Endoscopic-Guided Suture Lateralization for Bilateral Vocal Fold Paralysis: Surgical Tips for Better Outcome.

OBJECTIVE: This study aims to describe a precise description of suture lateralization (SL) technique and evaluate its effectiveness and safety in management of bilateral vocal fold paralysis (BVFP). METHOD: A preclinical cadaveric study followed by application on a case series of BVFP patients. After the preliminary study executed to precisely localize the optimal sites for needle insertion, a prospective interventional study was conducted on 19 subjects presenting with respiratory distress due to BVFP. Data collection included their clinical presentation and a detailed assessment including auditory perceptual assessment, laryngoscopy (rigid or flexible), and video fluoroscopic swallowing study. RESULTS: Widening of the inter-glottic distance at the site of the sutures was statistically significant (P < 0.001). Decannulation was achieved in three out of four tracheotomized patients. The suturing led to a significant difference in loudness, jitter, and harmonic-to-noise ratio (P = 0.042, 0.004, and ≤0.001, respectively). CONCLUSION: This study suggests that SL is a feasible and effective technique with low incidence of adverse events and the potential of reversibility. Optimal localization of the suture insertion points translated into less intraoperative manipulation of the cords and shorter operative time.

Repair of posterior laryngeal cleft: a 10-year experience in a tertiary referral hospital.

OBJECTIVE: This study aimed to present experience with surgical treatment of laryngeal cleft cases through both open and endoscopic approaches. METHOD: A retrospective evaluation of all patients diagnosed as having a laryngeal cleft in a tertiary hospital over 10 years was performed. Pre-operative data, conservative and surgical management of cases, and outcomes were collected, tabulated and analysed. RESULTS: This study included 43 patients aged from 2 to 44 months with a median of 9.19 months. Concerning management technique, 12 patients had conservative treatment and the remaining 31 underwent a surgical procedure (of them, 20 patients underwent endoscopic intervention and 11 had the open surgical technique). In the open group, we used either tibial periosteum (six cases) or harvested costal cartilage (five cases). CONCLUSION: Surgical management in the form of endoscopic Coblation-assisted or an open approach is indicated in severe cases or mild cases not responding to conservative management.

Treatment of Vocal Fold Nodules: Transnasal Steroid Injection Versus Microlaryngoscopic Phonomicrosurgery.

OBJECTIVES: Vocal fold nodules (VFNs) are bilateral, mid-membranous, swellings of the vocal folds. Intralesional steroid injection was successfully tried in the management of benign vocal fold lesions including nodules. The aim of the present study was to compare treatment outcomes of vocal fold steroid injection (VFSI) and surgery in patients with VFNs in terms of lesion regression, subjective, and objective voice parameters. STUDY DESIGN: Nonrandomized controlled clinical trial. METHODS: This bicenter interventional study was conducted on 32 patients with VFNs, in the age range of 16-63 years. Sixteen patients underwent transnasal VFSI under local anesthesia (the injection group), and 16 underwent surgical excision of the nodules under general anesthesia (the surgery group). Prior to intervention and at the follow-up visit, participants were subjected to videolaryngoscopic examination with evaluation of nodules' sizes as well as subjective voice assessment by auditory perceptual assessment (APA) of voice and the international nine-item Voice Handicap Index (VHI-9i). Objective voice assessments including the measurements of cepstral peak prominence, jitter, shimmer, harmonic to noise ratio, and maximum phonation time were also administered. RESULTS: The size of vocal fold nodules was significantly decreased postintervention in both studied groups. There was a decrease in the VHI-9i score, a decrease in the values of jitter and shimmer, together with an increase in the values of cepstral peak prominence and maximum phonation time after interventions indicating improvement of subjective and objective voice outcomes in both groups. CONCLUSION: Office-based transnasal VFSI is a safe and tolerable therapy option for VFNs. Voice outcomes of VFSI were comparable to surgery, hereby VFSI can be considered a promising therapy for VFNs and could be used as an alternative to surgery in selected cases.

