Culture and successful eradication of Helicobacter pylori from heterotopic gastric mucosa.

Helicobacter pylori colonizes the gastric mucosa of humans and can cause chronic gastritis, peptic ulcer disease, gastric cancer or mucosa-associated-lymphoid tissue (MALT) lymphoma. Here, we report the case of a 61-year-old male patient who presented with tickle of the throat, globus sensation and heartburn. In an esophagogastroduodenoscopy subpharyngeal localized heterotopic gastric mucosa (HGM), reflux esophagitis and a chronic gastritis were diagnosed. HGM and stomach were H. pylori positive as proven by culture and histopathological examination. After eradication therapy with a proton pump inhibitor (PPI), amoxicillin and clarithromycin followed by PPI treatment, the patient reported clinical improvement and the histopathological changes in the HGM due to H. pylori infection improved, too. This case report demonstrates that culture and susceptibility testing of H. pylori using established protocols succeeds not only from tissue samples of the stomach but also from heterotopic gastric mucosa. Eradication therapy may not only improve typical H. pylori associated discomforts of the stomach but also extragastric signs and symptoms of H. pylori infection.

[Auditory processing disorders : Consensus statement by the German Society for Phoniatry and Paedaudiology]. / Auditive Verarbeitungs- und Wahrnehmungsstörungen: Konsensus-Statement der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie.

The consensus statement published by the German Society for Phoniatry and Paedaudiology in the year 2000 has been revised and actualized. The revised version takes into account current scientific and clinical findings. Aspects of the definition of auditory processing disorders (APD) are described extensively. These include symptoms, anamnestic information and diagnostic steps (preliminary examinations, subjective and objective audiological procedures). APD can appear in different forms, some of which can be classified within subtypes. Furthermore, factors which need to be considered in order to differentiate between APD and other diseases are specified. Therapeutic intervention possibilities which are rated according to their prognostic values conclude the article.

[Correlations between "questionnaire of auditory perception disorders" and "Heidelberger test of phonemic discrimination"]. / Zusammenhänge zwischen "Anamnesebogen für Auditive Verarbeitungs- und Wahrnehmungsstörungen" und "Heidelberger Lautdifferenzierungstest".

BACKGROUND: A standardized anamnestic questionnaire of central auditory processing disorders ("Anamnestischer Erhebungs- und Beobachtungsbogen für auditive Verarbeitungs- und Wahrnehmungsstörungen") (FB-AVWS) was developed by German paedaudiologists. The present study examined the relations between this questionnaire and the results of selected auditory-perceptual tests to evaluate the validity of the FB-AVWS. SUBJECTS AND METHOD: As part of a multicentric study, 113 pupils in primary schools were examined by the "Heidelberger Lautdifferenzierungstest", a test of phonemic discrimination and identification (HLAD). Additionally, the parents answered the FB-AVWS. Sensitivity, specificity and correlations with the FB-AVWS were determined referred to the HLAD. RESULTS: We found significant, though moderate correlations, between the scale "auditory discrimination" of the FB-AVWS and the subtests "kinaesthetic/phonemic identification" and "phonemic analysis" of the HLAD. The other subscales of the FB-AVWS showed no significant correlations with the HLAD and its several subtests. The values for the sensitivity of the FB-AVWS were relatively high (93 and 100 %) as where the negatively predictive values for the HLAD as a whole and the subscale 1B (98 and 100 %), referred to HLAD. The specificity and the positive values were relatively low for the HLAD as a whole and for several of its subtests. CONCLUSION: The FB-AVWS is a useful supplementation for the complementary clinical evaluation of central auditory disorders. It allows an assessment of the child's auditory perception and processing skills compared to the general population of primary school children. However, it is not valid as a screening or diagnostic instrument.

[Status of hearing aid use by children in schools for the hearing impaired and deaf]. / Zum Stand der Hörgeräteversorgung bei Schülern und Schülerinnen der Schwerhörigen- und Gehörlosenschule.

