Otitis Media: Long-Term Effect on Central Auditory Nervous System.

OBJECTIVES: To analyze the central auditory nervous system function through behavioral and electrophysiological tests in children with a history of otitis media and subsequent bilateral tubes placement surgery. METHODS: The participants were divided into two groups between eight and 14 years old: control group (CG) consisted of 40 children with no history of otitis media; experimental group (EG) consisted of 50 children with documented history of otitis media and undertook a surgery for bilateral tubes placement. All children completed audiological evaluation (audiometry, speech audiometry, and immittance audiometry), behavioral evaluation (tests: dichotic digits, synthetic sentence identification with ipsilateral competing message, gaps-in-noise, frequency pattern), and electrophysiological evaluation (Auditory Brainstem Response, ABR, Frequency Following Response, FFR (verbal), and Long Latency Auditory Evoked Potential, LLAEP). RESULTS: The EG group showed significantly poorer performance (p<0.001) than the CG for all auditory abilities studied. The results revealed significant latency delays and reduced amplitude (p<0.05) of waves III and V for ABR; significant latency delay was seen of potentials P2, N2, and P300 for LLAEP; significant latency delays and reduced amplitude (p<0.05) were observed for FFR in children with a history of otitis media. CONCLUSION: The results demonstrate negative effect of otitis media in the auditory abilities and electrophysiological measures in children with a history of otitis media.

Children's language development after cochlear implantation: a literature review. / O desenvolvimento da linguagem da criança após o implante coclear: uma revisão de literatura.

AIM: review the literature for studies that describe the language development of children after they receive cochlear implants. RESEARCH STRATEGIES: Literature review on the PubMed, Web of Science, Scopus, and Science Direct databases, tracing the selection and critical analysis stages in the journals found and selected. SELECTION CRITERIA: We selected original articles looking at children with cochlear implants, which mentioned language development after surgery. Case studies, dissertations, books chapters, editorials, and original articles that did not mention aspects of oral communication development, perception of sounds and speech, and other stages of human development, in the title, abstract, or text, were excluded. DATA ANALYSIS: A protocol was created for this study including the following points: author, year, location, sample, type of study, objectives, methods used, main results, and conclusion. RESULTS: 5,052 articles were found based on the search descriptors and free terms. Of this total, 3,414 were excluded due to the title, 1,245 due to the abstract, and 358 from reading the full text; we selected 35, of which 28 were repeated. In the end, seven articles were analyzed in this review. CONCLUSION: We conclude that cochlear implant users have slower linguistic and educational development than their peers with normal hearing - though they are better than conventional prostheses users - and they are able to match them over time. There is great variability in the test methodologies, thus reducing the effectiveness and reliability of the results found.

O desenvolvimento da linguagem da criança após o implante coclear: uma revisão de literatura / Children's language development after cochlear implantation: a literature review

RESUMO Objetivo Levantar na literatura a descrição do desenvolvimento de linguagem de crianças usuárias de implante coclear. Estratégias de pesquisa Buscas na plataforma Pubmed e nas bases de dados Web of Science, Scopus e Science Direct, seguindo etapas de seleção e análise crítica dos periódicos encontrados e escolhidos. Critérios de seleção Selecionados artigos originais que abordavam crianças usuárias de implante coclear, nos quais eram mencionados o desenvolvimento de linguagem após a cirurgia. Excluídos artigos de estudo de caso, dissertações, capítulos de livros, editoriais e artigos originais que não referenciavam no título, no resumo ou no texto aspectos de desenvolvimento da comunicação oral, percepção dos sons e da fala e outras fases do desenvolvimento humano. Análise dos dados Foi criado um fichamento protocolar contemplando os seguintes pontos: autor, ano, local, amostra, tipo de estudo, objetivos, métodos utilizados, resultados principais e conclusão. Resultados Encontrados 5.052 artigos a partir da busca de descritores e termos livres. Desses, 3.414 foram excluídos pelo título, 1.245, pelo resumo e 358, pela leitura do texto completo, sendo selecionados 35, dos quais, 28 estavam repetidos. Ao final, sete artigos foram analisados nesta revisão. Conclusão Verifica-se que os usuários de implante coclear apresentam desenvolvimento linguístico e educacional aquém de seus pares com audição normal, porém melhor que os usuários de próteses convencionais, podendo igualar-se a eles com o passar do tempo. Há uma grande variabilidade nas metodologias dos testes, diminuindo, portanto, a efetividade e a confiabilidade dos resultados encontrados.