Developing an arabic questionnaire to assess sensory processing disorders among preschool Egyptian children.

BACKGROUND: Sensory processing disorder (SPD) is a neurophysiologic disorder in which sensory input is poorly detected, modulated, interpreted and/or to which atypical responses occur. The objective of this study was to validate an Arabic questionnaire for identification of SPD among preschool Arabic-speaking children with Autism Spectrum Disorders (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). METHODS: A newly constructed Arabic questionnaire for assessment of SPD was completed by parents of 100 Egyptian Arabic-speaking children including 40 typically-developing children (control group), 30 children with ASD, and 30 children with ADHD in the age range 3-6 years RESULTS AND CONCLUSION: Sensory processing differences were detected between typically-developing children and children with ASD and ADHD. Significant differences were found in auditory processing, visual processing, oral sensory processing, olfactory processing, total scores and emotional/social response. The current study revealed non-significant differences between ASD and ADHD children as regards auditory, visual, touch, oral sensory, olfactory and total processing scores. On the other hand, ASD children showed higher scores in proprioceptive processing and lower scores in emotional/social response than children with ADHD. The designed Arabic questionnaire is a valid and reliable assessment tool for identification of SPD in preschool Arabic-speaking children.

Clinical and videofluoroscopic evaluation of feeding and swallowing in infants with oropharyngeal dysphagia.

BACKGROUND: Dysphagia impacts infants' health and well-being and may result in aspiration pneumonia. OBJECTIVE: This study aimed to evaluate feeding and swallowing functions in infants with dysphagia to determine the possible causes of dysphagia and their relationship with the medical diagnoses. Clinical and videofluoroscopic findings were compared to determine the diagnostic accuracy of clinical evaluation and identify clinical predictors of laryngeal penetration and aspiration. METHODS: This study was conducted on 60 infants in the age range 2-19 months (median seven months) with suspected aspiration and/or feeding problems. All cases were subjected to both clinical and videofluoroscopic evaluation of swallowing. RESULTS: The two most frequently observed videofluoroscopic findings were aspiration and suck-swallow-breathing incoordination. Infants with structural laryngeal abnormalities were significantly more likely to experience aspiration. A significant association was found between the presence of aspiration and the presence of both recurrent chest infection and gurgly voice combined, which increased the risk of aspiration by 3.57 times. However, the presence of gagging alone and gagging combined with a recurrent chest infection significantly reduced the risk of aspiration. The clinical assessment accuracy presented 56.70%, with 55.60% sensitivity, 58.30% specificity, and a positive predictive value higher than the negative. CONCLUSION: The study highlights the importance of complementing clinical evaluation, in infants with dysphagia, with an objective evaluation of swallowing such as videofluoroscopy due to the high proportion of false positives noticed in clinical evaluation and the high prevalence of silent aspiration in infants.

Acoustic Features of Cry of Deaf and Hard-of-Hearing Infants.

Previous research has demonstrated differences in the acoustic features of crying signals between deaf and typical hearing (TH) infants. This study aims at comparing the acoustic parameters of cries of infants with different degrees of deafness versus TH infants. About 110 infants aged 6-12 months (61 TH infants, 34 infants with bilateral deafness of variable degrees and 15 infants with unilateral deafness) were enrolled in the study. Results indicated that the most important acoustic parameters to demonstrate the difference between the crying of TH infants and deaf and hard-of-hearing (DHH) infants as well as between the crying of infants with different degrees of deafness are F0, cry duration, intensity, F2, and F4. In terms of accuracy, the parameter that showed the highest accuracy to differentiate between TH infants and DHH infants was F0 (74.5%). The accuracy of the combined acoustic parameters (F0, cry duration, intensity, and F4) was 70%. F0 was considered the best predictor and F4 the second best predictor of severity of deafness.

