[How to render an expert opinion on dysphonia]. / Begutachtung der Stimmfunktionsstörung.

In Germany, parameters for medicolegal evaluation of dysphonia have to be revised against the background of communication disorders getting more important in a modern communication society. In this work, up-to-date diagnostic tools are reviewed and evaluated for medicolegal purposes. Parametrization is -performed according to the International Classification of Functioning, Disability and Health ICF. Following this schema, -dysphonia is graded as follows: 1) No dysphonia (no problem, percentile 0-4) impairment of the whole person 0%, 2) Slight, strain-induced dysphonia (slight problem, percentile 5-24) -impairment of the whole person 0-10%, 3) Moderate dysphonia (moderate problem, percentile 25-49) impairment of the whole person 20-30%, 4) Severe dysphonia (severe problem, percentile 50-95) impairment of the whole person 40-50%, 5) Complete loss of voice (extreme problem, percentile 96-100%) impairment of the whole person 50%.

Voice handicap index and voice-related quality of life in small laryngeal carcinoma.

Laryngeal cancer can affect the patients' voice. For assessment of the patients' self-perception of their voice, several tools were introduced into clinical routine. The voice handicap index questionnaire (VHI) is regarded as the "gold standard". However, in benign laryngeal pathologies and in functional dysphonia, the shorter voice-related quality of life questionnaire (V-RQOL) proved to be equivalent. This study examines the correlation of both questionnaires in patients who had been treated for small (T1 and T2) laryngeal cancer. It was performed during regular outclinic examinations. In total, 65 patients aged 62.1 ± 10.0 years completed the German versions of the VHI and V-RQOL. Their average VHI total score was 38.9 ± 26.0 points and the average V-RQOL score was 70.1 ± 24.4%. The total scores correlated with |ρ| = 0.92 and p < 0.01. Both questionnaires give quasi identical results, the shorter V-RQOL may be favoured for clinical application.

[Phoneme analysis and phoneme discrimination of juvenile speech therapy school students]. / Lautanalyse und Lautdiskrimination jugendlicher Sprachheilschüler.

BACKGROUND: Phoneme analysis and phoneme discrimination, important factors in acquiring spoken and written language, have been evaluated in juvenile speech therapy school students. The results have been correlated with the results of a school achievement test. The following questions were of interest: Do students in the lower verbal skill segment show pathological phoneme analysis and phoneme discrimination skills? Do the results of the school achievement test differ from the results by students visiting German "Hauptschule"? How does phoneme analysis and phoneme discrimination performance correlate to other tested parameters? PATIENTS AND METHODS: 74 students of a speech therapy school ranging from 7 (th) to 9 (th) grade were examined (ages 12;10-17;04) with the Heidelberg Phoneme Discrimination Test H-LAD and the school achievement test "Prüfsystem für Schul- und Bildungsberatung PSB-R 6-13". RESULTS: Compared to 4 (th) graders the juvenile speech therapy school students showed worse results in the H-LAD test with good differentiation in the lower measuring range. In the PSB-R 6-13 test the examined students did worse compared to students visiting German "Hauptschule" for all grades except 9 (th) grade. Comparing H-LAD and PSB-R 6-13 shows a significant correlation for the sub-tests covering language competence and intelligence but not for the concentration tests. CONCLUSIONS: Pathological phoneme analysis and phoneme discrimination skills suggest elevated need for counseling, but this needs to corroborated through additional linguistic parameters and measuring non-verbal intelligence. Further trails are needed in order to clarify whether the results can lead to sophisticated therapy algorithms for educational purposes.

[Swallowing-related quality of life in oral cavity cancer. The German version of the Anderson Dysphagia Inventory]. / Schluckbezogene Lebensqualität bei Mundhöhlenkarzinomen. Anderson-Dysphagia-Inventory, deutsche Version.