ABSTRACT Aim review the literature for studies that describe the language development of children after they receive cochlear implants. Research strategies Literature review on the PubMed, Web of Science, Scopus, and Science Direct databases, tracing the selection and critical analysis stages in the journals found and selected. Selection criteria We selected original articles looking at children with cochlear implants, which mentioned language development after surgery. Case studies, dissertations, books chapters, editorials, and original articles that did not mention aspects of oral communication development, perception of sounds and speech, and other stages of human development, in the title, abstract, or text, were excluded. Data analysis A protocol was created for this study including the following points: author, year, location, sample, type of study, objectives, methods used, main results, and conclusion. Results 5,052 articles were found based on the search descriptors and free terms. Of this total, 3,414 were excluded due to the title, 1,245 due to the abstract, and 358 from reading the full text; we selected 35, of which 28 were repeated. In the end, seven articles were analyzed in this review. Conclusion We conclude that cochlear implant users have slower linguistic and educational development than their peers with normal hearing - though they are better than conventional prostheses users - and they are able to match them over time. There is great variability in the test methodologies, thus reducing the effectiveness and reliability of the results found.

The Diagnosis and Treatment of Reading and/or Spelling Disorders in Children and Adolescents.

BACKGROUND: 3-11% of children and adolescents suffer from a reading andor spelling disorder. Their poor written-language skills markedly impair their scholastic performance and are often associated with other mental disorders. A great deal of uncertainty still surrounds the question of the appropriate methods of diagnosis and treatment. METHODS: We systematically searched for pertinent publications in databases and literature reference lists, summarized the evidence in six tables, and examined some of it in a meta-analysis. Recommendations were developed in a consensus conference. RESULTS: A reading and/or spelling disorder should only be diagnosed if performance in these areas is below average. It should be determined whether an attention deficit-hyperactivity disorder, anxiety disorder, or disorder of arithmetical skills is also present. Reading and spelling performance should be reinforced with systematic instruction about letter-sound and sound-letter correspondences, letter-syllable-morpheme synthesis, and sound-syllablemorpheme analysis (g' = 0.32) (recommendation grade A). Spelling ability responds best to spelling-rule training (recommendation grade A). Irlen lenses, visual and/or auditory perceptual training, hemispheric stimulation, piracetam, and prism spectacles should not be used (recommendation grade A). CONCLUSION: Evidence- and consensus-based guidelines for the diagnosis and treatment of reading and/or spelling disorders in children and adolescents are now available for the first time. Reading and spelling abilities should be systematically and comprehensively reinforced, and potential comorbid disorders should be sought and treated appropriately. The efficacy of many treatments now in use has not been documented; if they are to be used in the future, they must be tested in randomized, controlled trials. For adult sufferers, adequate diagnostic instruments and therapeutic methods are not yet available.

Hearing rehabilitation in cerebral palsy: development of language and hearing after cochlear implantation / Reabilitação auditiva na paralisia cerebral: desenvolvimento da audição e linguagem após implante coclear

INTRODUCTION: Auditory rehabilitation in children with bilateral severe-to-profound sensorineural hearing loss with cochlear implant has been developed in recent decades; however, the rehabilitation of children with cerebral palsy still remains a challenge to otolaryngology and speech therapy professionals. OBJECTIVE: To verify the effectiveness of cochlear implants in the development of auditory and language skills in children with cerebral palsy. METHODS: A prospective analytical study. The evaluation of auditory responses to speech test was applied to the children in this study at regular intervals following implantation. Standardized tests that assess and quantify the development of auditory and language skills were administered and speech therapy video records and speech therapy files were analyzed. All children went through individually tailored intensive audiological rehabilitation programs following cochlear implantation. RESULTS: Two participants had gradual auditory and language development when compared to other participants who reached advanced levels in hearing and oral language classifications. CONCLUSION: The use of the Cochlear implant enabled participants to reach advanced stages of hearing and language skills in three of the five participants with cerebral palsy in this study. This electronic device is a viable therapeutic option for children with cerebral palsy to help them achieve complex levels of auditory and language skills. .