Developing an Arabic Screening Test for Adult-Onset Chronic Aphasia.

AIM: To develop a time-efficient Arabic test battery for adult-onset chronic aphasia that provides information about the type and the severity of the disorder. PATIENT AND METHODS: A total of 90 participants were recruited and divided into 3 groups. The groups consisted of 30 adult-onset post-stroke chronic aphasic patients, 30 adult non-aphasic adults with central neurological disorders, and a group of 30 non-brain-damaged healthy adults. All participants were assessed using the Mansoura Arabic Screening Aphasia Test (MASAT), which consists of 4 main sections: (1) language expression abilities including repetition and naming items, (2) language comprehension questions, (3) fluency, and (4) reading, writing and calculation items. The content validity, internal consistency, clinical validity, and convergent validity of the MASAT were evaluated. RESULTS: The MASAT demonstrated statistically high reliability and validity. The high α-values in all subtotal scores among the 3 groups were judged to denote excellent intercorrelation among the screening test items. CONCLUSION: The MASAT is a valid and a reliable brief assessment tool that can be completed on the first clinic appointment that detects the type and severity of Arabic-speaking aphasic patients.

Language and cognitive outcome for high-risk neonates at the age of 2-3 years - experience from an Arab Country.

AIM: To investigate the effect of different neonatal risk factors on different language parameters as well as cognitive abilities among Arabic speaking Egyptian children at the age of two to three years of life and to find out which risk factor(s) had the greatest impact on language and cognitive abilities. METHODS: This retrospective cohort study was conducted on 103 children with age range of 2-3 years (median age 31 mo). They were 62 males and 41 females who were exposed to different high-risk factors in the perinatal period, with exclusion of metabolic disorders, sepsis/meningitis, congenital anomalies and chromosomal aberrations. The studied children were subjected to a protocol of language assessment that included history taking, clinical and neurological examination, audiological evaluation, assessment of language using modified preschool language scale-4, IQ and mental age assessment and assessment of social age. RESULTS: The studied children had a median gestational age of 37 wk, median birth weight of 2.5 kg. The distribution of the high-risk factors in the affected children were prematurity in 25 children, respiratory distress syndrome in 25 children, hypoxic-ischemic encephalopathy in 15 children, hyperbilirubinemia in 10 children, hypoglycemia in 13 children, mixed risk factors in 15 children. The results revealed that high-risk neonatal complications were associated with impairment of different language parameters and cognitive abilities (P < 0.05). The presence of prematurity, in relation to other risk factors, increases the risk of language and cognitive delay significantly by 3.9 fold. CONCLUSION: Arabic-speaking children aged 2-3 years who were exposed to high-risk conditions in the perinatal period are likely to exhibit delays in the development of language and impairments in cognitive abilities. The most significant risk factor associated with language and cognitive impairments was prematurity.

Validation and Adaptation of the Singing Voice Handicap Index for Egyptian Singing Voice.

BACKGROUND: Measuring the severity of a voice disorder is difficult. This can be achieved by both subjective and objective measures. The Voice Handicap Index is the most known and used self-rating tool for voice disorders. The Classical Singing Handicap Index (CSHI) is a self-administered questionnaire measuring the impact of vocal deviation on the quality of life of singers. OBJECTIVES: The objective of this study was to develop an Arabic version of the CSHI and to test its validity and reliability in Egyptian singers with different singing styles with normal voice and with voice disorders. METHODS: The interpreted version was administered to 70 Egyptian singers including artistic singers (classical and popular) and specialized singers (Quran reciters and priests) who were divided into 40 asymptomatic singers (control group) and 30 singers with voice disorders. Participants' responses were statistically analyzed to assess the validity and reliability, and to compare the patient group with the control group. RESULTS AND CONCLUSIONS: Quran reciters, patients with no previous professional training, and patients with vocal fold lesions demonstrated the highest scores. The Arabic version of CSHI is found to be a reliable, valid, and sensitive self-assessment tool that can be used in the clinical practice for the evaluation of the impact of voice disorders on singing voice.