To evaluate and possibly improve the hearing aid fittings of children attending the Westphalian School for the Hearing Impaired or the Westphalian School for the Deaf, regular pedaudiologic consulting hours were established at both schools. During a 2-year period, 115 children were examined once, 35 children twice, and 5 children three times. The examinations comprised ear microscopy, audiometry, and a check of the hearing aids with a 0.6-cm3 coupler (children up to 7 years) or 2-cm3 coupler, respectively. The following criteria were used to assess the quality of the hearing aid setting: status of the external auditory canal and middle ear, acceptance of wearing the hearing aid, status of the ear mold, technical status of the hearing aid, and its setting. The results were related to four variables: gender, type of school, age, and mean hearing loss. Overall, just 40.9% of all children showed satisfactory hearing aid performance at the first examination and just 37.1% at the second. A significant influence of the variables on the hearing aid performance was documented for hearing loss only. The higher the hearing loss, the more likely the children were to have good hearing aid status. Analysis of the different parameters revealed that an incorrect setting was the main problem, with a rate of 20.9%; the rate of the other parameters varied from 6.1% to 15.7%. Thus, no parameter was of major relevance to the results. The results of the second examination were poorer in most parameters than those of the first. These alarming results, which are probably not only of regional significance, demonstrate that the hearing aid status of children attending schools for the hearing impaired or for the deaf is in urgent need of improvement.

[Acid esophago-pharyngeal reflux as etiology of hoarseness]. / Saurer ösophago-pharyngealer Reflux als Ursache von Heiserkeit.

BACKGROUND: Gastroesophageal reflux has been implicated in otolaryngologic problems, particularly chronic hoarseness that cannot be attributed to other causes. PATIENTS AND METHODS: To study this relationship between gastroesophageal reflux and chronic hoarseness we used 24-h dual-site ambulatory pH-recordings in 68 patients with chronic hoarseness and laryngeal lesions suggestive of acid irritation. RESULTS: Thirty-eight patients (56%) had evidence of at least one esophago-pharyngeal reflux episode. The mean number of esophago-pharyngeal episodes was 6.7 +/- 12 within 24 hours (range: 1-34 episodes). The mean duration of these episodes was 201 +/- 28 seconds (range: 6 seconds-19.6 minutes). Most patients with esophago-pharyngeal reflux had no evidence of pathologic gastroesophageal reflux. Only 28.9% of the patients with esophago-pharyngeal reflux episodes also had pathologic gastroesophageal phageal reflux, whereas 23.3% of the patients without esophago-pharyngeal reflux had no gastroesophageal reflux disease. The esophago-pharyngeal reflux occurred mainly in the upright position. CONCLUSIONS: Occult esophago-pharyngeal reflux, predominantly in the upright position, appears to be common and severe in patients with chronic hoarseness. Gastroesophageal reflux may be an important factor in the pathogenesis of chronic hoarseness. The causative mechanisms are not clear.

A cross-sectional study of speech- and language-abilities of children with normal hearing, mild fluctuating conductive hearing loss, or moderate to profound sensoneurinal hearing loss.

A total of 1528 pre-school children (mean age 4 years and 9 months), being identified as speech or language delayed, were evaluated with respect to micro-otoscopy, nose and throat pathology, hearing function, and speech-language abilities. Subjects were classified into groups of (I) constant normal hearing, (II) fluctuating conductive hearing loss and (III) bilateral moderate to profound sensorineural hearing loss requiring hearing aids. In groups II and III, severe speech and language pathologies were found more frequently than in group I. Additionally, auditory perception skills were less in group II, even if peripheral hearing function was normalized. Group III was affected more than group II, but not significantly. The results indicate that in children having speech or language delay for severals reasons, mild fluctuating hearing loss can additionally alter language acquisition, but less than in cases of moderate or profound sensoneurinal hearing loss. The need of early detection of sensoneurinal hearing loss appears widely accepted; this study demonstrates also the necessity of early diagnosis of mild fluctuating hearing loss, especially in children with speech-language delay.

A possible role of Helicobacter pylori infection in the etiology of chronic laryngitis.

In order to study a possible role of Helicobacter pylori infection in chronic laryngitis, we performed endoscopic and histological assessments in addition to a urease test for the bacterium in 35 patients with chronic hoarseness. Six of the patients investigated (17.1%) revealed a positive urease test of the laryngeal biopsy (four male and two female patients). These H. pylori-positive patients were treated with omeprazole and an antibiotic regimen using clarithromycin and metronidazole. This led to an eradication of the H. pylori and resolution of clinical signs and symptoms. These findings show a possible role of H. pylori infection in the etiology of chronic laryngitis in certain patients and can be important for clinical diagnosis and treatment.