INTRODUÇÃO: A reabilitação auditiva em crianças com deficiência auditiva neurossensorial severa a profunda bilateral com o Implante Coclear foi consagrado nas últimas décadas, contudo, ainda permanece um desafio para a otorrinolaringologia e a fonoaudiologia a reabilitação do portador de paralisia cerebral. OBJETIVO: Verificar a efetividade do Implante Coclear no desenvolvimento das habilidades auditivas e de linguagem em crianças com paralisia cerebral. MÉTODO: Estudo analítico prospectivo. Foram aplicados testes padronizados que avaliam e quantificam o desenvolvimento das habilidades auditivas e de linguagem. Foram analisadas as filmagens das terapias fonoaudiológicas e os registros descritos ao término de cada sessão de terapia. RESULTADOS: As crianças analisadas apresentaram desenvolvimento auditivo e de linguagem satisfatório quando comparado às demais crianças que alcançaram níveis mais complexos nas categorias de audição e evolução significativa no desenvolvimento da linguagem oral. CONCLUSÃO: O uso do Implante Coclear favoreceu o alcance de etapas avançadas das habilidades de audição e linguagem em três das cinco crianças com paralisia cerebral desse estudo. Esse dispositivo eletrônico tem sido uma opção terapêutica viável para que crianças com paralisia cerebral alcancem etapas complexas no que se refere às habilidades auditivas e de linguagem. .

Hearing rehabilitation in cerebral palsy: development of language and hearing after cochlear implantation.

INTRODUCTION: Auditory rehabilitation in children with bilateral severe-to-profound sensorineural hearing loss with cochlear implant has been developed in recent decades; however, the rehabilitation of children with cerebral palsy still remains a challenge to otolaryngology and speech therapy professionals. OBJECTIVE: To verify the effectiveness of cochlear implants in the development of auditory and language skills in children with cerebral palsy. METHODS: A prospective analytical study. The evaluation of auditory responses to speech test was applied to the children in this study at regular intervals following implantation. Standardized tests that assess and quantify the development of auditory and language skills were administered and speech therapy video records and speech therapy files were analyzed. All children went through individually tailored intensive audiological rehabilitation programs following cochlear implantation. RESULTS: Two participants had gradual auditory and language development when compared to other participants who reached advanced levels in hearing and oral language classifications. CONCLUSION: The use of the Cochlear implant enabled participants to reach advanced stages of hearing and language skills in three of the five participants with cerebral palsy in this study. This electronic device is a viable therapeutic option for children with cerebral palsy to help them achieve complex levels of auditory and language skills.

Longitudinal functional performance among children with cochlear implants and disabilities: a prospective study using the Pediatric Evaluation of Disability Inventory.

OBJECTIVE: Functional outcomes are important in children with cochlear implants (CI) and additional disabilities as studies on auditory skill and speech/language development may not identify functional benefits from implantation. This study sought to measure functional performance skills of young children with developmental disabilities post-CI. METHODS: Eight children with cognitive disabilities undergoing cochlear implantation were enrolled in a prospective study of language and functional abilities; 6 with 1 year follow-up were included in the analysis. Functional performance was measured using Pediatric Evaluation of Disability Inventory (PEDI), providing standardized (mean: 50) and scaled scores (range: 0-100) of functional domains: Self-Care, Mobility and Social Function. The PEDI was administered pre-implant, 6 and 12 months post-implantation along with language testing at the same intervals. RESULTS: All children had cognitive disability; 5 also had motor delay. The ages at CI ranged from 13.8 to 134 months. For functional abilities, children did not make significant changes in domain-specific standard scores over 1 year. Children made progress in scaled scores by 1-year post-implant. The largest increase for all domains occurred in the first 6 months (7-11.5 point increase). For language abilities, children made a median 5.5-month increase in receptive language age (p=0.06) and 5-month increase in expressive language age (p=0.03) in the first year post-CI with no change in language quotients. Receptive language level was significantly (p<0.05) associated with increasing scores in the domains of Self-Care and Social Function. CONCLUSIONS: This is the first study to measure daily functional abilities in children with implants and disabilities using a standardized tool. Although our small group of complex children did not have an increase in standard scores (gap-closing trajectories), they made progress in skill development on scaled scores. Receptive language appears to play a key role in social functioning in this population. Functional assessments are informative for treatment planning and identifying specific areas to target intervention.

Cochlear implantation in a child with CINCA syndrome who also has wide vestibular aqueducts.