BACKGROUND: The objective of this study was to validate the German version of the Anderson Dysphagia Inventory (ADI), as well as to grade it by using health-related quality of life as an external criterion. PATIENTS AND METHODS: A total of 102 patients (26 women, 76 men) aged 34-90 years (61.1+/-10.8) with a treated squamous cell carcinoma of the oral cavity participated in the study. All study participants independently completed the German version of the ADI and the SF-36 questionnaire on health-related quality of life. The German ADI was tested for its validity and reliability, and subjected to a factor analysis. RESULTS: The internal consistency reliability of the ADI was calculated using Cronbach's alpha coefficient and was equal to 0.942. In the split-half reliability the Spearman-Brown coefficient scored 0.916. Factor analysis showed a one-factor result. The correlation coefficients between the point scores of the German ADI and the following clinical parameters demonstrated construct validity: radiation (p<0.001), T-classification (p=0.002), surgical method (p=0.018), not, however, tumor site (p=0.115). The grading system was as follows: scores <55 are regarded as "definitely noticeable"; scores 55-70 are considered as "more noticeable than not"; while scores >70 are classified as " more unnoticeable than not". CONCLUSION: The German translation of the ADI is a validated and reliable method to assess swallowing-related quality of life.

[Speech developmental delay in preschool children: evaluation of screening with anamnesis questions]. / Sprachentwicklungsstörungen bei Vorschulkindern: Bewertung des Screenings mit Anamnesefragen.

BACKGROUND: In western societies, delay of speech development is frequent and important as it may affect the entire development of a child. Therefore, early diagnosis and treatment is of outstanding relevance. For screening purposes in clinical practice, questionnaires focussing on speech development are assumed to be both valid and economic assessment tools. In this study, results of a questionnaire based on "milestones in early childhood development" as previously reported by Michaelis for German children were compared with results of systematic German speech development tests. PATIENTS AND METHODS: In a retrospective study, data were collected from 25 German preschool children. Their parents had completed a questionnaire on their child's development prior to the examination with 4 questions focussing on speech development. In this report, the answers on these 4 questions are evaluated against the background of systematic German speech development tests, i.e. the H-SET and PLAKSS, and an unsystematic examination by an experienced speech and language phonologist. RESULTS: The questionnaire had a sensitivity of 50% and a specificity of 7%. The positive and negative predictive values were 55.9% and 5%, respectively. CONCLUSION: A questionnaire based on "milestones in early childhood development" as previously reported by Michaelis for German children, is clinically invalid for screening speech development in preschool children.

[Quality of life in dysphonia]. / Lebensqualität bei Dysphonien.

Quality of life is multidimensional and comprises physical, emotional, and social aspects. It has always been the implicit focus of medical work. However, since the 1980s it has been possible to measure it explicitly. Quality of life is impaired in dysphonic patients; this finding is supported by specific studies on self-reported physical, emotional, and social well-being. For practical application of these data, it is recommended to measure all three domains. From a therapeutic point of view, verbal intervention following the PLISSIT model (permission, limited information, special suggestions, intensive therapy) has been proven to enhance patient satisfaction. Therefore, this clinical procedure is recommended for routine application in dysphonic patients.

[Grading of the voice-related quality of life index]. / Graduierung des Voice-Related-Quality-of-Life-Index.

BACKGROUND: Although the voice-related quality of life (VRQOL) questionnaire has proved to be an appropriate diagnostic tool, there are no recommendations on how to grade the score. In this study the VRQOL was graded against the background of health-related quality of life. PATIENTS AND METHODS: A total of 105 patients (56 women and 49 men) aged 49.4+/-16.1 years who presented with dysphonia of benign origin completed a German version of the VRQOL and the SF-36 health survey after giving informed consent. There was an organic disorder in 50%, in 37% a functional disorder and 13% had no disorder. RESULTS: The only difference between the results of the VRQOL and the SF-36 was in the subscale on social functioning which showed a moderately strong (r(S)=0.40) and highly significant reduction in dysphonic patients (p<0.001). These results were therefore used as an external criterion for the graduation of the VRQOL results. The data suggest that VRQOL values of 0-40 can be classified as "clinically relevant deterioration", values of 41-80 as "no clinically relevant deterioration" and values over 80 as "normal" voice-related quality of life". CONCLUSIONS: The suggested grading system simplifies the assessment of individual VRQOL values. Now their clinical relevance as indication and end-point parameters must be investigated.