[Prevention of unilateral hearing loss]. / Prävention bei einseitiger Schwerhörigkeit.

Unilateral hearing loss entails many problems in hearing during the entire life of the affected patients. This article is an attempt to inform about the special problems of the hearing loss in infancy and about preventive measures for the benefit of these patients.

[Screening tests in childhood. Hearing screening--a necessity?]. / Screening-Untersuchungen im Kindesalter. Hörscreening--Eine Notwendigkeit?

The incidence of hearing loss in early childhood is not exactly defined in the Federal Republic of Germany. There are only some publications on this problem giving incidental information. By analysing this sparse data we tried to determine whether in incidence of hearing loss also applies to the German region. It appears necessary that hearing loss is screened in Germany, considering that other diseases having a lower incidence are also screened.

[Significance of results of developmental physiologic studies for therapy of hearing handicapped children]. / Die Bedeutung entwicklungs-physiologischer Untersuchungsergebnisse für die Therapie hörbehinderter Kinder.

Hearing loss in infancy may produce central deprivation of the auditory system, especially in the first year during the critical period of brain development. It is there fore necessary to treat any hearing loss, severe or mild, by hearing aids or operation as early as possible.

[Value assessment of MIRA (multichannel infant reflex audiometry). 1. On response detection from activity curves]. / Wertabschätzung der MIRA (Multichannel Infant Reflex Audiometry). 1. Zur Antworterkennung aus den Aktivitätskurven.

The activity curves (sucking, breathing, eye movements) of 18 babies were inspected for alterations which might indicate reactions of hearing. In 10 cases, 4 of them also confirmed by ABR findings, we found it possible to deduce the hearing threshold from alterations of the respective activities alone even without knowledge of the occurrence of the stimulus (blind experiment, addition of the stimulus time after identification of activity alterations). Greater discrepancies are discussed with respect to the experience of the investigator and to different methods of audiometry.

[A diagnostic problem: hearing disorder in childhood]. / Das Diagnoseproblem: Hörstörungen im Kindesalter.

Hearing losses of different etiology can impair the individual development during the entire childhood. Especially moderate hearing losses are difficult to diagnose because they rather present as speech or learning disorders. From the paedaudiologist's view methods are printed out for an early detection of hearing loss during childhood.

[Do hemoglobinopathies correlate with genetically-induced hearing disorders?]. / Korrelieren Hämoglobinopathien mit genetisch bedingten Hörstörungen?

In hereditary deafness a battery of audiological and medical investigations are needed to find out the aetiological factors. We tested the blood of children impaired hearing for hemoglobinopathies. Such anomalies might provide a clue to the aetiology. We found abnormal structures of hemoglobin in 5 children suffering from Fanconi's anemia. Four of these children had prenatal conductive hearing loss. The other children showed no abnormal hemoglobin.

[Comparison of different audiometric procedures for infants less than 1 year old]. / Ein Vergleich der verschiedenen Audiometrieverfahren für das erste Lebensjahr.

The comparison of all the hearing test methods that have been advocated during recent years shows that all have severe drawbacks and are thus unsuitable for screening for hearing loss in newborns. Therefore it is better to screen by the high risk registry. All high risk children must be seen by the paedaudiologist.

Multichannel infant reflex audiometry (MIRA) a new method for evaluating hearing in infants (preliminary results).

Multichannel infant reflex audiometry, applicable up to about 1 year of age, is based on the simultaneous registration of sucking and breathing activities and of eye movements together with marks which indicate the side, beginning, and end of the stimulus. Sucking and breathing are reduced or altered by suprathreshold stimuli. The threshold of responses is 20-40 dB lower than that obtained with behavioral tests and comparable in most cases with BERA thresholds.

[Multichannel infant reflex audiometry (MIRA)]. / Multichannel Infant Reflex Audiometry (MIRA).

A new method for evaluation of hearing threshold in babies is presented. The method does not require much time, cost or personnel and is practicable for infants up to about 12 months. It is based on synchronous electrical registration of sucking and breathing activities as well as of eye movements evoked by acoustic stimuli. Sucking and breathing are reduced by supra-threshold stimuli, preparing the baby for attentive listening. Eye movements are directed towards localizing the site of the stimulus.