Dysphagia in amyotrophic lateral sclerosis: Quantification of bulbar motor dysfunction

BACKGROUND

Dysphagia as a sequel and possible early sign of amyotrophic lateral sclerosis (ALS) is caused by progressive impaired bulbar motor function.

OBJECTIVE

To evaluate bulbar motor dysfunction in patients suffering from ALS compared to a healthy reference group.

METHODS

A clinical study and prospective group comparison was designed. Patients and healthy volunteers were examined in the outpatient clinic of our university medical center. Ten patients with ALS and 20 healthy volunteers were included. All participants underwent a flexible endoscopic evaluation of swallowing (FEES) and a manometric measurement of the maximal sub-palatal atmospheric pressure generated by suction as well as of the prevalent pressure during swallowing. Additionally, the Sydney Swallow Questionnaire (SSQ) was completed by all participants to score the self-rated extent of dysphagia.

RESULTS

Comparing maximal suction pressures, the group of patients showed significantly lower values (p < .001). There was a significant correlation between reduced pressures and the degree of dysphagia (SSQ score) (r = -0.73).

CONCLUSIONS

As the oral cavity is an easily accessible compartment of the upper digestive tract, manometric measurements might serve as a simple instrument in order to detect or to monitor bulbar motor dysfunction. Oral manometry may facilitate early detection and monitoring of dysphagia in ALS. Larger studies are required to confirm our findings.

[Therapeutic success of proton pump inhibitors in the therapy of contact granulomas]

According to the current S2k guideline "Gastroesophageal Reflux Disease (GERD)" of 05/2014, an empirical proton pump inhibitor (PPI) therapy in double standard dose (e. g. Pantoprazole 40 mg 2 ×/day) is recommended for the extraesophageal GERD manifestation (e. g. with formation of a contact granuloma, CG) for 8 weeks. However, valid study data don't exist.In a prospective study from 05.2015 to 12.2019 39 patients consecutively randomized with endoscopically proven KG received PPIs in single (1 × PPI, n = 22) or double standard dose (2 × PPI, n = 17) for 8 weeks. A possible gastrolaryngeal reflux as well as throat sensations, a tendency to clear the throat or a hoarseness were recorded at first presentation and at control after 4 months.This was archieved by videolaryngostroboscopy to detect hoarseness and to assess the development of the granuloma (progression, constant, remission < 50 %, > 50 % or complete). The two groups were compared.The granuloma disappeared or regressed in 40 % of the cases with 1 × PPIs and in 77 % of the cases with 2 × PPIs (p < 0.05) after therapy. At the control appointment 23 % of the patients with 1 × PPIs were completely symptom-free and 77 % of the patients with 2 × PPIs. Throat sensation was the most frequent symptom at first presentation with 64 %. In the control group after PPI therapy in single or double standard dose, throat sensations were only detectable in 33 % and 15 % in case of granuloma remission. However, if the granuloma was persistent, the symptoms could hardly be influenced.The therapy of a KG with PPIs in double standard dose is more effective than in single standard dose. These results must be confirmed on a larger collective.

[Speech and Language Disorders in the Elderly]

Cerebrovascular insults and neurodegenerative diseases are the main causes of acquired speech and language disorders. A massive increase in the prevalence of both is evident from the age of 65 years. By the age of 90 years, more than 10 % of the population would have experienced a stroke and 30 % would have suffered from neurodegenerative diseases. Common risk factors are adiposity, hypertension and diabetes. The term aphasia subsumes acquired language disorders that have to be further classified in order to optimize diagnostics and therapy. Also prognosis depends on whether the disease is progressive or not. The Primary Progressive Aphasia (PPA) is based on neurodegenerative cortical lesions. It causes speech and language disorders. The 3 variants of PPA complete the former classification of Broca- and Wernicke aphasias that are mainly caused by cerebrovascular insults.In cerebral diseases, disorders of articulation are often combined with dysphonia. Therefore, in addition to dysarthria, a "dysarthrophonia" is evident. The main reasons for this are cortical lesions due to cerebrovascular insults or neurodegenerative diseases. Degenerative extrapyramidal diseases also often affect articulation. Depending on the kind of basal ganglia disease, dysarthria or dysarthrophonia is seen in 70-100 % of patients which might be combined with dysphagia. Vascular insults and neurodegenerative diseases are also causes of brainstem and cerebellar disorders that affect motor speech. Therapeutic approaches to the speech and language disorders depend on the nature of the underlying disease, namely whether it is progressive or regressive.