[Satisfaction of dysphonic patients with psychosomatic assessment and intervention]. / Zufriedenheit dysphoner Patienten mit einer psychosomatischen Diagnostik und Intervention.

BACKGROUND: Comorbid physical and psychological complaints are more common in patients with dysphonia than in the general population. In a prospective randomized study the effects of structured psychosomatic diagnostics and verbal intervention on the satisfaction of patients with dysphonia were investigated. MATERIALS AND METHODS: A total of 54 dysphonic patients (33 women, 21 men, age 51.1+/-16.4 years) with dysphonia (organic n=36, functional n=18) were examined and their subjective experiences were collected by the following psychometric questionnaires: voice-related quality of life (VRQOL), hospital anxiety and depression scale (HADS-D) and the "Giessener Beschwerdebogen" (Giessen questionnaire on physical complaints GBB). Patients were randomized into 2 groups: group 1 (n=27) filled in the questionnaires and the answers were reviewed within the medical consultation. This was followed by an interview on patient satisfaction. In the control group 2 (n=27) a medical examination and consultation were carried out and then questioned on patient satisfaction. The psychometric questionnaires were completed by the patients shortly before leaving the department. RESULTS: The study group 1 was significantly more satisfied than group 2 on different statistic levels according to the items compared. CONCLUSIONS: Patients suffering from dysphonia are positively influenced with respect to patient satisfaction by a structured psychosomatic diagnostic and intervention.

[Outpatient satisfaction in phoniatrics and pedaudiology]. / Zufriedenheit ambulanter Patienten in der Phoniatrie und Pädaudiologie.

BACKGROUND: The purpose of this study was the development of a standardized, reliable and valid questionnaire to evaluate outpatient satisfaction of phoniatrics and pedaudiology ambulatory care, considering specific aspects of the process and institutional features from the psychosocial point of view. DESIGN: The stress-theoretical conceptualized questionnaire with 89 single items and 3 open questions, distinguishes between practical, appraisal, emotional, informational and participational support. The survey was conducted with 91 patients. RESULTS: The questionnaire is a reliable and valid instrument for measuring outpatient satisfaction. The interclass correlations, Cronbach's alpha and Kaiser-Meyer-Olkin coefficients reached satisfactory values. Quantitative and qualitative more information about timely orientation related to operational aspects and the duration of examination and treatment, the questionnaire on the individual case history, medical instruments, examinations itself and therapy planning, all correlated with specific episodes of ambulatory care with a high degree of satisfaction. CONCLUSIONS: Patient satisfaction is one of the central outcome parameters in medicine. It describes specific strengths and weaknesses of an institution and enables external quality comparisons. For the latter more global questions are required while increasing specificity and a number of detailed items reduce the comparability with other medical providers. A reliable and valid instrument for measuring outpatient satisfaction with a high level of specificity, practicability and relative comparability can be proposed for use in phoniatrics and pedaudiology.

[Automated postlaryngectomy telephone test]. / Automatisierung des Postlaryngektomie-Telefontests.

OBJECTIVE: In this study, an objective version of the postlaryngectomy telephone test (PLTT) for measuring speech intelligibility based on automatic speech recognition is presented. METHODS: Thirty-one patients with tracheoesophageal substitute voice (25 men and six women, 63.4+/-8.7 years) were evaluated by 11 naïve listeners. The automatic measurement of speech intelligibility was expressed by means of word accuracy and word recognition rates, or the percentage of correctly recognized words from a word sequence. These automatic measures were compared with the subjectively obtained PLTT values. RESULTS: The average PLTT intelligibility of the 11 naïve listeners was 47%; the automatically obtained word accuracy and word recognition rates were much lower (approximately 0% and 15%, respectively). The correlation between subjective and automatic evaluation, however, reached more than 0.9 in some of the examined cases. CONCLUSION: Automatic speech recognition provides an efficient, objective measure that is equivalent to the overall PLTT intelligibility value.