Chronic infantile neurological cutaneous and articular (CINCA) syndrome is a severe auto-inflammatory disease, due to mutation of the CIAS1 gene. CINCA syndrome should be considered the most severe of a spectrum of three disorders all due to mutation of the CIAS1 gene. CINCA syndrome produces a triad of symptoms of neonatal onset: maculopapular urticarial rash, chronic meningitis, and chronic non-inflammatory arthropathy with recurrent fever. CINCA syndrome is also associated with sensory organ damage, especially progressive hearing loss and loss of vision. In this case report, we present the first case of cochlear implantation in a 13-year-old child with CINCA syndrome. Cochlear implantation was successful at rehabilitating the hearing loss with the child able to continue mainstream education, with her academic performance and speech discrimination both showing marked improvement. Anakinra (an interleukin 1 receptor antagonist) is now in widespread use to treat CINCA syndrome and is known to rapidly reverse the inflammatory features of CINCA syndrome. However, current evidence suggests that anakinra has limited effectiveness in reversing the sensorineural hearing loss seen in CINCA syndrome. We therefore propose that cochlear implantation is a viable treatment option in this rare yet severe auto-inflammatory disease, if the patient has failed to respond to anakinra. Owing to the unknown pathogenesis of the progressive hearing loss seen in CINCA syndrome and the limited effectiveness of anakinra in reversing the progressive hearing loss, we suggest that cochlear implantation is the modality of choice in rehabilitating severe-to-profound hearing loss not responsive to anakinra.

A comparison of the perceptual evaluation of speech production between bilaterally implanted children, unilaterally implanted children, children using hearing aids, and normal-hearing children.

OBJECTIVE: The purpose of this study was to compare the perceptual evaluation of several speech characteristics between bilaterally implanted children (biCI), unilaterally implanted children (uniCI), children using hearing aids (HA), and normal-hearing children (NH). DESIGN: Perceptual evaluations of intelligibility, phonation, resonance, and articulation were compared between the several subgroups. STUDY SAMPLE: Thirteen biCI children, 14 uniCI children, 10 HA children using hearing aids and 11 NH children participated. RESULTS: The biCI children did not show statistically significant differences with the NH children for overall intelligibility, phonation, and resonance. Yet, significantly more distortions and consonant cluster reductions were observed in the biCI children compared with the NH children. In comparison with the uniCI and HA children, the NH as well as the biCI children obtained better evaluations for intelligibility, phonation, resonance, and articulation of consonants. CONCLUSIONS: The results of this study demonstrated a possible additional beneficial effect of bilateral implantation on several speech characteristics of prelingually deaf children and as a consequence highlighted the interest of further research.

Lexical and grammatical development in a child with cochlear implant and attention deficit: A case study.

This is the first study to explore lexical and grammatical development in a deaf child diagnosed with Attention Deficit Hyperactivity Disorder, Inattentive sub-type (ADHD/I). The child, whose family language was Spanish, was fitted with a cochlear implant (CI) when she was 18 months old. ADHD/I, for which she was prescribed medication, was diagnosed 3;6 years later. Speech samples were videotaped over the first 4 years of CI use and during a follow-up session 1 year later. Samples were transcribed according to CHAT conventions and several measures of expressive language were obtained. Receptive language was evaluated with standardized tests. Results show that while some aspects of her development seemed relatively positive (e.g., acquisition of verbal morphemes at the same auditory age as typical children), other characteristics were atypical for a CI user: (1) preference for paralexical expressions in early lexicon; (2) lexical errors in colours and other abstract words; and (3) low MLU and varied grammatical errors including disorganized discourse. Medication had a positive effect on all these characteristics, providing evidence of a link with ADHD/I. This study concludes that ADHD/I had a direct impact on the lexical and grammatical development in this child, as well as an indirect influence over her communicative style. More studies are needed to explore language characteristics of children with CI and ADHD.

Living donor liver transplantation for congenital absence of the portal vein.

The congenital absence of the portal vein (CAPV) is a rare venous malformation in which mesenteric venous blood drains directly into the systemic circulation. Liver transplantation (OLT) may be indicated for patients with symptomatic CAPV refractory to medical treatment, especially due to hyperammonemia, portosystemic encephalopathy, hepatopulmonary syndrome, or hepatic tumors. Because portal hypertension and collateral circulation do not occur with CAPV, significant splanchnic congestion may occur when the portocaval shunt is totally clamped during portal vein (PV) reconstruction in OLT. This phenomenon results in severe bowel edema and hemodynamic instability, which negatively impact the patient's condition and postoperative recovery. We have successfully reconstructed the PV in living donor liver transplantation (LDLT) using a venous interposition graft, which was anastomosed end-to-side to the portocaval shunt by a partial side-clamp, using a patent round ligament of the liver, which was anastomosed end-to-end to the graft PV with preservation of both the portal and caval blood flows. Owing to the differences in anatomy among patients, at LDLT for CAPV liver transplant surgeons should seek to preserve both portal and caval blood flows.