[Treatment of laryngeal dystonia with botulinum toxin]

The treatment of laryngeal dystonias with botulinum toxin is successful. Every patient suffering from a laryngeal dystonia should be assured of high quality therapeutic intervention. Therefore it is important to establish general standards by experts in this field. In this connection, we want to focus here on different relevant aspects of laryngeal dystonias. This includes new aspects in etiology, anatomical landmarks for the injection, standards in diagnostics and therapy and finally open issues needing discussion.

Real-time MRI of swallowing: intraoral pressure reduction supports larynx elevation

The reduction in intraoral pressure during swallowing has previously been linked to bolus transport, although no such relation has yet been proven. The purpose of this work was to evaluate the time course of intraoral pressure during swallowing using simultaneous real-time magnetic resonance imaging (MRI) and dynamic pressure recordings. Real-time MRI based on highly undersampled radial fast low-angle shot (FLASH) and regularized nonlinear inverse reconstruction was performed at 3 T using a standard head coil and a mid-sagittal section covering the entire oral cavity. Voluntary swallowing (10 mL of pineapple juice or saliva) was monitored for about 30 s in 11 normal subjects at spatial and temporal resolution of 1.3 × 1.3 × 8 mm³ and 40 ms, respectively. Simultaneously, the intraoral atmospheric pressure was recorded at a resolution of 10 ms during the entire course of deglutition. Quantitative measures of bolus transport, larynx elevation and submental muscle changes were obtained from the image series. As a key result, negative intraoral pressure accompanied laryngeal elevation during swallowing in all subjects. A reduction in submental muscle length during swallowing was also observed. No correlations of maximum negative pressure with larynx elevation and submental muscle change were found. In conclusion, intraoral pressure reduction during swallowing is not connected to oral bolus transport, but supports laryngeal elevation by palatal fixation of the tongue.

Successful Treatment of Autophonia with Botulinum Toxin: Case Report

Objectives:

We sought to treat autophonia due to a patulous eustachian tube using botulinum toxin.

Methods:

Because we assumed that the patulous eustachian tube was caused by abnormal activity of paratubal muscles (tensor and levator veli palatini muscles and salpingopharyngeus muscle), paralysis was performed via injection of botulinum toxin type A in a 45-year-old female professional musician who had had chronic unilateral autophonia for 20 years. In addition to a patient interview, an endoscopic examination of the nasopharynx (posterior rhinoscopy), ear microscopy, and impedance audiometry were performed to verify the diagnosis and the outcome after treatment.

Results:

The autophonia disappeared 1 week after treatment. Normalized tympanic ventilation was verified by impedance audiometry after 8 weeks. The period of symptom relief was 9 months.

Conclusions:

The administration of botulinum toxin type A provides a new option in the treatment of patulous eustachian tube. The reliability of this method and the effect of repeated injections remains to be proved in future studies.

[On the reliability of brainstem electric response audiometry (BERA)]

BACKGROUND

Brainstem electric response audiometries (BERA) are in clinical use for a number of years. The aim of our study was to evaluate data regarding the long-term reliability of BERA-determined frequency specific thresholds in hearing disabled children.

MATERIAL AND METHODS

In a group of 97 hearing disabled children we sought to compare Notched-Noise- (NN) BERA threshold as well as Click-BERA thresholds taken shortly after birth with behavioral audiometry thresholds determined after 3.2 years (mean).

RESULTS

We found a significant correlation between both BERA methods and the behavioral tests. However, the correlation coefficients for NN-BERA were higher than for Click-BERA thresholds.

CONCLUSION

Our results provide evidence for a high reliability of the NN-BERA for characterization of early onset hearing disabilities in children. Our data suggest that pathologic findings in the Click-BERA should always be followed by a frequency specific analysis with NN-BERA.

Real-time magnetic resonance imaging of normal swallowing

PURPOSE

To evaluate the use of a novel real-time magnetic resonance imaging (MRI) technique for the assessment of normal swallowing dynamics.