[Complaints of patients with dysphonia]. / Klagsamkeit von Patienten mit Dysphonien.

BACKGROUND: In this study, the problems and difficulties experienced by German-speaking voice patients were assessed using a structured questionnaire. METHODS: A total of 54 patients, 30 women and 24 men, aged 48.5+/-15.8 years suffering from benign organic and functional voice disorders, underwent systematic phoniatric examination including a detailed interview about the voice problem. The same procedure was applied to 56 age and gender matched normal control persons. RESULTS: There were no significant gender or diagnosis-related differences concerning the number and type of symptoms and symptom-related complaints (p>0.05). Most patients (88.9%) felt disturbed by their voice problem in a total of 118 different daily situations. CONCLUSIONS: The way patients experience voice disorders does not depend on the origin of the disorder and not on the gender. The data allow the conclusion that the case history of dysphonic patients can be assessed by a structured voice interview.

[Questionnaire on auditory perception disorders: psychometric correlates in preschool children]. / Anamnesebogen für auditive Verarbeitungs- und Wahrnehmungsstörungen : Psychometrische Korrelate im Vorschulalter.

BACKGROUND: A standardized questionnaire on central auditory processing disorders ["Anamnesebogen zur Erfassung auditiver Verarbeitungs- und Wahrnehmungsstörungen (AVWS)"] was developed by the German Society of Phoniatrics and Pediatric Audiology and standardized for school-age children. This study was designed to elucidate the validity of this questionnaire in preschool children. METHODS: The responses, which were given by the parents of 84 preschool children with respect to auditory discrimination and auditory memory, were correlated with the results of the Heidelberg screening test for preschool children (HVS), and their accuracy of prediction was determined. RESULTS: Similar to the results of other studies in school-age children, weak but significant correlations were found between the questionnaire results regarding auditory discrimination and auditory memory and the respective results of the HVS subtests. With a few exceptions, the questionnaire's accuracy of prediction was low. CONCLUSION: For preschool children, the questionnaire provides a reasonable method to get specific information about a child's history in a standardized and economic way. However, it is not valid as a screening or diagnostic tool.

[Grading of the Voice Handicap Index]. / Graduierung des Voice-Handicap-Index.

BACKGROUND: The Voice Handicap Index (VHI) questionnaire is currently regarded as the gold standard for the measurement of subjective suffering caused by dysphonia. The object of this study was to show how to weight or grade the result yielded by the VHI. To this end, the result obtained with the VHI was graded against the external criterion of health-related quality of life and also compared with the VHI results obtained in persons not affected by dysphonia. PATIENTS AND METHODS: A total of 101 patients (61 women, 40 men) aged between 19 and 86 (48.4 +/- 14.6) years and suffering from benign dysphonia (organic in 62%, functional in 38%: 62% and 38%, respectively in the women, 63% and 37%, respectively, in the men) took part in the study. The instruments used were a German version of the VHI and the SF-36 Health Survey on health-related quality of life, which is commercially available. RESULTS: There are two subscales to the SF-36, but only the values for physical health were significantly reduced and correlated significantly with the results on the VHI scale. This subscale was therefore used as the external standard for grading of the VHI results. Following the separation of the VHI results recorded in the nondysphonic test subjects a four-point grading of the VHI results emerged. CONCLUSIONS: VHI values of 0-11 are classified as grade 0 suffering (almost certainly not noticeable), while values of 12-28 reflect grade 1 (more likely unnoticeable than conspicuous) suffering; values of 29-56 reflect grade 2 suffering (more probably noticeable than not), and values of 57-120 suggest a classification of certainly noticeable and are graded as grade 3 suffering.

[Basic research on vocal fold dynamics: three-dimensional vibration analysis of human and canine larynges]. / Grundlagenuntersuchungen für Stimmlippendynamik : 3D-Schwingungsanalyse menschlicher und caniner Kehlköpfe.