The surgical treatment of Landau-Kleffner syndrome.

The medical management of Landau-Kleffner syndrome is usually effective for seizure control and eventual seizure remission. However, the response for language and behavior is often poor. Surgery, in the form of multiple subpial transections (MSTs) to include Wernicke's area has been suggested as a way forward if electrophysiologic lateralization can be demonstrated. Surgical series in the literature are few and outcome from surgery variable.

Concurrent and predictive validity of parent reports of child language at ages 2 and 3 years.

The MacArthur-Bates Communicative Development Inventories (CDI; Dale, 1996; Fenson et al., 1994), parent reports about language skills, are being used increasingly in studies of theoretical and public health importance. This study (N = 113) correlated scores on the CDI at ages 2 and 3 years with scores at age 3 years on tests of cognition and receptive language and measures from parent-child conversation. Associations indicated reasonable concurrent and predictive validity. The findings suggest that satisfactory vocabulary scores at age 2 are likely to predict normal language skills at age 3, although some children with limited skills at age 3 will have had satisfactory scores at age 2. Many children with poor vocabulary scores at 2 will have normal skills at 3.

Cerebral hemispherectomy: hospital course, seizure, developmental, language, and motor outcomes.

OBJECTIVE: To compare hemispherectomy patients with different pathologic substrates for hospital course, seizure, developmental, language, and motor outcomes. METHODS: The authors compared hemispherectomy patients (n = 115) with hemimegalencephaly (HME; n = 16), hemispheric cortical dysplasia (hemi CD; n = 39), Rasmussen encephalitis (RE; n = 21), infarct/ischemia (n = 27), and other/miscellaneous (n = 12) for differences in operative management, postsurgery seizure control, and antiepilepsy drug (AED) usage. In addition, Vineland Adaptive Behavior Scale (VABS) developmental quotients (DQ), language, and motor assessments were performed pre- or postsurgery, or both. RESULTS: Surgically, HME patients had the greatest perioperative blood loss, and the longest surgery time. Fewer HME patients were seizure free or not taking AEDs 1 to 5 years postsurgery, but the differences between pathologic groups were not significant. Postsurgery, 66% of HME patients had little or no language and worse motor scores in the paretic limbs. By contrast, 40 to 50% of hemi CD children showed near normal language and motor assessments, similar to RE and infarct/ischemia cases. VABS DQ scores showed +5 points or more improvement postsurgery in 57% of patients, and hemi CD (+12.7) and HME (+9.1) children showed the most progress compared with RE (+4.6) and infarct/ischemia (-0.6) cases. Postsurgery VABS DQ scores correlated with seizure duration, seizure control, and presurgery DQ scores. CONCLUSIONS: The pathologic substrate predicted pre- and postsurgery differences in outcomes, with hemimegalencephaly (but not hemispheric cortical dysplasia) patients doing worse in several domains. Furthermore, shorter seizure durations, seizure control, and greater presurgery developmental quotients predicted better postsurgery developmental quotients in all patients, irrespective of pathology.

Language development of a multiply handicapped child after cochlear implantation.

The presence of additional handicaps in hearing-impaired children makes the prediction of language ability after cochlear implantation unreliable. Only limited follow-up data on developmental improvement after implantation among multiply handicapped children is available. The present study reports the course of development (audiological and linguistic) after cochlear implantation in one subject with moderate mental retardation. Preoperatively, his language development showed 34 months delay when compared to chronological age. The difference had shortened to 23 months by 2 years post-surgery. The subject's cognitive delay had not changed upon 2-year follow-up. The cochlear implant can be credited to his improvement in language development.

Facial animation in children with Möbius syndrome after segmental gracilis muscle transplant.

Möbius syndrome is a complex congenital anomaly involving multiple cranial nerves, including the abducens (VI) and facial (II) nerves, and often associated with limb anomalies. Muscle transplantation has been used to address the lack of facial animation, lack of lower lip support, and speech difficulties these patients experience. The purpose of this study was to investigate the results of bilateral, segmental gracilis muscle transplantation to the face using the facial vessels for revascularization and the motor nerve to the masseter for reinnervation. The outcome of the two-stage procedure was assessed in 10 consecutive children with Möbius syndrome by direct interview, speech assessment, and oral commissure movement. Preoperative data were collected from direct questioning, viewing of preoperative videotapes, notes from prior medical evaluations, and rehabilitation medicine and speech pathology assessments. All of the patients developed reinnervation and muscle movement. The children who described self-esteem to be an issue preoperatively reported a significant posttransplant improvement. The muscle transplants produced a smile with an average commissure excursion of 1.37 cm. The frequency and severity of drooling and drinking difficulties decreased postoperatively in the seven symptomatic children. Speech difficulties improved in all children. Specifically, of the six children with bilabial incompetence, three received complete correction and three had significant improvement. Despite the length and complexity of these procedures, complications were minimal. Muscle transplantation had positive effects in all problematic areas, with a high degree of patient satisfaction and improvement in drooling, drinking, speech, and facial animation. The surgical technique is described in detail and the advantages over regional muscle transfers are outlined. Segmental gracilis muscle transplantation innervated by the motor nerve to the masseter is an effective method of treating patients with Möbius syndrome.