Evaluating the diagnostic accuracy of Arabic SNAP test for children with hypernasality.

UNLABELLED: Nasometry is a method of measuring the acoustic correlates of resonance through a computer-based instrument called nasometer. High nasalance scores in comparison to normative data suggest hypernasality and/or other nasality disorders, while low scores suggest hyponasality. Normative values of nasalance for Egyptian Arabic speakers were established using the Arabic SNAP (Simplified Nasometric Assessment Procedures) test. OBJECTIVES: to evaluate the diagnostic accuracy of Arabic SNAP test to allow for its use in the differentiation between normal and hypernasal speech in Egyptian Arabic-speaking children. METHODS: Nasalance scores of normal children (n=92) on Arabic SNAP test were compared to those of 30 children with velopharyngeal insufficiency due to cleft palate. Receiver operating characteristic (ROC) curve was used to determine cutoff points with the highest sensitivity and specificity. RESULTS: Statistically significant differences were found between both groups for all items in nasometric evaluation (p<0.05) except for prolonged/m/sound (p>0.05). Cutoff points were determined and certain items were selected for routine nasometric evaluation. CONCLUSION: The Arabic SNAP test is a sensitive and specific tool for evaluation of children with hypernasality and can be used for both diagnosis and follow up of these cases.

Automatic Pre-Attentive Auditory Responses: MMN to Tone Burst Frequency Changes in Autistic School-Age Children.

OBJECTIVE: Autism is a pervasive developmental disorder that includes deficits in socialization, communication, and adaptive functioning. The mismatch negativity (MMN) is a component of evoked response potentials that reflects pre-attentive change detection. The purpose of this study was to determine whether a group of autistic school-age children had abnormal changes in auditory MMN and to analyze and compare the results with an age-matched group of normal children. MATERIALS AND METHODS: This prospective study was carried out on 31 autistic school-age children. Thirty age-, gender-, and IQ-matched children served as a control group. The children were evaluated through diagnostic procedures that included psychometric and speech language tests and audiological assessments. Auditory MMNs were recorded from all participants, and the peak amplitudes and latencies were measured. RESULTS: The mean ages were 11.3±2.8 and 11.2±3.2 years for the autistic and normal children, respectively. The MMN amplitudes obtained from the two groups were found to be statistically significantly different. The MMN amplitudes were reduced, and latencies were prolonged in autistic versus normal children. CONCLUSION: Our results suggest that children with autism do have auditory changes at the level measured by MMN, mainly pre-attentive response, which argues for a doubt on affection of the supposed origin of auditory MMN in those children.

The nature of articulation errors in Egyptian Arabic-speaking children with velopharyngeal insufficiency due to cleft palate.

UNLABELLED: Even with early surgical repair, the majority of cleft palate children demonstrate articulation errors and have typical cleft palate speech. OBJECTIVE: Was to determine the nature of articulation errors of Arabic consonants in Egyptian Arabic-speaking children with velopharyngeal insufficiency (VPI). SUBJECTS AND METHODS: Thirty Egyptian Arabic-speaking children with VPI due to cleft palate (whether primary repaired or secondary repaired) were studied. Auditory perceptual assessment (APA) of children speech was conducted. Nasopharyngoscopy was done to assess the velopharyngeal port (VPP) movements while the child was repeating speech tasks. Mansoura Arabic Articulation test (MAAT) was performed to analyze the consonants articulation of these children. RESULTS AND CONCLUSION: The most frequent type of articulatory errors observed was substitution, more specifically, backing. Pharyngealization of anterior fricatives was the most frequent substitution, especially for the /s/ sound. The most frequent substituting sounds for other sounds were /ʔ/ followed by /k/ and /n/ sounds. Significant correlations were found between the degrees of the open nasality and VPP closure and the articulation errors. On the other hand, the sounds (/ʔ/,/h/,/ʕ/,/n/,/w/,/j/) were normally articulated in all studied group. The determination of articulation errors in VPI children could guide the therapists for designing appropriate speech therapy programs for these cases.