MATERIALS AND METHODS

In a cohort of 10 healthy subjects, real-time MRI movies at 24.3 frames per second were obtained in sagittal, coronal, and axial orientation during self-controlled swallows of 5 mL pineapple juice as oral contrast bolus. All studies were performed with the use of a commercial MRI system at 3 T combining two sets of radiofrequency receiver coils. Real-time movies relied on a fast low-angle shot (FLASH) MRI sequence with radial undersampling and image reconstruction by nonlinear inversion yielding 41.23 msec acquisition time for an in-plane resolution of 1.5 mm. Evaluations focused on clinical image quality as well as visualization and temporal quantification of distinct swallowing functions.

RESULTS

Throughout the entire process, the swallowing dynamics were well depicted and characterized with almost no visible image artifacts in all subjects. The mid-sagittal plane turned out to be most valuable. The movies allowed for a quantitative determination of the temporal pattern of all swallowing events.

CONCLUSION

The proposed real-time MRI technique yields noninvasive, robust, and quantitative access to the physiology of normal swallowing in healthy subjects at high temporal resolution and image quality.

Stroboscopy Versus High-Speed Glottography: A Comparative Study

OBJECTIVES

To evaluate and to compare the diagnostic value of videostroboscopy (VS) and high-speed glottography (HGG) in dysphonic patients.

STUDY DESIGN

Randomized, prospective study.

METHODS

A total of 162 patients underwent indirect laryngoscopy using both methods (VS and HGG). The resulting 324 films were evaluated by two professionals (laryngologists, MDs) using a standardized protocol containing established criteria to classify vocal fold vibratory movement qualities.

RESULTS

The rating "not assessable" was mentioned significantly more often in VS than in HGG (P < .001). In HGG, methodologic failures were less frequent, and the length of investigation was shorter. Even if the agreement between the two raters was higher in HGG (54%) compared with VS (42%), both percentage values show a low accordance in diagnostic findings.

CONCLUSIONS

Regardless of the method used (VS or HGG), perceptive evaluations of vibratory movements of vocal folds revealed a higher variability than assumed. This result supports the need for objective methods to analyze vocal fold vibratory movements. Therefore, real-time imaging of vocal fold vibratory movements using HGG will be necessary.

The Supraglottic Nerve Supply: An Anatomic Study With Clinical Implications

OBJECTIVES

To describe the course of the superior laryngeal nerve (SLN) and its branches, in particular, with regard to supraglottic motor and sensory functions.

METHODS

In 30 normal human hemilarynges, the SLN with its internal (intSLN) and external branch (extSLN) were dissected under microsurgical conditions and marked with acrylic dye. All anatomic structures of the larynges (muscles, cartilages, and ligaments) were dissected in detail.

RESULTS

The intSLN subdivides into three branches. The superior branch (I) runs to the lingual (extralaryngeal) part of the epiglottis and sends small fibers through the epiglottic foramina to the laryngeal surface. The middle branch (II) runs through the aryepiglottic fold into the ventricular fold, and the inferior branch (III) to the piriform sinus and to the postcricoid region, forming various anastomoses (e.g., ansa galeni) with the recurrent laryngeal nerve (RLN). The extSLN runs to the cricothyroid muscle (CT) and sends a branch through the CT along the lower rim of the thyroid cartilage into the larynx and up to the ventricular fold. This ventricular branch is a potential candidate for the innervation of the ventricular muscle (VM).

CONCLUSIONS

Our results may contribute to a better understanding of supraglottic actions that provide primary functions of the larynx (such as swallowing, coughing, and breathing). An enhanced knowledge of neurolaryngology also provides a basis for interpreting disorders or paralyzes following surgical treatments (e.g., thyroid surgery, partial laryngectomy) and helps to lower the risks.

Molecular epidemiology of group A rotavirus diarrhea among children in Buenos Aires, Argentina, from 1999 to 2003 and emergence of the infrequent genotype G12

To examine the epidemiology of rotaviruses in Buenos Aires, Argentina, we screened 1,212 stool samples from children with diarrhea in the southern district of Buenos Aires from 1999 to 2003. We identified 187 samples (15.4%) that were positive for group A rotavirus by use of antigen enzyme-linked immunosorbent assay. Among these specimens, 112 were available for typing: 93 (83.0%) were single-type infections, 9 (8.0%) were mixed-type infections with more than one G or P type, and 10 (8.9%) were G and/or P nontypeable. In contrast to the findings in our last study, from 1996 to 1998, genotype P[4], G2 strains were almost completely absent and P[8], G1 and P[8], G4 strains were dominant, representing more than 80% of the G and P types found. Genotypes G2 and G9 were detected in few samples, and type G3 was completely absent. We identified several uncommon genotype G12 strains, representing the first detections outside of Asia and the United States, by sequencing. Using a genotype G12-specific reverse transcription-PCR, we identified eight (6.7%) positive samples for the 1999 to 2003 period. The high degree of sequence identity between recent G12 isolates from Argentina, the United States, and Asian countries suggests a relatively recent introduction(s) of these strains into humans from a common progenitor. The Argentinean G12 strains belonged to genotype P[9], similar to most of the recently described Asian G12 strains. The finding of G12 strains in several other regions of the world raises the possibility that G12 may be emerging globally and suggests that surveillance for this strain should be conducted routinely.