Continuous unilateral epileptiform discharge and language delay: effect of functional hemispherectomy on language acquisition.

PURPOSE: To assess the efficacy of functional hemispherectomy in promoting language acquisition in a child with severe language delay and continuous left hemispheric epileptiform discharge in the absence of clinical seizures. We report a 6-month-old girl who initially presented with a right hemiparesis secondary to a lesion of probable prenatal origin in the distribution of the left middle cerebral artery. Weeks later, she developed infantile spasms. At 1.5 years of age, because of intractable seizures, the patient had fenestration of the left porencephalic cyst and anterior temporal lobectomy. The seizures ceased; however, language development remained limited to 35 words at 3.5 years of age. The EEG showed almost continuous epileptiform activity over the left hemisphere with no independent epileptiform potentials contralaterally. She underwent a functional left hemispherectomy. METHODS: Imaging, electroencephalographic investigation, pre- and postoperative psychological and speech assessment were carried out. RESULTS: Considerable language, speech, and behavior improvement was noted within 2 months of surgery. CONCLUSIONS: Interictal epileptiform discharges can interfere with the development of contralateral hemispheric function in the absence of clinical seizures. Early functional hemispherectomy may have a role in promoting optimal language development in appropriately selected patients. Although the primary indication for functional hemispherectomy is to control intractable seizures, a secondary proposed indication is to reduce functional impairment of the other hemisphere by electrical interference.

Landau-Kleffner syndrome with continuous spikes and waves during slow-wave sleep.

The Landau-Kleffner syndrome is sometimes associated with continuous spike-waves during slow-wave sleep. The clinical significance of this association is unclear. In order to investigate differences in glucose metabolic patterns between awake and sleep states in two children with Landau-Kleffner syndrome and continuous spike-waves during slow-wave sleep, fluorodeoxyglucose positron-emission tomographic (PET) studies were performed in each state. In the first patient, the awake interictal PET study revealed moderate hypometabolism in the thalamus and frontal and temporal cortex and mild hypometabolism in the parietal and anterior cingulate cortex bilaterally. Occipital cortex was severely hypometabolic bilaterally. In a repeat PET study performed during sleep in which continuous spike-waves during slow-wave sleep were present, the only difference noted compared to the awake study was a marked bilateral increase in temporal cortex metabolism. The awake interictal PET in the second child was normal, except for mildly increased relative glucose metabolism in the left inferior temporal cortex. The sleep PET study with continuous spike-waves during slow-wave sleep in this child showed hypermetabolism in both temporal lobes; however, this was more pronounced, with a wider distribution in the left temporal cortex. In normal subjects, PET studies performed during awake and sleep states have not revealed such differences. Whether the temporal lobes are involved in the generation of continuous spike-waves during slow-wave sleep remains to be confirmed in a larger group of patients. The first child was treated surgically with multiple subpial transection, following which continuous spike-waves during slow-wave sleep disappeared and language function improved.(ABSTRACT TRUNCATED AT 250 WORDS)

Cleft palate and velopharyngeal dysfunction.

Surgical and prosthetic interventions are effective means of managing cleft palate and velopharyngeal dysfunction. Most patients are managed surgically because usually there is life-long benefit from that type of intervention and an operation does not require continued cooperation from the patient. In selected cases, prosthetic intervention is preferred. Over the past century, the efficacy of such interventions has increased markedly. Not all of the factors responsible for these improved results are understood. Disagreement among care providers persists regarding the specific criteria for intervention, the use of ancillary tools beyond perceptual speech evaluation for both pre-intervention and postintervention assessments, the technical details of intervention, and the ideal age for intervention. In spite of general success of interventions for cleft palate and velopharyngeal dysfunction, much fertile ground remains to be tilled and harvested by current and future students of the problem.