BACKGROUND: The understanding of normal and pathological vocal fold dynamics is the basis for a pathophysiological motivated voice therapy. Crucial vocal fold dynamics concerning voice production occur at the medial part of the vocal fold which is seen as the most critical region of mucosal wave propagation. Due to the limited size of the larynx the possibilities of laryngeal imaging by endoscopic techniques are limited. MATERIAL AND METHODS: This work describes an experimental set-up that enables quantification of the entire medial and superior vocal fold surface using excised human and in vivo canine larynges. RESULTS: The data obtained enable analysis of vocal fold deflections, velocities, and mucosal wave propagation. The reciprocal dependencies can be examined and different areas of vocal fold dynamics located. The vertical components obscured in clinical endoscopy can be visualized. This is not negligible. CONCLUSIONS: In particular it is shown that the vertical deflection, which cannot be observed by clinical examination, plays an important part in the dynamics and therefore cannot be omitted for therapeutic procedures. The theoretically assumed entrainment and influence of the two main vibration modes enabling normal phonation is confirmed.

[Critical factors for subjective burden of mothers of children with developmental language disorders]. / Bedingungen des Erlebens der Mütter von Kindern mit Sprachentwicklungsstörungen.

BACKGROUND: In earlier studies, it was found that mothers of children with developmental language disorders had a higher incidence of anxiety and depression in comparison to the normal population. This study concentrated on the following questions: is the perceived stress, anxiety and depression of mothers with children with developmental language disorders higher than in the normal population, even for those mothers who are not exposed to any further stressors? and what environmental factors play an important role in the mental health of the mothers? MATERIALS AND METHODS: A total of 90 mothers (aged 32.9+/-4.7 years) of preschoolers diagnosed with a developmental language disorder, but with otherwise normal development, participated in the study. The mental health of the mothers was assessed using the Perceived Stress Scale (PSS) and the German version of the Hospital Anxiety and Depression Scale (HASD-D). Environmental factors were captured by a structured anamnestic procedure. Predictors of mental health were determined using multivariate regression analysis. RESULTS: The entire sample demonstrated significant levels of stress, anxiety and depression. In comparison to the standardized values, those mothers of children with developmental language disorders who were not exposed to any further stressors, were also shown to have significantly higher rates of stress and depression on the scales used, although not significantly higher levels of anxiety. A significant predictor of positive overall mental health of the mothers was the extent of adequate support in child rearing. CONCLUSIONS: Health professionals dealing with children with developmental language disorders must reckon with a considerable number of mothers whose mental health is negatively affected. When treating a child with a developmental language disorder, measures to improve the mother's state of well-being should be considered, including counseling and self-help groups.

[Subjective aspects in mothers of speech impaired children]. / Subjektive Aspekte bei Müttern von Kindern mit Sprachentwicklungsstörungen.

OBJECTIVE: The purpose of this study was to evaluate the subjective burden in mothers of speech impaired children against the presence or absence of emotional disorders such as anxiety and depression. METHODS: A total of 89 mothers (age 33.3+/-5.5 years, range: 19.6-43.8 years) of 89 speech impaired preschool children (23 girls, 66 boys, age: 3.9+/-1.5 years, range: 1.6-7.1 years) were examined. Screening for a depressive or anxiety disorder was performed using the German version of the Hospital Anxiety and Depression Scale HADS-D. The "Short Questionnaire on Current Burden" (Kurzfragebogen zur Aktuellen Belastung, KAB) was used to measure the level of perceived subjective burden at the time of the investigation. RESULTS: A higher score in the KAB test occurred significantly more often in mothers with a positive HADS depression/anxiety subscale result than in those with a negative one. CONCLUSIONS: There is a need for specific assessment of wellbeing in mothers of speech impaired children. In clinical practice, one may restrict oneself to the use of a screening test for anxiety and depression.

[Hearing impairment in children and adolescents with Down's syndrome]. / Hörvermögen bei Kindern und Jugendlichen mit Down-Syndrom.