Quality of life after treatment for laryngeal carcinomas

The objective of this study was to evaluate the impact of different surgical treatments as well as of radiotherapy for laryngeal carcinomas on health-related quality of life (QL). In a prospective, randomized multicenter study (five university hospitals in Germany), a total of 146 patients with laryngeal carcinomas (UICC stages: I-IV) underwent different surgical treatments (32 total laryngectomies, 81 CO(2) laser microsurgical partial laryngectomies, 33 open partial laryngectomies). Postoperative radiotherapy was performed in 44 patients. QL data were obtained by using the EORTC QLQ-C30 questionnaire (developed by the European Organization for Research and Treatment of Cancer). Impaired QL data were seen after total laryngectomy and after radiotherapy. Radiotherapy seemed to have more impact on QL than surgical treatment. Global QL was not affected by any treatment. In general, the QL data were not as discriminating as presumed. To evaluate coping abilities, objective measures (voice, swallowing, breathing) should be obtained for comparison in further investigations.

Functional anatomy of the recurrent and superior laryngeal nerve

BACKGROUND AND AIMS

The purpose of this study was to present the current topographic and anatomical knowledge in neurolaryngology, with special regard to laryngeal paralyses as a major complication in thyroid surgery.

PATIENTS AND METHODS

Microscopic anatomical preparation of 22 human hemilarynges was accomplished.

RESULTS

Due to their neuroanatomical courses, the following extralaryngeal nerves may be at risk in thyroid surgery: the external branch of the superior laryngeal nerve, the paralaryngeal part of the vagal nerve, the Ansa Galeni, the trunk of the recurrent laryngeal nerve (RLN) and the delicate branches of the RLN to the posterior cricoarytaenoid muscle. The anterior and posterior branches of the RLN (antRLN and postRLN) are less endangered by thyroid surgery because they are covered by the thyroid cartilage and posterior cricoarytaenoid muscle (PCA), respectively. In contrast, the antRLN is vulnerable if a ventilation tube is dislocated, with cuff-induced pressure to the glottic level.

CONCLUSION

The increased knowledge in neurolaryngology provides the basis for a selective neuromonitoring to lower the risk of laryngeal paralyses after thyroid surgery.

Laser microsurgical bilateral posterior cordectomy for the treatment of bilateral vocal fold paralysis

OBJECTIVES

We performed a prospective study to assess respiratory function and voice quality before and after laser microsurgical bilateral posterior cordectomy performed for chronic airway obstruction in patients with bilateral vocal fold paralysis.

METHODS

In 17 patients a laser microsurgical posterior cordectomy was performed as an immediate bilateral approach. Roughness, breathiness, hoarseness, and dyspnea were evaluated both subjectively (on a scale from 0 to 3) and objectively (body plethysmography, computerized voice analysis: Göttingen Hoarseness Diagram).

RESULTS

After laser surgery, the patients' respiratory function was significantly increased and was sufficient for all activities of daily living. The body plethysmographic measure of airway resistance had superior descriptive power and correlated significantly with the clinical degree of dyspnea (scale 0 to 3). Pretreatment and posttreatment impairment of voice quality was objectively documented with the Göttingen Hoarseness Diagram; the phonatory results measured with it correlated significantly with the subjective clinical evaluation of hoarseness. Aphonia did not occur.

CONCLUSIONS

A bilateral approach for laser microsurgical posterior cordectomy combines excellent airway improvement and satisfactory voice preservation. In bilateral vocal fold paralysis, pretreatment and posttreatment clinical data should be evaluated by objective measures.