Assessment of white matter integrity of autistic preschool children with diffusion weighted MR imaging.

The purpose was to assess white matter integrity of autistic preschool children with diffusion weighted MR imaging. Prospective study was carried on 19 autistic children (mean age 55.2ms, IQ of 86.5) and 10 sex, age and IQ matched control (mean age 53.2ms, IQ 84.5). The childhood Autism Rating Scale (CARS), social age and language age were calculated. Patients and controls underwent diffusion weighted MR imaging of the brain with b factor of 0, 500 and 1000s/mm(2). The apparent diffusion coefficient (ADC) value at different regions of the white matter were calculated and correlated with CARS, social age and language age. There were significant differences at the ADC value of the white matter between autistic and control children at genu (P=0.043), splenium (P=0.003) of the corpus callosum, frontal white matter (P=0.015) and temporal white matter (P=0.020). There was positive correlation of CARS score with ADC value of the genu (r=0.63, P=0.001), splenium (r=0.59, P=0.005), frontal white matter (r=0.81, P=0.001) and temporal white matter (r=0.74, P=0.001). The social age well correlated with ADC value of the frontal white matter (r=0.81, P=0.001) and language age well correlated with ADC value of the temporal white matter (r=0.78, P=0.001). We concluded that ADC value can be helpful in assessment of integrity of the white matter in autistic preschool children and well correlated with CARS score, social age and language age.

Standardization of nasometry for normal Egyptian Arabic speakers.

OBJECTIVE: The aim of this study was to collect the normative values of nasalance for Egyptian Arabic speakers in different age groups, using Arabic speech samples in order to compare patients with disturbed nasality. MATERIAL AND METHODS: This study included 300 normal Egyptian volunteers divided into three groups according to their ages: group I = children (n = 92; age 3 years, 3 months to 9 years), group II = teenagers (n = 76; age 9-18 years) and group III = adults (n = 132; age above 18 years). The Nasometer II 6400 was used for the analysis of speech samples. All subjects were asked to perform four speech tasks that were based on the MacKay-Kummer SNAP Test-R and modified to be applicable to the Arabic language, especially to the Egyptian dialect. RESULTS: The normative values for nasometric assessment in the different age groups were studied. The results demonstrated nasalance score variations according to age and gender. Most of the nasalance score norms of the Egyptian children demonstrated statistically significant differences when compared with the norms of children for the MacKay-Kummer Test-R. CONCLUSION: The Egyptian Arabic SNAP test is an easy, noninvasive and objective procedure that is suitable for all age groups.

Developing an articulation test for Arabic-speaking school-age children.

OBJECTIVE: The aim of this study was to develop an Arabic articulation test using familiar and visually transparent words in order to be used as a criterion for comparing phonemes of both normal and phonologically disordered Arabic-speaking children. MATERIAL AND METHODS: A picture-naming test was designed for the Mansoura Arabic Articulation Test (MAAT) to elicit spontaneous single-word responses representing all possible consonant positions and vowels of Colloquial Egyptian Arabic. Three expert phoniatricians were asked to review MAAT and complete a questionnaire. The MAAT was presented to 100 normal Arabic-speaking Egyptian children randomly selected from the first- and second-grade kindergarten. They were 52 males and 48 females with ages ranging between 42 and 70 months. Children's responses were converted to a percent correct score for sound utterances and picture identification. RESULTS: Statistically non-significant differences were found among experts' opinions reflecting approval for the MAAT items. A statistically highly significant adequate correlation was found between correct word utterances and picture identification which proved the content validity of MAAT. Test-retest reliability proved the consistency of MAAT. CONCLUSION: MAAT is a valid and reliable test that can be applied to collect the phonetic inventory of Arabic-speaking young children.