BACKGROUND: There are controversial opinions about the incidence of hearing impairment of children and adolescents with Down's syndrome as an additional cause for obstruction in social and communicative live. Next to congenital diseases of the inner ear, functional limitations can often lead to conductive hearing disorders in patients with Down's syndrome. PATIENTS AND METHODS: The hearing ability, otoscopic and audiometric characteristics of 115 patients aged 3.2+/-2.9 years were analysed retrospectively over 42 months. RESULTS: A total of 86 children showed morphologic otoscopic peculiarities: transitory evoked otoacoustic emissions (TEOAE) were often non-reproducible, even in patients with normal hearing abilities(14.1% of cases), and were not evaluable in 32.8% of cases. Half of the patients showed hearing loss, 82% of whom suffered from a conductive hearing loss, 6.9% from a combined, and 8.6% from isolated sensorineural hearing loss. Hearing loss was first diagnosed when the children were 4.6+/-3.4 years old. CONCLUSION: The frequent occurrence of hearing loss justifies and requires an early and continuous pedaudiological examination. As a common screening examination, TEOAE is limited due to its cost, however, it fulfils its purpose as a means of distinguishing healthy children from those with possible hearing disorders. In most cases, objective and subjective audiometric methods must be combined in order to precisely define the hearing ability.

[Voice Handicap Index (VHI) in inpatient voice rehabilitation medicine]. / "Voice Handicap Index" (VHI) in der stationären Stimmrehabilitation.

BACKGROUND: The focus of this study was to determine if the Voice Handicap Index (VHI) is a valid tool for evaluating an inpatient voice rehabilitation program. PATIENTS AND METHODS: A total of 39 German-speaking patients were asked to complete a German version of the VHI questionnaire at the beginning and 3 months after attending a voice rehabilitation program on an inpatient basis at the Bad Gögging voice center. The data collected were documented and assessed using Microsoft Excel and MATLAB. RESULTS: A significant reduction of the VHI summary score was achieved by 10 of 39 patients. An increased number of voice therapy sessions before the program diminished (!) the VHI score 3 months after the program. Work disability because of the dysphonia before the beginning of the voice rehabilitation program showed no significant correlation with the VHI score. CONCLUSIONS: At present, the VHI cannot be regarded as a reliable measure to evaluate benefit derived from completing a voice rehabilitation program on an inpatient basis. Apparently, numerous prior treatment regimens constitute a negative prognostic criterion for rehabilitation success as measured subjectively by the VHI.

[Prosthetic voice rehabilitation after laryngectomy. Failures and complications after previous radiation therapy]. / Prothetische Stimmrehabilitation nach Laryngektomie. Komplikationen und Misserfolge nach vorheriger Bestrahlung.

BACKGROUND: Indwelling voice prostheses are state of the art for post-laryngectomy voice rehabilitation. The aim of this study was to identify the impact of radiation prior to tracheoesophageal puncture on success rate and complications. PATIENTS AND METHODS: We undertook a retrospective study of 145 patients who had undergone prosthetic voice restoration between 1990 and 2002 (Provox) and Provox2). Risks of functional failure and complications in 17 patients with previous radiation therapy were compared to those of 128 patients without such therapy. RESULTS: Previous radiation increased not only the risk of functional failure by 2.9 (P=0.023), but also the risk of shunt-related complications such as aspiration around the prosthesis (1.51; P=0.046), widening of the shunt (2.32; P=0.014), esophageal (2.51; P=0.013) or tracheal (3.29; P=0.0023) dislocation of the prosthesis and spontaneous (2.51; P=0.047) or surgical closure (3.76; P=0.037) of the shunt. CONCLUSION: Primary tracheoesophageal puncture during laryngectomy is recommended in cases without previous radiation therapy, especially when post-laryngectomy radiation is likely. In patients with previous radiation therapy, generally good success rates decrease, however, without absolute contraindication of tracheoesophageal puncture. These results may affect salvage surgery concepts.