Human cortical motor representation of the larynx as assessed by transcranial magnetic stimulation (TMS)

OBJECTIVES

To analyze characteristic features and details on motor-evoked potentials (MEPs) of the cricothyroid and vocalis muscles from single-pulse cortical transcranial magnetic stimulation (TMS) in normal subjects to characterize cortical motor representation of laryngeal muscles.

STUDY DESIGN

Prospective, experimental investigation on healthy volunteers.

METHOD

MEPs of the cricothyroid and vocalis muscles elicited by cortical TMS with a figure-8-shaped coil were investigated in two groups of six healthy subjects each, with special regard to MEP amplitude as a function of the coil position on the head surface along the interaural line.

RESULTS

Bilateral reproducible responses of the cricothyroid and the vocalis muscles could be observed in all subjects. For the cricothyroid muscle, maximal responses were obtained at mean stimulus positions of 7.5 +/- 1.4 cm (contralateral) and of 7.3 +/- 1.3 cm (ipsilateral), respectively. For the vocalis muscle, we found maximal responses at mean stimulus positions of 10.3 +/- 1.9 cm (contralateral) and of 9.6 +/- 1.6 cm (ipsilateral), respectively. Despite a considerable overlap of these coil positions, from which reproducible MEPs could be elicited in both groups of the laryngeal muscles, statistically significant separation of the cricothyroid-and vocalis-associated cortical representation areas was possible.

CONCLUSIONS

Our observations point to two different cortical motor representation areas, with the cricothyroid muscle-related area being located more medially.

Assessment of irregular voices after total and laser surgical partial laryngectomy

OBJECTIVES

To assess the merits of computer-aided voice analysis procedures for very irregular voices of patients after total and laser surgical partial laryngectomy, and to characterize qualitative differences in speech and voice function between these 2 groups of patients.

DESIGN

Cross-sectional study.

SETTING

University hospital in Göttingen, Germany

PATIENTS

Twenty-nine patients with advanced laryngeal carcinomas (T3-T4; according to the Union Internationale Contre le Cancer, TNM staging system, stages III-IVa) were examined: 18 patients with tracheoesophageal speech (voice prosthesis) after total laryngectomy and 11 patients who underwent partial transoral resection of the larynx (by means of laser microsurgery without surgical voice rehabilitation).

MAIN OUTCOME MEASURES

Speech intelligibility was measured by a standardized and validated telephone test, and voice quality was determined by 2 computerized voice analysis systems (multidimensional voice program and Göttingen hoarseness diagram).

RESULTS

The telephone test demonstrated a significantly better speech performance of the patients who had undergone organ-preserving surgery. The voices of both patient groups were too irregular for a qualitative differentiation with the multidimensional voice program. The multidimensional voice program results also failed to show significant correlations to speech intelligibility. The Göttingen hoarseness diagram showed significantly more regular voices in patients with partial laryngectomy than total laryngectomy. These results were correlated with speech intelligibility.

CONCLUSIONS

The Göttingen hoarseness diagram is suitable for a qualitative assessment even of irregular voices. Voice prosthesis offers a voice quality that at best approaches that of patients with partial laryngectomy.

Neuronal nitric oxide synthase-immunoreactivity. A neuromodulating system independent of peripheral nasal gland denervation in guinea pig nasal mucosal tissue after treatment with botulinum toxin type A

The influence of botulinum toxin type A (BTA) on cellular mechanisms has not been studied in much detail. Since nitric oxide (NO) is of increasing interest as a neuromodulator in the innervation of the nose, its localization was examined in the nasal mucosa of guinea pigs treated with BTA or saline. Neuronal nitric oxide synthase-immunoreactivity (nNOS-IR) was found around vessels and nasal glands. Immunoreactivity was seen in the respiratory epithelium, in the periost and the osteocytes of the turbinate bone. A distinct interindividual difference in the strength of nNOS-IR was obvious among the animals, but there was no difference in the strength of immunoreactivity between the animals treated with BTA or saline. NO might therefore contribute to the regulation of vascular tone, glandular function, respiratory epithelial cell function and bone metabolism. BTA does not seem to influence the processes regulated and modulated by NO. This may represent a benefit for the application of BTA.

