz) and phonetic stimuli (/ε/ versus /e/). RESULTS: Control children and children with SLI differed significantly in the non-word repetition as well as in the dichotic listening task but not in the two other tasks. Only the control children recognized the frequency difference in the MMN-experiment. The phonetic difference was discriminated by both groups, however, effects were longer lasting for the control children. Group differences were not significant. CONCLUSIONS: Children with SLI show limitations in auditory processing that involve either a complex task repeating unfamiliar or difficult material and show subtle deficits in auditory processing at the neural level.

[Reading and writing disorder (RWD) - criteria for a speech therapist intervention]. / Die Lese-Rechtschreibstörung (LRS) - Kriterien für eine sprachtherapeutische Intervention.

BACKGROUND: Children with specific language impairments carry a high risk for the development of reading and writing disorders. While deficits in phonological encoding have been well studied, there has been little research in the german speaking world into the possible correlation between linguistic ability and reading or writing skills in elementary school children. MATERIAL AND METHODS: Using a group of 27 children between the ages of 8 and 11, a battery of tests were performed to research possible correlations between linguistic ability and reading and writing ability in elementary school children. RESULTS: There was a slight correlation between writing ability of pseudo words for vocabulary (r=0.48, p<0.05), sentence repeating (r=0.50, p<0.05) and grammar (r=0.58, p<0.01). Vocabulary and grammar however were significantly correlated with writing ability (r=0.38, p<0.05). In particular, phonological encoding was significantly worse compared to receptive or expressive abilities. 67% of the children with RWD had also linguistic deficits, 15% had only phonological deficits and the remaining 18% no language deficits. CONCLUSION: The results confirm both delays as comorbid problems. Therefore it is clear that when a reading and writing disorder is present, then speech and language problems should be also suspected and appropriate speech therapy instituted.

[Etiology, diagnosis, differential diagnosis and therapy of vocal fold paralysis]. / Ätiologie, Diagnostik, Differenzialdiagnostik und Therapie von Stimmlippenparesen.

Etiology of vocal fold paralysis is broad: e. g. iatrogenic/traumatic, associated with neoplasms or with systemic diseases. The cause of idiopathic paralysis is unknown. The main symptom of unilateral vocal fold paralysis is hoarseness because of a remaining glottic gap during phonation. Patients with bilateral vocal fold paralysis typically have no impairment of the voice but dyspnea. Examination of patients with an idopathic vocal fold paralysis is a CT of the vagal nerve and recurrent laryngeal nerve from skull base to neck and mediastinum. Serological tests are not obligatory. Differential diagnosis of vocal fold immobility is vocal fold paralysis/neurological causes and arthrogene causes such as arytenoid subluxation, interarytenoid adhesion and vocal fold fixation in laryngeal carcinomas. Voice therapy is a promising approach for patients with unilateral vocal fold paralysis, but not all patients benefit sufficiently. Temporary vocal fold augmentation by injection medialization results in satisfactory voice quality that is comparable with a thyroplasty. Patients with bilateral vocal fold immobility show typically dyspnea requiring immediate therapy such as temporary tracheotomy or reversible laterofixation of the paralyzed vocal chord. If the paralysis persists a definitive enlargement of the glottic airway by eg. arytenoidectomy needs to be performed.

[Management of T1a vocal fold carcinoma]. / Management des T1a Stimmlippenkarzinoms.

About 2/3 of the larynx carcinomas affect the vocal chords. The main risk factor is smoking. Carcinomas in this localisation often arise from leukoplakias with dysplasia. A typical symptom is dysphonia. Arrest of vibration in microlaryngostroboscopy is a hint that a carcinoma could be present. Transoral laser cordectomy or radiotherapy show equivalent oncological results and results in quality of voice in the treatment of vocal fold carcinoma (T1a). As lymph node and distant metastasis are very rare, follow-up can concentrate on microlaryngoscopy. In case of a suspicious area on the vocal fold, biopsy of the affected tissue is needed to plan correct treatment. The prognosis of the T1 vocal chord carcinoma is quite good with a 5-year survival rate of almost 100%.