Neuronal nitric oxide synthase immunoreactivity in the nasal mucosa of patients with idiopathic and allergic rhinitis

The localization of neuronal nitric oxide synthase (nNOS) in the mucosa of the inferior and middle turbinates of 30 patients with and without allergic rhinitis was examined by immunohistochemical methods. Staining of paraffin sections from allergic and nonallergic patients revealed nNOS immunoreactivity (nNOS-IR) in the muscular layer of vessels, in the basal portion of submucosal glands and in the periost and the osteocytes of the turbinate bones. In contrast to earlier investigations, nNOS-IR was also seen in the nasal respiratory epithelium of allergic and nonallergic patients. The immunostaining of sections of submucosal glands from allergic patients was stronger than that of sections from patients with idiopathic rhinitis or patients with no nasal obstruction. The present result - nNOS-IR around glands is elevated in patients with allergic rhinitis - could indicate that this enzyme is involved in the pathogenesis and symptomatology of allergic rhinitis.

Botulinum toxin type A induces apoptosis in nasal glands of guinea pigs

Nasal hypersecretion is predominantly caused by overaction of nasal glands, which are mainly under cholinergic control. In this work, we investigated the influence of botulinum toxin A (BTA) on the nasal mucosal tissue of the maxillary sinus turbinates of guinea pigs (n = 10) that were painlessly sacrificed 10 days (short-term group) or 3 months (long-term group) after local treatment with 20 units of BTA (Botox) or 0.2 mL of 0.9% sodium chloride (control). Histologic investigation of the nasal mucosal tissue of the BTA-treated animals (short-term group) showed degeneration of glands and ducts and apoptotic nuclei on TUNEL staining of these structures. The control animals revealed normal glandular tissue and no apoptosis. The animals of the long-term group showed almost normal glandular tissue and only a few apoptotic nuclei. In conclusion, BTA induces temporary apoptosis in the nasal glandular compartment of guinea pigs.

[Nd:YAG laser treatment of the lower turbinates with contact in hyperreflexic and allergic rhinopathy]

BACKGROUND

Nasal obstruction caused by mucosal swelling due to hyperreflectory or allergic rhinitis is a very frequent disorder. We would like to report about our first results (ENT department, University of Göttingen) in the reduction of hyperplastic inferior turbinates by Nd:YAG Laser treatment.

PATIENTS AND METHOD

One hundred seventeen patients with nasal obstruction were treated by Nd:YAG laser between October 1993 and February 1997. We used the laser in "contact mode" and all outpatients were under local anaesthesia. Follow-up was possible in 83 cases. A subjective scale was used to evaluate our results. One quarter of the patients suffered from an allergic rhinitis.

RESULTS

For 80% the nasal airflow was increased. Sixty percent had excellent or good results without any nasal obstruction after therapy. The patients with allergic rhinitis performed as well as the patients with hyperreflectory rhinopathy. This improvement appeared as early as four weeks after treatment and was permanent in 37 of 40 cases with long-term observation of at least one year. Side effects: 14% reported a dry nasal mucosa for two weeks; 31% had a bloody nasal secretion for two days after treatment, but did not bleed. Fifteen percent complained of pain during the procedure.

CONCLUSION

The reduction of the inferior turbinates by Nd:YAG laser is an effective treatment of equal value in symptomatic therapy of the hyperplastic turbinates due to hyperreflectory and allergic rhinopathy. Seventy-three percent of these patients would like to be treated in this way again if necessary.

[Early detection and hearing aid management of pediatric unilateral hearing loss]

BACKGROUND

Unilateral hearing loss in children is frequently an incidental diagnosis, usually late. As in binaural hearing disorders, early detection is extremely important to protect the function of the "remaining ear" and thus ensure acquisition of speech. Prompt initial probatory treatment with a conventional hearing aid is necessary to take advantage of the sensitive phases of development and maturation of the auditory pathways. This allows lateralisation as well as a better discrimination, avoiding cocktail party and non-physiologic head shadow effects.

PATIENTS

The study includes 32 children with a conventional hearing aid. The average age of diagnosis was 5.5 years. The children were initially treated with a conventional hearing aid.

RESULTS

The etiology remained unknown in the majority of the cases. Twenty-seven of the children were observed over a longer period, averaging 2 years. Hearing aid acceptance was found to be 63% with a measurable hearing improvement in 59% of the patients, even in the presence of severe hearing disorders. In the majority of the cases, the etiology remained unknown.

CONCLUSION

More knowledge about risk factors for unilateral hearing losses in children should improve the chances for early detection, making hearing aid supply at a younger age possible. This should happen firstly in a probatory manner and in cases with hearing aid acceptance and a measurable hearing improvement definitely.